Drinking Water Source, Chlorinated Water, and Colorectal Cancer: A Matched Case-Control Study in Ethiopia

Background: There is no study conducted on the association between disinfection byproducts (DBPs) in chlorinated drinking water and colorectal cancer (CRC) in Ethiopia. Therefore, this study aimed to determine the relation between chlorine based DBPs in drinking water and CRC in Addis Ababa, Ethiopia. Methods: A facility based matched case control study was conducted involving 224 cases and 448 population controls from June 2020 to May 2021. Cases were defined as histologically confirmed CRC cases. Cases were matched with controls by residence, age, and sex using frequency and individual matching. Geocoding of cases, health facility, and georeferencing of controls were carried out. Data was collected using a pretested structured questionnaire. Pearson Chi square and Fisher’s exact tests were employed to assess associations. Stratified analysis was used to detect confounding factors and effect modification. A multivariable conditional logistic regression was used to identify risk factors of CRC. Results: Of 214 CRC cases, 148 (69.2%) used chlorinated water whereas out of 428 controls 161 (37.6%) used chlorinated water. In the final regression model, drinking chlorinated surface water (adjusted matched odds ratio [adjusted mOR] = 2.6; 95% CI 1.7-4.0), history of swimming (adjusted mOR = 2.4; 95% CI 1.4-4.1), years at the place of current residence (adjusted mOR = 1.5; 95% CI 1.1-2.2), hot tap water use for showering (adjusted mOR; 3.8 = 95% CI 2.5-5.9) were significantly associated with CRC. The stratified analysis confirmed that smoking and meat ingestion were not effect modifiers and confounders. Conclusion: Drinking chlorinated water for extended years is a significant risk factor for CRC in Addis Ababa, Ethiopia. In addition, hot tap water use for showering, and swimming history are risk factors for CRC. This information is essential to design integrated interventions that consider chlorination by-products and exposure routes toward the prevention and control of CRC in Ethiopia. Initiating alternative methods to chlorine disinfection of drinking water is also essential.

Environmental Health Education: From Museum Specimens and Math Word Problems to Virtual and Augmented Reality

Environmental degradation and its severe impact on human health has revealed the necessity for effective educational interventions. Given the importance of “Environment,” “Health,” and “Education,” as key pillars for the achievement of sustainable development, the education for environmental health is evolving into a main component of current strategies against environmental health threats, such as climate change and urban air pollution. Environmental Health Education, which must be considered as a strategical response against environmental degradation, offers vast capacity for innovation alongside every educational stage. For instance, the application of new technologies, such as virtual and augmented reality applications, the adoption of innovative interdisciplinary educational approaches, and the incorporation of Arts are evolving into a new era’s educational perspectives. All the new trends in formal, non-formal and informal Environmental Health Education should be captured and assessed, in favor of protecting both local and global natural environment, human and animal health, and promoting sustainability.

Removal of Cadmium, Copper, and Lead From Water Using Bio-Sorbent From Treated Olive Mill Solid Residue

Olive Mill Solid Residue (OMSR) can be utilized as a bio-sorbent in wastewater treatment. Even though several studies on OMSR as a bio-sorbent were carried out, there is still a need to investigate a simple and relatively inexpensive OMSR treatment that increases pollutant removal. In this study; OMSR is used in batch experiments to remove toxic heavy metals from aqueous solutions including Cd2+, Cu2+, and Pb2+ ions. The effect of OMSR treatment (untreated; OMSR-U, treated with n-hexane; OMSR-H, and treated with water; OMSR-W) was investigated by chemical oxygen demand and cation exchange capacity. It was confirmed by both tests that OMSR-W was the best treatment. The same result was re-confirmed by batch uptake experiments of the heavy metal ions. Using OMSR-W as a bio-sorbent; the effect of several parameters such as pH, contact time, bio-sorbent concentration, metal ions concentration, and the presence of other metal species were studied to figure their influence on the metal ions uptake. The optimum conditions for single metal systems were found to occur at pH 5.5, an initial metal concentration of 50 mg/L, a shaking time of 60 minutes, a bio-sorbent concentration of 20 g/L. In binary metal ions solutions; Cd2+ uptake was increased in presence of Cu2+ or Pb2+. However, the uptake of Cu2+ and Pb2+ was decreased in presence of other metals. The equilibrium sorption data for single metal systems were described by the Langmuir isotherm model. The highest value of maximum uptake was found for Pb2+ (4.587 mg/g) followed by Cd2+ (4.525 mg/g) and Cu2+ (4.367 mg/g). These results show that OMSR-W, which has a very low economical value, could be used for the treatment of wastewater contaminated with heavy metals.

