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Fulltext Fecal Contamination in the Wastewater Irrigation System and its Health Threat to Wastewater-Based Farming Households in Addis Ababa, Ethiopia

Ali AS, Gari SR, Goodson ML, Walsh CL, Dessie BK, Ambelu A

Environ Health Insights, 2023;17:11786302231181307.
PMID: 37362237 DOI: 10.1177/11786302231181307

Due to rapidly growing demand, the production of vegetables is increasing along the Akaki Rivers. The objective of this study was to examine the degree of fecal contamination and levels of fecal contamination and dissemination throughout the wastewater irrigation system. Irrigation water, irrigated soil, and leafy vegetables were collected twice during 2 vegetable growing seasons, at the maturity period of the growing season, from 19 sampling points along the 2 Akaki Rivers. Composite samples were taken from all sampling points and E.coli was enumerated. The mean E.coli load in wastewater and non-wastewater sources were 1.16±5.53 CFU/100 ml and 2.232±1.292 CFU/100 ml respectively. All counts of E. coli in the wastewater exceeded the WHO's standards indicating that the irrigation water quality was unacceptable. In the wastewater-irrigated and non-wastewater-irrigated soil, the mean E.coli were 3.62 ±1.582 CFU/g and 1.322±87.1 CFU/g respectively. Meanwhile, the mean E.coli counts on the lettuce and Swiss chard were 78 ± 2 CFU/g and 44 ±3CFU/g respectively. The E.coli count on the leafy vegetables was found to be associated with the E.coli in the wastewater and soil. The production of leafy vegetables using wastewater with unacceptably high levels of E.coli and high occupational exposure introduces high levels of risk to the farming communities and to the consumers. Leafy, low-growing raw edible vegetables need careful treatment during food production and harvesting procedures or activities.
Fulltext Prevalence and risk factors of childhood diarrhea among wastewater irrigating urban farming households in Addis Ababa

Ali AS, Gari SR, Goodson ML, Walsh CL, Dessie BK, Ambelu A

PLoS One, 2023;18(11):e0288425.
PMID: 37939075 DOI: 10.1371/journal.pone.0288425

INTRODUCTION: Childhood diarrhea is one of the major contributors to the morbidity of under-five children in Ethiopia. Although researchers determine the risk factors varyingly, the exposure route to the pathogens is usually complicated. This study aims to investigate the prevalence and risk factors of diarrhea among children under the age of five among wastewater irrigation farming households in Addis Ababa, Ethiopia.
METHODS: Cross-sectional study was conducted among 402 farming households from November 2021 to February 2022. Data was collected using a face-to-face interviewer-administered questionnaire. Stata version 14 software was used to analyze data. Factors associated with the prevalence of diarrhea was identified using binary logistic regression. Multivariable analysis was carried out to determine an adjusted odds ratio at a confidence level of 95% and level of significance at 0.05.
RESULTS: The overall prevalence of under-five children diarrheal cases was 22.3%. The odds of diarrhea are associated with a multitude of variables. Major wastewater-related determinants associated with diarrhea are body washing with irrigation water [AOR: 37.7, 95%CI (3.1, 358)], contaminated cloth with irrigation water [AOR:10.8,95%CI(0.6, 205)], use of protective clothing during farm work [28.9,95%CI (3.9, 215)], use of farm work cloths at home [AOR: 31.7, 95%CI (4.4, 226)], and bringing unwashed farm tools to home [94 (5.7, 1575)].
CONCLUSION: The high prevalence of under-five children diarrheal disease among wastewater irrigation households was strongly associated with factors related to occupational exposure. Thus, to decrease childhood diarrheal among urban agriculture farmers, appropriate precautions need to be taken.
Distribution of helminth eggs in environmental and stool samples of farming households along Akaki River in Addis Ababa, Ethiopia

Gurmassa BK, Gari SR, Solomon ET, Goodson ML, Walsh CL, Dessie BK, et al.

Trop Med Health, 2023 Nov 24;51(1):67.
PMID: 37996901 DOI: 10.1186/s41182-023-00558-0

BACKGROUND: Helminth infections are a public health issue in countries with poor sanitation facilities. However, there little information on the epidemiological association between helminths in wastewater and soil samples and rates of helminth infection among farming households along the Akaki River in Addis Ababa, Ethiopia.
METHODS: A cross-sectional study was conducted between November 2021 and February 2022. A stratified random sampling technique was used to select farming households. The sample size for each district was determined by a proportionate allocation to the number of households. From wastewater-irrigated farms, 70 wastewater samples, 28 soil samples, and 86 farmers' stool samples were collected and analyzed for helminths. A questionnaire was used to gather ethnographic data, about farming households, whereas wastewater and soil sample analysis was used to generate quantitative data on helminth loads. The data were systematically analysed by developing themes, and bias evaluated using triangulation validation methodologies. Potential pathways to helminth infection were evaluated by measuring. Total number of helminth eggs in wastewater, soil samples and farmer's stools was investigated using Poisson regression.
RESULTS: In this study, 82.9% of wastewater samples, 57.1% of soil samples, and 18.6% of farmers' stool samples contained helminth eggs. The most prevalent helminth was Ascaris lumbricoides in all samples (wastewater 67%, soil 25%, and stool 10.5%), followed by hookworm (wastewater 10%, soil 21.4%, and stool 6.9%) and Trichuris trichiura eggs (wastewater 5.7%, soil 10.7%, and stool 1.2%). There was a positive association between the total number of helminth eggs in wastewater and soil samples with counts in farmers' stool. The Poisson regression coefficients for wastewater and soil were, 1.63 (95% CI = 1.34-1.92) and 1.70 (95% CI = 1.39-2.01), (p
Incidence of diarrhea and risk factors among wastewater-irrigating urban farmers along Akaki Rivers in Addis Ababa

