Flemming Konradsen - Academia.edu (original) (raw)

Papers by Flemming Konradsen

The Special SIMA Seminar on Malaria in Irrigated Agriculture at the 18th ICID International Congr... more The Special SIMA Seminar on Malaria in Irrigated Agriculture at the 18th ICID International Congress on Irrigation and Drainage was one of the activities aimed at increasing awareness in the agricultural community on the potential of environmental interventions to reduce malaria under Output 4 of SIMA. This document contains papers and abstracts submitted for this seminar in Montreal, Canada. The authors themselves are responsible for their contributions and it is hoped that the publication of these proceedings will stimulate discussions among participants of the seminar as well as in the wider SIMA Network. This seminar is organized by SIMA, the CGIAR Systemwide Initiative on Malaria and Agriculture, in collaboration with the International Water Management Institute (IWMI). This and subsequent scientific seminars will gather experts on malaria and agriculture to contribute to the development of a comprehensive knowledge base on malaria and agriculture

Occupational pesticide intoxications among farmers in Bolivia: a

choice due to pressure on the water re-sources, but the reliable flows and the nutri-ent values o... more choice due to pressure on the water re-sources, but the reliable flows and the nutri-ent values of wastewater also make farmers appreciate this resource. However, on-going research in Phnom Penh, Cambodia, indicates that exposure to urban wastewater represents a serious risk for skin diseases, especially dermatitis, on the hands and legs of aquacul-tural producers (van der Hoek et al, 2005). Moreover, the use of wastewater exposes agri-and aqua-cultural producers, as well as con-sumers, to increased risks of helminth infec-tions, such as Ascaris (round worm), Trichuris (whipworm), and hookworm (Blumental and Peasey, 2002; WHO, 2006a). In the rural areas of northern Vietnam, human excreta have been used as fertilizer in

Background Sri Lanka has reduced its overall suicide rate by 70% over the last two decades throug... more Background Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through regulation of a series of agricultural pesticides. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation. Methods We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011-16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners’ records, and the person’s family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides. Results We identified 337 suicidal deaths. Among them, 193 (57.3%) were due to ingestion of pesticides and 82 (24.3%) to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsi...

Crisis, Jan 21, 2018

In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immed... more In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immediately prior to the event. From reviewing the literature we proposed four interventions: (a) farmer identification cards (ID); (b) prescriptions; (c) cooling-off periods; and (d) training pesticide vendors. We aimed to identify the most promising intervention. The study was conducted in Sri Lanka. We mapped stakeholders' interest and power in relation to each intervention, and followed this by a ranking exercise. Seven focus group discussions (FGDs) were conducted to assess facilitators and barriers to implementation. Vendor training was the most supported intervention, being ranked first by the stakeholders. The participants in the FGDs strongly supported training of vendors as it was seen to be easy to implement and was considered more convenient. Farmer IDs, prescriptions, and cooling-off periods were thought to have more barriers than facilitators and they were strongly opposed b...

BMC public health, Feb 20, 2018

In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide... more In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such high-risk individuals. We aimed to test the feasibility and acceptability of vendor-based restrictions on pesticide sales for such high-risk individuals. We conducted a pilot study in 14 (rural = 7, urban = 7) pesticide shops in Anuradhapura District of Sri Lanka. A two-hour training program was delivered to 28 pesticide vendors; the aim of the training was to help vendors recognize and respond to customers at high risk of pesticide self-poisoning. Knowledge and attitudes of vendors towards preventing access to pesticides for self-poisoning at baseline and in a three month follow-up was evaluated by questionnaire. Vendors were interviewed to explore the practice skills taught in the training and their assessment of the program. The scores of knowledge a...

The Lancet, 2017

Background Agricultural pesticide self-poisoning is a major public health problem in rural Asia. ... more Background Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning. Methods We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. Findings Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293•3 per 100 000 person-years of follow-up in the intervention group vs 318•0 per 100 000 in the control group; rate ratio [RR] 0•93, 95% CI 0•80-1•08; p=0•33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1•22, 0•88-1•68]) or non-fatal (1135 vs 1153; RR 0•97, 0•86-1•08) self-harm events involving all methods. Interpretation We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia.

