Abstract
The severe man-made degradation of water and soil in the Aral Sea basin is considered to cause serious human health problems. Hence, the Center for Development (ZEF) in collaboration with the Institute for Hygiene and Public Health at the Bonn University Clinics, Germany, conducted a study on diarrhoeal diseases and its risk factors in the Khorezm Region between May 2003 and March 2004. In the study, we investigated the risk factors water, sanitation and hygiene for diarrhoeal disease by applying a combination of quantitative (exposure assessment, epidemiological data) and qualitative methods (standardized interviews, structured observations).
Diarrhoeal disease incidence in children was much higher than expected and even exceeded, with 4.6 episodes per person year for children under 5 years old, global median numbers. For those under 2 years of age, mean person-time incidence was extremely high with 6.7 episodes per child per year. Although seasonality of the age stratified person-time incidence was found, overall diarrhoeal disease incidence was high for all seasons with disease rates for the winter follow-up assessment ranging 30–59% below summer rates.
Multiple linear regression analysis revealed that visible contamination of drinking water during storage and the absence of anal cleansing materials were significantly associated with the number of diarrhoeal episodes per household, pointing to the importance of hygiene in prevention of faecal-oral disease transmission.
Exposure estimations according to drinking water monitoring assessed that roughly one quarter of the population was exposed to faecally contaminated drinking water at the source and an estimated 12% were at risk from excess nitrate in drinking water. A large part of the population was expected to ingest about 5–7 g d−1 of salt from drinking water in 2003.
Overall, the findings show that at the time of the study the domestic domain played a major role with regard to faecal-oral disease transmission in Khorezm, Uzbekistan. Unhealthy excreta handling and disposal habits as well as unsafe drinking water treatment and handling practices have to be urgently tackled in order to break the faecal-oral transmission route.
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Herbst, S., Fayzieva, D., Kistemann, T. (2012). Water and Sanitation-Related Health Aspects in Khorezm, Uzbekistan. In: Martius, C., Rudenko, I., Lamers, J., Vlek, P. (eds) Cotton, Water, Salts and Soums. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1963-7_9
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