GeoHealth Centre, Institute for Hygiene & Public Health, University Hospital Bonn, Bonn, Germany.
Health & Economics Finance Development Consortium, Nairobi, Kenya.
Sci Total Environ. 2018 May 15;624:1411-1420. doi: 10.1016/j.scitotenv.2017.12.232. Epub 2017 Dec 27.
Wetlands are a source of water out of which humans derive their livelihoods in Sub-Saharan Africa. They are often over-utilized and expose humans to disease-causing infectious agents. This calls for an evaluation of the role of water, sanitation and hygiene (WASH) and their effects in disease prevention and transmission in wetlands. A health risk assessment based on syndromic surveillance of self-reported abdominal complaints and fever gathered from a rural wetland in semiarid Kenya is presented with symptoms serving as proxies for real health threats in wetlands. The incidence of abdominal complaints was significantly higher for those using unimproved water sources compared to improved water users (odds ratio 7.5; 95% CI 2.59-26.9; p=0.001). Drainage of stagnant water near the house (odds ratio 0.2; 95% CI 0.08-0.54; p=0.002) and sanitary hygiene (odds ratio 0.4; 95% CI 0.71-0.97; p=0.056) were associated with reduced risk of abdominal complaints. Drainage of water was also associated with reduced risk of fever (odds ratio 0.3; 95% CI 0.02-0.59; p=0.002) and so was the use of mosquito nets (odds ratio 0.6; 95% CI 0.39-0.02; p=0.063). Usage of wetlands in the afternoon, e.g. for irrigated agriculture, increased the incidence of fever (odds ratio 1.5; 95% CI 0.91-2.33; p=0.040). Overall, there appears a greater likelihood of reducing pathogen exposure in the domestic than in the occupational domain or in the proximity to the wetland. We show that WASH, environmental hygiene and human behaviour are risk factors associated with the contraction of diseases characterized by abdominal complaints (e.g. diarrhoea) and fever (e.g. malaria) in wetlands. The same factors also have the potential to promote human health in the context of wetlands. We demonstrate the applicability of syndromic approaches in surveillance-scarce areas and emphasize the importance of adopting an integrated health-based wetland management that considers WASH and incorporates strategies based on grassroots level risk assessments.
湿地是撒哈拉以南非洲地区人类赖以获取生计的水源，但这些湿地往往被过度利用，使人类面临致病传染病的威胁。因此，需要评估水、环境卫生和个人卫生（WASH）在湿地疾病预防和传播中的作用。本文基于肯尼亚半干旱地区一个农村湿地中自我报告的腹痛和发热症状进行综合征监测，评估了健康风险，这些症状可以作为湿地实际健康威胁的替代指标。结果表明，与使用改良水源的人相比，使用未改良水源的人腹痛的发生率显著更高（比值比 7.5；95%置信区间 2.59-26.9；p=0.001）。房屋附近死水的排水（比值比 0.2；95%置信区间 0.08-0.54；p=0.002）和卫生与个人卫生（比值比 0.4；95%置信区间 0.71-0.97；p=0.056）与腹痛风险降低相关。排水还与发热风险降低相关（比值比 0.3；95%置信区间 0.02-0.59；p=0.002），使用蚊帐也与发热风险降低相关（比值比 0.6；95%置信区间 0.39-0.02；p=0.063）。例如，下午在湿地中进行灌溉农业等活动会增加发热的发生率（比值比 1.5；95%置信区间 0.91-2.33；p=0.040）。总体而言，在家庭环境中减少病原体暴露的可能性似乎大于在职业环境中或在靠近湿地的环境中减少病原体暴露的可能性。我们的研究表明，WASH、环境卫生和人类行为是与湿地中出现的腹痛（例如腹泻）和发热（例如疟疾）等疾病相关的危险因素。同样的因素也有可能在湿地背景下促进人类健康。我们展示了综合征方法在监测资源匮乏地区的适用性，并强调了采用基于卫生的综合湿地管理的重要性，该管理应考虑 WASH，并纳入基于基层风险评估的策略。
