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Ali AS, Gari SR, Goodson ML, Walsh CL, Dessie BK, Ambelu A. Incidence of diarrhea and risk factors among wastewater-irrigating urban farmers along Akaki Rivers in Addis Ababa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-13. [PMID: 38944842 DOI: 10.1080/09603123.2024.2374001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
The importance of diarrhea risk associated with wastewater exposure in agriculture is almost unknown. This study aimed to examine diarrheal infection and risk factors among farmers using wastewater for irrigation in Addis Ababa. A cross-sectional study was employed among 380 farmers (190 exposed and 190 unexposed farmers). Among these, a cohort of 200 adults (100 wastewater-exposed, 100 unexposed farmers) aged 25-69 years were selected and followed up biweekly for two successive vegetables growing seasons to examine the incidence of diarrhea. The incidence rate of reported diarrhea was 12 episodes per 1,000 person-weeks at risk and a maximum of 17 episodes per 1,000 person-weeks at risk. Strongly associated risk factors include washing body and clothes with wastewater [AOR: 4.2, 95%CI (1, 11.2)], using working clothes at home [AOR: 4.7, 95%CI (0.25, 87)], and wearing protective cloth [AOR: 5.6, 95 CI (0.3, 70)]. Moreover, hand washing after work, washing feet and boots, and on-site hand washing were significant determinants of farmers' diarrhea. Exposure to wastewater significantly contributes to the risk of diarrhea among adults. Significant determinants of diarrhea among farmers include washing the body and clothes with irrigation water, contamination with soil and irrigation water, and on-site hand washing. Increased risk factors include hand contamination, washing vegetables with irrigation water, eating raw vegetables, and using work clothes at home.
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Affiliation(s)
- Adnan Sirage Ali
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Environmental Management, Kotebe University of Education, Addis Ababa, Ethiopia
| | - Sirak Robele Gari
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michaela L Goodson
- Department of Medicine, Newcastle University Medicine Malaysia, Johor Bahru, Malaysia
| | - Claire L Walsh
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Bitew K Dessie
- Water and Land Resource Centre, Addis Ababa University, Addis Ababa, Ethiopia
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
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Wu X, Nawaz S, Li Y, Zhang H. Environmental health hazards of untreated livestock wastewater: potential risks and future perspectives. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:24745-24767. [PMID: 38499926 DOI: 10.1007/s11356-024-32853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
Due to technological and economic limitations, waste products such as sewage and manure generated in livestock farming lack comprehensive scientific and centralized treatment. This leads to the exposure of various contaminants in livestock wastewater, posing potential risks to both the ecological environment and human health. This review evaluates the environmental and physical health risks posed by common pollutants in livestock wastewater and outlines future treatment methods to mitigate these risks. Residual wastes in livestock wastewater, including pathogenic bacteria and parasites surviving after epidemics or diseases on various farms, along with antibiotics, organic wastes, and heavy metals from farming activities, contribute to environmental damage and pose risks to human health. As the livestock industry's development increasingly impacts society's future negatively, addressing the issue of residual wastes in livestock wastewater discharge becomes imperative. Ongoing advancements in wastewater treatment systems are consistently updating and refining practices to effectively minimize waste exposure at the discharge source, mitigating risks to environmental ecology and human health. This review not only summarizes the "potential risks of livestock wastewater" but also explores "the prospects for the development of wastewater treatment technologies" based on current reports. It offers valuable insights to support the long-term and healthy development of the livestock industry and contribute to the sustainable development of the ecological environment.
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Affiliation(s)
- Xiaomei Wu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Shah Nawaz
- Department of Anatomy, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Ying Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
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Nasim N, El-Zein A, Thomas J. A review of rural and peri-urban sanitation infrastructure in South-East Asia and the Western Pacific: Highlighting regional inequalities and limited data. Int J Hyg Environ Health 2022; 244:113992. [PMID: 35752101 DOI: 10.1016/j.ijheh.2022.113992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Abstract
Rural and peri-urban communities in developing countries rely on sanitation systems which are often unsafely managed. One of the major barriers to assess safely managed sanitation is a lack of data about the existing sanitation infrastructure and levels of containment safety. The aim was to review rural and peri-urban on-site sanitation studies in order to understand different infrastructure types, associated management practices and any impacts on human health. The scope was limited to South-East Asia and Western Pacific regions in order to better identify regional inequalities. Among the 155 reviewed articles, 73 studies (47%) linked sanitation infrastructure to poor human health. Nearly all articles reported latrine ownership (n = 149, 96%) while sanitation infrastructure types were covered less frequently (n = 104, 67%). In particular, there was a lack of published literature describing back-end characteristics (dimension and materials) (n = 12, 8%) and/or management practices (n = 4, 3%). This stems from a limited application of research methodologies that characterise sanitation infrastructure and faecal sludge management (containment, emptying and on-site treatment). Inequality between regions was prevalent with three quarters of the studies on latrine back-end infrastructure from Bangladesh and India in South-East Asia. A strategic research approach is needed to address the current knowledge gaps regarding sanitation infrastructure and safe faecal sludge management.
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Affiliation(s)
- Nabeela Nasim
- School of Civil Engineering, The University of Sydney, Australia.
| | - Abbas El-Zein
- School of Civil Engineering, The University of Sydney, Australia.
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Risk Factors Associated with Diarrheal Episodes in an Agricultural Community in Nam Dinh Province, Vietnam: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042456. [PMID: 35206644 PMCID: PMC8872501 DOI: 10.3390/ijerph19042456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023]
Abstract
In Vietnam, data on the risk factors for diarrhea at the community level remain sparse. This study aimed to provide an overview of diarrheal diseases in an agricultural community in Vietnam, targeting all age groups. Specifically, we investigated the incidence of diarrheal disease at the community level and described the potential risk factors associated with diarrheal diseases. In this prospective cohort study, a total of 1508 residents were enrolled during the 54-week study period in northern Vietnam. The observed diarrheal incidence per person-year was 0.51 episodes. For children aged <5 years, the incidence per person-year was 0.81 episodes. Unexpectedly, the frequency of diarrhea was significantly higher among participants who used tap water for drinking than among participants who used rainwater. Participants who used a flush toilet had less frequent diarrhea than those who used a pit latrine. The potential risk factors for diarrhea included the source of water used in daily life, drinking water, and type of toilet. However, the direct reason for the association between potential risk factors and diarrhea was not clear. The infection routes of diarrheal pathogens in the environment remain to be investigated at this study site.
