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Noomnual S, Konthonbut P, Kongtip P, Woskie SR. Mental Health Disorders among Thai Farmers: Occupational and Non-Occupational Stressors. HUMAN AND ECOLOGICAL RISK ASSESSMENT : HERA 2024; 30:180-200. [PMID: 38828009 PMCID: PMC11139011 DOI: 10.1080/10807039.2024.2310810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/21/2024] [Indexed: 06/05/2024]
Abstract
This cross-sectional study aimed to identify occupational and non-occupational factors that impact levels of stress, depression, and anxiety among farmers located in the northern part of Thailand, including the potential psychological impacts of pesticide use. The participants (N=270) were interviewed with a survey adopted and modified from peer-reviewed articles and questionnaires. The survey consists of four parts, including demographic information and pesticide exposure; perceived farm stressors employing Farm Stressor Survey (FSS); mental health disorder utilizing Srithanya Stress Scale (ST5), Nine-Questions Depression- Rating Scale (9Q), and Depression Anxiety Stress Scale 21 (DASS21); in addition to COVID-related stress utilizing COVID Stress Scale (CSS). The participants were categorized into two groups i.e., Spray and No Spray based on their self-reported occupational use of pesticide spraying within the past year. No significant associations were observed between occupational pesticide exposures and mental health disorder scores. Being female, having a second job besides a farmer, having applied pesticides for greater than 20 years, and having a higher farm stressor perception showed a significant positive association with self-reported mental health disorders; while having a good agricultural practice and PPE use showed a significant negative association with those outcomes. This pilot study scrutinized expanded sources of stress in farm work and provided information for the development of more effective mental disorder intervention programs for Thai farmers.
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Affiliation(s)
- Saisattha Noomnual
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvithi Road, Bangkok 10400, Thailand
| | - Pajaree Konthonbut
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvithi Road, Bangkok 10400, Thailand
| | - Pornpimol Kongtip
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvithi Road, Bangkok 10400, Thailand
| | - Susan R. Woskie
- Department of Public Health, University of Massachusetts Lowell, Zuckerberg College of Health Sciences, O’Leary Library Room 540, 61 Wilder St., Lowell, MA 01854, U.S.A
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Wallace DA, Gallagher JP, Peterson SR, Ndiaye-Gueye S, Fox K, Redline S, Johnson DA. Is exposure to chemical pollutants associated with sleep outcomes? A systematic review. Sleep Med Rev 2023; 70:101805. [PMID: 37392613 PMCID: PMC10528206 DOI: 10.1016/j.smrv.2023.101805] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/03/2023]
Abstract
Environmental exposures may influence sleep; however, the contributions of environmental chemical pollutants to sleep health have not been systematically investigated. We conducted a systematic review to identify, evaluate, summarize, and synthesize the existing evidence between chemical pollutants (air pollution, exposures related to the Gulf War and other conflicts, endocrine disruptors, metals, pesticides, solvents) and dimensions of sleep health (architecture, duration, quality, timing) and disorders (sleeping pill use, insomnia, sleep-disordered breathing)). Of the 204 included studies, results were mixed; however, the synthesized evidence suggested associations between particulate matter, exposures related to the Gulf War, dioxin and dioxin-like compounds, and pesticide exposure with worse sleep quality; exposures related to the Gulf War, aluminum, and mercury with insomnia and impaired sleep maintenance; and associations between tobacco smoke exposure with insomnia and sleep-disordered breathing, particularly in pediatric populations. Possible mechanisms relate to cholinergic signaling, neurotransmission, and inflammation. Chemical pollutants are likely key determinants of sleep health and disorders. Future studies should aim to evaluate environmental exposures on sleep across the lifespan, with a particular focus on developmental windows and biological mechanisms, as well as in historically marginalized or excluded populations.
