Fresh produce, when consumed raw, can be a source of exposure to antimicrobial residues, antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) of clinical importance. This review aims to determine: (1) the presence and abundance of antimicrobial residues, ARB and ARGs in fresh agricultural products sold in retail markets and consumed raw; (2) associated health risks in humans; and (3) pathways through which fresh produce becomes contaminated with ARB/ARGs. We searched the Ovid Medline, Web of Science and Hinari databases as well as grey literature, and identified 40 articles for inclusion. All studies investigated the occurrence of multidrug-resistant bacteria, and ten studies focused on ARGs in fresh produce, while none investigated antimicrobial residues. The most commonly observed ARB were E. coli (42.5%) followed by Klebsiella spp. (22.5%), and Salmonella spp. (20%), mainly detected on lettuce. Twenty-five articles mentioned health risks from consuming fresh produce but none quantified the risk. About half of the articles stated produce contamination occurred during pre- and post-harvest processes. Our review indicates that good agricultural and manufacturing practices, behavioural change communication and awareness-raising programs are required for all stakeholders along the food production and consumption supply chain to prevent ARB/ARG exposure through produce.

Background: The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. Objective: We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. Methods: We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). Results: This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. Conclusions: Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. International Registered Report Identifier (IRRID): PRR1-10.2196/33365

In Bangladesh, approximately 31% of urban residents are living without safely managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing low-income communities (LICs) under a sewerage connection within the proposed sewerage network plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bills equally among sharing households, or by users per household. Participants also suggested the government’s cooperation with development-partners/NGOs to ensure sewerage connection construction, operation, and maintenance and prerequisite policy changes such as assuring land tenure.

In Bangladesh, cities produce huge volumes of solid waste, sewage, and greywater with limited resources to manage it. Waste and sanitation workers, key players in managing waste, are continuously exposed to different health hazards in their work due to lack of occupational safety and basic protections. This vulnerability has been exacerbated by the COVID-19 Pandemic. Focusing on workers’ experiences and everyday working realities, this study sought to assess the organizational capacity, gaps, and challenges of local waste management authorities during COVID-19. It also sought to deepen understanding of job arrangements, occupational safety, hygiene knowledge, and practices of these waste workers at their workplace. A qualitative study was conducted consisting of 61 key informant interviews with seven categories of local officials and 50 in-depth interviews with five categories of waste and sanitation workers in 10 cities of Bangladesh. An inductive content analysis approach was adopted. The results showed that COVID-19 had aggravated the existing waste management challenges and imposed severe health risks on waste workers. Respective conservancy departments lagged behind due to lack of safe cleaning methods and equipment, and limited funds for waste worker training, which ultimately led to poor occupational safety for workers. This vulnerable worker group lacked basic job facilities, received poor payment and insufficient protective equipment, and rarely had any health support from their employers. Also, they were not provided with an adequate understanding of occupational safety and health hygiene; and no appropriate handwashing facilities at their workplace to tackle infectious diseases like COVID-19. The study investigated this countercomplaint and discussed the current arrangements from the prespective of both city authorities and waste workers. The study recommended more automated waste collectors and compositors for the conservancy departments, increased active monitoring, work benefits, safety equipment for waste workers, and tailored training to eradicate work-related health hazards and injuries.

Water chlorination is widely used in emergency responses to reduce diarrheal diseases, although communities with no prior exposure to chlorinated drinking water can have low acceptability. To better inform water treatment interventions, the study explored acceptability, barriers, and motivating-factors of a piped water chlorination program, and household level chlorine-tablet distribution, in place for four months in Rohingya refugee camps, Cox’s Bazar, Bangladesh. We collected data from June to August 2018 from four purposively selected refugee camps using structured observation, key-informant-interviews, transect-walks, group discussions, focus-group discussions, and in-depth-interviews with males, females, adolescent girls, and community leaders. Smell and taste of chlorinated water were commonly reported barriers among the population that had previously consumed groundwater. Poor quality source-water and suboptimal resultant treated-water, and long-queues for water collection were common complaints. Chlorine-tablet users reported inadequate and interrupted tablet supply, and inconsistent information delivered by different organisations caused confusion. Respondents reported fear of adverse-effects of "chemicals/medicine" used to treat water, especially fear of religious conversion. Water treatment options were reported as easy-to-use, and perceived health-benefits were motivating-factors. In vulnerable refugee communities, community and religious-leaders can formulate and deliver messages to address water taste and smell, instil trust, allay fears, and address rumours/misinformation to maximise early uptake.

Globally, 2.2 billion urban residents are living without safely-managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the feasibility of connecting low-income communities (LICs) within the proposed sewerage network by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bill equally among sharing households, or by users per household. Participants also suggested the government's cooperation with development-partners/NGOs to ensure sewerage connection construction, operation and maintenance and prerequisite policy changes such as assuring land tenure.