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Tram NT, Phuc PD, Phi NH, Trang LT, Nga TT, Ha HTT, Cam PD, Canh TQ, Karanis P. Cryptosporidium and Giardia in Biogas Wastewater: Management of Manure Livestock and Hygiene Aspects Using Influent, Effluent, Sewage Canal Samples, Vegetable, and Soil Samples. Pathogens 2022; 11:174. [PMID: 35215118 PMCID: PMC8875155 DOI: 10.3390/pathogens11020174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Cryptosporidium and Giardia are two water- and foodborne protozoan parasites that can cause diarrheal diseases. Poor microbial quality, sanitation conditions, and hygiene practices at exposure to biogas wastewater are important risk factors for human and animal infection. This study highlights the presence and level of both parasites in the environment in relation to biogas waste reuse in Vietnam. A total of 239 samples were collected from different types of samples in the studied districts in Bac Giang province in 2020 via direct immunofluorescent detection to study the occurrence of Cryptosporidium spp. and Giardia spp. (oo)cysts. Among the samples, Cryptosporidium was found in 19 (7.9%) with concentration from 1.104 to 3.105 oocysts/100 mL, while Giardia in 40 (16.7%) with concentration from 1.104 to 2.106 cysts/100 mL, respectively. In detail, the results show that the percentages of positive detection of Cryptosporidium spp. and Giardia spp. in influent, effluent, sewage canal, and vegetables were 13.1% (11/84), 6.0% (5/83), 15.4% (2/13) and 5.9% (1/17) and 26.2% (22/84), 7.2% (6/83), 7.7% (1/13) and 5.9% (1/17), respectively. The results show a trend of decreasing Cryptosporidium and Giardia densities, without statistical significance. Although these parasites decreased after biogas treatment, the remaining loads observed in biogas effluent can reach the watercourses and soil receiving it. Further investigations are needed to contribute to a general understanding of the risk of protozoan parasites, as well as strategies to control and reduce the contamination of environmental water sources and plants and reduce the burden of the pathogens in biogas wastewater in Vietnam.
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Affiliation(s)
- Nguyen Thuy Tram
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin, Hanoi 122000, Vietnam; (N.T.T.); (L.T.T.); (T.T.N.); (H.T.T.H.); (P.D.C.)
| | - Pham Duc Phuc
- Center for Public Health and Ecosystem Research (CENPHER), Hanoi University of Public Health, 1A Duc Thang, Hanoi 122000, Vietnam; (P.D.P.); (N.H.P.)
| | - Nguyen Hong Phi
- Center for Public Health and Ecosystem Research (CENPHER), Hanoi University of Public Health, 1A Duc Thang, Hanoi 122000, Vietnam; (P.D.P.); (N.H.P.)
| | - Le Thi Trang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin, Hanoi 122000, Vietnam; (N.T.T.); (L.T.T.); (T.T.N.); (H.T.T.H.); (P.D.C.)
| | - Tang Thi Nga
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin, Hanoi 122000, Vietnam; (N.T.T.); (L.T.T.); (T.T.N.); (H.T.T.H.); (P.D.C.)
| | - Hoang Thi Thu Ha
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin, Hanoi 122000, Vietnam; (N.T.T.); (L.T.T.); (T.T.N.); (H.T.T.H.); (P.D.C.)
| | - Phung Dac Cam
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin, Hanoi 122000, Vietnam; (N.T.T.); (L.T.T.); (T.T.N.); (H.T.T.H.); (P.D.C.)
| | - Tran Quang Canh
- Department of Medical Laboratory Science, Hai Duong Medical Technical University, 1 Vu Huu, Thanh Binh, Hai Duong 17000, Vietnam;
| | - Panagiotis Karanis
- Medical Faculty, University of Cologne, University Hospital, 50931 Cologne, Germany
- Department of Basic and Clinical Sciences, Medical School, Anatomy Institute, University of Nicosia, Nicosia 2408, Cyprus
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Pham-Duc P, Nguyen-Viet H, Luu-Quoc T, Cook MA, Trinh-Thi-Minh P, Payne D, Dao-Thu T, Grace D, Dang-Xuan S. Understanding Antibiotic Residues and Pathogens Flow in Wastewater from Smallholder Pig Farms to Agriculture Field in Ha Nam Province, Vietnam. ENVIRONMENTAL HEALTH INSIGHTS 2020; 14:1178630220943206. [PMID: 33088179 PMCID: PMC7543113 DOI: 10.1177/1178630220943206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Contact with livestock wastewater on farms and in communities can pose a risk to human and animal health. METHODS This cross-sectional study was conducted in 180 households and 24 pig farms (96 wastewater samples) to explore information about pig production, livestock waste management, antibiotic use, and to analyze antibiotic residues and microbial contamination, respectively. RESULTS Of the 120 households raising pigs, biogas systems were the most commonly used to treat animal waste (70%), followed by compositing (19%), and the remaining respondents discharged waste directly into drains or ponds (11%). The majority of respondents (78%) used antibiotics to treat and prevent disease in pigs, but 32% of them did not know of any disadvantages of antibiotic abuse. ELISA assays were performed on half of the wastewater samples (n = 48), demonstrating that residues of flouroquinolones and sulfonamides were present in 6.3% (3/48) and 22.9% (11/48) of tested samples, respectively. The average residual level of sulfamethazine was 27.8 ug/l. Further, E. coli concentrations exceeding regulatory levels in Vietnam were found in nearly all samples. Salmonella spp. was also found in 57.3% of samples, though prevalence rates varied across the different sites. Finally, G. lamblia was found in 8.4% of samples, and C. parvum was found in 5.2% of samples. CONCLUSIONS This study suggests that livestock wastewater carried potential harmful pathogens and antibiotic residues that could come into contact with humans in the community. Thus, appropriate operation and application of livestock wastewater treatment (such as biogas or composting) and management should be a continued focused.
