Disease burden due to gastrointestinal infections among people living along the major wastewater system in Hanoi, Vietnam

Faecal Pathogen Flows and Their Public Health Risks in Urban Environments: A Proposed Approach to Inform Sanitation Planning

“…Recent studies assessing the health risk related to urban sanitation have identified a number of dominant exposure pathways, with findings influenced by the study scope and site of assessment. Examples include: ingestion of fresh produce [ 7 ]; swimming, playing or bathing in open drainage channels [ 5 , 34 ]; ingestion by urban farmers [ 21 ]; and ingestion from drainage canals and produce [ 35 ]. Based on this evidence, our conceptual approach adopted six generic exposure points, noting that these could and should be locally discussed and determined.…”

“…Equally important to exposure points are the factors that influence exposure risk: exposure quantity, frequency and population exposed. These values are likely to be context-dependent: this study drew on data from a number of recent risk assessments that involved household and field surveys [ 5 , 7 , 21 , 33 ]. Applying our proposed approach in a specific location could involve use of existing methods to consider local exposure pathways [SSP module 2, 24] or direct data collection on local exposure behaviours from household surveys, focus group discussions and transect surveys [ 7 , 20 ].…”

“…QMRA has been applied to urban sanitation in developing countries to determine the magnitude of risk [ 5 , 21 , 33 , 34 , 35 ] and the potential log 10 reduction achievable by different treatment or interventions [ 57 ]. While these studies bear similarities to the approach suggested in this paper, and demonstrate that QMRA can be a useful and important tool for use in urban sanitation, they do not carry the same aim of comparing a range of alternative sanitation options on the basis of relative health risk considering the local context.…”

“…The key literature source on pathogen removal, Feacham [ 19 ], is currently being updated by the Global Water Pathogen Project (GWPP), in which a global panel of experts are synthesising available research on water pathogens and their removal in sanitation systems, shared in an online platform (GWPP-2007). Pathogen exposure and health risk assessment are increasingly being applied to urban sanitation [ 5 , 6 , 7 , 20 , 21 , 22 ] which is often based on detailed field work in selected locations. These studies have highlighted challenges in monitoring pathogens in developing countries where analyses are limited due to cost and ability to measure all types of pathogens and various pathways, and results can be inconclusive.…”

Periurban Transformations in the Global South and Their Impact on Water-Based Livelihoods

“…Farmers using wastewater have a significantly higher risk of gastroenteric diseases and intoxication [78,82], while others highlight the possibility of safe use of wastewater, if it follows prescribed, e.g., the WHO guidelines on the safe use of wastewater, excreta and greywater [69,83]. In some areas wastewater irrigation had an impact on crop quality resulting in a reduction in market prices, inter alia due to the consumers' concerns about potential health risks from these vegetables [56,64,67,70].…”