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Cited by 78Fecal contamination and water qualityWastewater Treatment and ReusePublic Health and Environmental Issues

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

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Fuhrimann, Samuel, Winkler, Mirko S., Stalder, Michelle, Niwagaba, Charles B., Babu, Mohammed, Kabatereine, Narcis B., Halage, Abdullah A., Utzinger, Jürg +2 more·2016·Microbial Risk Analysis
DOI 10.1016/j.mran.2016.11.003
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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.

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  • Because of their propensity to play in soil and near open drains, children in urban informal settlements are thought to be at significantly higher risk of colonization and infection with fecal pathogens compared to other residents.

    “Because of their propensity to play in soil and near open drains, children in particular are thought to be at significantly higher risk of colonization and infection with fecal pathogens compared to other residents 60 .”

    From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [60]

    The Exposure assessment (§2.3; page unavailable) identifies children playing in contaminated slum environments as at risk of daily accidental water ingestion. The estimated gastroenteritis incidence (§3.1; page unavailable) is higher for these children than for several other exposed groups, but higher still for urban farmers. The paper does not establish colonization, specifically attribute exposure to playing in soil or near open drains, or show that children have higher risk than all other residents. (LLM, conf=0.87)

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Authors
Fuhrimann, S., Winkler, M. S., Stalder, M., Niwagaba, C. B., Babu, M., Kabatereine, N. B., Halage, A. A., Utzinger, J., Cissé, G., & Nauta, M.
Affiliations
  • Swiss Tropical and Public Health Institute (CH)
  • Makerere University (UG)
  • National Water and Sewerage Corporation (UG)
  • Imperial College London (GB)
  • Technical University of Denmark (DK)
Corresponding author
Fuhrimann, Samuel
ORCID
Venue
Microbial Risk Analysis
Publisher
Elsevier BV
Published
2016-12
Volume
4
Pages
16-28
ISSN
2352-3522 (ISSN-L)
DOI
10.1016/j.mran.2016.11.003
OpenAlex
W2550292463
Semantic Scholar
128bdc1b44ee447815ab26af7e266f07d0b68ecf
Cited by
78
References
77
Citations by year
2026: 5 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 14 · 2020: 11 · 2019: 7 · 2018: 9 · 2017: 5 · 2016: 1
FWCI
4.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Microbial Risk Analysis (publishedVersion, cc-by)
  • Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion, cc-by)
  • Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
  • ETH Zürich Research Collection (cc-by)
Topics
  • Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
  • Physical Sciences › Environmental Science › Waste Management and Disposal › Wastewater Treatment and Reuse
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
Keywords
gastrointestinal infections, wastewater exposure, disease burden, disability-adjusted life years, Lake Victoria, slum dwellers, sanitation workers, urban farmers, children, Escherichia coli, Salmonella, Ascaris lumbricoides, fecal sludge management, water reuse, microbial contamination, Kampala

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