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Affiliation(s)
- Phuc Pham-Duc
- Center for Public Health and Ecosystem
Research, Hanoi University of Public Health, Hanoi, Vietnam
- Institute of Environmental and
Sustainable Development, Hanoi, Vietnam
| | - Hung Nguyen-Viet
- Center for Public Health and Ecosystem
Research, Hanoi University of Public Health, Hanoi, Vietnam
- International Livestock Research
Institute, Hanoi, Vietnam
| | - Toan Luu-Quoc
- Faculty of Environmental &
Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Meghan A Cook
- Center for Public Health and Ecosystem
Research, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Dave Payne
- Secretariat Office of Vietnam One Health
Partnership for Zoonoses, Hanoi, Vietnam
| | - Trang Dao-Thu
- Secretariat Office of Vietnam One Health
Partnership for Zoonoses, Hanoi, Vietnam
| | - Delia Grace
- International Livestock Research
Institute, Hanoi, Vietnam
| | - Sinh Dang-Xuan
- Center for Public Health and Ecosystem
Research, Hanoi University of Public Health, Hanoi, Vietnam
- International Livestock Research
Institute, Hanoi, Vietnam
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Contreras JD, Trangucci R, Felix-Arellano EE, Rodríguez-Dozal S, Siebe C, Riojas-Rodríguez H, Meza R, Zelner J, Eisenberg JNS. Modeling Spatial Risk of Diarrheal Disease Associated with Household Proximity to Untreated Wastewater Used for Irrigation in the Mezquital Valley, Mexico. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:77002. [PMID: 32634028 PMCID: PMC7340213 DOI: 10.1289/ehp6443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Reusing wastewater for irrigation is a longstanding practice that enhances crop yields and improves climate resilience. Without treatment, however, wastewater contains harmful pathogens and chemicals. Reuse of untreated wastewater has been shown to be harmful to the health of nearby communities, but the routes of exposure are unknown and do not appear to be occupational. Some routes occur throughout entire communities, such as food contamination. Other routes may be spatially dependent, such as spread by domestic animals or through aerosolization. OBJECTIVES To examine whether those wastewater exposure routes with a spatial dependency affect health, we estimated the risks of diarrheal disease in children under age 5 associated with living near wastewater canals, while adjusting for potential individual- and household-level confounders. METHODS We conducted three surveys over 1 y in the Mezquital Valley, Mexico, to measure diarrhea in children. The distance between each participating household and a wastewater canal was measured using GPS coordinates. The association between proximity and diarrhea was estimated with a multilevel logistic regression model accounting for spatial autocorrelation. RESULTS A total of 564 households completed one to three surveys, resulting in 1,856 survey observations of 646 children. Children living 100m from a canal had 45% lower odds of diarrhea than those living within 10m of a canal, and children living 1000m away had 70% lower odds of diarrhea [100m vs. 10m adjusted odds ratio (OR)=0.55, 95% credible interval (CI): 0.33, 0.91; 1000m vs. 10m adjusted OR=0.30, 95% CI: 0.11, 0.82]. DISCUSSION The estimated decline in diarrheal prevalence with household distance from a canal persisted after controlling for occupational exposure. Identifying the specific routes of exposure that drive this relationship will help identify which interventions, such as upstream treatment, can reduce health risks for entire communities where wastewater exposure occurs. https://doi.org/10.1289/EHP6443.
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Affiliation(s)
- Jesse D Contreras
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rob Trangucci
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Eunice E Felix-Arellano
- Dirección de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Sandra Rodríguez-Dozal
- Dirección de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Christina Siebe
- Instituto de Geología, Universidad Nacional Autónoma de México, Ciudad de México, Distrito Federal, México
| | | | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Russo GS, Eftim SE, Goldstone AE, Dufour AP, Nappier SP, Wade TJ. Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis. WATER RESEARCH 2020; 176:115729. [PMID: 32240845 DOI: 10.1016/j.watres.2020.115729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 05/26/2023]
Abstract
Recreational water quality guidelines protect the public from health risks associated with water recreation by helping to prevent unacceptable concentrations of pathogenic organisms in ambient water. However, illness risk is associated with both the concentration of pathogens in the water and the degree of contact with those pathogens. Different recreational activities can result in different levels of contact with ambient water containing water-borne pathogens. We conducted a systematic literature review and meta-analysis to evaluate risks of illness associated with different recreational activities and different levels of contact to ambient surface waters. We screened 8,618 potentially relevant studies for quantitative measures of risk using inclusion/exclusion criteria established in advance. We categorized recreational activities as swimming, sports-related contact, minimal contact, and sand contact. We combined relative risks using a random effects meta-analysis for adverse health outcome categories representing gastrointestinal illness, respiratory illness, skin, eye, ear, nose, throat, and cold/flu illness. We identified 92 studies meeting our inclusion criteria. Pooled risk estimates indicate significant elevation of gastrointestinal illness with the recreational activity categories swimming (2.19, 95% CI: 1.82, 2.63) and sports-related contact (2.69, 95% CI: 1.04, 6.92), and nonsignificant elevation of gastrointestinal illness with minimal contact (1.27, 95% CI: 0.74, 2.16). We also found a significant elevation of respiratory illness with swimming (1.78, 95% CI: 1.38, 2.29) and sports-related contact (1.49, 95% CI: 1.00, 2.24), and no elevation of respiratory illness with minimal contact (0.90, 95% CI: 0.71, 1.14). This study suggests that exposures associated with different types of recreational activities are important characteristics of the exposure pathway when assessing illness risk associated with recreation in ambient surface waters.
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Affiliation(s)
- Gary S Russo
- U.S. Environmental Protection Agency, Office of Water, Office of Science and Technology, Standards and Health Protection Division, 1200 Pennsylvania Avenue, NW, Mail Code 4305T, Washington, DC, 20460, USA.
| | | | | | - Alfred P Dufour
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 26 West Martin Luther King Drive, Mail Code 587, Cincinnati, OH, 45268, USA
| | - Sharon P Nappier
- U.S. Environmental Protection Agency, Office of Water, Office of Science and Technology, Health and Ecological Division, 1200 Pennsylvania Avenue, NW, Mail Code 4304T, Washington, DC, 20460, USA
| | - Timothy J Wade
- U.S. Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, 109 T.W. Alexander Drive, Mail Code 58C, Research Triangle Park, NC, 27709, USA
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Nguyen KT, Nguyen HM, Truong CK, Ahmed MB, Huang Y, Zhou JL. Chemical and microbiological risk assessment of urban river water quality in Vietnam. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2559-2575. [PMID: 31065920 DOI: 10.1007/s10653-019-00302-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
The contamination and risk by nutrients (NH4+, NO2-, NO3- and PO43-), COD, BOD5, coliform and potentially toxic elements (PTEs) of As, Cd, Ni, Hg, Cu, Pb, Zn and Cr were investigated in urban river (Nhue River), Vietnam during 2010-2017. The extensive results demonstrated that concentrations of these contaminants showed significant spatial and temporal variations. The Nhue River was seriously polluted by NH4+ (0.025-11.28 mg/L), PO43- (0.17-1.72 mg/L), BOD5 (5.8-179.6 mg/L), COD (1.4-239.8 mg/L) and coliform (1540-326,470 CFU/100 mL); moderately polluted by As (0.2-131.15 μg/L) and Hg (0.11-4.1 μg/L); and slightly polluted by NO2- (0.003-0.33 mg/L) and Cd (2.1-18.2 μg/L). The concentrations of NH4+, PO43-, COD, BOD5 and coliform frequently exceeded both drinking water guidelines and irrigation water standards. Regarding PTEs, As, Cd and Hg concentrations were frequently higher than the regulatory limits. Human health risks of PTEs were evaluated by estimating hazard index (HI) and cancer risk through ingestion and dermal contacts for adults and children. The findings indicated that As was the most important pollutant causing both non-carcinogenic and carcinogenic concerns. The non-carcinogenic risks of As were higher than 1.0 at all sites for both adults (HI = 1.83-7.4) and children (HI = 2.6-10.5), while As posed significant carcinogenic risks for adults (1 × 10-4-4.96 × 10-4). A management strategy for controlling wastewater discharge and protecting human health is urgently needed.