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Affiliation(s)
- Danielle A Wallace
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jayden Pace Gallagher
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shenita R Peterson
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Seyni Ndiaye-Gueye
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kathleen Fox
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dayna A Johnson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Han L, Wang Q. Association between organophosphorus insecticides exposure and the prevalence of sleep problems in the US adults: An analysis based on the NHANES 2007-2018. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 255:114803. [PMID: 36963182 DOI: 10.1016/j.ecoenv.2023.114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between organophosphorus pesticides (OPPs) exposure and sleep problems. METHODS In this study, data from 6295 participants aged 18 years or older were collected from the National Health and Nutrition Examination Survey (NHANES). The dialkyl phosphate compounds (DAPs) metabolites, OPPs exposure biomarker, were examined using solid phase extraction-high coupled with isotope dilution-ultrahigh performance liquid chromatography-tandem mass spectrometry. Data on short sleep duration (SSD), self-reported trouble sleeping and self-reported sleep disorder were collected from the database. Weighted generalized logistic model, weighted quantile sum (WQS) model, and quantile-based g calculation (QGC) methods were used for analyzing the collected data. RESULTS The prevalence of SSD, self-reported trouble sleeping and self-reported sleep disorder in this study were 28.91 % (1814/6274), 25.31 % (1593/6294), and 9.05 % (289/3195), respectively. After confounding factors adjustments, the prevalence of SDD in participants with high log-transformed DETP, DMTP, DEDTP, and DMDTP were 1.19 times (OR: 1.11-1.28, P < 0.001), 1.09 times (OR: 1.03-1.15, P = 0.003), 1.26 times (OR: 1.17-1.37, P < 0.0001), and 1.10 times (OR: 1.04-1.17, P = 0.003) than in participants with low showed, respectively. A non-linear relationship was noted between SSD with the urinary concentration of DEP (P for nonlinearity < 0.001), DMP (P for nonlinearity < 0.001), DMTP (P for nonlinearity = 0.006), and DMDTP (P for nonlinearity = 0.001). The WQS results showed that the prevalence of SDD was 1.28 times (95 % CI: 1.17-1.40, P < 0.001) higher in participants with high co-exposure to OPPs than in those with low co-exposure, with DEDTP having the enormous weights (0.50). The QGC results also revealed a significant positive association between the co-exposure of DAPs and SSD (OR: 1.08, 95 % CI:1.02-1.16, P = 0.01) with DETP having the most positive weight (0.44). As for the association between DAPs with self-report sleep disorder, only DEP was detected that it was positively associated with self-reported sleep disorder with all confounding factors adjusted (OR: 1.17; 95 % CI: 1.07-1.29, P = 0.001). However, all DAPs have not detected a significant association with the prevalence of self-reported trouble sleeping. Besides, there was no significant association between co-exposure to OPPs with self-reported trouble sleeping and self-reported sleep disorder. CONCLUSION The results of this study indicated that high levels of single or mixture urinary DAP, indicating for OPPs exposure, were associated with an increased prevalence of SSD in general adults, which has significant implications for preventing OPPs pollution and protecting sleep health.
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Affiliation(s)
- Lu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China.
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Zheng R, García-González J, Romero-del Rey R, López-Villén A, García-Alvarez R, Fadul-Calderon R, Requena-Mullor M, Alarcón-Rodríguez R. Occupational Exposure to Pesticides as a Risk Factor for Sleep Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3149. [PMID: 36833840 PMCID: PMC9964445 DOI: 10.3390/ijerph20043149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Inadequate sleep has been linked to a variety of impairments in bodily functions, including endocrine, metabolic, higher cortical function, and neurological disorders. For this reason, the aim of this study was to analyze the link between occupational pesticide exposure and sleep health among farmers in Almeria. A cross-sectional study was conducted among a population living on the coast of Almeria (southeastern Spain), where about 33,321 hectares of land are used for intensive agriculture in plastic greenhouses. A total of 380 individuals participated in the study: 189 greenhouse workers and 191 control subjects. The participants were contacted during their annual scheduled occupational health survey. Data on sleep disturbances were collected using the Spanish version of the Oviedo Sleep Questionnaire. Agricultural workers were found to be at a significantly higher risk of insomnia, especially among those who did not wear protective gloves (OR = 3.12; 95% C.I. = 1.93-3.85; p = 0.04) or masks (OR = 2.43; 95% C.I. = 1.19-4.96; p = 0.01). The highest risk of insomnia related to pesticide applicators was observed in those who did not wear a mask (OR = 4.19; 95% C.I. = 1.30-13.50; p = 0.01) or goggles (OR = 4.61; 95% C.I. = 1.38-10.40; p = 0.01). This study supports previous findings indicating an increased risk of sleep disorder in agricultural workers exposed to pesticides at work.
