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Wastewater Quality and the Risk of Intestinal Nematode Infection in Sewage Farming Families in Hyderabad, India

Use of sewage or wastewater in agriculture is becoming increasingly common as a result of a global water scarcity. Intestinal nematode infections have been identified as the main health risk associated with this practice. To protect consumer and farmer health, the World Health Organization (WHO) has established an intestinal nematode water quality standard. However, because of a lack of well-designed studies, the validity of this guideline is questioned. This report presents the findings of a study on the risk of intestinal nematode infections in farming families occupationally exposed to untreated and partially treated wastewater in Hyderabad, India. The study found an increased risk of hookworm (odds ratio [OR] 3.5, 95% confidence interval [CI] = 2.2–5.5), Ascaris lumbricoides (OR = 5.3, 95% CI = 2.0–14), and Trichuris trichiura (OR = 5.6, 95% CI = 1.8–18) infection when untreated wastewater (150 intestinal nematode ova/liter) was used for crop production. Use of partially treated wastewater (28 intestinal nematode ova/liter) was only associated with an increased risk (OR = 3.2, 95% CI = 1.2–8.6) of A. lumbricoides infection. The findings of the study suggest that the current WHO intestinal nematode guideline of 1 ova/liter is sufficient to protect farmer health.

Received February 25, 2008. Accepted for publication June 11, 2008.

Acknowledgments: This report is dedicated to Felix P. Amerasinghe, who provided invaluable assistance to the study but passed away in June 2005. We thank Urmila Mata, Rama Devi, and Liaquat Ullah for conducting interviews, collecting stool samples, and organizing health camps. We also thank Simon Cousens, Chris Scott, Wim van der Hoek, Flemming Konradsen, Laura Rodrigues, Mimi Jenkins, Sandy Cairncross, and Anne Peasey (members of the doctoral panel for Jeroen H. J. Ensink) for contributing significantly to the design of the study.

Financial support: The Wastewater Research in Hyderabad was supported from core money from the International Water Management Institute. Simon Brooker is supported by a Wellcome Research Career Development Fellowship (081673).

^* Address correspondence to Jeroen H. J. Ensink, Department of Infectious Diseases and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: jeroen.ensink{at}lshtm.ac.uk

Authors’ address: Jeroen H. J. Ensink, Ursula J. Blumenthal, and Simon Brooker, Department of Infectious Diseases and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.