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Affiliation(s)
- Kien Thanh Nguyen
- Centre for Green Technology, School of Civil and Environmental Engineering, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Hung Manh Nguyen
- Department of Hydraulic Works Management, Directorate of Water Resources, Ministry of Agriculture and Rural Development, 2nd Ngoc Ha Street, Ba Dinh District, Hanoi, Vietnam
| | - Cuong Kim Truong
- Laboratory Division, Institute of Irrigation Planning, 162A Tran Quang Khai Street, Hoan Kiem District, Hanoi, Vietnam
| | - Mohammad Boshir Ahmed
- Centre for Green Technology, School of Civil and Environmental Engineering, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Yuhan Huang
- Centre for Green Technology, School of Civil and Environmental Engineering, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - John L Zhou
- Centre for Green Technology, School of Civil and Environmental Engineering, University of Technology Sydney, Broadway, NSW, 2007, Australia.
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Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladesh. Trop Med Infect Dis 2018; 4:tropicalmed4010005. [PMID: 30587776 PMCID: PMC6473641 DOI: 10.3390/tropicalmed4010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. METHODS This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. RESULTS The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). CONCLUSIONS The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.
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Experience and Future Perceived Risk of Floods and Diarrheal Disease in Urban Poor Communities in Accra, Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122830. [PMID: 30545071 PMCID: PMC6313637 DOI: 10.3390/ijerph15122830] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 01/05/2023]
Abstract
Diarrheal disease is a critical health condition in urban areas of developing countries due to increasing urbanization and its associated problems of sanitation and poor access to good drinking water. Increasing floods in cities have been linked to the risk of diarrheal disease. There are few studies that specifically link flooding with diarrhea diseases. This may be due to the fact that secondary data mainly hospital recorded cases, and not individual cases at the household level are used. Furthermore, of the few papers that consider the flood-diarrheal diseases nexus, none have considered risk perceptions in general, and more specifically, whether households that have experienced floods which resulted in a reported case of diarrhea, have higher perceived risks of future occurrences of the two phenomena compared to households that had different experiences. Yet, this is critical for the development of interventions that seek to increase protective behaviors and reduce the risk of contracting diarrhea. We surveyed 401 households in some selected urban poor communities in Accra, the capital of Ghana. Results show that households that experienced floods which resulted in a reported case of diarrhea, have higher perceived risk of future occurrence of the two phenomena compared to other households. We recommend public education that reduces the risk of exposure to flood and diarrhea through flood mitigation measures, including the construction of drains in communities and educating communities on good sanitation.
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Adegoke AA, Amoah ID, Stenström TA, Verbyla ME, Mihelcic JR. Epidemiological Evidence and Health Risks Associated With Agricultural Reuse of Partially Treated and Untreated Wastewater: A Review. Front Public Health 2018; 6:337. [PMID: 30574474 PMCID: PMC6292135 DOI: 10.3389/fpubh.2018.00337] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/01/2018] [Indexed: 01/25/2023] Open
Abstract
The use of partially treated and untreated wastewater for irrigation is beneficial in agriculture but may be associated with human health risks. Reports from different locations globally have linked microbial outbreaks with agricultural reuse of wastewater. This article reviews the epidemiological evidence and health risks associated with this practice, aiming toward evidence-based conclusions. Exposure pathways that were addressed in this review included those relevant to agricultural workers and their families, consumers of crops, and residents close to areas irrigated with wastewater (partially treated or untreated). A meta-analysis gave an overall odds ratio of 1.65 (95% CI: 1.31, 2.06) for diarrheal disease and 5.49 (95% CI: 2.49, 12.10) for helminth infections for exposed agricultural workers and family members. The risks were higher among children and immunocompromised individuals than in immunocompetent adults. Predominantly skin and intestinal infections were prevalent among individuals infected mainly via occupational exposure and ingestion. Food-borne outbreaks as a result of crops (fruits and vegetables) irrigated with partially or untreated wastewater have been widely reported. Contamination of crops with enteric viruses, fecal coliforms, and bacterial pathogens, parasites including soil-transmitted helminthes (STHs), as well as occurrence of antibiotic residues and antibiotic resistance genes (ARGs) have also been evidenced. The antibiotic residues and ARGs may get internalized in crops along with pathogens and may select for antibiotic resistance, exert ecotoxicity, and lead to bioaccumulation in aquatic organisms with high risk quotient (RQ). Appropriate mitigation lies in adhering to existing guidelines such as the World Health Organization wastewater reuse guidelines and to Sanitation Safety Plans (SSPs). Additionally, improvement in hygiene practices will also provide measures against adverse health impacts.
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Affiliation(s)
- Anthony A. Adegoke
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
- Department of Microbiology, Faculty of Science, University of Uyo, Uyo, Nigeria
| | - Isaac D. Amoah
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Thor A. Stenström
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Matthew E. Verbyla
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, CA, United States
| | - James R. Mihelcic
- Department of Civil & Environmental Engineering, University of South Florida, Tampa, FL, United States
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Julian TR, Vithanage HSK, Chua ML, Kuroda M, Pitol AK, Nguyen PHL, Canales RA, Fujii S, Harada H. High time-resolution simulation of E. coli on hands reveals large variation in microbial exposures amongst Vietnamese farmers using human excreta for agriculture. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 635:120-131. [PMID: 29660716 DOI: 10.1016/j.scitotenv.2018.04.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 05/16/2023]
Abstract
Infectious disease transmission is frequently mediated by the environment, where people's movements through and interactions with the environment dictate risks of infection and/or illness. Capturing these interactions, and quantifying their importance, offers important insights into effective interventions. In this study, we capture high time-resolution activity data for twenty-five Vietnamese farmers during collection and land application of human excreta for agriculture. Although human excreta use improves productivity, the use increases risks of enteric infections for both farmers and end users. In our study, the activity data are integrated with environmental microbial sampling data into a stochastic-mechanistic simulation of E. coli contamination on hands and E. coli ingested. Results from the study include frequent and variable contact rates for farmers' hands (from 34 to 1344 objects contacted per hour per hand), including highly variable hand-to-mouth contact rates (from 0 to 9 contacts per hour per hand). The frequency of hand-to-mouth contacts was substantially lower than the widely-used frequency previously reported for U.S. Office Workers. Environmental microbial contamination data highlighted ubiquitous E. coli contamination in the environment, including excreta, hands, toilet pit, handheld tools, soils, surfaces, and water. Results from the simulation suggest dynamic changes in E. coli contamination on hands, and wide variation in hand contamination and E. coli ingested amongst the farmers studied. Sensitivity analysis suggests that E. coli contamination on hands and ingested doses are most influenced by contamination of handheld tools, excreta, and the toilet pit as well as by frequency of hand-to-mouth contacts. The study findings are especially relevant given the context: no farmers reported adequate storage time of human excreta, and personal protective mask availability did not prevent hand-to-mouth contacts. Integrating high time-resolution activity data into exposure assessments highlights variation in exposures amongst farmers, and offers greater insight into effective interventions and their potential impacts.