Journal of agromedicine, Jan 27, 2017

Pesticide self-poisoning is now considered one of the two most common methods of suicide worldwid... more Pesticide self-poisoning is now considered one of the two most common methods of suicide worldwide. Encouraging safe storage of pesticides is one particular approach aimed at reducing pesticide self-poisoning. CropLife Sri Lanka (the local association of pesticide manufacturers), with the aid of the Department of Agriculture, distributed lockable in-house pesticide storage boxes free of charge to a farming community in a rural district of Sri Lanka. Padlocks were not provided with the boxes. These storage boxes were distributed to the farmers without prior education. We carried out a cross sectional follow-up survey to assess the usage of boxes at 7 months after distribution. In an inspection of a sample of 239 box-recipients' households, 142 households stored pesticides in the provided box at the time of survey. Among them, only 42 (42/142, 29.65%) households had locked the box; the remaining households (100/142, 70.4%) had not locked the box. A simple hand over of in-house pes...

Journal of Water, Sanitation and Hygiene for Development, 2013

This study was done in four rural communities in Ghana to assess uptake of household latrines. A ... more This study was done in four rural communities in Ghana to assess uptake of household latrines. A total of 156 household interviews, 16 focus group discussions and 8 in-depth interviews with key informants were conducted. Study findings show that only 8.5% of households were using improved sanitation facilities with more than 75% of the households relying on open defecation and communal trench latrines. Knowledge of technological options was very limited and the cost for preferred latrines was unaffordable. Though health-related benefits motivated household latrine uptake, those related to personal security, privacy, social status and convenience were ranked higher. Sanitation uptake was constrained mainly by finances, poor sanitation promotion and general biophysical factors. High costs of latrine construction could be reduced by introducing cheaper technological options, using low-cost construction materials and labor contributions from households. Financing models like microcredit...

The Southeast Asian journal of tropical medicine and public health, 2006

The ancient practice of applying latrine wastes to agricultural land has maintained soil fertilit... more The ancient practice of applying latrine wastes to agricultural land has maintained soil fertility in Vietnam for several centuries but may be associated with health risks if the wastes are inadequately treated before usage. This study aimed at investigating the perceptions and handling practices using latrine wastes as fertilizers in a community in central Vietnam. Information was collected through structured questionnaire interviews administered to 75 farming households, focus group discussions, and key informant interviews. The majority (64%) of households had a single vault latrine, a possession that was associated with low income (chi2= 12.45; p < 0.05). Most households (85%) used latrine waste in agriculture that was composted before usage (98%). Households often mixed the composted excreta with kitchen ashes and powdered lime likely to increase pH and pathogen die-off. About 28% of households that were applying latrine waste as fertilizer composted three to six months, and...

Environmental health : a global access science source, Jan 21, 2006

Pesticide use and its consequences are of concern in Bolivia due to an intensive and increasing u... more Pesticide use and its consequences are of concern in Bolivia due to an intensive and increasing use. To assess the magnitude and reasons for occupational pesticide intoxication, a cross-sectional study with interviews and blood-tests was performed among 201 volunteer farmers from 48 villages in the temperate and subtropical valleys in the eastern part of the Andes Mountains in Bolivia. Of these 171 male farmers using pesticides in their agricultural production were used in the statistical analysis, including linear- and logistic regression analysis. This study documented a frequent use of the most toxic pesticides among farmers who have had almost no instructions in how to use pesticides and protect themselves against the dangers of intoxication, reflected in the hazardous practices used when handling pesticides. Symptoms of intoxications were common in connection with spraying operations. The risk of experiencing symptoms and the serum cholinesterase activity were influenced by whe...

Environmental health : a global access science source, Jan 16, 2009

For centuries farmers in Vietnam have fertilized their fields with human excreta collected direct... more For centuries farmers in Vietnam have fertilized their fields with human excreta collected directly from their household latrines. Contrary to the official guideline of six-month storage, the households usually only store human excreta for three to four months before use, since this is the length of time that farmers have available to produce fertilizer between two cropping seasons. This study aimed to investigate whether hygienically safe fertilizer could be produced in the latrines within this period of time. By inoculating eggs of the helminth parasite indicator Ascaris suum into heaps of human excreta, a die-off experiment was conducted under conditions similar to those commonly used in Vietnamese latrines. Half a ton of human excreta was divided into five heaps containing increasing concentrations of lime from 0% to 11%. Regardless of the starting pH, which varied from 9.4 to 11.6, a >99% die-off of eggs was obtained after 105 to 117 days of storage for all lime concentratio...

