Thor Axel Stenström

Quantification of the health risk associated with wastewater reuse in Accra, Ghana: a contribution toward local guidelines

Quantitative Microbial Risk Assessment (QMRA) models with 10,000 Monte Carlo simulations were applied to ascertain the risks of rotavirus and Ascaris infections for farmers using different irrigation water qualities and consumers of lettuce irrigated with the different water qualities after allowing post-harvest handling. A tolerable risk (TR) of infection of 7.7 x 10(-4) and 1 x 10(-2) per person per year were used for rotavirus and Ascaris respectively. The risk of Ascaris infection was within a magnitude of 10(-2) for farmers accidentally ingesting drain or stream irrigation water; approximately 10(0) for farmers accidentally ingesting farm soil and 10(0) for farmers ingesting any of the irrigation waters and contaminated soil. There was a very low risk (10(-5)) of Ascaris infection for farmers using pipe-water. For consumers, the annual risks of Ascaris and rotavirus infections were 10(0) and 10(-3) for drain and stream irrigated lettuce respectively with slight increases for rotavirus infections along the post-harvest handling chain. Pipe irrigated lettuce recorded a rotavirus infection of 10(-4) with no changes due to post harvest handling. The assessment identified on-farm soil contamination as the most significant health hazard.

Diarrhea and dengue control in rural primary schools in Colombia: study protocol for a randomized controlled trial

BackgroundDiarrheal diseases and dengue fever are major global health problems. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Poor household water management and sanitation are therefore potential determinants of both diseases. Little is known of the role of stored water for the combined risk of diarrhea and dengue, yet a joint role would be important for developing integrated control and management efforts. Even less is known of the effect of integrating control of these diseases in school settings. The objective of this trial was to investigate whether interventions against diarrhea and dengue will significantly reduce diarrheal disease and dengue entomological risk factors in rural primary schools.Methods/designThis is a 2×2 factorial cluster randomized controlled trial. Eligible schools were rural primary schools in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Eligible pupils were school children in grades 0 to 5. Schools were randomized to one of four study arms: diarrhea interventions (DIA); dengue interventions (DEN); combined diarrhea and dengue interventions (DIADEN); and control (C). Schools were allocated publicly in each municipality (strata) at the start of the trial, obviating the need for allocation concealment. The primary outcome for diarrhea is incidence rate of diarrhea in school children and for dengue it is density of adult female Aedes aegypti per school. Approximately 800 pupils from 34 schools were enrolled in the trial with eight schools in the DIA arm, nine in the DEN, eight in the DIADEN, and nine in the control arms. The trial status as of June 2012 was: completed baseline data collections; enrollment, randomization, and allocation of schools. The trial was funded by the Research Council of Norway and the Lazos de Calandaima Foundation.DiscussionThis is the first trial investigating the effect of a set of integrated interventions to control both dengue and diarrhea. This is also the first trial to study the combination of diarrhea-dengue disease control in school settings.Trial registrationCurrent Controlled Trials ISRCTN40195031

Long-term hygienic barrier efficiency of a compact on-site wastewater treatment system.

The long-term use of a filter-based, on-site wastewater treatment system increases nutrient discharge to receiving waters and may reduce its hygienic barrier efficiency. The main purpose of this research was to assess the hygienic barrier efficiency and the associated health risks of an on-site system that had exceeded its 5-yr design capacity with respect to phosphorus (P) removal. The system was investigated for bacteria and virus removal and assessed with respect to potential health risks in relation to reuse of effluent for irrigation. The system consists of a septic tank, a pressure-dosed vertical flow biofilter, and an up-flow filter unit with lightweight clay aggregates. The total P concentration in the effluent had increased gradually from initially <0.1 mg P L(-1) during the first 2 yr of operation to 1.8 mg P L(-1) after 5.3 yr. Escherichia coli was used as an indicator organism for fecal bacteria removal, whereas bacteriophages phiX174 and Salmonella typhimurium phage 28B (S.t. 28B) were used to model enteric virus removal. An overall decrease in E. coli removal occurred from a complete (approximately 5.6 log10) reduction during the first 3 yr of operation to 2.6 log10 reduction. The removal amounts of the bacteriophages phiX174 and S.t. 28B were 3.9 and 3.7 log10, respectively. Based on removal of S.t. 28B, the risks of rotavirus infection and disease for the investigated scenarios were above the acceptable level of 10(-4) and 10(-3), respectively, as defined by the World Health Organization.

Virus removal by unsaturated wastewater filtration: effects of biofilm accumulation and hydrophobicity.

Enhanced treatment of septic tank effluent can improve the hydraulic function and performance of infiltration systems and constructed wetlands. By intermittent spray application of septic tank effluent onto a coarse-grained filter media, an unsaturated flow regime beneficial for pathogen removal is created. A column filtration study showed an increase in PRD-1 removal by time of operation with corresponding biofilm accumulation in the filter material. The same increased removal was observed for 1 mum polystyrene beads, irrespective of their hydrophilic/hydrophobic surface properties. A control experiment with sorption of 1 mum hydrophobic and hydrophilic polystyrene beads to different glass surfaces with hydrophobic and hydrophilic properties indicate that mechanisms other than hydrophobic interactions may govern the rate of attachment to the filter media. For a given volumetric flow-rate in the columns, the presence of biofilm altered the hydrodynamic characteristics and this resulted in increased retention time and particle removal.