Biomonitoring of metals and trace elements in urine of central Ethiopian populations

Heavy metals in Ethiopian drinking water and public health risks: Insights from nationwide and regional analysis

The ambitious sustainable development goal (SDG) 6 of the United Nations, which aims to achieve universal access to safe water and sanitation by 2030, remains elusive for many developing countries like Ethiopia. This is often due to a multitude of intricate factors, including the escalating degradation of water quality. Here, we present a comprehensive nationwide and regional analysis of heavy metal pollution in drinking water sources and the associated human health risks in Ethiopia based on a dataset of 11 heavy metal concentrations (n = 975) collated from available studies. Results indicate significant variations in heavy metal pollution in drinking water sources in Ethiopia, with 44 % of the total concentration exceeding maximum permissible limits. The mean concentrations were ranked as follows: Pb (1.92 mg/L) > Zn (1.25 mg/L) > Fe (0.56 mg/L) > Mn (0.43 mg/L) > Cu (0.40 mg/L) > Co (0.30 mg/L) > As (0.12 mg/L) > Ni (0.12 mg/L) > Cr (0.10 mg/L) > Cd (0.06 mg/L) > Hg (0.04 mg/L). We found that children are more vulnerable to non-carcinogenic health risks than adults, with the highest hazard quotient (HQ) exceedances of up to a factor of 1823 and 762, respectively. Furthermore, a Monte Carlo-based probabilistic risk assessment highlighted significant concerns regarding co-exposure to multiple heavy metals. The measured concentrations, ingestion rates, and exposure frequencies were identified as sensitive parameters. Overall, a higher risk was attributed to Pb and As, with river drinking water sources and the Tigray region requiring immediate mitigation measures. In conclusion, the findings emphasize the urgent need to test and purify water before consumption and to implement effective public health interventions. Furthermore, a multifaceted approach including regular monitoring, source protection, and proper waste management is recommended to expedite the achievement of SDGs and promote water sustainability in resource-limited Ethiopia and sub-Saharan Africa.

Public health assessment of Kenyan ASGM communities using multi-element biomonitoring, dietary and environmental evaluation

The Kakamega gold belt's natural geological enrichment and artisanal and small-scale gold mining (ASGM) have resulted in food and environmental pollution, human exposure, and subsequent risks to health. This study aimed to characterise exposure pathways and risks among ASGM communities. Human hair, nails, urine, water, and staple food crops were collected and analysed from 144 ASGM miners and 25 people from the ASGM associated communities. Exposure to PHEs was predominantly via drinking water from mine shafts, springs and shallow-wells (for As>Pb>Cr>Al), with up to 366 µg L-1 arsenic measured in shaft waters consumed by miners. Additional exposure was via consumption of locally grown crops (for As>Ni>Pb>Cr>Cd>Hg>Al) besides inhalation of Hg vapour and dust, and direct dermal contact with Hg. Urinary elemental concentrations for both ASGM workers and wider ASGM communities were in nearly all cases above bioequivalents and reference upper thresholds for As, Cr, Hg, Ni, Pb and Sb, with median concentrations of 12.3, 0.4, 1.6, 5.1, 0.7 and 0.15 µg L-1, respectively. Urinary As concentrations showed a strong positive correlation (0.958) with As in drinking water. This study highlighted the importance of a multidisciplinary approach in integrating environmental, dietary, and public health investigations to better characterise the hazards and risks associated with ASGM and better understand the trade-offs associated with ASGM activities relating to public health and environmental sustainability. Further research is crucial, and study results have been shared with Public Health and Environmental authorities to inform mitigation efforts.

Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study

Fluoride (F) exposure in drinking water may lead to reduced cognitive function among children; however, findings largely remain inconclusive. In this pilot study, we examined associations between a range of chronic F exposures (low to high: 0.4 to 15.5 mg/L) in drinking water and cognition in school-aged children (5-14 years, n = 74) in rural Ethiopia. Fluoride exposure was determined from samples of community-based drinking water wells and urine. Cognitive performance was measured using: 1) assessments of ability to draw familiar objects (donkey, house, and person), and 2) a validated Cambridge Neuropsychological Test Automated Battery's (CANTAB) Paired Associate Learning (PAL), which examines memory and new learning and is closely associated with hippocampus function of the brain. Associations between F and cognitive outcomes were evaluated using regression analysis, adjusting for demographic, health status, and other covariates. The median (range) of water and urine F levels was 7.6 (0.4-15.5 mg/L) and 6.3 (0.5-15.7 mg/L), respectively; these measures were strongly correlated (r = 0.74), indicating that water is the primary source of F exposure. Fluoride in drinking water was negatively associated with cognitive function, measured by both drawing and CANTAB test performance. Inverse relationships were also found between F and drawing objects task scores, after adjusting for covariates (p < 0.05). Further analysis using CANTAB PAL tasks in the children confirmed that F level in drinking water was positively associated with the number of errors made by children (p < 0.01), also after adjusting for covariates (p < 0.05). This association between water F and total errors made became markedly stronger as PAL task difficulty increased. Fluoride exposure was also inversely associated with other PAL tasksthe number of patterns reached, first attempt memory score and mean errors to success. These findings provide supportive evidence that high F exposures may be associated with cognitive deficits in children. Additional well-designed studies are critically needed to establish the neurotoxicity of F in children and adults exposed to both low levels known to protect dental caries, as well as excess F levels in drinking water.

Macroelement and Microelement Levels in the Urine in Experimental Acanthamoebiasis

Free-living amoebas can impact the excretion of macroelements and microelements in urine. The aim of the present study was to examine the concentrations of macroelements, including calcium (Ca), phosphorus (P), sodium (Na), potassium (K), and magnesium (Mg), as well as microelements such as manganese (Mn), zinc (Zn), copper (Cu), iron (Fe), and chromium (Cr), in the urine during acanthamoebiasis while considering the host's immunological status. This is the first study to show an increase in urinary excretion of Ca, Mn, Cu, Fe, Na, and Cr, along with a decreased excretion of K, in immunocompetent mice 16 days post Acanthamoeba sp. infection. In the final phase of infection (24 dpi), there was a further decrease in urinary K excretion and a lower level of P in Acanthamoeba sp. infected immunocompetent hosts. During acanthamoebiasis in immunosuppressed hosts, increased excretion of Zn, Fe, and Cr was observed at the beginning of the infection, and increased Na excretion only at 16 days post Acanthamoeba sp. infection. Additionally, host immunosuppression affected the concentration of Fe, Cr, Zn, Cu, Mn, and Ca in urine.

Urinary Levels of 14 Metal Elements in General Population: A Region-Based Exploratory Study in China

Metal pollution may lead to a variety of diseases; for this reason, it has become a matter of public concern worldwide. However, it is necessary to use biomonitoring approaches to assess the risks posed to human health by metals. In this study, the concentrations of 14 metal elements in 181 urine samples obtained from the general population of Gansu Province, China, were analyzed using inductively coupled plasma mass spectrometry. Eleven out of fourteen target elements had detection frequencies above 85%, namely, Cr, Ni, As, Se, Cd, Al, Fe, Cu and Rb. The concentrations of most metal elements in the urine of our subjects corresponded to the medium levels of subjects in other regional studies. Gender exerted a significant influence (p < 0.05) on the concentrations of Tl, Rb and Zn. The concentrations of Ni, As, Pb, Sr, Tl, Zn, Cu and Se showed significant differences among different age groups and the age-related concentration trends varied among these elements. There were significant differences in the urine concentrations of Zn and Sr between those subjects in the group who were frequently exposed to soil (exposed soil > 20 min/day) and those in the group who were not, indicating that people in regular contact with soil may be more exposed to metals. This study provides useful information for evaluating the levels of metal exposure among general populations.