High Strength Wastewater Reclamation Capacity of Vetiver Grass in Tropics: The Case of Ethiopia

It is generally accepted that industrial wastewater like tannery effluent is high strength wastewater. The aim of this study was to examine the capacity of Vetiver grass for the treatment of high strength wastewater in a constructed wetland. Two constructed wetland beds were designed and one of them was not planted used as a control group. The grass was planted with 20 cm by 20 cm distance from each seedling. The biometric characteristics of Vetiver grass was evaluated by taking randomly selected clusters of the grass. The concentration of chromium in the extract of parts of the grass was determined by atomic absorption spectrophotometer. The Chromium bioaccumulation and Translocation factor was estimated. Composite samples before and after treatment of 4 different hydraulic retention time was collected. The physiochemical analysis of the wastewater has been carried out. The constructed wetland bed with Vetiver grass performed that, BOD, COD, NH4-N, NO3-N, TN, PO4-P, and TP were reduced at the retention time of 9 days by 91.9%, 96.3%, 62%, 86%, 88.7%, 96.3%, and 92.2% respectively. Chromium was also reduced by 97% at retention time of both 7 and 9 days over the planted bed. The bed with plant performs significantly better than without plant at P-value <.01. Therefore, Vetiver grass has a capacity to reclaim high strength industrial wastewater in tropical areas.

Effect of Wastewater Discharge From Coffee Processing Plant on River Water Quality, Sidama Region, South Ethiopia

In Ethiopia, most of the coffee processing plants are generating large amounts of wastewater with high pollutant concentrations and discharge directly into the water bodies untreated or partially treated. The main objective of this study was to assess the effects of coffee wastewater discharged to river water quality using physicochemical parameters and macro-invertebrate indices. This study was conducted from November to the end of December 2019. Ten wastewater and river water samples were taken from coffee the processing plant and river. The macro-invertebrate samples were collected by kick sampling technique using a standard hand net. Shannon and Simpson diversity indices were examined at 3 sampling stations. The Pielou evenness index was also determined. It was found that except for TDS all the parameters of the raw wastewater and river water did not comply with the international discharge limit. The mean concentration of Faro coffee processing plant wastewater were BOD5 (2409.6 ± 173.1 mg/L), COD (4302 ± 437 mg/L), TSS (2824.6 ± 428.4 mg/L), TDS (3226 ± 623.6 mg/L), and TS (4183.3 ± 432.9 mg/L). Whereas from Bokaso coffee processing plant were BOD5 (3770 ± 604.4 mg/L), COD (4082.6 ± 921.9 mg/L), TSS (2766 ± 501.7 mg/L), TDS (3017 ± 747.6 mg/L), and TS (3874 ± 471.1 mg/L). A total of 392 macroinvertebrates belonging to 24 families and 7 orders were collected. The benthos assemblage communities in this river were 40, 56, and 296 at downstream 1, downstream 2, and upstream respectively. The value of the Simpson diversity index varies from 0.4 to 0.75. In the same manner, the value of the Shannon diversity index also varied from 0.5 to 1.36. Most of the physicochemical parameters of the raw wastewater were beyond the national and international discharge limits. The quality of Orsha river water downstream was more adversely affected compared to upstream.

Assessment of Bacteriological Quality of Sheep Carcasses, Effect Level of 2.5% Citric Acid Spray on Bacterial Contamination of Meat, and Hygiene Practices of Workers in a Selected Abattoir in Debrezeit Town, Central Ethiopia

