Diarrhoeal diseases among adult population in an agricultural community Hanam province, Vietnam, with high wastewater and excreta re-use

BMC Public Health

Peter Odermatt¹  Jakob Zinsstag¹  Christian Zurbrügg²  Phung Dac Cam³  Jan Hattendorf¹  Hung Nguyen-Viet²  Phuc Pham-Duc² 

[1] University of Basel, P.O. Box, CH-4003, Basel, Switzerland;Sandec - Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology, P. O. Box, CH-8600, Dübendorf, Switzerland;National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi, Vietnam

关键词: Vietnam;    Agriculture;    Excreta;    Wastewater;    Diarrhoeal disease;   

Others  :  1126834
DOI  :  10.1186/1471-2458-14-978

 received in 2013-08-03, accepted in 2014-09-17,  发布年份 2014

【 摘 要 】

Background

Despite the potential health risks of wastewater and excreta use as fertiliser in agriculture, it is still widespread in Vietnam. However, the importance of diarrheal risk in adults’ associated with the combined exposures to both excreta and wastewater use in agriculture is largely unknown. This study was carried out to determine diarrhoeal incidence and associated risk factors among the adult population exposed to wastewater and excreta used in agriculture in Hanam province, Vietnam.

Methods

An open cohort of 867 adults, aged 16–65 years, was followed weekly for 12 months to determine the incidence of diarrhoea. A nested case–control study was used to assess the risk factors of diarrhoeal episodes. Two hundred and thirty-two pairs of cases and controls were identified and exposure information related to wastewater, human and animal excreta, personal hygiene practices, and food and water consumption was collected.

Results

The incidence rate of reported diarrhoea was 0.28 episodes per person-years at risk. The risk factors for diarrhoeal diseases included direct contact with the Nhue River water (odds ratio [OR] = 2.4, attributable fraction [AF] 27%), local pond water (OR = 2.3, AF 14%), composting of human excreta for a duration less than 3 months (OR = 2.4, AF 51%), handling human excreta in field work (OR = 5.4, AF 7%), handling animal excreta in field work (OR = 3.3, AF 36%), lack of protective measures while working (OR = 6.9, AF 78%), never or rarely washing hands with soap (OR = 3.3, AF 51%), use of rainwater for drinking (OR = 5.4, AF 77%) and eating raw vegetables the day before (OR = 2.4, AF 12%).

Conclusions

Our study shows that professional exposure to wastewater and excreta during agricultural activities are significantly contributing to the risk of diarrhoea in adults. The highest attributable fractions were obtained for direct contact with Nhue River and local ponds, handling practices of human and animal excreta as fertilisers, lack of protective measures while working and poor personal hygiene practices, and unsafe food and water consumption were associated with the risk of diarrhoeal episodes in adults. Improve personal hygiene practices and use of relevant treated wastewater and excreta as the public health measures to reduce these exposures will be most effective and are urgently warranted.

