Modes of waste disposal in Berekum and Dormaa.
\r\n\tIn the last decades, particular attention to this field has been paid to the coastal erosion problem all over the world. Indeed, the deployment of artificial reservoirs, modification of the runoff characteristics of internal areas, sand extraction from rivers, and harbor siltation, caused a decrease of sediment input on the coastal environments, and, therefore, a generalized deficit in the sediment budget. Often, dredging activities are required to collect sediment finalized to “soft” techniques to restore beaches or to move the sand trapped in the harbor (clean or contaminated).
\r\n\tMoreover, the coastal protections induced hydrodynamics and morphodynamics modifications inducing sometimes strong variations to the sediment transport regime.
\r\n\tHistorically, all these aspects are related to specific research areas ranging from engineering, geology, geomorphology, biology, etc, but it is difficult to find a comprehensive overview of these topics.
\r\n\r\n\tThis book is intended to collect original works and review concerning numerical and experimental investigation, theoretical works, methodological approaches, and any other technique that allow giving the actual state-of-the-art in the field of sediment transport.
",isbn:"978-1-80355-868-4",printIsbn:"978-1-80355-867-7",pdfIsbn:"978-1-80355-869-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"e7b1c1592e32fe87af399022616ad0f8",bookSignature:"Dr. Davide Pasquali",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11136.jpg",keywords:"Longshore Sediment Transport, Sediment Budget, Morphodynamics, Hydrodynamics, Sediment Transport, Sedimentation, Mathematical Modelling, Erosion and Deposition, Dredging, Harbor Siltation, Contaminated Sediment, Water Quality",numberOfDownloads:45,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 4th 2021",dateEndSecondStepPublish:"February 23rd 2022",dateEndThirdStepPublish:"April 24th 2022",dateEndFourthStepPublish:"July 13th 2022",dateEndFifthStepPublish:"September 11th 2022",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Davide Pasquali is currently a Research Fellow in the Department of Civil, Construction-Architectural, and Environmental Engineering (DICEAA) at the University of L’Aquila. 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In Ghana, the increasing rate at which waste is generated in the cities is alarming; yet government has not been able to respond in an equal measure. The proportion of populations living in urban areas in Africa is expected to increase from 40% in 2010 to about 57% in 2050 [1]. This incomparable rise in the level of urbanization in the first half of the twenty-first century Africa has goaded a variety of questions, apprehension, and agitation about the possible connotations of this development on the quality of life of Africa’s rising population, and for environmental health in general [2]. This phenomenon has unquestionably buoyed a proclivity to consider the twenty-first century as marshaling in a period of predominantly urban civilization in Africa where urbanism is rapidly dominating ruralism [3]. Yet, the challenge of considerable transformation in the manner and pattern of urban functionality becomes ever more complex in the midst of unsustainable waste management problems [4].
\nThe last three decades have seen a tremendous shift in government policies toward decentralization in the developing world. These policies are typically a component of comprehensive process of political, economic, social and technical reforms [5]. This has been inspired by new efforts of democratization and process of ‘modernization’ of the state. It can be argued that these initiatives combined to foster accountability, cost consciousness and competition in the public sector as well as develop a new role for the state in enabling and regulating rather than taking the place of the private sector. On the flipside, solid waste management (SWM) has become an important part of the urban environment as well as the planning of the urban infrastructure to safeguard a safe and healthy human environment. Continuous urbanization of developing countries at a very high rate has created serious problems of waste disposal as a result of uncontrolled and unmonitored urbanization [6]. Waste is a continually growing problem at the global, regional and local levels. The World Bank [7, 8], reported that there will be 70% increase in urban solid waste globally with a projected rise in the amount of waste, from 1.3 to 2.2 billion tonnes per year from 2012 to 2025, which will lead to a rise in the annual global costs of global waste from $205 billion to $375 billion. Within the same 13 years span, developing countries are facing the greatest challenges in the waste management sector.
\nIn Africa, the poor state of solid waste management in urban areas is not only an environmental problem but also a major social handicap. In Kenya, it is expected that the amount of solid waste generated will increase from 2000 to 10,171 tonnes per day by 2025 [9]. The problem is further aggravated by the lack of financial as well as technical expertise in SWM technology and management especially in the sphere of collection, transportation, processing and final disposal. Whereas aspects like recycle, reuse and recovery of the solid waste is disorganized in most cases. In this context, the responsible persons or agencies concerned with public health and environment protection face the crisis of ineffective SWM. In the Ghanaian context, the situation is not different. Due to rapid urbanization, Ghana’s major agglomerations have been growing quickly but have lacked a concurrent expansion in SWM. Addaney and Oppong [4] observe that Ghana like other developing countries has over the years had difficulties in municipal solid waste management with regards to infrastructural and technical inefficiencies. In view of this, the government has attempted to decentralize the SWM service delivery. These efforts have often become embroiled in politics, with less emphasis on efficient SWM delivery. In isolated cases where services have been decentralized, there have been inadequate policy direction and limited resource transfers to the lower levels of governance. Consequently, effective decentralized solid waste management has not been forthcoming.
\nThe solid waste management subsector has been bedeviled with ineffectiveness despite the adoption of a number of policies and reform programs. Principally, decentralization has been designed to ensure efficiency and better service delivery at the local level. Despite this, there still exist challenges such as asymmetrical waste collection, waste overflow from bins, inadequate storage containers, and disposal of waste in unauthorized space in most municipalities in Ghana [4]. These challenges lead to public health hazards, esthetic nuisance, and environmental pollution. The public health implications have been fazing, accounting for about 5% of the GDP [10]. Data from the Ghana Health Service indicate that six (6) out of the top ten (10) diseases in Ghana are linked to poor environmental sanitation, with malaria, diarrhea and typhoid fever jointly constituting 70–85% of out-patient cases at health facilities [10]. The Berekum and Dormaa Municipalities are no exception to these undesirable environmental problems.
\nTherefore, this study attempts to unpack the difficulties face by the municipal authorities in keeping pace with solid waste facilities development and management. It is driven by the question of how decentralized SWM has evolved to ensure quality and sustainable service delivery in the medium-size towns of Berekum and Dormaa in the Brong Ahafo Region of Ghana. It analyzed the evolving practices of decentralized solid waste collection for sustainable service delivery, the service quality of decentralized urban SWM institutions; and the factors which explain the differences in service quality of the decentralized SWM of the two municipalities. It adopts the assertion that the inability of municipal authorities to effectively manage their solid waste usually leads to inefficient use of time and resources, and which eventually leads low productivity and poor service quality [4, 11].
\nGenerating solid waste (SW) is inevitable. Cities in developing countries have frequently been unable to keep up with the provision of basic services [12]. About 40% of the solid waste generated in developing countries is uncollected, piles up on streets and in drains, contributing to flooding and the spread of disease. In addition, domestic and industrial effluents are often released into waterways with little or no treatment [12]. Solid waste has been a major challenge for municipal authorities for about 6000 years now [13]. The concept of waste is relative in two main respects. Firstly, something becomes waste when it loses its primary function for the user. Hence, one person’s waste output is often someone else’s raw material input. Secondly, the notion of waste is also relative to the technological state of the art and to the location of its generation ([14], p. 70). Waste is therefore a very dynamic concept and must be looked at within these two contexts. Many transnational organizations including the United Nations Environment Programme (UNEP) have their own definitions to the notion of waste. The UNEP [15] defined waste as any substances or objects which are disposed of or are intended to be disposed of or are required to be disposed of by national law.