Occurrence and probabilistic risk assessment of polycyclic aromatic hydrocarbons in blood and urine of auto-mechanics in Akure Metro, Nigeria

This study provides baseline data on the concentration of polycyclic aromatic hydrocarbons (PAHs) in blood and urine samples of auto-mechanics, using Nigeria as a case study. Eighteen auto-mechanics participated in the study excluding two controls. The concentrations for the ΣPAHs across all participants (excluding control) ranged from 1.67 to 3.30 (2.17 ± 0.58) in blood with a significantly higher (P < 0.05) range of 7.61 to 10.76 (8.69 ± 1.00) in urine. The high molecular weight PAHs (4-6 rings) dominated the PAH profile in both blood (≥ 92%) and urine (≥ 87%) across all locations. Dibenz(a)anthracene was the most distributed PAH, while acenaphthene and indeno(1,2,3-cd)pyrene were the least distributed. The dermal route constituted approximately 99% of the total chronic exposure, followed by ingestion, and the least via inhalation. The hazard index (HI) was below the safe thresholds (HI = 1), suggesting non-carcinogenic PAH effects. However, all the participants including control samples had carcinogenic risk (CR) values above the acceptable level of 10^-6 in both blood and urine samples. The carcinogenic and mutagenic potencies were higher in urine than in blood. The results suggest less acute toxicity and more potential chronic effects. The computed elimination ratio (> 1) suggests low excretion in urine and a potentially harmful trend. Molecular diagnostic ratios and principal component analysis suggest mixed PAH sources. The study revealed biomonitoring solely dependent on blood analysis may greatly underestimate health risks due to PAH exposure. To the best of our knowledge, this study is the first to provide levels of PAHs in the blood and urine of Nigerian mechanics. Findings herein will support policymakers at all levels in re-focusing attention to the less prioritized professions that pre-disposes people to PAHs and other emerging pollutants in society.

A method for reliable quantification of mercury in occupational and environmental medical urine samples by inductively coupled plasma mass spectrometry

Over the last years, inductively coupled plasma mass spectrometry (ICP-MS) has been applied as a method for human-biomonitoring of metals in the concentration range of occupational and environmental medicine. In large scale routine monitoring, the determination of mercury (Hg) by ICP-MS remains challenging due to several reasons. Amongst others, stability of dissolved Hg and avoiding memory effects are the key facts for reliable quantification. To address these issues, we developed a robust approach for biomonitoring of mercury in human urine samples by ICP-MS. Using a solution containing HNO₃, HCl and thiourea, prepared samples and calibrators were stabilized for up to 72 h. A rinse time of only 30 seconds efficiently prevented contamination of consecutive samples with Hg concentrations up to 30 μg L^-1, hence significantly reducing acquisition times compared to published methods. Recovery experiments revealed iridium as an ideal internal standard to compensate matrix effects independently from creatinine concentration. Recoveries of 95.0-104.0% were obtained for Hg levels covering the range of biomonitoring guidance values established by the German Human-Biomonitoring Commission. Excellent intra-day precision and inter-day precision of ≤3.0% for two different Hg levels were achieved. The detection and quantification limit accounted for 21.7 ng L^-1 and 65.6 ng L^-1, respectively, enabling reliable quantification even in the range of environmental background exposures. Additionally, the method was externally validated by successful participation in the inter-laboratory comparison program G-EQUAS. With the developed method, we hence provide a sensitive and robust tool for mercury exposure assessments in future large scale human-biomonitoring studies.