【 授权许可】

   
2014 Pham-Duc et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]van der Hoek W, Hassan MU, Ensink JHJ, Feenstra S, Raschid-Sally L, Munir S, Aslam R, Ali N, Hussain R, Matsuno Y: Urban wastewater: A valuable resource for agriculture - A case study from Haroonabad, Pakistan. International Water Management Institute (IWMI), Colombo, Sri Lanka 2002. Report 63
• [2]AATSE: Water recycling in Australia. Australia: Australian Academy of Technological Sciences ans Engineering, Victoria; 2004.
• [3]Raschid-Sally L, Carr RM, Buechler S: Managing wastewater agriculture to improve livelihoods and environmental quality in poor countries. Irrig Drain 2005, 54(1):11-22.
• [4]Jiménez B, Asano T: Water reclamation and reuse around the world in water reuse: an international survey of current practice, issues and needs. London: IWA Publishing; 2008:648.
• [5]Keraita B, Jim‚nez B, Drechsel P: Extent and implications of agricultural reuse of untreated, partly treated and diluted wastewater in developing countries. Agr Vet Sci Nutr Nat Resour 2008, 3(58):15.
• [6]Scheierling SM, Bartone CR, Mara DD, Drechsel P: Improving wastewater use in agriculture: an emerging priority. World Bank Policy Research Working Paper 5412 2010.
• [7]WHO: Guidelines for the safe use of wastewater, excreta and greywater - volume 3: wastewater and excreta use in aquaculture. Geneva, Switzerland: World Health Organization; 2006.
• [8]Phuc PD, Konradsen F, Phuong PT, Cam PD, Dalsgaard A: Practice of using human excreta as fertilizer and implications for health in Nghean Province, Vietnam. S E Asian J Trop Med Public Health 2006, 37(1):222-229.
• [9]Jensen PK, Phuc PD, Knudsen LG, Dalsgaard A, Konradsen F: Hygiene versus fertiliser: the use of human excreta in agriculture–a Vietnamese example. Int J Hyg Environ Health 2008, 211(3–4):432-439.
• [10]WHO: Guidelines for the safe use of wastewater, excreta and greywater - volume 2: wastewater use in agriculture. Geneva, Switzerland: World Health Organisation; 2006.
• [11]WHO: Guidelines for the safe use of wastewater, excreta and greywater - volume 4: excreta and greywater use in agriculture. Geneva, Switzerland: World Health Organization; 2006.
• [12]WHO: World Health Report 2005 - make every mother and child count. Geneva, Switzerland: WHO Press; 2005.
• [13]Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al.: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380(9859):2197-2223.
• [14]Blumenthal UJ, Peasey A: Critical review of epidemiological evidence of the health effects of wastewater and excreta use in agriculture. London: London School of Hygiene and Tropical Medicine; 2002.
• [15]Feenstra S, Hussain R, van der Hoek W: Health risks of irrigation with untreated urban wastewater in the southern Punjab, Pakistan. IWMI Pakistan Report 107 2000.
• [16]Blumenthal UJ, Cifuentes E, Bennett S, Quigley M, Ruiz-Palacios G: The risk of enteric infections associated with wastewater reuse: the effect of season and degree of storage of wastewater. Trans R Soc Trop Med Hyg 2001, 95:131-137.
• [17]Trang DT, Bui TT, Molbak K, Phung DC, Dalsgaard A: Epidemiology and aetiology of diarrhoeal diseases in adults engaged in wastewater-fed agriculture and aquaculture in Hanoi, Vietnam. Trop Med Int Health 2007, 12(Suppl 2):23-33.
• [18]Online information of Hanam province http://hanam.gov.vn/vi-vn/Pages/Article.aspx?ChannelId=6&articleID=92 webcite
• [19]GSO: General Statistic Office of Vietnam. 2012. http://www.gso.gov.vn/default.aspx?tabid=386&idmid=3&ItemID=14171 webcite
• [20]MONRE, ADB, GEF, UNEP: Vietnam national environmental performance assessment (EPA) report. Vietnamese Ministry of natural Resources and Environment, ADB TANo6069-REG 2006.
• [21]Phuc PD, Nguyen-Viet H, Hattendorf J, Zinsstag J, Cam PD, Odermatt P: Risk factors for Entamoeba histolytica infection in an agricultural community in Hanam province, Vietnam. Parasit Vectors 2011, 4:102. BioMed Central Full Text
• [22]Pham-Duc P, Nguyen-Viet H, Hattendorf J, Zinsstag J, Cam PD, Zurbrügg C, Odermatt P: Ascaris lumbricoides and Trichuris trichiura infections associated with wastewater and human excreta use in agriculture in Vietnam. Parasitol Int 2013, 62(2):172-180.