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Affiliation(s)
- Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, CH-8600 Dübendorf, Switzerland; Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
| | - Hasitha S K Vithanage
- UNESCO-IHE Institute for Water Education, 2601 Delft, The Netherlands; Sri Lanka National Water Supply and Drainage Board, Dehiwala-Mount Lavinia, Sri Lanka
| | - Min Li Chua
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan
| | - Matasaka Kuroda
- Graduate School of Engineering, Katsura Campus, Kyoto University, Nisikyo-ku, 615-8510, Kyoto, Japan
| | - Ana K Pitol
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, CH-8600 Dübendorf, Switzerland; Laboratory of Environmental Chemistry, School of Architecture, Civil, and Environmental Engineering (ENAC), École Polytechnique FÉdÉrale de Lausanne (EPFL), CH 1015 Lausanne, Switzerland
| | - Pham Hong Lien Nguyen
- School of Environmental Science and Technology, Hanoi University of Science and Technology, Viet Nam
| | - Robert A Canales
- Community, Environment & Policy Department, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Avenue, Campus PO Box 245210, Drachman Hall A229, Tucson, AZ 85724, USA
| | - Shigeo Fujii
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan
| | - Hidenori Harada
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan; Research Institute for Humanity and Nature, 457-4 Kamigamo Motoyama, Kita-ku 603-8047, Kyoto, Japan.
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Hall DC, Le QB. Factors Influencing Mitigation of Risk of Waterborne Disease in Vietnam Among Small Scale Integrated Livestock Farmers. Front Vet Sci 2018; 5:154. [PMID: 30038910 PMCID: PMC6046405 DOI: 10.3389/fvets.2018.00154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/18/2018] [Indexed: 11/16/2022] Open
Abstract
The integrated livestock, crops, and fish (VAC) model of integrated small scale agriculture has been important to economic and ecological sustainability in Vietnam for many centuries. Recently, emerging waterborne diseases including avian influenza as well as the potential for zoonotic disease arising from small scale farms have jeopardized the VAC model. In order to promote mitigation of the risk of waterborne and other diseases in the VAC system, there needs to be recognition of the significant predictors of such behavior, particularly with respect to water sources including well and rain water. We report primarily quantitative results of research generated from 300 farms in each of North and South Vietnam that indicate the small scale farmers who are more likely to engage in mitigation of waterborne disease are those who raise pigs, perceive themselves to be more at risk of HPAI infection from well water, report they are good livestock managers, value the advice of health care workers, and where a female household member is the decision maker for family health. These results bear importance to water and health policy formulators in rural Vietnam. (JEL I130, I180, O130, Q180, Q570). JEL CLASSIFICATIONS:I130: Health and economic development I180: Public health O130: Economic Development: Agriculture; Environment Q180: Agricultural policy; Food policy Q570: Ecological economics: biodiversity conservation
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Affiliation(s)
- David C Hall
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Quynh B Le
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
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Amoah ID, Adegoke AA, Stenström TA. Soil-transmitted helminth infections associated with wastewater and sludge reuse: a review of current evidence. Trop Med Int Health 2018; 23:692-703. [PMID: 29779225 PMCID: PMC6055670 DOI: 10.1111/tmi.13076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review current evidence on infections related to the concentration of soil-transmitted helminth (STH) eggs in wastewater, sludge and vegetables irrigated with wastewater or grown on sludge-amended soils. METHOD Search of Web of Science, Science Direct, PubMed and Google Scholar databases for publications reporting on STH egg concentration in wastewater, sludge and vegetables and for epidemiological studies on wastewater/sludge reuse and STH infections. RESULTS STH egg concentrations were variable but high in wastewater and sludge especially in developing countries. They ranged from 6 to 16 000 eggs/L in wastewater and from 0 to 23 000 eggs/g in sludge and far exceed limits set in the WHO guideline for wastewater/sludge reuse. Numbers of STH eggs on vegetables ranged from 0 to 100 eggs/g. The concentration of STH eggs in wastewater, sludge and vegetables therefore relates to risks of infection through different exposure routes. CONCLUSION Epidemiological evidence reveals an increased prevalence of STH infections associated with direct exposure to wastewater or sludge (farmers) and consumption of vegetables grown on soil treated with it. This calls for increased efforts to reduce the adverse health impact of wastewater and sludge reuse in line with the WHO multi-barrier approach.
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Affiliation(s)
- Isaac Dennis Amoah
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Anthony Ayodeji Adegoke
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Thor Axel Stenström
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
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Ström G, Albihn A, Jinnerot T, Boqvist S, Andersson-Djurfeldt A, Sokerya S, Osbjer K, San S, Davun H, Magnusson U. Manure management and public health: Sanitary and socio-economic aspects among urban livestock-keepers in Cambodia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 621:193-200. [PMID: 29179075 DOI: 10.1016/j.scitotenv.2017.11.254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
Abstract
Livestock manure is a valuable source of nutrients for crop production, but can also pose a public health hazard and have negative environmental impacts. This study investigated manure management practices among urban and peri-urban livestock keepers in Cambodia, to identify risk behaviours and socio-economic aspects associated with the handling of manure. A survey including 204 households was conducted, using a structured questionnaire with questions on demographics, socio-economic characteristics and household practices related to manure management. Faecal samples were obtained from pig pens and pig manure storage units for analysis of the potential zoonotic pathogens Salmonella enterica (Polymerase Chain Reaction (PCR)), Ascaris suum and Trichuris suis (McMaster flotation technique). The survey revealed a difference in management between cattle and pig manure. Cattle manure was most commonly used as fertiliser for crop production (66%) (p<0.001), whereas pig manure was most commonly dumped in the environment (46%) (p<0.001). Logistic regression models showed that households with a lower socio-economic position were more likely to dump pig manure (p<0.001), with scarcity of agricultural land (p<0.001) and lack of carts for transportation of manure (p<0.01) being identified as contributing factors. Salmonella enterica was detected in 9.7% of manure samples, while Ascaris suum and Trichuris suis were detected in 1.6% and 2.4% of the samples, respectively. The results presented in this study indicate that manure management by urban and peri-urban households may pose a public health threat and an environmental hazard. There is evidently a need for further knowledge support to the livestock keepers to promote good management practices.
