Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda

Samuel Fuhrimann, Mirko S. Winkler, Michelle Stalder, Charles B. Niwagaba, Mohammed Babu, Narcis B. Kabatereine, Abdullah A. Halage, Jürg Utzinger, Guéladio Cissé, Maarten Nauta

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Abstract

In wastewater systems in Kampala, Uganda, microbial contamination has increased over the past two decades. Those people who live or work along the Nakivubo channel and wetland and those who use the recreational areas along the shores of Lake Victoria are at an elevated risk of gastrointestinal infections. A quantitative microbial risk assessment (QMRA) was applied for five population groups, characterised by different levels of exposure to wastewater in the Nakivubo area, namely: (i) slum dwellers at risk of flooding; (ii) children living in these slum settlements; (iii) workers maintaining the drainage system or managing faecal sludge (sanitation workers); (iv) urban farmers; and (v) swimmers in Lake Victoria. The QMRA was based on measured concentrations of Escherichia coli, Salmonella spp. and Ascaris spp. eggs in wastewater samples. Published ratios between measured organism and pathogenic strains of norovirus, rotavirus, Campylobacter spp., pathogenic E. coli, pathogenic Salmonella spp., Cryptosporidium spp. and Ascaris lumbricoides were used to estimate annual incidence of gastrointestinal illness and the resulting disease burden. The QMRA estimated a total of 59,493 disease episodes per year across all 18,204 exposed people and an annual disease burden of 304.3 disability-adjusted life years (DALYs). Incidence estimates of gastrointestinal disease episodes per year were highest for urban farmers (10.9) and children living in slum communities (8.3), whilst other exposed groups showed lower incidence (<4.3). Disease burden per person per year was highest in urban farmers (0.073 DALYs) followed by sanitation workers (0.040 DALYs) and children in slum communities (0.017 DALYs). Our findings suggest that the exposure to wastewater is associated with public health problems, particularly children and adults living and working along the major wastewater and reuse system in Kampala. Our findings call for specific interventions to reduce the disease burden due to exposure to wastewater.
Original languageEnglish
JournalMicrobial Risk Analysis
Volume4
Pages (from-to)16-28
Number of pages13
ISSN2352-3522
DOIs
Publication statusPublished - 2016

Keywords

  • Bacteria
  • Gastroenteritis
  • Intestinal parasites
  • Quantitative microbial risk assessment
  • Viruses
  • Wastewater

Cite this

Fuhrimann, Samuel ; Winkler, Mirko S. ; Stalder, Michelle ; Niwagaba, Charles B. ; Babu, Mohammed ; Kabatereine, Narcis B. ; Halage, Abdullah A. ; Utzinger, Jürg ; Cissé, Guéladio ; Nauta, Maarten. / Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda. In: Microbial Risk Analysis. 2016 ; Vol. 4. pp. 16-28.
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title = "Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda",
abstract = "In wastewater systems in Kampala, Uganda, microbial contamination has increased over the past two decades. Those people who live or work along the Nakivubo channel and wetland and those who use the recreational areas along the shores of Lake Victoria are at an elevated risk of gastrointestinal infections. A quantitative microbial risk assessment (QMRA) was applied for five population groups, characterised by different levels of exposure to wastewater in the Nakivubo area, namely: (i) slum dwellers at risk of flooding; (ii) children living in these slum settlements; (iii) workers maintaining the drainage system or managing faecal sludge (sanitation workers); (iv) urban farmers; and (v) swimmers in Lake Victoria. The QMRA was based on measured concentrations of Escherichia coli, Salmonella spp. and Ascaris spp. eggs in wastewater samples. Published ratios between measured organism and pathogenic strains of norovirus, rotavirus, Campylobacter spp., pathogenic E. coli, pathogenic Salmonella spp., Cryptosporidium spp. and Ascaris lumbricoides were used to estimate annual incidence of gastrointestinal illness and the resulting disease burden. The QMRA estimated a total of 59,493 disease episodes per year across all 18,204 exposed people and an annual disease burden of 304.3 disability-adjusted life years (DALYs). Incidence estimates of gastrointestinal disease episodes per year were highest for urban farmers (10.9) and children living in slum communities (8.3), whilst other exposed groups showed lower incidence (<4.3). Disease burden per person per year was highest in urban farmers (0.073 DALYs) followed by sanitation workers (0.040 DALYs) and children in slum communities (0.017 DALYs). Our findings suggest that the exposure to wastewater is associated with public health problems, particularly children and adults living and working along the major wastewater and reuse system in Kampala. Our findings call for specific interventions to reduce the disease burden due to exposure to wastewater.",
keywords = "Bacteria, Gastroenteritis, Intestinal parasites, Quantitative microbial risk assessment, Viruses, Wastewater",
author = "Samuel Fuhrimann and Winkler, {Mirko S.} and Michelle Stalder and Niwagaba, {Charles B.} and Mohammed Babu and Kabatereine, {Narcis B.} and Halage, {Abdullah A.} and J{\"u}rg Utzinger and Gu{\'e}ladio Ciss{\'e} and Maarten Nauta",
year = "2016",
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language = "English",
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Fuhrimann, S, Winkler, MS, Stalder, M, Niwagaba, CB, Babu, M, Kabatereine, NB, Halage, AA, Utzinger, J, Cissé, G & Nauta, M 2016, 'Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda', Microbial Risk Analysis, vol. 4, pp. 16-28. https://doi.org/10.1016/j.mran.2016.11.003

Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda. / Fuhrimann, Samuel; Winkler, Mirko S.; Stalder, Michelle; Niwagaba, Charles B.; Babu, Mohammed; Kabatereine, Narcis B.; Halage, Abdullah A.; Utzinger, Jürg; Cissé, Guéladio; Nauta, Maarten.