Ali AS, Gari SR, Goodson ML, Walsh CL, Dessie BK, Ambelu A

Int J Environ Health Res, 2024 Jun 30.
PMID: 38944842 DOI: 10.1080/09603123.2024.2374001

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.
Fulltext Urinary 8-OHdG level is not affected by geography and trace elements in nail of residents of Addis Ababa: It is shaped by interactions between different social factors

Dessie BK, Mehari B, Tefera M, Osman M, Tsegaye Y, Gari SR, et al.

Toxicol Rep, 2022;9:1777-1787.
PMID: 36518487 DOI: 10.1016/j.toxrep.2022.09.006

The objective of this study was to evaluate the association between exposure to heavy metals and oxidative DNA damage among residents living in the potentially more polluted downstream (Akaki-Kality) area of Addis Ababa, in comparison to the upstream area (Gullele). For this, 8-hydroxy-2'-deoxyguanosine (8-OHdG) was used as a biomarker for oxidative DNA damage and heavy metals (Fe, Zn, Mn, Cu, Ni, Cr, Pb, As) as indicators of exposure. The concentrations of heavy metals in nails were determined using inductively coupled plasma optical emission spectroscopy (ICP-OES), and 8-OHdG in urine using Enzyme-Linked with Immunosorbent Assay (ELISA), from 95 residents of the two areas, upstream and downstream. The urinary 8-OHdG concentration was not significantly different (p = 0.05) between the two Sub-Cities, with mean of 18.50 ± 4.37 ng/mg Creatinine in Akaki-Kality and 17.30 ± 5.83 ng/mg Creatinine in Gullele. Also, there were no statistically significant (p = 0.05) difference among the different demographic groups according to gender, age, educational status, body mass index or habit of alcohol consumption. However, the interactions of sex with age, sex with alcohol consumption and alcohol consumption with education were found to affect the urinary 8-OHdG levels of residents of the two Sub-Cities. The mean concentrations (µg/g) of the elements were 488 and 1035 for Fe, 106 and 251 for Zn, 13.0 and 31.2 for Mn, 5.23 and 6.63 for Cu, 11.2 and 7.39 for Ni, 2.23 and 2.02 for Cr, 0.09 and 0.63 for Pb; and 0.16 and 0.25 for As, in nail samples from Akaki-Kality and Gullele, respectively. The determined concentrations of the heavy metals in nails were not significantly associated (p = 0.05) with the corresponding urinary levels of 8-OHdG. Hence, the observed 8-OHdG might have been caused by environmental exposure to toxic substances other than the analyzed heavy metals.
Absence of significant association of trace elements in nails with urinary KIM-1 biomarker among residents of Addis Ababa in Upper Awash Basin, Ethiopia: a cross-sectional study

Dessie BK, Mehari B, Osman M, Gari SR, Desta AF, Melaku S, et al.

Biometals, 2022 Dec;35(6):1341-1358.
PMID: 36163536 DOI: 10.1007/s10534-022-00448-8

The Akaki River in the Upper Awash Basin, which flows through Addis Ababa, the capital city of Ethiopia, has been highly polluted by sewage from factories and residential areas. A population-based cross-sectional study was used to assess the association between trace elements and kidney injury from residents living in polluted areas downstream (Akaki-Kality) versus upstream (Gullele) in Sub-Cities of Addis Ababa. A total of 95 individuals (53 from Akaki-Kality and 42 from Gullele) were included in the study. Kidney injury molecule 1 (KIM-1), lead, arsenic, cadmium, cobalt, lead, manganese, zinc, iron, copper, chromium and nickel were evaluated in residents' urine and nail samples. A large proportion (74%) of the sample population contained KIM-1, including 81% residents in Akaki-Kality and 64% residents in Gullele. KIM-1 was, however, not significantly different (p = 0.05) between the two Sub-Cities, with median of 0.224 ng/mL in Akaki-Kality and 0.152 ng/mL in Gullele. Most of the analyzed elements, except Pb, As, Cd and Co, were found in all of the nail samples, with median (µg/g) in the range of 442‒714 Fe, 97.0‒246 Zn, 11.6‒24.1 Mn, 4.49‒5.85 Cu, 1.46‒1.66 Cr and 1.22‒1.41 Ni. The high incidence of KIM-1 indicates a potential for long term renal tubular damage among residents of the Sub-Cities. The concentrations of the elements in nails were, however, not significantly associated (p = 0.05) with the corresponding levels of KIM-1 in urine. Hence, the observed KIM-1 might be related to exposure to toxic substances or factors other than those included in this study.