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Affiliation(s)
- Gunilla Ström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Ann Albihn
- Department of Chemistry, Environment and Feed Hygiene, National Veterinary Institute, Ulls väg 2B, SE-751 89 Uppsala, Sweden; Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, PO Box 7036, 750 07 Uppsala, Sweden.
| | - Tomas Jinnerot
- Department of Microbiology, Section for Molecular Diagnostics, National Veterinary Institute, Ulls väg 2B, SE-751 89 Uppsala, Sweden.
| | - Sofia Boqvist
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, PO Box 7036, 750 07 Uppsala, Sweden.
| | | | - Seng Sokerya
- Centre for Livestock and Agriculture Development, PO Box 2423, Phnom Penh 3, Cambodia.
| | - Kristina Osbjer
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Sorn San
- National Veterinary Research Institute, St 371, Phnom Penh, Cambodia
| | - Holl Davun
- National Veterinary Research Institute, St 371, Phnom Penh, Cambodia
| | - Ulf Magnusson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
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Community Participatory Interventions to Improve Farmer Knowledge and Practices of Household Biogas Unit Operation in Ha Nam Province, Vietnam. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24 Suppl 2:S28-S35. [PMID: 29369254 DOI: 10.1097/phh.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The use of biogas systems to treat livestock waste is a common practice in Vietnam. However, farmers' knowledge and practices of the safe and appropriate use of household biogas units (HBUs) are still limited and could negatively impact human, animal, and environmental health. OBJECTIVE To assess the effectiveness of an intervention to improve knowledge and practices of biogas operation among farmers in 2 communes of Ha Nam Province, Vietnam. DESIGN A community-based intervention approach. SETTING This study was conducted from 2015 to 2016 in 2 communes of Ha Nam Province, Vietnam. PARTICIPANTS Only farmers with HBUs (N = 399) participated in this research. Farmers were assigned to either an intervention group or a control group at a ratio of 1:2. INTERVENTION Two intervention steps were implemented over a 6-month period as follows: (i) the core farmer group trained in 6 steps of HBU safe handling practice; and (ii) the core farmer group conducted peer-to-peer communication with its neighbors in the commune using the provided material. MAIN OUTCOME MEASURE(S) Farmers' knowledge and practices in biogas operation were assessed by a structured questionnaire. The questionnaire was administered before (baseline) and after the intervention (follow-up) to both the control and intervention groups. RESULTS There was a significant difference in the knowledge and practices of biogas operation between the 2 groups, in which farmers in the intervention group demonstrated better understanding of the related topic than the control group (P < .05, t test). A linear regression model indicated that baseline and follow-up scores in both knowledge and practices of the intervention group were higher than those of the control group. After the intervention, the mean difference score in knowledge and practices between the intervention and control groups was 5.0 and 2.0 points, respectively (P < .01). CONCLUSION A community-based intervention approach could be applied to improve knowledge and practices among farmers in using biogas systems. However, further studies should be conducted to assess the sustainability and effectiveness of this model.
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Sarker AR, Sultana M, Mahumud RA, Ali N, Huda TM, Salim uzzaman M, Haider S, Rahman H, Islam Z, Khan JAM, Van Der Meer R, Morton A. Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective. Glob Health Res Policy 2018; 3:1. [PMID: 29318195 PMCID: PMC5755417 DOI: 10.1186/s41256-017-0056-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. METHODS This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. RESULTS The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. CONCLUSIONS Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir M Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - M. Salim uzzaman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sabbir Haider
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hafizur Rahman
- Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Ghoshal UC, Gwee KA, Holtmann G, Li Y, Park SJ, Simadibrata M, Sugano K, Wu K, Quigley EMM, Cohen H. The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia-Pacific region - background and recommendations of a regional consensus meeting. J Gastroenterol Hepatol 2018; 33:57-69. [PMID: 28589613 DOI: 10.1111/jgh.13840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
The Asia-Pacific region is diverse, with regard to ethnicity, culture, and economic development incorporating some of the world's least and most developed nations. Gastrointestinal diseases are common in the Asia-Pacific region, and their prevalence, presentation, and management vary considerably within the region. There is growing evidence for an important role for the human gut microbiota in gastrointestinal health. As a consequence, geographic variations in the composition of the gut microbiota may contribute to variations in both the prevalence and response to therapy of specific diseases. Probiotics have been proposed as a valuable option in the prevention and treatment of a number of gastrointestinal illnesses, but the quality of available evidence to support their efficacy is variable. A meeting of international experts in adult and pediatric gastroenterology was held at the Sorbonne University, Paris, France, on April 11 and 12, 2016, to discuss current evidence supporting the use of probiotics in gastrointestinal disorders in the Asia-Pacific region. This article provides an overview of the discussions held at this meeting and recommends the formation of an Asia-Pacific Consortium on Gut Microbiota similar to those established in Europe and North America.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia
| | - Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Soo Jung Park
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Marcellus Simadibrata
- Faculty of Medicine, University of Indonesia and Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,RSUPN Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kentaro Sugano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Henry Cohen
- Clínica de Gastroenterología, Facultad de Medicina, Montevideo, Uruguay
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Contreras JD, Meza R, Siebe C, Rodríguez-Dozal S, López-Vidal YA, Castillo-Rojas G, Amieva RI, Solano-Gálvez SG, Mazari-Hiriart M, Silva-Magaña MA, Vázquez-Salvador N, Rosas Pérez I, Martínez Romero L, Salinas Cortez E, Riojas-Rodríguez H, Eisenberg JNS. Health risks from exposure to untreated wastewater used for irrigation in the Mezquital Valley, Mexico: A 25-year update. WATER RESEARCH 2017; 123:834-850. [PMID: 28755783 DOI: 10.1016/j.watres.2017.06.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/21/2017] [Indexed: 05/06/2023]
Abstract
Wastewater reuse for agriculture is common worldwide; wastewater treatment, however, is rare in many countries, leading to high potential for exposure to harmful pathogens. Mexico City, one of the largest producers of untreated wastewater for agricultural use worldwide, was the site of key epidemiologic studies conducted in the 1990s. We both reviewed the literature on and conducted a cross-sectional study of diarrheal risk and wastewater contamination to provide an updated assessment of health risks and to inform an upcoming update of the 2006 WHO guidelines on wastewater reuse. We surveyed communities in the Mezquital Valley that use wastewater for irrigation and communities that use well water to compare the prevalence of self-reported diarrheal disease in children under five years old. Wastewater, well water, household environmental samples, and stool samples were collected and analyzed. Communities exposed to wastewater had a higher one-week prevalence of diarrhea (10%) compared to unexposed communities (5%). This association remained in an adjusted modified Poisson regression model (PR = 2.31, 95% CI 1.00, 5.31), but not when limited to households engaged in agriculture. Water quality indicators document differences between irrigation water from the two community groups. These results are in agreement with 25 population studies identified by our review that were conducted since or not included in the 2006 WHO guidelines and show consistent negative impacts of wastewater exposure on health. While overall diarrheal prevalence has declined when compared to studies conducted over 25 years ago in the same region, the association of diarrheal disease and wastewater exposure has remained and possibly increased. With rising urbanization worldwide, attention to these risks and wastewater treatment is becoming increasingly important.
