Examination for intestinal parasites and enteric bacteria in the wastewater and treated wastewater from the city of Chiang Mai, Thailand.

An attempt to use treated wastewater for agriculture in the Chiang Mai area was made, but the re-use process had to be performed under a condition that limited the risks liable to leave pathogens present in the water. The objective of our study was to examine the intestinal parasites and enteric bacteria in the wastewater and treated wastewater from the Chiang Mai University campus as well as the treated wastewater from the Chiang Mai municipality. The raw wastewater (RW), primary treatment effluent water (PE), treated wastewater using the activated sludge system (AS) from the Chiang Mai University campus and treated wastewater using the aerated lagoon (AL) system from the Chiang Mai municipality were examined for intestinal parasites and enteric bacteria by using the centrifugal sedimentation and conventional methods respectively. The ground water (GW) and the irrigation water (IW) were used for comparison. All kinds of water were collected and examined twice a month for 6 months (February to July 2000). None of human intestinal parasites were found from any wastewater, whereas the RW and PE water contained hookworm larva, Ascaris egg and Taenia egg on some occasions. A small amounts of pathogenic bacteria that can cause severe diarrhea were detected. Salmonella enteritidis gr E was isolated from the AL water in April, while Vibrio cholerae type O139 was detected from the PE water in June. Some pathogenic bacteria that might cause gastroenteritis, such as Aerobacter spp, Citrobacter spp, Pseudomonas spp and Escherichia coli were also found in all kinds of water. Between the two types of treated wastewater, the bacteria found in AS water was less than that in AL water in terms of both amount and type of bacteria. The treated wastewater from the city of Chiang Mai, compared to natural water such as irrigation water, appears to be safe to use for agriculture.

Parasitic and bacterial contamination in collards using effluent from treated domestic wastewater in Chiang Mai, Thailand.

Thailand often has inadequate water supply for agriculture during the dry season. The reuse of treated wastewater treatment plants could solve this problem. Treatment of domestic wastewater of Chiang Mai municipality by the aerated lagoon system (AL) releases more than 25,000 m3 of treated water everyday. The reuse of wastewater in agriculture is an efficient use of water, especially in tropical countries or in drought zones. The objective of this study is to demonstrate the possibility of using treated wastewater in growing edible vegetables, ie collards (kale), without pathogenic parasite and bacterial contamination. Collards (Brassica oleracea var acephala) were grown using either the treated wastewater from the aerated lagoon system (AL) or ground water (GW). Three cropping times were scheduled in February, May and July, 2000. Samples of water from AL system and GW were taken two times per month (the consecutive weeks) from February to July and examined for bacteria and parasites. Irrigation water (IW) that was normally used in agriculture was also collected, at the same time of the AL and GW collection, for bacteria and parasite investigation. A soil sample was taken before and after each crop for parasite examination. Collards were also collected at the end of the crop for parasite investigation. The results showed that GW seems to be a clean water since no pathogenic bacteria were found although small amount of Escherichia coli was noted in May. For AL and IW, similar number and types of bacteria were found. They were Aeromonas sobria, A. hydrophila, E. coli, Citrobacter freundii, Pseudomonas aeruginosa, non-pathogenic type of Vibrio cholerae. The small number of Salmonella enteritidis gr E was found in AL in April. After investigating 12 samples in 6 months of each kind of water, ie GW, Al, and IW, no parasite was found. Only unidentified free living nematodes were found in IW but those parasites are non pathogenic. A small number of unidentified free living nematodes (UFLN), a natural parasite, were found in soil after cropping. After each cropping time, similar number of hookworm was found in the plots which used either GW or AL. Collards grown by using either GW or AL showed no harmful parasite contamination. We conclude that the effluent from wastewater treatment, using aerated lagoon system, of Chiang Mai municipality could be safely used for growing collards.

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.

Infant weight in relation to nutritional intake and morbidity in northern Thailand.

A cross-sectional study of 58 infants (age range 2-53 weeks) was carried out in a rural area of northern Thailand. Total dietary intake (energy and protein from breastmilk and supplementary food) was measured directly during continuous observation over 48 h of randomly selected study subjects in their homes. Associations between infant weight and total energy intake, total protein intake and morbidity were analysed by multiple regression analysis. Up to 6 months of age, heavier infants had larger energy intakes, when age and birthweight were taken into account. In the 7-12 months age group, heavier infants consumed more protein and had fewer respiratory infections. Weaned infants older than 6 months were significantly heavier and consumed more protein than infants of similar age who were still receiving breastmilk. The lower protein intakes of the latter infants were due to the low protein concentration of breastmilk compared with supplementary food.

