title: Reverse osmosis plant maintenance and efficacy in chronic kidney disease endemic region in Sri Lanka.
abstract: OBJECTIVE
  Chronic Interstitial Nephritis in Agricultural Communities (CINAC) causes major morbidity and mortality for farmers in North-Central province (NCP) of Sri Lanka. To prevent the CINAC, reverse osmosis (RO) plants are established to purify the water and reduce the exposure to possible nephrotoxins through drinking water. We assessed RO plant maintenance and efficacy in NCP.
  
  
  METHODS
  We have interviewed 10 RO plant operators on plant establishment, maintenance, usage and funding. We also measured total dissolved solids (TDS in ppm) to assess the efficacy of the RO process.
  
  
  RESULTS
  Most RO plants were operated by community-based organizations. They provide clean and sustainable water source for many in the NCP for a nominal fee, which tends to be variable. The RO plant operators carry out RO plant maintenance. However, maintenance procedures and quality management practices tend to vary from an operator to another. RO process itself has the ability to lower the TDS of the water. On average, RO process reduces the TDS to 29 ppm.
  
  
  CONCLUSIONS
  The RO process reduces the impurities in water available to many individuals within CINAC endemic regions. However, there variation in maintenance, quality management, and day-to-day care between operators can be a cause for concern. This variability can affect the quality of water produced by RO plant, its maintenance cost and lifespan. Thus, uniform regulation and training is needed to reduce cost of maintenance and increase the efficacy of RO plants.
authors.affiliation: Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka. jayasumanalk@yahoo.com.
authors.forename: Channa
authors.identifier: http://orcid.org/0000-0003-1789-2626
authors.initials: C
authors.lastname: Jayasumana
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90024, USA.
authors.forename: Omesh
authors.initials: O
authors.lastname: Ranasinghe
authors.affiliation: Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
authors.forename: Sachini
authors.initials: S
authors.lastname: Ranasinghe
authors.affiliation: Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka.
authors.forename: Imalka
authors.initials: I
authors.lastname: Siriwardhana
authors.affiliation: Department of Health Science, California State University Long Beach, Long Beach, CA, 90840, USA.
authors.forename: Sarath
authors.initials: S
authors.lastname: Gunatilake
authors.affiliation: Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka.
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
mesh_terms: D060766:Drinking Water / Q000032:analysis*; D006801:Humans; D009395:Nephritis, Interstitial / Q000517:prevention & control*; D009995:Osmosis; D051436:Renal Insufficiency, Chronic / Q000517:prevention & control*; D013188:Sri Lanka; D014874:Water Pollutants, Chemical / Q000032:analysis*; D014881:Water Supply / Q000191:economics / Q000379:methods* / Q000592:standards
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical
keywords: Chronic kidney disease of unknown etiology; North-Central Province; Pesticides; Reverse osmosis plant; Sri Lanka