• [23]Isenbarger DW, Hien BTT, Ha HT: Prospective study of the incidence of diarrhoea and prevalence of bacterial pathogens in a cohort of vietnamese children along the red river delta. J Epidemiol Infect 2001, 127:229-236.
• [24]Wright JA, Gundry SW, Conroy R, Wood D, Du Preez M, Ferro-Luzzi A, Genthe B, Kirimi M, Moyo S, Mutisi C, Ndamba J, Potgieter N: Defining episodes of diarrhoea: results from a three-country study in Sub-Saharan Africa. J Health Popul Nutr 2006, 24(1):8-16.
• [25]Molbak K, Jensen H, Ingholt L, Aaby B: Risk factor for diarrhoeal disease incidence in early childhood: a community cohort study from Guinea Bissau. Am J Epidemiol 1997, 146:273-282.
• [26]Greenland S, Thomas DC: On the need for the rare disease assumption in case–control studies. Am J Epidemiol 1982, 116:547-553.
• [27]Liang KY, Zeger SL: Longitudinal data analysis using generalized linear models. Biometrika 1986, 73:13-22.
• [28]Hosmer DW Jr, Lemeshow S: Applied logistic regression. New York: John Wiley & Sons Editions; 1989.
• [29]Porta M: A Dictionary of Epidemiology. In Volume 5th. New York: Oxford University Press, Inc; 2008.
• [30]Vyas S, Kumaranayake L: Constructing socio-economic status indices: how to use principal components analysis. In London, UK. Oxford University Press in association with The London School of Hygiene and Tropical Medicine; 2006:459-468.
• [31]Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A: Socio-economic differences in health, nutrition, and population within developing countries: an overview. Niger J Clin Pract 2007, 10(4):272-282.
• [32]Gwatkin DR, Rustein S, Johnson K, Pande R, Wagstaff A: Socio-economic differences in health, nutrition and population in Cote d’ Ivoire. Washington DC: HNP/Poverty Thematic Group of the World Bank; 2000:1-28.
• [33]WHO: Guidelines for drinking water quality - volume 1: recommendations. 3rd edition. Geneva, Switzerland: World Health Organization; 2004.
• [34]Cifuentes E, Blumenthal U, Ruiz-Palacios G, Bennett S, Quigley M: Health risk in agricultural villages practicing wastewater irrigation in central Mexico: perspectives for protection. Schriftenr Ver Wasser Boden Lufthyg 2000, 105:249-256.
• [35]Knudsen LG, Phuc PD, Hiep NT, Samuelsen H, Jensen PK, Dalsgaard A, Raschid-Sally L, Konradsen F: The fear of awful smell: Risk perceptions among farmers in Vietnam using wastewate and human excreta in agriculture. S E Asia J Trop Med Pub Health 2008, 39(2):341-352.
• [36]MOH: Regarding issuing of the sector standards. Hygiene standards of various type of latrines. Decision of the Ministry of Health N0. 08/2005/QD.BYT. Vietnamese Ministry of Health 2005.
• [37]Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung ICH, Schmidt WP: Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 2010, 39(Suppl 1):i193-i205.
• [38]Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung ICH, Jenkins MW, Scott B, Sugden S, Cairncross S: Interventions to improve disposal of human excreta for preventing diarrhoea. In Cochrane Database of Systematic Reviews. New Jersey: John Wiley & Sons; 2010.
• [39]Carr RM, Blumenthal UJ, Mara DD: Guidelines for the safe use of wastewater in agriculture: revisiting WHO guidelines. Water Sci Technol 2004, 50(2):31-38.
• [40]Jensen PK, Phuc PD, Konradsen F, Klank LT, Dalsgaard A: Survival of Ascaris eggs and hygienic quality of human excreta in Vietnamese composting latrines. Environ Health 2009, 8:57. BioMed Central Full Text
• [41]Anteneh A, Humie A: Assessment of the impact of latrine utilisation on diarrhoeal diseases in the rural community of Hulet Ejju Enessie Woreda, East Gojjam Zone, Amhara Region. Ethiop J Health Dev 2010, 24(2):110-118.
• [42]Nhi NTH, Toan NQ, Mai MQ, Dalsgaard A: A study on the qualtiy of rainwater and the habits of its collections, storage, consumption in Yen So commune, Hanoi. In The 2nd International Scientific Conference on Occupational and Environmental Health. Hanoi, Vietnam: National Institute of Environmental and Occupational Health; 2005.
• [43]Garrett V, Ogutu P, Ombeki S, Mwaki A, Aluoch G, Phelan M, Quick RE: Diarrhoea prevention in ahigh-risk rural Kenyan population thruogh point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting. Epidemiol Infect 2008, 136:1463-1471.