In: Microbial Risk Analysis, Vol. 4, 2016, p. 16-28.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Disease burden due to gastrointestinal pathogens in a wastewater system in Kampala, Uganda

AU - Fuhrimann, Samuel

AU - Winkler, Mirko S.

AU - Stalder, Michelle

AU - Niwagaba, Charles B.

AU - Babu, Mohammed

AU - Kabatereine, Narcis B.

AU - Halage, Abdullah A.

AU - Utzinger, Jürg

AU - Cissé, Guéladio

AU - Nauta, Maarten

PY - 2016

Y1 - 2016

N2 - In wastewater systems in Kampala, Uganda, microbial contamination has increased over the past two decades. Those people who live or work along the Nakivubo channel and wetland and those who use the recreational areas along the shores of Lake Victoria are at an elevated risk of gastrointestinal infections. A quantitative microbial risk assessment (QMRA) was applied for five population groups, characterised by different levels of exposure to wastewater in the Nakivubo area, namely: (i) slum dwellers at risk of flooding; (ii) children living in these slum settlements; (iii) workers maintaining the drainage system or managing faecal sludge (sanitation workers); (iv) urban farmers; and (v) swimmers in Lake Victoria. The QMRA was based on measured concentrations of Escherichia coli, Salmonella spp. and Ascaris spp. eggs in wastewater samples. Published ratios between measured organism and pathogenic strains of norovirus, rotavirus, Campylobacter spp., pathogenic E. coli, pathogenic Salmonella spp., Cryptosporidium spp. and Ascaris lumbricoides were used to estimate annual incidence of gastrointestinal illness and the resulting disease burden. The QMRA estimated a total of 59,493 disease episodes per year across all 18,204 exposed people and an annual disease burden of 304.3 disability-adjusted life years (DALYs). Incidence estimates of gastrointestinal disease episodes per year were highest for urban farmers (10.9) and children living in slum communities (8.3), whilst other exposed groups showed lower incidence (<4.3). Disease burden per person per year was highest in urban farmers (0.073 DALYs) followed by sanitation workers (0.040 DALYs) and children in slum communities (0.017 DALYs). Our findings suggest that the exposure to wastewater is associated with public health problems, particularly children and adults living and working along the major wastewater and reuse system in Kampala. Our findings call for specific interventions to reduce the disease burden due to exposure to wastewater.

AB - In wastewater systems in Kampala, Uganda, microbial contamination has increased over the past two decades. Those people who live or work along the Nakivubo channel and wetland and those who use the recreational areas along the shores of Lake Victoria are at an elevated risk of gastrointestinal infections. A quantitative microbial risk assessment (QMRA) was applied for five population groups, characterised by different levels of exposure to wastewater in the Nakivubo area, namely: (i) slum dwellers at risk of flooding; (ii) children living in these slum settlements; (iii) workers maintaining the drainage system or managing faecal sludge (sanitation workers); (iv) urban farmers; and (v) swimmers in Lake Victoria. The QMRA was based on measured concentrations of Escherichia coli, Salmonella spp. and Ascaris spp. eggs in wastewater samples. Published ratios between measured organism and pathogenic strains of norovirus, rotavirus, Campylobacter spp., pathogenic E. coli, pathogenic Salmonella spp., Cryptosporidium spp. and Ascaris lumbricoides were used to estimate annual incidence of gastrointestinal illness and the resulting disease burden. The QMRA estimated a total of 59,493 disease episodes per year across all 18,204 exposed people and an annual disease burden of 304.3 disability-adjusted life years (DALYs). Incidence estimates of gastrointestinal disease episodes per year were highest for urban farmers (10.9) and children living in slum communities (8.3), whilst other exposed groups showed lower incidence (<4.3). Disease burden per person per year was highest in urban farmers (0.073 DALYs) followed by sanitation workers (0.040 DALYs) and children in slum communities (0.017 DALYs). Our findings suggest that the exposure to wastewater is associated with public health problems, particularly children and adults living and working along the major wastewater and reuse system in Kampala. Our findings call for specific interventions to reduce the disease burden due to exposure to wastewater.

KW - Bacteria

KW - Gastroenteritis

KW - Intestinal parasites

KW - Quantitative microbial risk assessment

KW - Viruses

KW - Wastewater

U2 - 10.1016/j.mran.2016.11.003

DO - 10.1016/j.mran.2016.11.003

M3 - Journal article

VL - 4

SP - 16

EP - 28

JO - Microbial Risk Analysis

JF - Microbial Risk Analysis

SN - 2352-3522

ER -