Background: Meat safety is important for public health. As part of the meat chain abattoirs are required to give attention to meat hygiene and safety in order to minimize hazards. Therefore, the current study was conducted to evaluate the bacteriological quality of sheep carcasses, knowledge and hygienic practices of workers in a selected abattoir and to determine the effect level of 2.5% citric acid spray on total coliforms and aerobic bacteria load of raw sheep carcasses surfaces. Methods: A cross-sectional study design with structured questionnaire and observational checklists observation were used. A systematic random sampling technique was employed. A total of 50 sample swabs (25 swabs before citric acid spray and 25 after citric acid spray) were randomly taken from brisket, flank and rump of sheep’s carcasses. Swabs were moistened with buffered peptone water (BPW) and samples were taken by rubbing 100 cm2 (10 cm × 10 cm) area delineated by sterile aluminum template. In addition, we administered a structured questionnaire and an observational checklists to assess knowledge and hygienic practices of workers. Bacteriological quality of sheep carcasses were analyzed using the methods described by the US bacteriological analytical manual. Results: The mean count for aerobic bacteria of the sheep carcasses before and after citric acid spray were 7.2log10 CFU/ml and 6.4log10 CFU/ml, respectively. The test results also showed that 21 (84%) and 15 (60%) of the swab samples were positive before and after spraying citric acid, respectively. The mean counts for coliform bacterial of the sheep carcasses before and after citric acid spray were 3.5log10 CFU/ml and 2.9log10 CFU/ml, respectively. The mean total aerobic and coliform counts before and after citric acid spray were significantly different ( P < .05). Regarding the hygiene condition of workers, all the respondents reported that they always washed their hands with soap before and after entering the slaughtering room and 23 (53.5%) of the workers reported that they used hot water. Thirty-one (72.1%) of the workers reported that they do not used soap to wash hands after visiting toilet. Thirty-five (81.4%) of the production workers did not wear mouth mask while handling and distribute meat/carcass. On the other hand, all of the workers wore capes, gowns and boots at the time of the observation and only 18 (18.6%) of the production workers wore gloves at the time of the survey. Conclusion: The current study revealed that significant proportion of sheep carcasses were positive for total aerobic bacteria and total coliform. Moreover, the study also showed that spraying of sheep carcasses with 2.5% citric acid significantly reduced the total coliform and aerobic counts. However, we did not assessed how much spray results to this effect. Therefore, we recommended further studies to determine how much spray of 2.5% citric acid significantly reduce bacterial contamination of sheep carcasses. In addition, the abattoir has to follow the food hazard analysis critical control point (HACCP) system to minimize meat contamination during harvesting and processing. The abattoir has to also implement strict operation laws to improve hygiene conditions of the workers. In addition, the abattoir can minimize meat contamination using 2.5% citric acid as a decontaminant.

Global Health Impacts of Dust Storms: A Systematic Review

Background: Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. Method: In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. Results: The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. Conclusion: The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts. Registration: PROSPERO registration number CRD42018093325

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia

Background: Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices. Methods: A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used. Results: A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition. Conclusions: Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Optimized and Non-Optimized Personal Protective Equipment Use during the COVID-19 Pandemic in Thailand: A National Cross-Sectional Survey in a Resource-Limited Setting

Introduction: Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV2). COVID-19 is highly contagious, potentially fatal, and a global public health concern. Combining optimized personal protective equipment (PPE) use and hand hygiene is the best strategy for preventing COVID-19 in health care workers (HCWs). Methods: We conducted a national cross-sectional web-based survey of HCWs in the infection control program (IPC) in Thailand between May 5, 2020 and May 15, 2020. The primary objective was the prevalence of optimized PPE use amongst HCWs. The secondary objective was identification of the independent predictors of optimized PPE use. Results: We received a response from 46% of HCWs (756/1650), and all those who responded were nurse or HCWs who were registered in the IPC network. Five HCWs were excluded because of missing data, and 751 were included in the final analysis. The prevalences of PPE use were 22% (168/751) for optimized PPE use, 78% (583/751) for non-optimized PPE use, 35% (263/751) for PPE overuse, and 43% (320/751) for PPE underused. In univariate analysis, optimized PPE use was significantly associated with age, education level, knowledge of appropriate negative pressure room selection, and knowledge of apparently milder symptom severity in children than adults. In multivariate analysis, independent predictors of optimized PPE use were knowledge of appropriate negative pressure room selection (aOR = 1.95, 95% CI = 1.18-3.22), the difference in symptom severity between children and adults (aOR = 0.55, 95% CI = 0.37-0.81), and education level (aOR = 1.54, 95% CI = 1.04-2.27). Conclusion: The prevalence of optimized PPE use amongst HCWs was 22%. Independent predictors of optimized PPE use were COVID-19 knowledge-based factors and education level. Therefore, the continued education training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic.

Remote-Working Carbon-Saving Footprint: Could COVID-19 Pandemic Establish a New Working Model with Positive Environmental Health Implications?

Urban air pollution is a major problem with known negative health implications, such as respiratory and cardiovascular diseases. Lockdown measures have caused the reductions of various urban pollutants, such as nitrogen dioxide (NO2), particulate matters (PMs), and polycyclic aromatic hydrocarbons (PAHs). COVID-19 pandemic has also established remote-working as an antidote to declining economic activity due to lockdown measures. The environmental health implications of the new hybrid-working model, which drastically reduces the number of circulating vehicles, appear to be positive enough to reveal an emerging opportunity. Since this hybrid model may have started becoming a widely accepted working model, the current situation has revealed the opportunity of remote-working arrangements to serve as a supplementary mitigative and adaptive measure against urban environmental deterioration. Also, a remote-working carbon-saving footprint may be introduced in order to evaluate a firm’s carbon footprint reduction due to remote-working arrangements. These workings arrangements may be accompanied by improvements and expansions of urban green spaces and with broader use of electric vehicles, transforming our cities into more sustainable, safe, healthy, and worth-living environments.