The amount of available freshwater in most low- and middle-income countries is not sufficient to meet increasing demand. Treated municipal wastewater often becomes a significant source of irrigation water.
Wastewater is valuable and its reuse has many potential benefits: flow is reliable even where water is scarce, nutrients increase agriculture production, and it can be used in many income-producing enterprises. Wastewater use also provides low cost reduction of a pollution hazard from direct release to the environment.
Wastewater use is a health risk to people and animals. Contaminants can include pathogenic microorganisms and industrial pollutants. Some pathogens cause harm in smallest numbers, and wastewater may spread diseases to sewage systems workers, farmers, their families, downstream communities and consumers of irrigated produce.
Common wastewater pathogens include helminths like roundworms, tapeworms, whipworms, hookworms and schistosomes. Perhaps half of Tanzanians have urinary or intestinal schistosomiasis; likewise, about half the population are infected with soil-transmitted helminths. Diseases caused by these worms are exacerbated by inaccessible health care and mediocre treatments.
Data includes operational parameters from the Iringa wastewater treatment plant, a field survey of effluent use, observations, and a helminth assessment of four wastewater treatment plants. Effluent from Arusha, Iringa and Moshi met WHO standards for agricultural use; in Morogoro, the effluent included hookworm eggs.
Many soil-transmitted helminth eggs settle into the sludge and are viable for years, making the sludge infectious. Schistosoma eggs hatch when they come into contact with water. The resulting miracidae must find snails, their obligatory host, within 48 hours. Without snails, the life cycle of the schistosome will end.
Prevention, where actions are taken to prevent the occurrence of disease, is the most equitable way to deal with disease threats. Environmental modifications are generally more sustainable than treatment, and have longer-term impact. Environmental modifications that prevent disease include sewage treatment systems like waste stabilization ponds and constructed wetlands.
Recommendations for wastewater reuse are divided into five categories: planning, design, construction, implementation, and monitoring.
During planning, disease prevalence of humans and other animals must be evaluated. High background disease levels show that risk management procedures should be improved. Multisectoralism is crucial: the health sector and the engineering sector must work together. For effective disease control, engineering designs must consider the biological aspects of pathogens and their diseases; likewise, disease control will not be effective if health workers depend on drugs and health education without the preventive aspects inherent to well-engineered sewage treatment systems. Educational campaigns should improve knowledge and actions over the long term.
Waste stabilization ponds should include fish to eat the mosquito larvae; constructed wetlands should generally be subsurface to decrease habitat for mosquito larvae.
To protect workers and their families from wastewater pathogens, staff should wear clothing that can be cleaned in boiling water and rubber boots to protect their feet, and treatment plants should have a place to shower and disinfect after work.
Agricultural practices and crops can be changed to reduce pathogen transmission from wastewater irrigation; sludge can be stored or composted to reduce ova content before land application.
Regular monitoring should be site specific. Data on local disease incidence and prevalence should be collected periodically. Pond monitoring should include periodic checks for snails that are Schistosoma hosts. Influent should be tested for total petroleum hydrocarbons, heavy metals, pharmaceutics, and other pollutants; effluent should be monitored for coliforms and helminth eggs.
We need continued research to reduce the disease-carrying potential of wastewater while utilizing its fertilizer value, and on the role of natural systems like mangrove forests and marshes in cleaning sewage-laden streams and rivers.