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.