Bmc Public Health, 2007

Background: Acute poisoning by agricultural pesticides is a well established global public health... more Background: Acute poisoning by agricultural pesticides is a well established global public health problem. Keeping pesticides under safe storage is now promoted as a potential way to reduce the number of severe poisoning cases. However, there have been no published studies documenting the feasibility of such an approach. Therefore, the objective of the study presented here was to determine community perceptions and use of in-house safe storage boxes for pesticides in rural Sri Lanka. Methods: Boxes with a lock, to be used for the in-house safe storage of pesticides, were distributed to 200 randomly selected farming households in two agricultural communities. A baseline survey determined pesticide storage practices and household characteristics prior to distribution. The selected households were encouraged to make use of the box at community meetings and during a single visit to each household one month after distribution. No further encouragement was offered. A follow-up survey assessed storage practices seven months into the project. Results: Following the distribution of the boxes the community identified a number of benefits including the protection of pesticide containers against exposure from the rain and sun and a reduced risk of theft. Data were analysed for 172 households that reported agricultural use of pesticides at follow-up. Of these, 141 (82%) kept pesticides in the house under lock against 3 (2%) at baseline. As expected, the distribution of boxes significantly reduced the number of households storing pesticides in the field, from 79 (46%) at baseline to 4 (2%) at follow-up. There was a significant increase in the number of households keeping pesticides safe from children between baseline (64%) and seven months after the distribution of boxes (89%). The same was true for adults although less pronounced with 51% at baseline and 66% at follow-up. Conclusion: The farming community appreciated the storage boxes and made storage of pesticides safer, especially for children. It seems that additional, intensive promotion is needed to ensure that pesticide boxes are locked. The introduction of in-house safe storage boxes resulted in a shift of storage into the farmer's home and away from the field and this may increase the domestic risk of impulsive self-poisoning episodes. This increased risk needs attention in future safe storage promotion projects.

BMC Research Notes, 2014

Background: Personal digital assistants (PDAs) have been shown to reduce costs associated with su... more Background: Personal digital assistants (PDAs) have been shown to reduce costs associated with survey implementation and digitisation, and to improve data quality when compared to traditional paper based data collection. Few studies, however, have shared their experiences of the use of these devices in rural settings in Asia. This paper reports on our experiences of using a PDA device for data collection in Sri Lanka as part of a large cluster randomised control trial. Findings: We found that PDAs were useful for collecting data for a baseline survey of a large randomised control trial (54,000 households). We found that the PDA device and survey format was easy to use by inexperienced field staff, even though the survey was programmed in English. The device enabled the rapid digitisation of survey data, providing a good basis for continuous data quality assurance, supervision of staff and survey implementation. An unexpected advantage was the improved community opinion of the research project as a result of the device, because the use of the technology gave data collectors an elevated status amongst the community. In addition the global positioning system (GPS) functionality of the device allowed precise mapping of households, and hence distinct settlements to be identified as randomisation clusters. Future users should be mindful that to save costs the piloting should be completed before programming. In addition consideration of a local after-care service is important to avoid costs and time delays associated with sending devices back to overseas providers. Discussion: Since the start of this study, PDA devices have rapidly developed and are increasingly used. The use of PDA or similar devices for research is not without its problems; however we believe that the universal lessons learnt as part of this study are even more important for the effective utilisation of these rapidly developing technologies in resource poor settings.

Journal of Toxicology, 2011

Organophosphates and carbamates (OPs/CMs) are known for their acetylcholinesterase inhibiting cha... more Organophosphates and carbamates (OPs/CMs) are known for their acetylcholinesterase inhibiting character. A cross-sectional study of pesticide handling practices and self-perceived symptoms of acute pesticide poisoning was conducted using questionnaire-based interviews with 89 pesticide sprayers in Boeung Cheung Ek (BCE) Lake, Phnom Penh, Cambodia. The study showed that 50% of the pesticides used belonged to WHO class I + II and personal protection among the farmers were inadequate. A majority of the farmers (88%) had experienced symptoms of acute pesticide poisoning, and this was significantly associated with the number of hours spent spraying with OPs/CMs (OR = 1.14, CI 95%: 1.02–1.28). The higher educated farmers reduced their risk of poisoning by 55% for each extra personal protective measure they adapted (OR = 0.45, CI 95%: 0.22–0.91). These findings suggest that improving safe pesticide management practices among the farmers and enforcing the effective banning of the most toxic...