\nWastes that are solid are termed to as “refuse” or solid waste [16]. Waste has been defined differently by many Authors with different meaning. One definition is that waste is ‘unwanted’ by the first user. It is therefore anything that is no longer ‘unwanted’ dependent on the time and the prevailing circumstances. Solid waste today is increasingly defined as “natural resources out of place” or as “new materials for technologies not yet found” [17]. Many governments now regard waste as a useful source of income and as such policies have been geared toward this potential by both the government and the public sector to harnessing this potential. The recycling subsector for example, is an essential industry generating revenues and jobs for a larger number of people in the world today. Waste Watchers [18] defined solid waste management as everything that must be done to handle all the solid waste produced in a community, including collecting, transporting, processing and disposal of waste. Similar to this is the one put forward by Tchobanoglous et al. [19] that SWM involves the collection, treatment and disposal of non-hazardous waste.
\nWaste generation is the most important aspect to look at in order to have effective SWM system. The generation of waste varies considerably between countries based on the culture, public awareness and management [20, 21]. Waste generation comprise those activities in which materials are identified as no longer of any value by the owners/users and either thrown away or gathered for disposal [22]. Generally, developed countries generate more waste than developing countries [23]. Countries in Asian and African region produce waste in the range of 0.21–0.37 tonnes/capita/year, while European countries generate higher amount of waste with 0.38–0.64 tonnes/capita/year [24]. The waste generated by a population is a function of consumption patterns and thus of socioeconomic characteristics and the interest in and willingness to pay for collection services ([25], p. 35).
\nDisposal is broadly defined to include the collection, storage, treatment or processing, utilization, or final disposal of waste. It involves the process of getting rid of the waste materials that people generate [26]. Information on waste generation is important to determine the most suitable waste disposal options. The main purpose in implementing best practice for solid waste management is to prevent pollution. Pollution is a threat to human and other living organism and it may also damage the ecosystem and disrupt the natural cycle and climate on earth [27]. There are many disposal options available to suit the nature of waste and a country’s preference and interest. Economics and environmental aspects of waste disposal option are always the main issue in choosing the right technology [28]. Most developed countries, are on their way to eliminate land filling while some other countries still have problems with open dumping [29, 30].
\nDespite the development of many waste disposal option, landfills remain the most prominent system applied worldwide [30, 31]. Although a lot of improvement had been possible in the land filling system and the regulation on the type of waste that can be treated at landfill is stringent, most of landfills operated remain primitive [31]. Ayomoh et al. [32] had listed few problems related to improper landfill operation including, health deterioration, accidents, flood occurrences, pollution of surface and underground waters, unpleasant odor, pest infestation and gas explosion. Although the impacts from landfills are known, impacts from other alternative remain unanswered thus subject to critics [31]. Incineration has been the choice for developed countries as they have sufficient financial input and are looking into energy recovery from waste [33, 34]. Small countries such as Singapore adopt incineration as their waste disposal option due to scarcity of land [35]. Even that, incineration is also associated with some other risks. This includes the generation of carcinogenic and toxic compound.
\nSome scholars have observed that the impacts from incineration are overemphasized and the advancing technology had highly reduced the environmental impacts [31]. However, many of the countries prefer waste minimization compared to waste treatment such as landfill or incineration [35, 36]. Technology is advancing every day and chemical recycling of plastic wastes has also been made possible in these developed countries [37]. Regardless of the technology chosen, each has its advantages and disadvantages. The information on each disposal option needs to be clarified to determine the suitable option for each particular country. Few tools had been used in the environmental evaluation including in determining best waste disposal option. For example, life cycle assessment determined that the most economically feasible option for traditional market waste management in Indonesia is composting at a centralized plant, while biogas production option has the lowest environmental impact [28]. SW Plan software particularly to calculate capital and management cost is also available to determine the best integrated technology in waste management [38].
\nBefore 1985, incinerators were the technology used for handling waste in the urban centers of Ghana. This could not be sustained due to the lack of funds as a result of economic hardship in early 1980 and technical knowhow. In view of this by 1985 solid waste were dumped on all bola locations [39]. Thereafter a special department called the waste management department (WMD) was set up in the urban centers in 1985 to manage the waste in Ghana with financial and technical assistance from the German Agency for Technical Co-operation (GTZ). The first house to house collection started in Accra using animal drawn carts using donkeys in the high income residential areas. Waste collected was dumped into central containers. Using only 15 donkeys and 10 staff the carriage could collects 3–4 trips daily which covered 75–100 houses [39]. The GTZ project helped to improve the deteriorated waste management in Ghana. However their exit saw more deterioration in level of service quality and service coverage due to the fact that the public provision alone could not handle the growing urbanization of the towns and cities. This however calls for further decentralization to include the private initiative in solid waste management.
\nThe waste companies provided house-to-house and communal services. The communal service was mostly provided in the lower middle income areas using central containers. Residents who patronize this kind of service disposed of their waste by taking it to a central containers site. This containers are lifted full of waste and dispose of at designated disposal sites [39]. Private Sector Initiative (PSI) started in Accra and Tema in the early 1990s and later extended to Kumasi in the mid-1990. Afterwards, this initiative was extended to Takoradi and Tamale in 2000 and 2002 respectively. There year 2004–2007 saw the inclusion of more private companies in to waste business all over Ghana. The companies in Accra and Tema increased to 18 and 6 respectively by 2006. As a result, contracts were open up for competition. The first competitive bidding for solid wastes took place in Kumasi in 2007 and later in Accra in year 2008 [39]. The rapid population growth in Ghana has resulted in increased waste generation in the country. The amount of solid waste generated per day in Accra was 750–800 tonnes in 1994 [40]; 1800 tonnes per day in 2004; 2000 tonnes per day in 2007 this figure increased to 2200 in 2010 [41].
\nThe methods for solid waste disposal in Ghana are uncontrolled dumping of refuse, controlled dumping, sanitary land filling, composting, and incineration [42]. Open refuse dumps are most commonly located at the perimeter of major urban centers in open lots, wetland areas, or next to surface water sources. Open dumps are generally sited based on considerations of access to collection vehicles rather than hydrological or public health considerations. In rural areas and small towns, there are often no vehicles for collection hence uncontrolled dumping occurs within the built up areas with all its attendant health hazards and negative environmental impact [42]. Problems from landfills in Ghana include odor, insufficient covering material, flies and other vermin infestations and smoke from open fires. The increasing amount of waste received by these landfill make it necessary to find other disposal option since constructing new landfills may be difficult due to the scarcity of land, increase of land price and demand for a better disposal system. Effective solid waste therefore calls for a competent and responsible institutions as well as sound managerial system.