• [44]Heyworth JS, Glonek G, Maynard EJ, Baghurt PA, Finlay-Jones J: Consumption of untreated tank rainwater and gastroenteritis among young children in South Australia. Int J Epidemiol 2006, 35:1051-1058.
• [45]Rainwater harvesting http://www.who.int/water_sanitation_health/gdwqrevision/rainwater.pdf webcite
• [46]Rodrigo S, Leder K, Sinclair M: Quality of stored rainwater used for drinking in metropolitan South Australia. In Research Report. Vitoria, Autralia: Department of Epidemiology and Preventive Medicine, Monash University; 2009.
• [47]Daoud AK, Swaileh KM, Hussein RM, Matani M: Quality assessment of roof-harvested rainwater in the West Bank, Palestinian authority. J Wat Health 2011, 9(3):525-533.
• [48]Curtis V, Cairncross S, Yonli R: Domestic hygiene and diarrhoea-pinpointing the problem. Trop Med Int Health 2000, 5(1):22-32.
• [49]Cairncross S, Blumenthal U, Kolsky P, Moraes L, Tayeh A: The public and domestic domains in the transmission of disease. Trop Med Int Health 1996, 1:27-34.
• [50]Curtis V, Cairncross S: Effect of washing hands with soap on diarrhea risk in the community: a systematic review. Lancet Infect Dis 2003, 3:275-281.
• [51]Kaindi DW, Schelling E, Wangoh JM, Imungi JK, Farah Z, Meile L: Risk Factors for Symptoms of Gastrointestinal Illness in Rural Town Isiolo. Kenya: Zoonoses Public Health; 2011. doi:10.1111/j.1863-2378.2011.01425.x
• [52]Anh VT, Tram NT, Klank LT, Cam PD, Dalsgaard A: Faecal and protozoan parasite contamination of water spinach (Ipomoea aquatica) cultivated in urban wastewater in Phnom Penh, Combodia. Trop Med Int Health 2007, 12(2):73-81.
• [53]Bukenya GB, Nwokolo N: Transient risk factors for acute childhood diarrhoea in an urban community of Papua New Guinea. Trans R Soc Trop Med Hyg 1990, 84:857-860.
• [54]Gebru T, Taha M, Kassahun W: Risk factors of diarrhoeal disease in under-five children among health extension model and non model families in Sheko district rural community, Southwest Ethiopia: comparative cross-sectional study. BMC Public Health 2014, 14:395. BioMed Central Full Text
• [55]Godana W, Mengiste B: Environmental factors associated with acute diarrhea among children under five years of age in derashe district, Southern Ethiopia. Sci J Pubic Health 2013, 1(3):119-124.
• [56]Al-Mazrou YY, Khan MU, Aziz KMS, Farag MK, Al-Jefry M: Role of social factors in the prevalence of diarrhoeal diseases in under-five Saudi children. J Trop Pediatr 1995, 41(1):45-52.
• [57]Nakawesi JS, Wobudeya E, Ndeezi G, Mworozi EA, Tumwine JT: Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda. BMC Pediatr 2010, 10(69):1-5.
• [58]Woldemichael T: Diarrhoeal morbidity among young children in Eritrea: environmental and socioeconomic determinants. J Health Popul Nutr 2001, 19(2):83-90.
• [59]Hashizume M, Wagatsuma Y, Faruque ASG, Hayashi T, Hunter PR, Armstrong B, Sack DA: Factors determining vulnerability to diarrhoea during and after severe floods in Bangladesh. J Wat Health 2008, 06(3):323-332.
• [60]Binka FN, Anto FK, Oduro AR, Awini EA, Nazzar AK, Armah GE, Asmah RH, Hall AJ, Cutts F, Alexander N, Brown D, Green J, Gray J, Iturriza-Gómara M: Incidence and risk factors for paediatric rotavirus diarrhoea in northern Ghana. Trop Med Int Health 2003, 8:840-846.
• [61]Yap KL, Yasmin AM, Wong YH, Ooi YE, Tan SC, Jegathesan M, Khor CM, Low MC: A one year community-based study on the incidence of diarrhoea and rotavirus infection in urban and suburban Malaysian children. Med J Malaysia 1992, 47:303-308.
• [62]Mathers CD, Mathers CD, Stein C, Fat DM, Rao C, Inoue M, Tomijima N, Bernard C, Lopez AD, Murray CJL: Version 2 methods and results. In Global Burden of Disease 2000. Geneva, Switzerland: World Health Organisation; 2002.
• [63]Few R, Lake I, Hunter PR, Tran PG: Seasonality, disease and behavior: using multiple methods to explore socio-environmental health risks in the Mekong Delta. Soc Sci Med 2013, 80:1-9.
• [64]Feachem RG, Bradley DJ, Garelick H, Mara DD: Sanitation and disease: health aspects of excreta and wastewater management. New York: John Wiley & Sons Editions; 1983.