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Full Thesis 04.09.12 WASTEWATER AND EXCRETA USE IN AGRICULTURE IN NORTHERN VIETNAM: HEALTH RISKS AND ENVIRONMENTAL IMPACTS INAUGURALDISSERTATION zur Erlangung der Würde eines Doktors der Philosophie vorgelegt der Philosophisch-Naturwissenschaftlichen Fakultät der Universität Basel von Phuc Pham-Duc aus Hanoi, Vietnam Basel, 2011 Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultät auf Antrag von Prof. Dr. Jakob Zinsstag, Dr. Jeroen Herman Jan Ensink, PD Dr. Peter Odermatt. Basel, den 13. Dezember 2011 Prof. Dr. Martin Spiess Dekan Table of contents ________________________________________________________________________ TABLE OF CONTENTS LIST OF TABLES ............................................................................................................. iv LIST OF FIGURES ............................................................................................................ v LIST OF ABBREVIATIONS ............................................................................................ vi SUMMARY ...................................................................................................................... vii ACKNOWLEDGEMENTS ................................................................................................ x 1. INTRODUCTION .......................................................................................................... 1 1.1. The overview of wastewater and excreta use in agriculture ........................................ 1 1.2. The health risks related to the use of wastewater and excreta ..................................... 2 1.2.1 Excreted-pathogens transmission routes .................................................................... 3 1.2.2 Enteric virus pathogens .............................................................................................. 5 1.2.3 Enteric bacterial pathogens ........................................................................................ 5 1.2.4 Intestinal protozoan parasites ..................................................................................... 6 1.2.5 Soil-transmitted helminthiasis ................................................................................... 8 1.2.6 Diarrhoea related to the use of wastewater and excreta ........................................... 11 1.3 Wastewater and excreta use in agriculture and health risks in Vietnam ..................... 14 1.4 Integrated approach for assessing the health risks and environmental impacts .......... 16 2. AIM AND OBJECTIVES ............................................................................................. 20 3. DESCRIPTION OF THE STUDY SITES .................................................................... 21 4. METHODOLOGY ....................................................................................................... 27 4.1 Epidemiological studies .............................................................................................. 27 4.2 Quantitative Microbial Risk Assessment .................................................................... 29 4.3 Material Flow Analysis ............................................................................................... 32 4.4 Data analysis approaches ............................................................................................ 34 4.5 Ethical considerations ................................................................................................. 35 5. ASCARIS LUMBRICOIDES AND TRICHURIS TRICHIURA ASSOCIATED WITH WASTEWATER AND HUMAN EXCRETA USE IN AGRICULTURE IN VIETNAM ........................................................................................................................................... 36 5.1 Abstract ....................................................................................................................... 37 5.2 Introduction ................................................................................................................. 39 5.3 Methods ....................................................................................................................... 40 5.4 Results ......................................................................................................................... 45 5.5 Discussion ................................................................................................................... 55 5.6 Conclusion .................................................................................................................. 57 5.7 Conflict of interest ...................................................................................................... 57 5.8 Authors´ contributions ................................................................................................ 57 5.9 Acknowledgments ....................................................................................................... 58 6. RISK FACTORS FOR ENTAMOEBA HISTOLYTICA INFECTION IN AN AGRICULTURAL COMMUNITY IN HANAM PROVINCE, VIETNAM ................... 59 6.1 Abstract ....................................................................................................................... 60 6.2 Background ................................................................................................................. 61 6.3 Methods ....................................................................................................................... 62 6.4 Results ......................................................................................................................... 66 6.5 Discussion ................................................................................................................... 72 6.6 Conclusion .................................................................................................................. 75 6.7 Conflict of interest ...................................................................................................... 75 i Table of contents ________________________________________________________________________ 6.8 Acknowledgments ....................................................................................................... 75 6.9 Authors´ contributions ................................................................................................ 76 7. DIARRHOEAL DISEASES IN ADULTS IN AN AGRICULTURAL COMMUNITY, WHERE WASTEWATER AND EXCRETA WAS USED IN HANAM PROVINCE, VIETNAM ........................................................................................................................ 77 7.1 Abstract ....................................................................................................................... 78 7.2 Introduction ................................................................................................................. 80 7.3 Methods ....................................................................................................................... 81 7.4 Results ......................................................................................................................... 86 7.5 Discussion ................................................................................................................... 94 7.6 Conclusion .................................................................................................................. 97 7.7 Conflict of interest ...................................................................................................... 98 7.8 Acknowledgments ....................................................................................................... 98 7.9 Authors´ contributions ................................................................................................ 98 8. ASSESSMENT OF INFECTION RISKS OF DIARRHOEA ASSOCIATED WITH WASTEWATER AND EXCRETA USE IN AGRICULTURE IN HANAM PROVINCE, NORTHERN VIETNAM ................................................................................................. 99 8.1 Abstract ..................................................................................................................... 100 8.2 Introduction ............................................................................................................... 101 8.3 Materials and methods .............................................................................................. 102 8.4 Results ....................................................................................................................... 109 8.5 Discussion ................................................................................................................. 114 8.6 Conclusions ............................................................................................................... 117 8.7 Conflicts of interest ................................................................................................... 118 8.8 Acknowledgements ................................................................................................... 118 8.9 Authors´ contributions .............................................................................................. 118 9. ASSESSING NUTRIENT FLUXES IN A VIETNAMESE RURAL AREA DESPITE LIMITED AND HIGHLY UNCERTAINTY DATA ..................................................... 119 9.1 Abstract ..................................................................................................................... 120 9.2 Introduction ..............................................................................................................
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