\nThe Ministry of Local Government and Rural Development (MLGRD) is the institution responsible for waste management services at the national level. This institution formulates waste and sanitation policies and also provides oversight role to the assemblies and gives subsidies for the provision of SWM services. The Ministry supervises the activities of local Assemblies and passes order as required by law to the various Waste Management Departments of the local Assemblies who are directly responsible for effective solid waste management. As part of the decentralization process in Ghana, in 1988 the waste management functions became a sole responsibility of the Assemblies [43]. About 90% of the Assemblies budget is supported by the Central Government to carry out their obligations in the locality through the various departments. The WMD is responsible for all the waste collection, disposal and monitoring of all the activities of companies engaged by the Assemblies. On the legal and regulatory frameworks for effective solid waste management, the policy which regulates waste management in Ghana is primarily reflective of legislation enacted at the national level and decisions made in pertinent case law. The Central Government bestows local authority status, onto any town or city in accordance with Act 462 which come to replace the previous act enacted in 1988 [39]. In spite of this, the Government continues to exercise controls over the Metropolitan, Municipal, and District Assemblies (MMDAs). The Central Government usually gives directives that affect the Assemblies. The most important is the fact that, a considerable amount of the Assemblies revenue is a direct disbursement from the Central Government. This makes it very difficult for the assemblies to be free from government interference. However, the MMDAs have a constitutional mandate under the 1993 (Act 462) to effectively handle sanitation issue which includes solid-waste management and therefore needed to operate independently to benefit the people. This responsibility is farfetched due to lack of independence. The 1960 (Act 29) of the Criminal Code of Ghana, state in no uncertain terms that whoever places or permits to be placed, any refuse, or rubbish, or any offensive or otherwise unpleasant material, on any yard, street, enclosure, or open space, except for the reason that such a place has been designated by the Assembly for such intent and purpose commits an offense. The law requires individuals to take full responsibility for the streets, drains and space closer to their premises [39].
\nIn addition, the legal regime in Ghana mandate the Assemblies as owners of all the waste generated in municipalities and as a result has the mandate to collect, recycles and discards solid waste. The National Building Regulations, The 1996 (LI 1630) which is the national building regulation stipulates that a building for residential, commercial, industrial, civic or cultural use shall have a facility for refuse disposal, a standardized dustbin and other receptacles approved by the Assembly in which all the waste generated shall be stored pending final collection by the trucks to final disposal site [39]. SWM in Ghana is greatly influenced by the Environmental Sanitation Policy of 2008. This policy is an update of the 1999 policy with the view to meet the prevailing development objectives and address the aspirations of the principal actors in the sector after 8 years of slow implementation with very little impact [10]. With reference to environmental sanitation, the policy requires the Assemblies to control environmental sanitation and check pollution in all forms [39]. The policies tend to reflect prevailing ideas on solid waste management and give an overall evaluation of the prevailing circumstance in the country. It further ensured private sector participation and the provision of 80% of SWM in all the assemblies [39]. The Ministry of Local Government is mandated to regulate the waste business. The regulation works to promote competition via legal restrictions and regulatory rules and controls concerning market entry and exit, the capacities of companies operating in the waste market, user charges and the service standards. The local assemblies are mandated to outsource solid waste collection to decentralized agents service by contracts and also embark on frequent monitoring and evaluation of the service quality provided by the companies and sanction any insubordination according to the dictate of the contract.
\nThe policies and regulations and the contractual agreement that connect the assemblies with the companies are important factors that contribute to effective solid waste collection, treatment and disposal. These regulations include the Local Government Act, National Procurement Act, Local Governments By-law, Environmental Sanitation Policy, and other state conventions that provide rules for solid waste management. The Procurement Act [44] requires the Assemblies Tender Boards to use competitive bidding to select companies [39]. This call for appropriate mechanisms suitable for the local conditions from an environment, social and fiscal perspectives, and at the same time being more capable to be sustain over long period of time without reducing the resources it needs [45]. Based on this the conceptual framework of the study focuses on four key variables, namely: evolving practice of SWM, households’ involvement for service sustainability, private company capacity and lastly, regulatory mechanisms and control for solid waste management in relation to service quality.
\nThis study focused on two municipal areas (Berekum and Dormaa) located in the Brong Ahafo region of Ghana (see Figure 1). These municipalities were selected based on their rapid expansion and urbanization [46]. The total land size of the Berekum Municipality is 1635 km2. This area covers about 0.7% of the entire land area of Ghana (233,588 km2). The Berekum Municipality lies between latitudes 6°27 N and 7°00 N and longitude 2°52 W. According to the 2010 Population Census of Ghana, the population of the municipality stood at 129,628. The annual average population growth rate is 2.2%. The 2015 population of the municipality was 144,528. This growth rate compares favorably with both the regional and national rates of 2.3 and 2.5% respectively. Dormaa Municipality, on the other hand, lies between latitude 7° and 7°30’N and longitude 3° and 3°30’N. It covers a land area of 912 km2. The 2010 housing and population census of Ghana put the total population of Dormaa municipality at 159,789 with an annual growth rate of 2.4%.
\nMap of study area.
The study adopted the case study research method [47]. Purposive sampling [48] was used to select 12 communities from the two municipalities. Firstly, the study area was zoned into two clusters namely: Berekum municipality and Dormaa municipality. Secondly, purposive sampling was used to select twelve (12) areas from the two municipalities for the survey. Through a mixed methods design [49], both qualitative and quantitative research methods were used for the data collection and analysis. A household survey was conducted with household respondents to understand solid waste management and service delivery across the 12 selected communities. Using Slovin’s formula: n = N/1 + N(α)2, where ‘n’ is the sample size, ‘N’ is the total number of households, ‘α’ is the margin of error (0.05), a total sample size of 312 households across the 12 case study communities were randomly selected and involved in the household survey. The sample size of 312 was divided equally among the 12 selected communities. This gave a sample size of 26 for each selected area. Finally, accidental sampling method was used to select the respondents for interview. That is, the first person to be contacted in each selected house was interviewed. If the first person contacted was not ready, the next available person was interviewed. To gather statistical and policy information on solid waste management and service delivery the two municipalities, semi-structured interviews were also undertaken with an official of the Assemblies (Berekum and Dormaa), responsible for the environmental health and waste management of the municipalities. In analysis, the study used a cross-case analysis procedure to analyze the interview data. In this approach, responses to a common question from all interviewees in each category are analyzed together. The findings of the study were validated and verified through focus group discussions with household respondents in each of the 12 case study communities. This approach was appropriate in addressing the inconsistencies that had occurred during the data analysis.
\nCoverage of service in these two municipalities as a result of GTZ assistance in the 1980s were not available it is believe that coverage were very high. This is seen in the numerous waste dumping site which became known as “bola” in the old communities of these two municipalities. As these municipalities expanded the waste departments did not build new site for waste. With this, the coverage continued to fall from the 1990s of about 75–50 perfect by the year 2006 according to the municipal waste directors of Berekum and Dormaa. The fall off called for the involvement of the private companies. Checks by the study revealed that the private companies formally started in Berekum and Dormaa in 2006. These municipalities were not group into zones. One company provided SWM services in the municipalities, there was no competitive bidding, and one company was given the contract to provide house to house and community collection service. This discovery confirms what Oduro-Kwarteng [39] indicated of the evolution of decentralized SWM in the country.
\nBasically results from the data analyzed on waste disposal in the Berekum Municipality confirmed that three ways of waste collection exist in Berekum including House-to-house collection, communal dumpsites and open dump site (Table 1). From the survey, majority (62%) of the respondents disposed of their waste into communal containers. This is followed by 29% of the respondents who indicated that their waste was collected directly from their houses (which are mostly found in the new residential areas). A total of 16% indicated that they emptied their waste into open dump sites. Similar responses were observed in the Dormaa Municipality as most (63%) of the respondents indicated that waste was disposed of into communal containers. While 20% of the respondent said that waste was collected directly from their house, 17% also indicated that they emptied their waste into open dam sites.