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Affiliation(s)
- Ruirui Zheng
- Department of Nursing, Physiotherapy, and Medicine, University of Almería, 04120 Almería, Spain
| | - Jessica García-González
- Department of Nursing, Physiotherapy, and Medicine, University of Almería, 04120 Almería, Spain
| | - Raúl Romero-del Rey
- Department of Nursing, Physiotherapy, and Medicine, University of Almería, 04120 Almería, Spain
| | | | - Rafael García-Alvarez
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo 10103, Dominican Republic
| | - Rosario Fadul-Calderon
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo 10103, Dominican Republic
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy, and Medicine, University of Almería, 04120 Almería, Spain
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Ong-Artborirak P, Boonchieng W, Juntarawijit Y, Juntarawijit C. Potential Effects on Mental Health Status Associated with Occupational Exposure to Pesticides among Thai Farmers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9654. [PMID: 35955007 PMCID: PMC9367823 DOI: 10.3390/ijerph19159654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Pesticide-related mental health issues in Thailand, an upper-middle-income country, are not well known. This study aimed to investigate the association between the history of occupational exposure to pesticides and the mental health of Thai farmers. A cross-sectional study was carried out in the areas around Chiang Mai, a large city in Northern Thailand, between June 2020 and January 2021. A total of 6974 farmers from six districts were interviewed to determine whether they regularly experienced symptoms related to mental health by the Self-Reporting Questionnaire (SRQ-20) as well as their lifetime history of agricultural pesticide exposure from 31 active ingredients and five functional categories: insecticides, herbicides, fungicides, rodenticides, and molluscicides. The cut-off of 6 was used to evaluate probable mental disorder. Most of the farmers under investigation were men (53.8%), with a mean age of 55.2 (11.7) years, and were involved mainly in the planting of rice, fruit, and vegetables. About 86.7% reported having used pesticides on their crops at some point in their lives-mostly glyphosate, paraquat, 2,4-D, methomyl, and carbofuran. All functional groups, as well as pesticide classes like organochlorines, organophosphates, and carbamates, were significantly associated with a higher risk of probable mental disorder based on exposure duration, frequency, personal protective equipment usage, and hygienic behavior. In a model with multiple pesticides, there was an association between mental disorder and exposure to endosulfan (AOR = 2.27, 95%CI = 1.26-4.08) and methyl parathion (AOR = 2.26, 95%CI = 1.26-4.06). Having previously reported pesticide poisoning symptoms was related to mental disorder (AOR = 7.97, 95%CI = 5.16-12.31), the findings provided evidence of pesticide exposure posing a risk to farmers' mental health, particularly long-term and high-intensity exposure.