Circadian variation in fat concentration of breast-milk in a rural northern Thai population.

1. Twenty-five northern Thai mothers, breast-feeding their infants on demand, were studied in their homes for 24 h. All breast-feeds were test-weighed and pre- and post-feed expressed breast-milk samples (0.5 ml) taken at each feed. 2. The fat concentration of milk taken during a feed showed significant circadian variation, with maximum values between 16.00 and 20.00 hours and minimum values between 04.00 and 08.00 hours. Fat concentration at the start and at the end of a feed also varied significantly over 24 h. 3. Multiple regression analysis showed that the most important predictor of fat concentration at a feed was the length of time elapsed since the previous feed--the longer this interval, the lower the subsequent fat concentration. Other significant predictors were the fat concentration at the end of the previous feed, and the milk intake at the previous and at the current feed. 4. Fat concentration declined between feeds in proportion to the length of time between feeds, but the decline was less between sleep feeds than between waking feeds. This would appear to be a reflection of the lower post-feed fat concentration and higher pre-feed fat concentration of sleep feeds compared with waking feeds, when other variables relating to feeding pattern are taken into account. 5. The larger the milk intake at a feed, the greater was the increase in fat concentration from the start to the end of the feed. The change in fat concentration was less in feeds taking place during the sleep period than in daytime feeds.

Estimation of 24 h breast-milk fat concentration and fat intake in rural northern Thailand.

1. The present study assesses the accuracy with which mean 24 h breast-milk composition can be estimated if milk samples can only be collected during the daytime. 2. Twenty-five northern Thai mothers, feeding their infants on demand, were studied in their homes for 24 h. All feeds were test-weighed and 0.5 ml pre- and post-feed expressed milk samples taken at each feed. 3. If daytime sampling was restricted to two breast-feeds, it was found that the best estimate of 24 h fat concentration was given by two randomly chosen daytime feeds, predicting 24 h fat concentration with 95% confidence limits of +/- 7.0 g/l (equivalent to 21% of mean 24 h fat concentration). 4. Alternative sampling methods using the mean fat concentration of the feed after 08.00 hours and after 18.00 hours, or the first two feeds after 12.00 hours, predicted fat concentration with 95% confidence limits of +/- 9.7 g/l and +/- 8.9 g/l (28 and 26% of mean 24 h fat concentration) respectively. 5. If well-tolerated by mothers, it would be preferable to sample all daytime feeds, since this reduces the 95% confidence limits to +/- 3.3 g/l, equivalent to 10% of the mean 24 h fat concentration.

A WHO collaborative study on iron supplementation in Burma and in Thailand.

Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.

PIP: 4 collaborative trials of iron supplements with or without folate on the following groups: adult men and women in central Thailand; pregnant women in northeastern Thailand; adult women in northern Thailand; and pregnant women in Burma, are reported as separate studies here. Subjects took 30, 60, 120 or 240 mg Fe sulfate with or without 2.5 mg folic acid. Those with chronic disease or hemoglobin 80 g/L were excluded. Presence of hemoglobin EE or EF, or hookworm infestations were determined in some cases. Hemoglobin E, which tends to increase incidence of anemia, occurs in up to 4.8% of women in northern Thailand, 27.6% of adults in northeastern Thailand, and 19% of pregnant women in Burma. Hookworm infection was a high as 35% in central Thais. Iron supplementation significantly increased mean Hb and reduced incidence of anemia in all study groups. 20% of subjects remained anemic. In northeastern Thailand treatment for 15 weeks resulted in higher Hb than did 10 weeks treatment. No significant difference was seen with dose of Fe or inclusion of folate. Supervised administration of supplements had no additional effect. Gastrointestinal side effects were a problem, and were dose related, but tended to resolve after a while. The fact that Hb levels did not rise to normal levels indicates that a combined program possibly including parasite control and food fortification should be considered.

Effect of storage on the creamatocrit and total energy content of human milk.

Human milk samples were collected from mothers on the third post-partum day with a manual breast-pump and pooled. They were divided into aliquots and stored at room temperature (24-25 degrees C), and at 4 degrees, 37 degrees and -20 degrees C. The creamatocrit (CR) values decreased significantly after storage at room temperature (P less than 0.03), or at 37 degrees C (P less than 0.001) for 45 min and 30 min, respectively. Creamatocrit remained stable for 14 d at 4 degrees C, and for up to 28 d at -20 degrees C. However, freezing and thawing samples twice significantly decreased creamatocrit values (P less than 0.001). The total energy concentration of the samples stored at -20 degrees C was stable for 28 d. These results indicate that strict precautions must be taken when handling and storing human milk samples for analysis of lipid content.