\n\n | Do you pay for collection service? | \n||||||
---|---|---|---|---|---|---|---|
Berekum | \nYes | \nNo | \nTotal | \nDormaa | \nYes | \nNo | \nTotal | \n
Door to door | \n41 | \n0 | \n41 | \n\n | 31 | \n0 | \n31 | \n
Communal collection | \n0 | \n97 | \n97 | \n\n | 0 | \n98 | \n98 | \n
An open dump | \n0 | \n18 | \n18 | \n\n | 0 | \n27 | \n27 | \n
Total | \n27 | \n91 | \n156 | \n\n | 23 | \n85 | \n156 | \n
Modes of waste disposal in Berekum and Dormaa.
Source: Field Survey, 2015.
In the Berekum Municipality, the data analyzed shows that the House-to-house service of refuse disposal is primarily practiced in the new residential areas including Nyamenae and Awerempe-Estate. Similar results showed the same trend in the Dormaa Municipality as residential areas such as Kumidaa Street and Asikafo Amantem were found to be practicing house-to-house waste collection. These modes of waste collection were verified with key stakeholders (the Assemblymen, WMD and Private waste company). The introduction of this service in the municipalities reflect the trending urban form of solid waste management since such areas compose of settlements which house middle to high income earners who are in the position to pay for such service. As Oduro-Kwarteng [39] asserted in the formal introduction of this service in the urbanized areas in the two major cities in Ghana (Accra and Kumasi). Other towns and cities have grabbed this concept to enhance service delivery as far as SWM is concerned. All the respondents from these residential areas where house-to-house waste collection service takes place in the Berekum Municipality are required to pay a monthly charge of GH¢15 (US$3) per 120 liter dustbin. In the Dormaa Municipality, service beneficiaries pay an amount of GH¢10 (US$2) per 120 liter dustbin. The results show that service beneficiaries in the Dormaa Municipality slightly pay lower price than amount paid in the Berekum Municipality. According to the Assemblymen this charge was exorbitant and as a result accounted for the lack of patronage in the Municipality. Secondly, there was lack of patronage because the companies did not regularly and routinely collect waste in these areas. In view of this some people turned to burning as a means of dealing with their waste.
\nCommunal collection was mainly carried out in the old town residential areas of Kyiritwede Zongo and Amangoase for Berekum and Atoase, Ahantrase Ahenbronofor Dormaa Municipal. This mode of waste collection does not require any monthly fee or pay as you dump charges. Residents go to a central container and dispose of their waste. The next mode of collection is the open dump site collection this is seen in the suburbs; communities, who dispose of their waste at the open dump site, are emerging communities that the Assembly together with private companies have failed to supply with containers. In view of this, the people throw their waste in open dump pit this is seen in some part of Atonotia and the light industrial area of Berekum municipal and in New Dormaa for Dormaa Municipal. This findings supported studies by [42] who asserted that open refuse dumps are most commonly located at the perimeter of major urban centers in open lots, and are generally sited based on considerations of access to collection vehicles.
\nThis study also examined the extent to which the various households in the two municipalities participate in waste management services in relation to the mechanism for cost recovery, the eagerness-to-pay for service charge, eagerness to separate waste at source and monitoring of service quality. Table 2 presents the household’s views on the assessment on who ought to bear the cost of waste collection in the municipality. The study shows that, 58% of the respondents within the two municipalities who utilize the house-to-house waste service perceived both the Assembly and the individuals who generates the waste have to work very hard to recover more than 50% of the cost incurred if not all in waste collection and disposal. On the other hand, 24% opted for the generators to incur all the cost involved in waste management without any prejudice. Whereas 18% said the Assembly alone should incur the cost for waste management services.
\n\n | N | \nBerekum | \nDormaa | \n% | \n
---|---|---|---|---|
\n | ||||
Generator only | \n17 | \n10 | \n7 | \n24 | \n
Generator & Assembly | \n42 | \n18 | \n24 | \n58 | \n
Assembly only | \n13 | \n13 | \n\n | 18 | \n
\n | ||||
Generator only | \n10 | \n7 | \n3 | \n5 | \n
Generator & Assembly | \n87 | \n34 | \n53 | \n45 | \n
Assembly only | \n98 | \n56 | \n42 | \n50 | \n
\n | ||||
Generator only | \n2 | \n0 | \n2 | \n5 | \n
Generator & Assembly | \n14 | \n14 | \n0 | \n31 | \n
Assembly only | \n29 | \n\n | \n | 64 | \n
Opinion on who ought to bear the cost of waste collection services.
Source: Field Survey, 2015.
Regarding communal collection about 54% of the respondents said the Assembly alone should pay for the cost of waste collection, while about 45% indicated that the generator and the Assemblies have to collectively pay for waste services. Moreover, only 5% said only generators should pay for waste services. In view of the above, it is quite obvious that the companies need to be more responsible for results and to be more responsive to their client. This also implies that much attention must be given to household involvement to make sure the households are well informed about the fiscal problem confronting the Municipalities and the necessity to pay for service improvement.
\nTo further ascertain the household involvement in solid waste management, the resident’s eagerness to pay more for waste services was assessed. Table 3 indicates the results of the eagerness-to-pay service charges. To improve the effectiveness of the house-to-house service, the respondents were ask on their willingness to-pay more. The result on this shows that a total of 21% of the people interviewed were willing to pay more for waste services. This was due to the fact that the respondents were not satisfied with the existing service quality. However, the majority (53%) of the respondents confirmed their eagerness to pay the existing tariff for the service rendered, whereas a total of 26% were eager to pay less than prevailing tariff. This group saw the service quality to be very poor and that, wanted an improvement in service quality levels before tariffs are increased. This finding support what many call the need for government to encourage the principle of polluter-pays which financially resource service providers in service delivery.
\nHouseholds eagerness to pay for services | \nBerekum | \nDormaa | \nTotal | \n% | \n
---|---|---|---|---|
\n | ||||
Eagerness to pay more | \n9 | \n6 | \n15 | \n21 | \n
Eagerness to pay current user fees | \n21 | \n17 | \n38 | \n53 | \n
Eagerness to pay less than the current user fees | \n11 | \n8 | \n19 | \n26 | \n
\n | ||||
Pay tariffs at time of survey | \n0 | \n0 | \n0 | \n\n |
Eagerness to pay for the service | \n76 | \n63 | \n139 | \n71 | \n
\n | ||||
Pay tariff at time of survey | \n0 | \n0 | \n0 | \n\n |
Eagerness to pay for the service | \n12 | \n10 | \n22 | \n49 | \n
Respondents’ eagerness-to-pay user charges.
Source: Field Survey, 2015.
The result further indicated that, all the respondents were ready to pay any considerable tariff for the service if the service would be improved along frequent and routine waste collection of two times a week. It was again realized that the respondents wanted the tariffs to be charged on waste volumes and rate with which waste is being picked up. Regarding communal service, it came out from the study that all the respondents did not pay for services. However, over 65% from the survey were eager to pay for the tariff under one condition that service improves. The implication is that more effort should be geared toward educating the public and for that matter the customers to come to terms with the need to pay for services to recover cost to ensure better service quality. Moreover, the companies ought to be more responsive to complains of the customers so as to improve service quality.