Biological monitoring and health assessment of 21 metal(loid)s in children and adolescents in Liuzhou City, Southwest China

Exposure to metal(loid)s is associated with adverse effects on human health, especially for children and adolescents. This study was designed to evaluate metal(loid)s exposure in 2050 children and adolescents aged 6-18 years from Liuzhou City, Southwest China. The detection rates of 21 elements were all above 99%. We found that age was an important predictor for most elements, and that children exhibited more exposure than adolescents, expect for strontium (p < 0.05). Interestingly, urinary levels were higher in girls for 13 of our study elements. Multiple regression models also showed that dietary habits also affected the distribution of elements. Moreover, we estimated exposure risk by generating the hazard quotient (HQ) for single metal and the hazard index (HI) for the co-occurrence of metals. The HQ of cadmium was > 1 at the P95 value and that the risk of the mixed effect of cadmium, mercury, and thallium was not negligible, and indicated that the associated risk was of concern. Our results provide basic data on the reference values of urinary metal(loid) levels and an assessment of health risks for children and adolescents that reside in industrial areas.

Neuro-medical manifestations of fluorosis in populations living in the Main Ethiopian Rift Valley

Prolonged exposure to higher concentrations of fluoride (> 1.5 mg/L) is associated with dental and skeletal fluorosis. The effects of fluoride on dental and skeletal system have been studied extensively; however, the neurological consequences of fluoride in population-based studies are limited. The study aims to assess the epidemiology of neurological and other manifestations of fluorosis among rural populations living in the Main Ethiopian Rift valley. In this cross-sectional study, we enrolled 316 individuals from 23 rural communities in the Main Ethiopian Rift valley. Fluoride concentration was measured in drinking water samples collected from 23 community wells. Association between fluoride concentrations and clinical features of fluorosis was assessed using student t test, chi square, multivariable regression using adjusted odds ratio (OR). The mean fluoride concentration in the drinking water was 6.8 ± 4.3 mg/L (range: 0.3-15.5 mg/L). At least one clinical sign of skeletal fluorosis was observed in 54.4% (n = 175) of the study participants. Headache and joint pain reported by 67.1% and 56.3% of the participants as the most common neurological manifestation, and skeletal fluorosis symptom, respectively. The mean fluoride level was higher for those individuals who reported paresthesia compared to those with no-paresthesia. Loss of appetite, constipation, and fatigue were reported by 48.0%, 45.6%, and 56.6% of the participants, respectively. Signs of crippling fluorosis were observed in small proportion (1.6%) of the participants. Individuals who reported headache are most likely exposed to higher fluoride concentrations in drinking water compared to those reported no-headache (p < 0.001). The study demonstrates high prevalence of neuro-medical manifestations of fluorosis in population living in the Main Ethiopian Rift valley. Fluoride concentration in drinking water and joint pain were independent predictors of fluorosis.

Relationship Between Gymnastic Rhythmic Practice and Body Composition, Physical Performance, and Trace Element Status in Young Girls

This study evaluates the influence on body development of doing rhythmic gymnastics in girls from 10 to 17 years of age, the results of certain strength and flexibility abilities, and the trace element status (Ca, Fe, Zn, Cu, Mn, Cr, and Ni). The subjects were divided into three groups: (a) girls who practiced rhythmic gymnastics at a competition level (competition group); (b) girls who practiced this sport at a non-competitive level (training group); and (c) girls who do not practice any sport and with a low level of physical activity (control or sedentary group). Trace element status was determined in hair and urine samples. Results showed that doing rhythmic gymnastics does not alter the normal physical development of muscle mass, and even leads to a decrease in body fat content. Furthermore, better scores in the strength and flexibility test were obtained by the participants of this sports discipline. Statistically significant differences in urine Fe, Cu, and Mn values (p < 0.05) and in hair Cr, Cu, and Mn values (p < 0.05) were found between the two rhythmic gymnastics groups and the control group, and were higher in the competition and training groups. A principal component analysis model was performed to evaluate the possibility of cluster formation among the girls. The PCA results revealed a separation between the different groups although the separation was not perfect. PLS-DA was attempted in order to verify whether it was possible to discriminate between the groups included in this study. It was clear that the competition and control ones were very well classified (around 95% of correct predictions) but 20% of the girls belonging to the training group were misclassified as belonging to the competition one.