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Affiliation(s)
- Jesse D Contreras
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48105, United States
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48105, United States.
| | - Christina Siebe
- Instituto de Geología, Universidad Nacional Autónoma de México, Circuito de la Investigación, Ciudad Universitaria, Ciudad de México, Distrito Federal, 02376, Mexico
| | - Sandra Rodríguez-Dozal
- Dirección de Salud Ambiental, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, 62100, Mexico
| | - Yolanda A López-Vidal
- Facultad de Medicina, Universidad Nacional Autónoma de MéxicoCircuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Gonzalo Castillo-Rojas
- Facultad de Medicina, Universidad Nacional Autónoma de MéxicoCircuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Rosa I Amieva
- Facultad de Medicina, Universidad Nacional Autónoma de MéxicoCircuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Sandra G Solano-Gálvez
- Facultad de Medicina, Universidad Nacional Autónoma de MéxicoCircuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Marisa Mazari-Hiriart
- Instituto de Ecología, Universidad Nacional Autónoma de MéxicoCircuito Exterior S/N Anexo Jardín Botánico Exterior, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04500, Mexico
| | - Miguel A Silva-Magaña
- Instituto de Ecología, Universidad Nacional Autónoma de MéxicoCircuito Exterior S/N Anexo Jardín Botánico Exterior, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04500, Mexico
| | - Nallely Vázquez-Salvador
- Instituto de Ecología, Universidad Nacional Autónoma de MéxicoCircuito Exterior S/N Anexo Jardín Botánico Exterior, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04500, Mexico
| | - Irma Rosas Pérez
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Leticia Martínez Romero
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Eva Salinas Cortez
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Ciudad de México, Distrito Federal, 04510, Mexico
| | - Horacio Riojas-Rodríguez
- Dirección de Salud Ambiental, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, 62100, Mexico
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48105, United States.
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Dang-Xuan S, MacDonald LE, Schurer JM, Nguyen-Viet H, Pham-Duc P. Household Exposure to Livestock and Health in the CHILILAB HDSS Cohort, Vietnam. Asia Pac J Public Health 2017; 29:72S-83S. [PMID: 28719770 DOI: 10.1177/1010539517712758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Vietnam, pigs and poultry are predominantly produced by small-scale farmers, creating challenges for zoonotic disease management. The objective of this study was to characterize practices related to livestock and manure management and to measure association with 3 self-reported health symptoms (coughing, fever, and diarrhea/nausea/vomiting) in a region currently undergoing health transitions. We analyzed cross-sectional survey data collected from a subset (N = 5520) of the Chi Linh Health and Demographic Surveillance System cohort in Chi Linh district, Vietnam. Bivariate analyses indicated that female gender was a significant risk factor for all 3 health symptoms, whereas age (≥60 years), suburban living, low education level, and household wealth were risk factors for 2 symptoms. Overall, we found no indication that biogas production or exposure to livestock and manure adversely affected human health. Efforts to control zoonotic disease transmission should prioritize utilization of veterinarians, enhanced farm biosecurity, and improvements to commune drinking water/wastewater infrastructure.
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Affiliation(s)
| | | | - Janna M Schurer
- 1 Hanoi University of Public Health, Hanoi, Vietnam.,2 University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hung Nguyen-Viet
- 1 Hanoi University of Public Health, Hanoi, Vietnam.,3 International Livestock Research Institute, Hanoi, Vietnam
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22
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Fuhrimann S, Winkler MS, Pham-Duc P, Do-Trung D, Schindler C, Utzinger J, Cissé G. Intestinal parasite infections and associated risk factors in communities exposed to wastewater in urban and peri-urban transition zones in Hanoi, Vietnam. Parasit Vectors 2016; 9:537. [PMID: 27724979 PMCID: PMC5057403 DOI: 10.1186/s13071-016-1809-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 09/21/2016] [Indexed: 11/20/2022] Open
Abstract
Background Infections with intestinal parasites (helminths and intestinal protozoa) are endemic in Southeast Asia and inappropriate management and reuse of wastewater might exacerbate the risk of human infections. In rapidly growing urban settings, little is known about the extent of intestinal parasite infections. We assessed the point-prevalence and risk factors of intestinal parasite infections in population groups differently exposed to wastewater in urban and peri-urban transition zones in Hanoi, the capital of Vietnam. Methods A cross-sectional survey was carried out between April and June 2014 in people aged ≥ 18 years at risk of wastewater exposure from To Lich River: workers maintaining wastewater treatment facilities; urban farmers reusing wastewater; and urban dwellers at risk of flooding events. For comparison, two peri-urban population groups living in close proximity to the Red River were chosen: farmers using river water for irrigation purposes; and people living in the same communities. A single stool sample was subjected to Kato-Katz and formalin-ether concentration methods for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine risk factors and self-reported signs and symptoms. Results A total of 681 individuals had complete data records. Highest point-prevalence rates of intestinal parasite infections were observed for peri-urban farmers (30 %). Hookworm and Trichuris trichiura were the predominant helminth species (25 % and 5 %, respectively). Peri-urban farmers were at higher odds of infection with intestinal parasites than any other groups (adjusted odds ratio 5.8, 95 % confidence interval 2.5 to 13.7). Lack of access to improved sanitation and not receiving deworming within the past 12 months were associated with higher infection risk, while higher educational attainment and socioeconomic status were negatively associated with intestinal parasite infections. Conclusions Our results suggest that exposure to wastewater was not directly associated with infection with helminths and intestinal protozoa in different population groups in Hanoi. These findings might be explained by a high level of awareness of health risks and access to safe sanitary infrastructure in urban areas. The high prevalence rates observed in peri-urban farmers call for specific interventions targeting this population group. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1809-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel Fuhrimann
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Mirko S Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Phuc Pham-Duc
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, Hanoi, Vietnam
| | - Dung Do-Trung
- Department of Parasitology, National Institute of Malaria, Parasitology, and Entomology, Hanoi, Vietnam
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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23
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Fuhrimann S, Pham-Duc P, Cissé G, Tram NT, Thu Ha H, Dung DT, Ngoc P, Nguyen-Viet H, Anh Vuong T, Utzinger J, Schindler C, Winkler MS. Microbial contamination along the main open wastewater and storm water channel of Hanoi, Vietnam, and potential health risks for urban farmers. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 566-567:1014-1022. [PMID: 27325013 DOI: 10.1016/j.scitotenv.2016.05.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 06/06/2023]