\nOn the residents’ readiness to separate and recyclable their waste at the house (source) for collection, the result indicates that majority (50 and 49%) of the respondents in Berekum and Dormaa respectively were ready to separate their waste at the source given the necessary incentives. They pointed the increase in collection rate to two times a week, the free provision of plastic bags with variety of colors, and to be provided with free bins by the companies or the assembly for separate collection as the incentives needed for effective waste separation. Over 40% accepted to purchase their own receptacles for storing organic waste. Whereas 33% called the enforcement of by-laws to ensure everybody separate their waste. The respondents acknowledged their awareness on waste reuse, recycling, as well as composting. Majority indicated that they use food waste to feed livestock, salvage used plastics and cans, and sachet rubbers for the informal buyers or scavengers. Moreover some continue to engage in burning waste. Small number of them uses organic waste as manure for vegetable garden. Notwithstanding, the residents’ awareness on reuse and recycling of waste in the municipalities are very low as more reusable and recyclable materials continue to be seen in the streets, drains and streams. This implies that the existing collection system does not ensure recycling as varied wastes are sent to the dumping grounds with very little or no recycling by scavengers.
\nThe quality of SWM was assessed by asking the respondents to indicate service satisfaction by responding either satisfied or not satisfied with the quality of service on a five-point scale from very poor to very good in terms of two service quality attributes (reliability of collection and sanitary conditions at bin/container location). To rate the quality SWM of the service providers effectively, all the communities served by the waste management company were selected for the survey. The study shows considerable disparities in terms of quality in the existing SWM system as practiced in the municipalities. In the Berekum Municipality, a total of 65% of the respondents who patronize house-to-house collection service rated there liability of service and sanitary condition and waste overflow as fair and good. Areas such as Estate, Nyamebekyere and Osofokyere which have larger number of high and medium income households’ fall in this category of the respondents rated the quality of service of the company in their vicinity as good. The level of service quality could be attributed to the perceived quality of service by the people. This is because they pay for waste services that recover full cost and therefore they expect the service to be devoid of waste overflow from bins located in front of their house. The service reliability and sanitary conditions of communal collection in the low income areas of Atonotia, Kyirikwede and Amangoase were largely rated as poor by residents. Surprisingly, a total 76% of the respondents for communal collection rated the service as poor. This is because the waste overflow from communal containers unto the ground was widespread. The people in these areas confirmed that collection is irregular and the containers ‘sites are not desirably maintained by the company and the Assembly.
\nIn the Dormaa Municipality, the survey revealed similar results. There were also considerable disparities in terms of quality in the existing SWM system as practiced in the municipality. About 71% of the respondents who patronize house-to-house collection service rated the sanitary condition and waste spill over as good. In addition 59% said the reliability of waste collection was also good. Areas such as Kumidaa Street and Asikafo Amantem which have larger number of high and medium income households’ fall in this category of the respondents rated the quality of service of the company in their vicinity as good. The service reliability and sanitary conditions of communal collection in the low income areas of Atoase, Ahantrase and Ahenbrono were generally rated as poor by residents. Interestingly, about 67 and 74% in these areas rated the sanitary condition and Reliability of waste collection respectively as poor. To them, the rate of waste overflow, from communal containers unto the ground at the container sites were high. The households confirm that collection is irregular and the containers ‘sites are not cleaned by the company. Comparatively, more of the residents in Dormaa Municipality rated the service quality for the house to house as good than those from Berekum Municipality. Approximately 71 and 59% of the residents from Dormaa Municipality rated the sanitary condition at the container site and the reliability of waste collection respectively as good whereas 65 and 54% also rated the sanitary condition at the container site and the reliability of waste collection respectively in Berekum Municipality. Similar, results came out regarding communal collection. A total of 43 and 36% rated the sanitary condition at the container site and the reliability of waste collection respectively as good from the Dormaa Municipality whereas 27 and 24% also rated the sanitary condition at the container site and the reliability of waste collection respectively in Berekum Municipality.
\nTo monitor the quality of service effectively, the companies are mandated to furnish the Local Assembly with information on monthly basis. This comprises of performance targets, vehicle tour schedule, proceeds and expenditure from house-to-house collection and tonnage of waste disposed of. The key informants revealed that the performance targets as well as the formal rules and regulation for private waste companies were obviously elucidated in the contract signed. In addition, they affirmed that, the company cooperate with the Municipalities and provide information on tonnage on waste collected. This information is kept and used as the basis for paying the companies. With reference to house-to-house service, the companies further admitted that they (companies) provide the municipalities with information on revenues from the house-to-house services. In contrast, the staffs of the WMD were of the view that actual revenue from house to house collection is not properly accounted for in the reported to the Assemblies. Further result from them pointed out that detailed document on claims and revenue collected always lag behind time and the revenue figures usually were far below expectation. There was a clear evident of information asymmetry with the reports on cost and revenue in all the two municipalities. The information asymmetry in the report of the companies did not arguer well for the Assemblies to have a firm grip on cost and revenue to make any meaningful plan for effective cost recovery mechanism.
\nThe results further revealed that the Assembly alone set up the service charge for the communal as well as house-to-house service. They further pointed out that the tariff for house-to-house services devoid of any central government support are fixed by the individual companies and submitted to the Municipal Assemblies for approval. The Assemblies specify an indicative levy for house-to-house collection to be collected monthly and a unit price per emptying the skips for communal collection service as specified in the contract document. The final levies and the unit prices at are susceptible to changes using the price escalation formula in the contract after the award of contract. Concerning waste collection charges and fee (unit price) and cost recovery, the companies providing the house-to-house collection takes approved service fees from their client on monthly basis in both Berekum and Dormaa. The house-to-house collection fees for waste management were GH¢12 (US$2.50) Berekum and GH¢10 (US$2) for Dormaa but those who patronize the communal services do not pay for user charges. However the cost for lifting a tonne of waste keep increasing with time and over time, this has become a burden on the assemblies. It was further revealed that the user charges were not regularly reviewed. This has resulted in big cash flow problems for the companies due to the continuous increase in exchange rate of the cedi, inflation and fuel prices. The user charges need to be reviewed by the Assembly and published the new fees in national gazette as by-law for it to be legally binding on residents. This according to Assemblies is cumbersome and requires political will on the part of the central government and municipalities. This indicates clearly that there is a look warm attitude from the Municipal Authorities to implement full cost recovery through charging of all households in the two municipalities.
\nAlso, the key informants revealed that the Assemblies hardly conduct public education. There was only two and four count for Berekum and Dormaa Municipalities respectively. This has adversely affected the residents’ attitude toward waste management. The residents continue to litter indiscriminately. In relation to the Assembly’s commitment to bye-laws it revealed that the two assemblies had bye-laws fully gazetted to keep the companies and the residents within the confines of SWM best practices. However, the bye-laws were not strictly enforced. Subsequent result shows that the Assembly finds it difficult to fulfill the terms of payment as stated in SWM contractual arrangements with private companies. More so, there had not been any occasion where interest had been paid on delayed payments beyond the 3 months as stated in most contracts. The difficulties and holdups identified in the Assemblies commitment to its contractual obligations are basically lack of financial resources. The key informant from the waste management department said they keep on changing their schedule for educating the masses on waste management year in year out all because of the lack of funds. Conversely, according to the companies, the cost recovery mechanism is inadequate. With this the assemblies find it difficult to generate enough revenue to pay the companies. There was also weak mechanism in place to deal with residents who refuse to pay for the waste collection services rendered. The Assembly delays so much with the payment of monies and this in effect affects service quality. It can be concluded that Assemblies’ non-adherence to contract obligations have a major influence on service quality and productivity of companies.
