Pathways of diarrheal illness and risk mitigation in wastewater-irrigated urban vegetable farming

Urban Farm DB summary

A comparative cross-sectional study of 315 urban vegetable-farming households along the Akaki Rivers in Ethiopia used structured questionnaires, multivariable logistic regression, multilevel mixed-effects models and bootstrapped mediation analysis. Two-week diarrhea prevalence was 11.4% (36/315) among children and 8.7% among adults; in this cross-sectional design, which cannot establish causality, wastewater irrigation was associated with more than double the odds of diarrhea (AOR=2.10, 95% CI 1.30-3.40), frequent contact with irrigation water with 80% higher odds (AOR=1.80), and regular raw-vegetable consumption with 60% higher odds (AOR=1.60). Handwashing with soap (57% risk reduction), bathing after farm work (41% reduction) and household water treatment (45% reduction, AOR=0.55) were protective, clustering by irrigation site was modest (ICC about 6%), and hygiene practices mediated 28% of the exposure-outcome relationship.