OPERACIONALIZACIÓN DE VARIABLES O DESCRIPCIÓN DE

Increasing amounts and changing qualities of generated wastewater, presents huge challenges to management existing wastewater recovery and reuse systems (WHO 2006a; Mara et al.

2010). Pollution of the environment due to inadequate wastewater systems and disposal or reuse of wastewater and faecal sludge is a major public health issue for people living in LMICs. The problematic is greatest around their newly emerging or rapidly expanding urban centres (Rydin et al. 2012; Utzinger and Keiser 2006). For people whose livelihoods depend on the collection, sorting and reusing of wastewater and faecal sludge, and on population groups with poor access to improved sanitation and living in frequently flooded areas or consuming wastewater-fed crops and fish, measures to assess risks and reduce exposures are urgently needed (WHO 2006a, 2015; WHO and UNICEF 2012).

As outlined in the WHO guidelines environmental assessments, epidemiological surveys and QMRA can provide valuable information about health risks. Thus, practical examples to apply and make use of the generated data are needed to safely manage and reuse wastewater and faecal sludge in LMICs (Ensink and van der Hoek 2009; Nguyen-Viet et al. 2009). The risk analysis framework of the WHO guidelines was often poorly understood. Moreover, verification standardises and health-based targets were considered not feasible according to local wastewater recovery and reuse practices (WHO 2006a; Ferrer et al. 2012; Barker 2014).

Indeed, there is a paucity of quality-based environmental pollution and epidemiological data as well as accurate disease burden estimates for rapidly changing environments of cities, especially in Africa, Asia and Latin America (WHO 2006d). Moreover, discharge thresholds, verification limits and health-based targets need to be reviewed on the level of different LMICs to match their realities. For these reasons, there is an urgent need for practical examples on how to apply and make best use of riche evidence base of the WHO guidelines and apply different risk assessment approaches in LMICs (Fewtrell and Bartram 2001; WHO 2006a). The evidence obtained in a timely manner could inspire inter-sector collaboration (e.g. between urban planning, health, environment, agriculture and water sectors) and guide appropriate management and communication of risks to protect the health of vulnerable population groups around rapidly growing cities in LMICs (WHO 2006a; Mara et al. 2010; Pradyumna et al.

2015).

Chapter 3 – Background

3.2. Goals and objectives

This PhD thesis aims to generate evidence on health risks along urban and peri-urban wastewater recovery and reuse systems in LMICs. The health consequences are visible among people living and working along wastewater and faecal sludge management and reuse systems near a low-income African city (Kampala, Uganda) and a lower-middle-income Asian city (Hanoi, Vietnam).

The study addresses the following four objectives for Kampala and Hanoi in a comparative manner. Specifically, we will:

1) generate evidence on microbial and chemical contamination and treatment capacities along the wastewater management systems;

2) assess prevalence and risk factors of intestinal parasitic infections in different population groups exposed to wastewater and faecal sludge;

3) estimate the burden of gastrointestinal infections due to the exposure to wastewater; and 4) discuss and compare risk assessment approaches and their potential for application along

wastewater recovery reuse systems in LMICs.

3.3. Collaborative framework, the “Resource Recovery and Reuse project”

This PhD thesis contributes to the larger framework of a project funded by the Swiss Agency for Development and Cooperation (SDS) entitled “Resource Recovery and Reuse” (RRR). The project started in 2012 with the two aims (i) to increase the scale and viability of productive reuse of water, nutrients, organic matter and energy from municipal solid waste, faecal sludge, wastewater and agro-industrial waste streams through the analysis, promotion and implementation of economically viable business models; and (ii) to safeguard public health in the context of the rapidly expanding use of wastewater, excreta and grey water in agriculture and aquaculture, and to protect vulnerable groups from specific health risks through health risks assessment and mitigation and sanitation safety planning (SSP).

The RRR project is designed to run over a period of six years (from 2012 to 2018) in two distinct phases in the context of four selected cities Kampala (Uganda), Hanoi (Vietnam), Bangalore (India) and Lima (Peru). The first research-oriented phase (from 2012 to 2015) intended to test the feasibility and assess the enabling environment of 21 waste recovery and reuse business models and the SSP manual. The aim of the second RRR project phase is to

Chapter 3 – Background

scale-up the SSP manual in different cities around the world and implement the most feasible business models at the city level of Kampala and one other city.

Our main partner in this collaborating endeavour is WHO, while other international partners include the International Water Management Institute, the International Centre for Water Management Services, and the Department of Water and Sanitation in Developing Countries, Swiss Federal Institute of Aquatic Science and Technology. In Uganda, we closely work with the Makerere School of Public Health, the Vector Control Division of the Ministry of Health and the National Water and Sewerage Corporation. In Hanoi our main partner is the Center for Public Health and Ecosystem Research at Hanoi School of Public Health. Moreover, we closely work with the Department of Parasitology at the National Institute of Malaria, Parasitology and Entomology, the National Institute of Hygiene and Epidemiology, and the National Institute of Veterinary Research.