\nAlso, concerning the companies’ commitment to contractual obligations, indicators used includes company achieves daily collection target in the contract, company’s cover waste containers during transporting, company collection crew use protective clothing, company keeps container site free of litters and clean. The directors of both the private companies and the WMD interviewed said the companies were able to achieve their daily targets of about 80%. It was confirmed together with other key informant and the resident in the household survey that the collection crew have protective clothing and use them their activities, however very few about 10% refuse to wear theirs in most cases. The few workers who do not in most cases use the protective clothing started with the informal sector and believed they are responsive to the waste collection without protective clothing. Regarding the companies obligation to keeping the container sites clean especially with the communal collection. Twenty-five out of over 100 container sites were kept clean and tidy whiles the others had litters all over. Large heaps of waste remains at these container sites after solid waste has been move to the disposal sites. In relation to this is the companies’ obligation to repair and maintain communal waste skips. The key informant said the company barely does this function it is only the assemblies that squeeze some funds out of pressure from the residents for few repairs works on these containers.
\nRegarding the enforcement of legislation and sanctions, the municipal assemblies have the sole responsibility to enforce legislations and sanctions on the provision of public services. The Assembly uses bye-laws as well as terms and condition in the contract as the basic mechanism to managing solid waste collection services in their area of jurisdiction. It was realized from the companies’ point of view that the bye-laws were enforced. In addition they were also of the view that the monitoring of compliance was done effectively. In addition, they opined that the sanctions for noncompliance to the bye-laws were punitive enough. They also revealed that the environmental health standards and sanitation were strictly observed and enforced. However, the household survey shows a different picture. It indicated that very little have been done to enforce bye-laws. It was realized that, the Assemblies find it very difficult to sanction offenders due to the frequency at which these bye-laws are flouted. The residents show lax attitude toward effective waste management. It was also observed that there were inadequate waste containers and low frequency of waste collection especially with the communal collection. Relating to this is the lack of environmental sanitation courts in these areas. This hinders the enforcement of solid waste and sanitation regulation.
\nThe fines for non-compliance are the same in the two municipalities and are subject to review. They may be changed by the Assemblies after the service provider has been informed of such changes. The fine ranges from GH¢100 (US$20)-GH¢200 (US$40). The study revealed that the municipal assemblies have so far not been able to apply any sanction to the companies though evidence from the household survey shows the companies fail enormously in waste pick up as well as the cleaning up of the container sites. This study is therefore consistent with the finding of Oduro-Kwarteng that there is lack of sanctions in the waste management sector. In a similar study involving five cities, Oduro-Kwarteng [39] discovered that many of the contracts had credible threats of sanctions that required sanction, but non-complying companies were not penalized.
\nThe study focused on the evolving SWM practices, the quality of service as well as the factors that influence the private sector performance and their implications for solid waste collection in the medium towns. The study revealed that there were no significant disparities in service quality among the two municipalities. But more difference do exists among different communities due to the difference in the methods of waste collection. The service quality of house-to-house collection practiced at well-organized residential areas was higher than that of communal collection at old town lower income residential areas. The study further revealed that more waste is now been collected than before due to increasing role of the private sector in the waste business. Over 80% of waste generated in these municipalities are collected and send to a designated site for final disposal by the private sector waste management firms. This is much better than the 2006 figure of about 50–80% waste collection. In addition, the participation and involvement of households at any level of the SWM has been very slow principally due to the lack of funds and public education. Moreover, a shift toward cost recovery through charging all households a fixed charge for house-to-house collection is in places. However there were no mechanisms for full cost recovery to include majority of the residents who patronize communal collection service. The assembly therefore faces problems of financing bins, providing for other resources which resulted in to illegal dumping by some households.
\nFurthermore, the study revealed that there were weak regulatory practices and non-adherence to contractual obligations and these consequently provided no incentives for full cost recovery and better service quality. The weak regulatory practices such as no competitive bidding, prolonged periods before upward review of collection fees and service charges, no interest on monies delayed, and delay in payment of subsidy does not provide incentive mechanism for private sector growth and does not enhance better waste management service delivery. Again, the study revealed that there is a weak institutional capacity (inadequate personnel and logistics). The responsibility over solid waste collection and disposal is well beyond the capacity of waste management institutions. They could not collect the 20–80% waste as stated in the contract document due to lack of personnel and logistics for monitoring and supervision. However, it was revealed that the involvement of the private companies in the management of solid waste has strengthened the capacity of the municipal assemblies. Yet, this is still deemed inadequate to meet the required levels of urban solid waste collection. Finally, the study revealed that there is a lack of strict monitoring and enforcement of sanitation bye-laws in the municipalities. However, the study found that the bye-laws were punitive enough but lacked strict enforcement. The non-enforcement of the bye-laws has contributed immensely to the indiscriminate dumping in the municipalities.
\nIn order to address the problem of municipal solid waste in the study areas in particular and Ghana in general, it is strongly recommended that the policy mechanisms and strategies adopted should be holistic and comprehensive. The nature of the issues and challenges identified require multidimensional interventions in order to provide sustainable solutions. There is the need for clearly defined standards and service quality in the contract for regulating the private sector activities. This will facilitate a well-managed SWM system in the municipalities as the private companies were not abreast with these standards and the terms of the waste management contract. The study also recommends a capacity building training on waste management for the officials of Waste Management Department in the municipalities as well as the technical operation officers of the private sector waste management companies.
\nThere should also be full cost recovery for waste services. This requires the ‘pay as you throw’ (PAYT) mechanism for communal collection to ensure financial sustainability and quality service delivery. Although such mechanism has failed at initial stage in Accra in 1995, it worked well in Kumasi. The success of the PAYT in Kumasi was due to the participation and creating of public awareness, household participation and involvement at all levels as well as the enforcement of bye-laws on indiscriminate dumping. The prevailing system where communal collection is free for resident is not sustainable. Also, Assemblies should to be encouraged to be responsive to effective and quality service delivery. The environmental health unit should be restructured to make it more responsive to the challenges of SWM. The environmental health personnel can also be attached to the private companies to enforce bye-laws on paying for service and prevention of indiscriminate dumping of waste. Furthermore, the establishment of recycle firms should be encouraged by the Assemblies. They can start by forging partnership with the private sector companies. Also, the coordination for waste management should be encouraged within the context of environmental education and stricter enforcement of sanitation bye-laws. This is because environmental education creates environmental awareness and makes people conscious of environmental and sanitation issues. The enforcement of bye-laws is important in view of the fact that environmental awareness is not sufficient enough to ensure change in behavior. Therefore, stricter law enforcement is needed to deter people from dumping indiscriminately.
\nThe word “Probiotics” is derived from Latin language meaning life [1] and came into attention in 1953 by the German scientist Werner Kollath who defined them as “active substances that are essential for healthy development of life”. Later on, in 1992 Fuller defined them as “a live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance” [2]. Currently probiotics are defined as “live organisms that when administered in adequate amounts confer health benefits on the host” and are specified by the Food and Agriculture Organization of the United Nations and the World Health Organization (FAO/WHO, 2001). Probiotics are present mainly in fermented foods like cheese, bread, wine, kefir and kumis and are commercially available in the market as powders, tablets and packets [1]. Probiotics are used from centuries for the treatment of various diseases but it was not known until the 20th century that probiotics are healthy bacteria that replace harmful microbes in the gut and regulate gut flora [3]. The most extensively used probiotics are
In this chapter we summarized some of the mechanisms which are responsible for the health promoting effects of LA focussing primarily on immunomodulatory properties of LA. We also discussed the role of LA in preventing inflammatory bone loss and how modulation of gut microbiota and maintenance of gut integrity by LA can play a role in regulating bone health.