BMJ Open, 2014

IntroductionSri Lanka has one of the highest suicide and self-harm rates in the world and althoug... more IntroductionSri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm.Methods and analysisTo capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story in...

The publications in this series cover a wide range of subjects-from computer modeling to experien... more The publications in this series cover a wide range of subjects-from computer modeling to experience with water user associations-and vary in content from directly applicable research to more basic studies, on which applied work ultimately depends. Some research reports are narrowly focused, analytical and detailed empirical studies; others are wide-ranging and synthetic overviews of generic problems. Although most of the reports are published by IWMI staff and their collaborators, we welcome contributions from others. Each report is reviewed internally by IWMI staff, and by external reviewers. The reports are published and distributed both in hard copy and electronically (www.iwmi.org) and where possible all data and analyses will be available as separate downloadable files. Reports may be copied freely and cited with due acknowledgment.

Urban Water Journal, 2011

Assessment was done on the microbiological quality of water in hand-dug wells in urban communitie... more Assessment was done on the microbiological quality of water in hand-dug wells in urban communities in Kumasi, Ghana. A total of 256 water samples were taken from eight wells and examined for faecal coliforms, enterococci and helminths. High contamination levels were recorded in the wells, more so in the wet season, with faecal coliforms levels between 6.44 and 10.19 log units and faecal enterococci between 4.23 and 4.85 CFU per 100 ml. Influence on protection and lining of wells on water quality was not pronounced but mechanization reduced contamination significantly by about 3 log units. This study shows a stronger influence of poor sanitation and improper placement of wells on water quality compared to improvements made from lining and protection of wells. In the race to increase access to drinking water in poor urban settlements, quality of groundwater could be a major barrier, if provision of drinking water is not matched with improvements in sanitation and urban planning.

Tropical Medicine and International Health, 2001

BACKGRO UND BACKGROUND In arid and semi-arid countries there are often large areas where groundwa... more BACKGRO UND BACKGROUND In arid and semi-arid countries there are often large areas where groundwater is brackish and where people have to obtain water from irrigation canals for all uses, including domestic ones. An alternative to drawing drinking water directly from irrigation canals or village water reservoirs is to use the water that has seeped from the irrigation canals and irrigated ®elds and that has formed a small layer of fresh water on top of the brackish groundwater. The objective of this study was to assess whether use of irrigation seepage water for drinking results in less diarrhoea than direct use of irrigation water and how irrigation water management would impact on health. METHODS METHODS The study was undertaken in an irrigated area in the southern Punjab, Pakistan. Over a one-year period, drinking water sources used and diarrhoea episodes were recorded each day for all individuals of 200 households in 10 villages. Separate surveys were undertaken to collect information on hygiene behaviour, sanitary facilities, and socioeconomic status. RESULTS RESULTS Seepage water was of much better quality than surface water, but this did not translate into less diarrhoea. This could only be partially explained by the generally poor quality of water in the in-house storage vessels, re¯ecting considerable in-house contamination of drinking water. Risk factors for diarrhoea were absence of a water connection and water storage facility, lack of a toilet, low standard of hygiene, and low socioeconomic status. The association between water quality and diarrhoea varied by the level of water availability and the presence or absence of a toilet. Among people having a high quantity of water available and a toilet, the incidence rate of diarrhoea was higher when surface water was used for drinking than when seepage water was used (relative risk 1.68; 95% CI 1.31± 2.15). For people with less water available the direction of the association between water quality and diarrhoea was different (relative risk 0.80; 95% CI 0.69±0.93). This indicates that good quality drinking water provides additional health bene®ts only when suf®cient quantities of water and a toilet are available. In a multivariate analysis no association was found between water quality and diarrhoea but there was a signi®cant effect of water quantity on diarrhoea which was to a large extent mediated through sanitation and hygiene behaviour. CONCLUSIO NS CONCLUSIONS Increasing the availability of water in the house by having a household connection and a storage facility is the most important factor associated with reduced diarrhoea in this area. Safe use of canal irrigation water seems possible if households can pump seepage water to a large storage tank in their house and have a continuous water supply for sanitation and hygiene. Irrigation water management clearly has an impact on health and bridging the gap between the irrigation and drinking water supply sectors could provide important health bene®ts by taking into account the domestic water availability when managing irrigation water.