Human urinary biomonitoring in Western Kenya for micronutrients and potentially harmful elements

Spot urinary elemental concentrations are presented for 357 adults from Western Kenya collected between 2016 and 2019 as part of a wider environmental geochemical survey. The aim of this study was to establish population level urinary elemental concentrations in Western Kenya for micronutrients and potentially harmful elements for inference of health status against established thresholds. For elements where thresholds inferring health status were not established in the literature using urine as a non-invasive matrix, this study generated reference values with a 95% confidence interval (RV95s) to contextualise urinary elemental data for this population group. Data are presented with outliers removed based upon creatinine measurements leaving 322 individuals, for sub-categories (e.g. age, gender) and by county public health administrative area. For Western Kenya, reference values with a 95% confidence interval (RV95s) were calculated as follows (μg/L): 717 (I), 89 (Se), 1753 (Zn), 336 (Mo), 24 (Cu), 15.6 (Ni), 22.1 (As), 0.34 (Cd), 0.47 (Sn), 0.46 (Sb), 7.0 (Cs), 13.4 (Ba and 1.9 (Pb). Urinary concentrations at the 25th/75th percentiles were as follows (μg/L): 149/368 (I), 15/42 (Se), 281/845 (Zn), 30/128 (Mo), 6/13 (Cu), 1.7/6.1 (Ni), 2.0/8.2 (As). 0.1/0.3 (Cd), 0.05/0.22 (Sn), 0.04/0.18 (Sb), 1.2/3.6 (Cs), 0.8/4.0 (Ba) and 0.2/0.9 (Pb). Urinary concentrations at a population level inferred excess intake of micronutrients I, Se, Zn and Mo in 38, 6, 57 and 14% of individuals, respectively, versus a bioequivalent (BE) upper threshold limit, whilst rates of deficiency were relatively low at 15, 15, 9 and 18%, respectively. Each of the administrative counties showed a broadly similar range of urinary elemental concentrations, with some exceptions for counties bordering Lake Victoria where food consumption habits may differ significantly to other counties e.g. I, Se, Zn. Corrections for urinary dilution using creatinine, specific gravity and osmolality provided a general reduction in RV95s for I, Mo, Se, As and Sn compared to uncorrected data, with consistency between the three correction methods.

Water Quality Threats, Perceptions of Climate Change and Behavioral Responses among Farmers in the Ethiopian Rift Valley

This work aims to assess water quality for irrigated agriculture, alongside perceptions and adaptations of farmers to climate change in the Main Ethiopian Rift (MER). Climate change is expected to cause a rise in temperature and variability in rainfall in the region, reducing surface water availability and raising dependence on groundwater. The study data come from surveys with 147 farmers living in the Ziway–Shala basin and water quality assessments of 162 samples from groundwater wells and surface water. Most groundwater samples were found to be unsuitable for long term agricultural use due to their high salinity and sodium adsorption ratio, which has implications for soil permeability, as well as elevated bicarbonate, boron and residual sodium carbonate concentrations. The survey data indicate that water sufficiency is a major concern for farmers that leads to frequent crop failures, especially due to erratic and insufficient rainfall. An important adaptation mechanism for farmers is the use of improved crop varieties, but major barriers to adaptation include a lack of access to irrigation water, credit or savings, appropriate seeds, and knowledge or information on weather and climate conditions. Local (development) agents are identified as vital to enhancing farmers’ knowledge of risks and solutions, and extension programs must therefore continue to promote resilience and adaptation in the area. Unfortunately, much of the MER groundwater that could be used to cope with declining viability of rainfed agriculture and surface water availability, is poor in quality. The use of saline groundwater could jeopardize the agricultural sector, and most notably commercial horticulture and floriculture activities. This study highlights the complex nexus of water quality and sufficiency challenges facing the agriculture sector in the region, and should help decision-makers to design feasible strategies for enhancing adaptation and food security.