LA is a type of lactic acid bacteria (LAB). LAB constitute a group of gram-positive, acid tolerant, catalase negative, non-sporulating and generally rod-shaped bacteria [13] that are frequently associated with dairy, meat and plants [14]. LAB produce lactic acid from carbohydrate fermentation which make them important in fermentation and agriculture-based industries. They are used for imparting unique textures and flavors and for preservation and acidification of different food items [10]. LAB comprised a number of genera such as
LA has great immunomodulatory properties. Because of the immune modifying properties of LA it is considered for the treatment of various inflammatory diseases. LA can be an inexpensive therapeutic for treatment of numerous clinical manifestations involving malfunctioning of the immune system. Here we discuss various studies highlighting the importance of LA as a potential therapeutic for the prevention of several immune related disorders. It is observed that LA and
LA regulates the secretion of cytokines from various immune cells and maintains the balance between inflammatory and anti-inflammatory cytokines. It is observed that LA treatment significantly altered the production of interleukin (IL)-4 and interferon (IFN)-γ from splenocytes in the presence of purified tumor antigen. LA and
One of the mechanisms by which LA inhibits the progression of inflammatory diseases is by modulating T cells (Figure 1). It is observed that LA-CGMCC 7282 along with
Schematic diagram depicting immumodulatory properties and effect of LA on gut permeability and dysbiosis.
On the basis of these above discussed studies, we can consider that LA has immune regulatory properties. LA has capabilities of regulating various innate and adaptive immune cells and therefore can maintain immune homeostasis. Altogether, these studies suggest that immunomodulatory properties of LA can be employed for regulating the disrupted immune homeostasis in various inflammatory diseases.
Trillions of microbes reside in human gastrointestinal tract. These microbes contribute in number of vital functions related to health. These are source of essential vitamins and nutrients. Microbes extract energy from food, modulate immune system and maintain gut permeability. Gut microbiota usually promotes human health but alteration in the gut lead to various clinical manifestations. Alteration in gut microbiota is termed as dysbiosis. Gut microbiota can be altered by various factors like diet, toxins, pathogens, drugs, antibiotics, etc. [63]. Dysbiosis is reported in various diseases like IBS, IBD, diabetes, obesity, cardiovascular diseases, asthma, allergy, etc. [63, 64, 65, 66, 67]. Dysbiosis is also observed in leukemia where selective modulation of
Gut barrier is very important for the regulation of the immune homeostasis and for preventing the access of pathogens into the gut lumen. Through the leaky gut, pathogens invade into the lumen and lead to uncontrolled inflammation. Gut barrier is regulated by tight Junctions (TJs) which are present between the intestinal epithelial cells. TJs are transmembrane proteins and are divided into four groups: claudins, occludin, tricullin and junctional adhesion molecules (JAMs). Transmembrane TJs are linked with the actin cytoskeleton through the cytosolic scaffold proteins like zona occludens (ZOs) which are of three types ZO-1, ZO-2 and ZO-3 [81]. Alteration in expression of TJs leads to increase in gut permeability and intestinal inflammation which is responsible for various inflammatory diseases like IBD [82, 83, 84, 85, 86], colon cancer [87] and RA [88].
Several studies have shown that LA administration maintain gut permeability. It is observed that the mixture of LA-KLDS1.0901 and
Bone is a dynamic and metabolically active organ that is being remodeled throughout the life of the organisms. Bone remodeling is regulated by three different types of bone cells viz. osteoclasts (bone eating cells), osteoblasts (bone forming cells) and osteocytes. Osteoblasts are derived from multipotent stem cells that also give rise to fibroblasts, adipocytes, chondrocytes and myoblasts [93]. Osteoblasts are responsible for formation of osteoid matrix by depositing collagen which later on get calcified. The major constituent of osteoid matrix is type 1 collagen which provide resistance against fractures. Osteoid matrix also consists of various other non-collagenous proteins which are responsible for various critical functions of bone [94]. Osteoblast differentiation depends on a number of paracrine and transcription factors such as Runx2 and osterix and members of bone morphogenetic protein (BMP) family [94]. Osteoclasts are giant polynuclear cells that have special ability of resorbing bone [95]. Osteoclasts differentiate from monocytic progenitors that also give rise to cells of other monocytic lineages such as macrophages, dendritic cells, granulocytes and microglia. Osteoclast differentiation depends on two important cytokines: MCSF and receptor activator of nuclear factor кb ligand (RANKL). MCSF stimulate proliferation and differentiation of osteoclast progenitors. RANKL acts with the help of its receptor RANK and coupling molecule TNF receptor associated factor 6 (TRAF 6) to promote the differentiation and commitment of precursor cells [95]. Bone resorption starts when osteoclasts attach to the surface of bone and form a unique structure called sealing zone. Sealing zone permit the osteoclasts to form resorption space. Osteoclasts acidifies the resorption space to degrade the mineral and organic compartment of the bone. For this osteoclast secrete various lysosomal enzymes such as cathepsin K into the resorption space. To mediate bone resorption osteoclasts, form a specialized structure called as ruffled border that increase the surface area for active transport of H+ through proton pump. Osteoclasts comparatively resorb a large area of bone and then die by apoptosis [94]. Osteocytes are osteoblasts that have been entrapped in the osteoid matrix during matrix calcification under the influence of bone specific alkaline phosphatase produced by osteoblasts [93, 94]. Osteocytes sense mechanical force and tissue strain and send signal to the other osteocytes and osteoblasts by forming cellular network termed as canaliculi permeating the entire bone matrix [93, 94]. Dynamic equilibrium between the osteoblasts and osteoclasts maintains bone integrity. Multiple interactions take place between the bone forming osteoblasts and bone resorbing osteoclasts to regulate the process of bone remodeling [96]. Osteoblasts positively regulate osteoclast differentiation by secreting RANKL and MCSF at pre-osteoblastic stage and negatively by secreting the RANKL decoy receptor osteoprotegerin (OPG). Bone remodeling restore microdamages and ensure the release of calcium and phosphorus in normal host physiology [97]. Bone remodeling consist of four phases viz. activation phase, resorption phase, reversal phase and formation phase [97]. In activation phase, MCSF and RANKL induce the differentiation of osteoclast progenitors into osteoclasts. During resorption phase pre-osteoclasts migrate at the surface of bone and get differentiated into mature osteoclasts and start resorbing bone. Resorption phase is followed by reversal phase where mononuclear cells remove the collagen remnants and prepare the surface for osteoblasts where they can next start the process of bone formation. Mononuclear cell also provides various signals for the differentiation and migration of osteoblasts [93, 97]. During formation phase osteoblasts replace the resorbed bone with new bone [97] (Figure 2). Bone remodeling is regulated by various factors such as hormones like estrogen and parathyroid hormone and immune cells like T cells and B cells. Below we next discusse the role of immune system in regulation of bone health and the potential of LA in preventing bone resorption via immunomodulation.
Schematic representation of bone remodeling. Bone remodeling occurs in four phases viz. 1) Activation phase: MCSF and RANKL induce the differentiation of osteoclast progenitors into osteoclasts. 2) Resorption phase: Mature osteoclast with unique ruffled border starts resorption of bone by secreting cathepsin K, and H+ in sealing zone. After resorption osteoclasts detach from the surface of bone and undergo apoptosis. 3) Reversal phase: During reversal phase osteoblasts precursor get differentiated into mature osteoblasts and are recruited to the resorption site. 4) Formation phase: Osteoblasts get occupied in the resorbed lacuna and start depositing the bone matrix. After formation phase osteoid gets mineralized and bone surface returns to resting phase with bone lining cells.