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Affiliation(s)
- Parichat Ong-Artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Waraporn Boonchieng
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Chudchawal Juntarawijit
- Faculty of Agriculture Natural Resources and Environment, Naresuan University, Phitsanulok 65000, Thailand
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Aguera RG, Freires CDS, Oliveira LOD, Monteiro LR, Lini RS, Romoli JCZ, Freire BM, Nerilo SB, Machinski Junior M, Batista BL, Mossini SAG. Risk evaluation of occupational exposure of southern Brazilian flower farmers to pesticides potentially leading to cholinesterase inhibition and metals exposure. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 93:103874. [PMID: 35537679 DOI: 10.1016/j.etap.2022.103874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 06/14/2023]
Abstract
This work presents a frequency matched observational study comparing flower farmers exposed to pesticides and unexposed individuals as controls. All subjects were interviewed before plasma and urine collection. Manganese and Zinc were measured in theses samples by using dynamic reaction cell inductively coupled mass spectrometry. Cholinesterase activity was analyzed through spectrophotometry by using a modified version of the Ellman method. Seventy-eight percent of subjects reported occupational contact with pesticides, from which 37% reported exposure for over 9 years. Flower farms farmers had increased odds of having headache and irritability, respectively, by factors of 6.2 and 2.4 than the control subjects. While the odds of exposed subjects to have insomnia was smaller than control subjects by a factor of 0.34. Exposure to pesticides had a significant effect regarding the plasmatic plasma and urinary manganese levels and whole blood cholinesterase activity (p < 0.05). High levels of plasma and urinary manganese, as well as cholinesterase inhibition in whole blood, were evident in the flower farmers who participated in the study.
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Affiliation(s)
- Raul Gomes Aguera
- Program in Biosciences and Pathophysiology, State University of Maringa, Av. Colombo, 5790, Maringá 87020-900, Paraná, Brazil.
| | - Camila da Silva Freires
- Graduate in Pharmacy, State University of Maringa, Av. Colombo, 5790, Maringá 87020-900, Paraná, Brazil.
| | - Luís Otavio de Oliveira
- Graduate in Biomedicine, State University of Maringa, Av. Colombo, 5790, Maringá 87020-900, Paraná, Brazil.
| | - Lucilena Rebelo Monteiro
- Instituto de Pesquisas Energeticas e Nucleares, Av. Lineu Prestes, 2242, São Paulo, SP 05508-000, Brazil.
| | - Renata Sano Lini
- Program in Biosciences and Pathophysiology, State University of Maringa, Av. Colombo, 5790, Maringá 87020-900, Paraná, Brazil.
| | | | - Bruna Moreira Freire
- Center for Natural and Human Sciences, ABC Federal University (UFABC), Avenue dos Estados nº 5001, Santo Andre, SP 09210-580, Brazil.
| | | | - Miguel Machinski Junior
- Program in Health Science, State University of Maringa, Av. Colombo, 5790, Maringá 87020-900, Paraná, Brazil.
| | - Bruno Lemos Batista
- Center for Natural and Human Sciences, ABC Federal University (UFABC), Avenue dos Estados nº 5001, Santo Andre, SP 09210-580, Brazil.
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Khacha-ananda S, Intayoung U, Wunnapuk K, Kohsuwan K, Srisai P, Sapbamrer R. Urinary Levels of Sirtuin-1, π-Glutathione S-Transferase, and Mitochondrial DNA in Maize Farmer Occupationally Exposed to Herbicide. TOXICS 2022; 10:toxics10050252. [PMID: 35622665 PMCID: PMC9145378 DOI: 10.3390/toxics10050252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 12/10/2022]
Abstract
Epidemiologic studies have suggested an association between agrochemical exposure and risk of renal injury. Farmers face great risks to developing adverse effects. The most appropriate biomarker related to renal injury needs to be developed to encounter earlier detection. We aim to study the association between early renal biomarker and occupational herbicide exposure in maize farmers, Thailand. Sixty-four farmers were recruited and interviewed concerning demographic data, herbicide usage, and protective behavior. Two spot urines before (pre-work task) and after (post-work task) herbicide spraying were collected. To estimate the intensity of exposure, the cumulative herbicide exposure intensity index (cumulative EII) was also calculated from activities on the farm, type of personal protective equipment (PPE) use, as well as duration and frequency of exposure. Four candidate renal biomarkers including π-GST, sirtuin-1, mitochondrial DNA (mtDNA) were measured. Most subjects were male and mostly sprayed three herbicides including glyphosate-based herbicides (GBH), paraquat, and 2,4-dichlorophenoxyacetic acid (2,4-D). A type of activity in farm was mixing and spraying herbicide. Our finding demonstrated no statistical significance of all biomarker levels between pre- and post-work task urine. To compare between single and cocktail use of herbicide, there was no statistical difference in all biomarker levels between pre- and post-work task urine. However, the urinary mtDNA seems to be increased in post-work task urine. Moreover, the cumulative EII was strongly associated with change in mtDNA content in both ND-1 and COX-3 gene. The possibility of urinary mtDNA as a valuable biomarker was promising as a noninvasive benchmark for early detection of the risk of developing renal injury from herbicide exposure.