Human biomonitoring of 73 elements in blood, serum, erythrocytes and urine

BACKGROUND

Human biomonitoring studies of trace elements in biological fluids are mostly limited to a certain number of elements or biological materials. In this study, we describe the significant extension of a biomonitoring to 73 elements being present in concentration ranges from ng/L to g/L in clinically relevant specimens such as blood, serum, erythrocytes and urine.

METHODS

The samples were collected from 102 occupationally non-exposed inhabitants of northern Germany. The elements were determined either by inductively coupled plasma tandem mass spectrometry (ICP-MS/MS) in the low concentration range or by inductively coupled plasma optical emission spectrometry (ICP-OES) for essential trace elements and electrolytes.

RESULTS

Mean values and selected percentiles of element concentrations are presented for all sample materials. From the results, we calculated the distribution of elements between plasma and blood cells. Application of ICP-MS/MS improves selectivity and accuracy in the determination of elements that are strongly spectrally interfered, such as Cr, Ge, Pd or Ti in blood samples.

CONCLUSIONS

This publication provides very valuable information for occupational or environmental hygienists, toxicologists and clinical chemists due to the particularly high number of determined elements and presented concentration ranges.

Urinary biomarker of strontium exposure is positively associated with semen quality among men from an infertility clinic

Experimental studies have shown that nonradioactive strontium (Sr), in the form of Sr²⁺, have a positive effect on semen quality, but human evidence is lacking. This study aimed to examine the associations between nonradioactive Sr exposure and semen quality in Chinese men (n = 394). We recruited men who presented at an infertility clinic in Wuhan, China to seek for semen parameter analyses. Urinary Sr concentration as an exposure biomarker was measured using inductively coupled plasma mass spectrometer. We estimated the associations between urinary Sr concentrations and semen parameters using multivariable logistic and linear regression models. In multivariable linear regressions models, positive dose-response associations were estimated for sperm concentration, motility, and count across increasing urinary Sr quartiles (all p for trends<0.05), and the consistent positive associations were also observed for urinary Sr concentration modeled as a continuous exposure. In multivariable logistic models, decreased risks of below-reference sperm concentration, motility, and count were also estimated across increasing urinary Sr quartiles (all p for trends<0.05). Our results suggest that nonradioactive Sr exposure may have a beneficial effect on semen quality, but more investigations are warranted to confirm the results.

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method

BACKGROUND

Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations.

OBJECTIVE

In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method.

METHOD

We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use.

RESULTS

We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults.

CONCLUSIONS

These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.

Biomonitoring human urinary levels of 26 metal elements in multi-race coexistence region of Xinjiang, China

The human biological monitoring of metals (metalloids) is of importance, which concentrations could indicate a wide range of health related information. Reference values (RVs) of metals (metalloids) in specific matix of populations are critically required when performing a statistical evaluation accurately. Recent studies show that RVs of metals (metalloids) are influenced by many multiple factors, including lifestyle, diet, dissimilar environment, location, as well as race. However, it is virtually absent across many nations/regions, especially multi-race coexistence regions. The aim of the work was to establish RVs of metals (metalloids) in urine of adult in Xinjiang, China. Totally 178 urine samples from healthy volunteers were collected and analyzed by inductively coupled plasma mass spectrometer or optical emission spectrometer (ICP-MS/OES). RVs of 26 metals (metalloids) in urine for adult of Xinjiang, China were then established. Effects of race, gender and age on RVs were investigated using partial least squares discriminant analysis and student T-test. The result demonstrated that above factors showed mild influence for the establishment of RVs. The RVs derived from total 178 urine adult samples (Han and Uygur half of each) can be applied for different race, gender and age periods. Moreover, it was observed that three metals (metalloids), As, Sc and Ba significantly varied between some subgroups. The established RVs will be valuable for future health or environmental evaluation, and can serve as a theoretical reference for RVs establishment in multi-race coexistence region.