Socio-Environmental Determinants and Health Effects of Water Contamination Among Children in Pakistan: A Narrative Review.

Pakistan is experiencing one of the world's most severe water crises, with environmental and socio-environmental factors collectively contributing to unsafe drinking water and adverse child health outcomes. Environmental determinants, including climate change, agricultural practices, and groundwater depletion, drive water contamination, resulting in exposure to toxic contaminants such as arsenic, lead, and other heavy metals. Simultaneously, socio-environmental determinants, including education, sanitation, and governance, influence children's exposure and vulnerability to contaminated water. Because children are particularly susceptible to infectious diseases, malnutrition, and neurodevelopmental injury from environmental toxicants, understanding these interconnected pathways is essential for developing effective public health strategies. This narrative review synthesizes current evidence on the environmental and socio-environmental determinants of water contamination in Pakistan and examines their relationship with child health outcomes. The available evidence indicates that protecting child health requires integrated, long-term strategies that address both the environmental drivers of water contamination and the social factors that influence children's exposure and vulnerability.