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Affiliation(s)
- Supakit Khacha-ananda
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, Sri Phum, Muang, Chiang Mai 50200, Thailand; (U.I.); (K.W.); (K.K.)
- Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, 239, Huay Kaew Road, Muang, Chiang Mai 50200, Thailand
- Correspondence:
| | - Unchisa Intayoung
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, Sri Phum, Muang, Chiang Mai 50200, Thailand; (U.I.); (K.W.); (K.K.)
| | - Klintean Wunnapuk
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, Sri Phum, Muang, Chiang Mai 50200, Thailand; (U.I.); (K.W.); (K.K.)
| | - Kanyapak Kohsuwan
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, Sri Phum, Muang, Chiang Mai 50200, Thailand; (U.I.); (K.W.); (K.K.)
| | | | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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Fuhrimann S, van den Brenk I, Atuhaire A, Mubeezi R, Staudacher P, Huss A, Kromhout H. Recent pesticide exposure affects sleep: A cross-sectional study among smallholder farmers in Uganda. ENVIRONMENT INTERNATIONAL 2022; 158:106878. [PMID: 34592653 DOI: 10.1016/j.envint.2021.106878] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Poorly educated smallholder farmers in low-income countries are highly exposed to pesticides. This can result in adverse mental health issues, of which sleep problems might be an underlying indicator. We aim to examine the association between sleep problems and pesticide exposure among smallholder farmers in Uganda. METHODS A cross-sectional survey with 253 smallholder farmers was conducted between October and December 2019. Sleep problems were assessed during the week before the visit using the Medical Outcomes Study Sleep Scale (MOS-SS). Exposure to pesticides was assessed as application days of any pesticide and as use of 2,4-D, glyphosate, mancozeb, organophosphates & carbamates, pyrethroids and other pesticides during the week and year prior to the visit. Associations were assessed using adjusted multivariable logistic regression models. RESULTS Increased odds ratio (OR) for the sleep problem index 6-items (OR [95% Confidence Interval] 1.99 [1.04; 3.84] and 3.21 [1.33; 7.82]), sleep inadequacy (1.94 [1.04; 3.66] and 2.49 [1.05-6.22]) and snoring (3.17 [1.12; 9.41] and 4.07 [1.04; 15.14]) were observed for farmers who respectively applied pesticides up to two days and three or more days in the past week compared to farmers who did not apply during the past week. Gender-stratified analyses showed a higher OR for female applicators (4.27 [1.76-11.16]) than for male applicators (1.82 [0.91-3.79]) for the association between the sleep problem index 6-items and pesticide use in the week before the visit. Increased ORs were also observed for the association between the sleep problem index 6-item and mancozeb exposure during the past year 2.28 [1.12-4.71] and past week 2.51 [0.86-7.55] and glyphosate exposure during the past week 3.75 [1.24-11.8] compared to non-applicators. DISCUSSION Our findings suggest an increased risk of sleep problems among smallholder farmers in a pesticide-exposure-dependent way in a low-income context. Further gender-stratified, longitudinal investigations are warranted to confirm these findings.
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Affiliation(s)
- Samuel Fuhrimann
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
| | - Iris van den Brenk
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Aggrey Atuhaire
- Uganda National Association of Community and Occupational Health (UNACOH), Kampala, Uganda
| | - Ruth Mubeezi
- Makerere University, School of Public Health, Kampala, Uganda
| | - Philipp Staudacher
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600 Dübendorf, Switzerland; Institute of Biogeochemistry and Pollutant Dynamics, CHN, Universitätsstrasse 16, ETH Zürich, 8092 Zürich, Switzerland
| | - Anke Huss
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
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