Abstract
The use of wastewater in agriculture and aquaculture has a long tradition throughout Asia. For example, in Hanoi, it creates important livelihood opportunities for >500,000 farmers in peri-urban communities. Discharge of domestic effluents pollute the water streams with potential pathogenic organisms posing a public health threat to farmers and consumers of wastewater-fed foodstuff. We determined the effectiveness of Hanoi's wastewater conveyance system, placing particular emphasis on the quality of wastewater used in agriculture and aquaculture. Between April and June 2014, a total of 216 water samples were obtained from 24 sampling points and the concentrations of total coliforms (TC), Escherichia coli, Salmonella spp. and helminth eggs determined. Despite applied wastewater treatment, agricultural field irrigation water was heavily contaminated with TC (1.3×10(7)colony forming unit (CFU)/100mL), E. coli (1.1×10(6)CFU/100mL) and Salmonella spp. (108 most probable number (MPN)/100mL). These values are 110-fold above Vietnamese discharge limits for restricted agriculture and 260-fold above the World Health Organization (WHO)'s tolerable safety limits for unrestricted agriculture. Mean helminth egg concentrations were below WHO tolerable levels in all study systems (<1egg/L). Hence, elevated levels of bacterial contamination, but not helminth infections, pose a major health risk for farmers and consumers of wastewater fed-products. We propose a set of control measures that might protect the health of exposed population groups without compromising current urban farming activities. This study presents an important example for sanitation safety planning in a rapidly expanding Asian city and can guide public and private entities working towards Sustainable Development Goal target 6.3, that is to improve water quality by reducing pollution, halving the proportion of untreated wastewater and increasing recycling and safe reuse globally.
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Affiliation(s)
- Samuel Fuhrimann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Phuc Pham-Duc
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, Hanoi, Vietnam
| | - Guéladio Cissé
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nguyen Thuy Tram
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Hoang Thu Ha
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Do Trung Dung
- Department of Parasitology, National Institute of Malaria, Parasitology, and Entomology, Hanoi, Vietnam
| | - Pham Ngoc
- Department of Animal Hygiene, National Institute for Veterinary Research, Hanoi, Vietnam
| | - Hung Nguyen-Viet
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, Hanoi, Vietnam; International Livestock Research Institute, Hanoi, Vietnam
| | - Tuan Anh Vuong
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mirko S Winkler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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24
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Assessing potential health impacts of waste recovery and reuse business models in Hanoi, Vietnam. Int J Public Health 2016; 62:7-16. [PMID: 27572686 DOI: 10.1007/s00038-016-0877-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/04/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES In resource-constrained settings, the recovery of nutrients and the production of energy from liquid and solid waste are important. We determined the range and magnitude of potential community health impacts of six solid and liquid waste recovery and reuse business models in Hanoi, Vietnam. METHODS We employed a health impact assessment (HIA) approach using secondary data obtained from various sources supplemented with primary data collection. For determining the direction (positive or negative) and magnitude of potential health impacts in the population, a semiquantitative impact assessment was pursued. RESULTS From a public health perspective, wastewater reuse for inland fish farming, coupled with on-site water treatment has considerable potential for individual and community-level health benefits. One of the business models investigated (i.e. dry fuel manufacturing with agro-waste) resulted in net negative health impacts. CONCLUSIONS In Hanoi, the reuse of liquid and solid waste-as a mean to recover water and nutrients and to produce energy-has considerable potential for health benefits if appropriately managed and tailored to local contexts. Our HIA methodology provides an evidence-based decision-support tool for identification and promotion of business models for implementation in Hanoi.
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Lam S, Nguyen-Viet H, Tuyet-Hanh TT, Nguyen-Mai H, Harper S. Evidence for Public Health Risks of Wastewater and Excreta Management Practices in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12863-85. [PMID: 26501297 PMCID: PMC4627004 DOI: 10.3390/ijerph121012863] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022]
Abstract
The use of wastewater and excreta in agriculture is a common practice in Southeast Asia; however, concerns remain about the potential public health risks of this practice. We undertook a scoping review to examine the extent, range, and nature of literature, as well as synthesize the evidence for associations between wastewater and excreta management practices and public health risks in Southeast Asia. Three electronic databases (PubMed, CAB Direct, and Web of Science) were searched and a total of 27 relevant studies were included and evaluated. The available evidence suggested that possible occupational health risks of wastewater and excreta management practices include diarrhea, skin infection, parasitic infection, bacterial infection, and epilepsy. Community members can be at risk for adverse health outcomes through consuming contaminated fish, vegetables, or fruits. Results suggested that practices including handling, treatment, and use of waste may be harmful to human health, particularly farmer’s health. Many studies in this review, however, had limitations including lack of gender analyses, exposure assessment, and longitudinal study designs. These findings suggest that more studies on identifying, quantitatively assessing, and mitigating health risks are needed if sustainable benefits are to be obtained from wastewater and excreta reuse in agriculture in Southeast Asia.
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Affiliation(s)
- Steven Lam
- Department of Population Medicine, University of Guelph, Guelph 50 Stone Rd. E., Guelph, ON N1G 2W1, Canada.
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, 138 Giang Vo. Street, Hanoi 10000, Vietnam.
| | - Hung Nguyen-Viet
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, 138 Giang Vo. Street, Hanoi 10000, Vietnam.
- International Livestock Research Institute (ILRI), 17A Nguyen Khang Street, Trung Hoa Ward, Cau Giay District, Hanoi 10000, Vietnam.
- Swiss Tropical and Public Health Institute, 57 Socinstrasse, CH-4002 Basel, Switzerland and University of Basel, Basel CH-4002, Switzerland.
| | - Tran Thi Tuyet-Hanh
- Department of Environmental Health, Hanoi School of Public Health, 138 Giang Vo. Street, Hanoi 10000, Vietnam.
| | - Huong Nguyen-Mai
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, 138 Giang Vo. Street, Hanoi 10000, Vietnam.
| | - Sherilee Harper
- Department of Population Medicine, University of Guelph, Guelph 50 Stone Rd. E., Guelph, ON N1G 2W1, Canada.
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