title: Skin disease among farmers using wastewater in rice cultivation in Nam Dinh, Vietnam.
abstract: OBJECTIVE
  To assess the risk of skin disease among farmers occupationally exposed to wastewater.
  
  
  METHODS
  One-year follow-up study with monthly assessments of wastewater exposure and skin disease in Nam Dinh, northern Vietnam, in two adjacent communes with contrasting levels of wastewater use. In each commune, 200 households were randomly selected.
  
  
  RESULTS
  Of the 1103 individuals aged > or =15 years, 381 reported a skin problem at baseline or at any of the monthly visits, primarily dermatitis (eczema) and superficial fungal infections. Among the 874 subjects who were free from skin disease at baseline and who could be followed up > or =11 months, 183 developed a new skin disease (cumulative incidence 21%). Exposure to wastewater was a major risk factor for skin disease with a relative risk (RR) of 1.89 [95% confidence interval (CI) 1.39-2.57] in multivariable analysis. Other risk factors for skin disease were involvement in agriculture in general (RR = 2.59, 95% CI 1.11-6.02), flower cultivation (RR = 1.36, 95% CI 1.01-1.83), vegetable farming (RR = 1.47, 95% CI 1.04-2.08), and a history of eczema (RR = 1.47, 95% CI 1.05-2.05).
  
  
  CONCLUSIONS
  Exposure to wastewater is a major risk factor for skin disease. In future studies, an attempt should be made to link specific chemical or biological agents in the wastewater to specific skin diseases.
authors.affiliation: Division of Enteric Infections, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam. tranghai16@yahoo.com
authors.forename: Thuy Trang
authors.initials: TT
authors.lastname: Do
authors.forename: Wim
authors.initials: W
authors.lastname: van der Hoek
authors.forename: Dang Tuan
authors.initials: DT
authors.lastname: Nguyen
authors.forename: Dac Cam
authors.initials: DC
authors.lastname: Phung
authors.forename: Huu Viet
authors.initials: HV
authors.lastname: Vu
authors.forename: Duc Luu
authors.initials: DL
authors.lastname: Do
authors.forename: Flemming
authors.initials: F
authors.lastname: Konradsen
authors.forename: Anders
authors.initials: A
authors.lastname: Dalsgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D009783:Dermatitis, Occupational / Q000453:epidemiology* / Q000209:etiology; D003881:Dermatomycoses / Q000453:epidemiology* / Q000209:etiology; D004485:Eczema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D012275:Oryza; D012307:Risk Factors; D012722:Sewage / Q000009:adverse effects*; D014744:Vietnam / Q000453:epidemiology
chemical_list: D012722:Sewage