Bone is an immunomodulatory organ and various immune cells affect the development of bone. Bone cells and immune cells interact with each other in the bone marrow which is the common niche for the development of both bone and immune system. In bone marrow, bone cells and immune cells interact with each other and affects each other development. The interaction between the bone and immune system is now studied under a new field of immunology termed as Osteoimmunology, a term coined by Choi et al. in 2006. Impact of various immune cells and cytokines secreted by immune cells on bone development is now known [97]. It is observed that cytokines such as IL-1, TNF-α, IL-6, IL-11, IL-15 and IL-17 induce bone resorption whereas cytokines such as IL-4, IL-10, IL13, IL-18, IFN-γ and granulocyte macrophage colony stimulating factor (GM-CSF) prevent bone loss. In various bone disorders the role of immune system has been discovered such as osteoporosis, RA and periodontitis. Osteoporosis is an inflammatory disease and several immune cells affect the development of osteoporosis. To study the immunology of osteoporosis we integrative biology started a novel field termed by us as “Immunoporosis” which deals specifically with the role of immune cells in osteoporosis [96]. Th17 cells and Tregs have most vital role in the development of bones and their balance is required for proper regulation of bone mass. CD4+FOXP3+ Tregs enhance bone mass by inhibiting osteoclastogenesis by directly suppressing the production of RANKL and MCSF [98]. Another mechanism by which CD4+FOXP3+ Tregs inhibit osteoclastogenesis or bone loss is by interacting with the CD80 and CD86 present on osteoclast precursors via CTLA-4, thereby inhibiting osteoclast differentiation [96]. Not only CD4+FOXP3+ Tregs, now the effect of CD8+FOXP3+ Tregs on bone is also discovered. It is observed that the CD8+ Tregs prevent bone loss by inhibiting the formation of actin ring resulting in suppression of osteoclastogenesis [99]. Unlike Tregs, Th17 cells promote bone loss by inducing osteoclastogenesis via secretion of RANKL. Th17 also secrete IL-17 which induce bone loss by promoting RANKL expression on osteoclastogenesis supporting cells and by stimulating expression of inflammatory cytokines such as TNFα, IL-1 and IL-6 which further upregulate RANKL expression [9, 100]. Imbalance of Tregs and Th17 cells leads to bone loss which occurs during post-menopausal osteoporosis (PMO). Lack of estrogen promotes PMO. Estrogen prevents osteoporosis by inhibiting osteoclastogenesis but estrogen deficiency causes increased osteoclastogenesis by stimulating differentiation of Th17 cells. We also found in our studies that level of Th17 cells and inflammatory cytokines such as TNFα, IL-6, IL-17 and RANKL increased during post-menopausal osteoporosis [9, 101, 102]. Several studies have shown the role of Tregs and Th17 cells imbalanc in pathogenesis of RA [103]. The frequency of Th17 cells are enhanced in the joints and synovial fluid of RA patients [104] whereas the percentage of Tregs get significantly decreased in RA patients [105]. Similarly, the role of Tregs and Th17 cells imbalance is also found to be associated with periodontitis inflammation [106] and osteoarthritis [107]. Apart from these various other immune cells such as Th1, Th2, Th9 cells and γδ T cells are also involved in regulating bone health [97].
As immune system has such an important role in regulation of bone health, proper maintenance of immune homeostasis is very much required. Immune homeostasis for bone regulation is maintained by various factors such as estrogen hormone. Various strategies are used to prevent bone loss due to immune disruptions such as Denosumab, rituximab and TNF blockers [108, 109]. These strategies are proven effective but they also exert various adverse effects in the long run. Recently the use of probiotics is found to be effective in treatment of various inflammatory disorders such as IBD, obesity, diabetes, etc. [110, 111, 112]. Probiotics are also considered for the treatment of various bone disorders. LA is one of these probiotics. It is observed that LA has great potential of treating various bone pathologies. From comparison of different
Role of Tregs/Th17 cells axis in regulation of bone health:
S.No. | Commercially available strains of LA | Source | Effect on bone | Reference |
---|---|---|---|---|
1. | ATCC 4356 | ATCC | Modulated Treg-Th17 cell axis and inhibited the expression of inflammatory cytokines | [9] |
2. | ATCC 314 | ATCC | Prevented freund’s complete adjuvant induced arthritis by decreasing the oxidative stress | [115, 118] |
2. | ATCC 11975 | ATCC | NR | — |
3. | ATCC 4375D-5 | ATCC | NR | — |
4. | ATCC 53671 | ATCC | NR | — |
5. | ATCC 4355 | ATCC | NR | — |
6. | ATCC 4357 | ATCC | NR | — |
7. | ATCC 9224 | ATCC | NR | — |
8. | ATCC BAA-2832 | ATCC | NR | — |
9. | ATCC 13651 | ATCC | NR | — |
10. | ATCC 11975 | ATCC | NR | — |
11. | ATCC 832 | ATCC | NR | — |
12. | ATCC 43121 | ATCC | NR | — |
13. | ATCC 53544 | ATCC | NR | — |
14. | ATCC 53545 | ATCC | NR | — |
15. | ATCC 53546 | ATCC | NR | — |
16. | ATCC 4796 | ATCC | NR | — |
18. | ATCC 53671 | ATCC | NR | — |
19. | ATCC 700396 | ATCC | NR | — |
20. | LA-1 | Chr. Hansen, Demark | Decreased the levels of inflammatory cytokines and enhanced the levels of anti-inflammatory cytokines in joints of osteoarthritic rats | [117] |
21. | LA-2 | Chr. Hansen, Demark | NR | — |
22 | LA-3 | Chr. Hansen, Demark | NR | — |
23 | LA-4 | Chr. Hansen, Demark | NR | — |
24 | LA-5 | Chr. Hansen, Demark | NR | — |
25 | LA-14 | Chr. Hansen, Demark | Decreased the inflammatory cytokines IL-1β and IL-6 in experimental apical periodontitis | [119] |
26 | DDS-1 | Nebraska cultures, Nebraska | NR | — |
27 | NCFM | Dansico, Madison | NR | — |
28 | SBT-2026 | Snow brand milk products, Japan | NR | — |
Different strains of LA and their effects on bone.
ATCC: American Tissue Culture Collection.
NR: Not reported.
A number of microbes are localized in the gut. Some of them are beneficial for health whereas others are pathogenic and a balance of these microbes is required for normal physiological functioning of body. But due to several reasons like surgery, medications, irradiation and antibiotics this balance is dysregulated which leads to modifications in gut microbiota composition [3]. Dysbiosis is observed in various bone pathologies. Normally gut is dominated by four types of microbial phyla:
Gut permeability has very important role in regulation of bone health. Various studies have shown that increase in gut permeability is associated with bone loss. Collins et al. group measured the intestinal permeability after 1, 4 and 8 weeks of ovx surgery and they found increased intestinal permeability one week after ovariectomy along with the increase in inflammatory cytokines like IL-1β and TNFα which are responsible for bone loss [126]. Estrogen deficiency during post-menopausal osteoporosis is responsible for increase in gut permeability. Estrogen has very significant role in regulating the gut barrier. It maintains gut barrier through its receptors which are present on the intestinal epithelial cells. There are two types of estrogen receptors: ERα and ERβ. ERβ has very important role in the regulation of TJs as ERβ−/− mice has disrupted expression of tight junction proteins [39]. Various other studies proved the role of estrogen in regulation of gut barrier. Langen et al. reported decreased expression of ERβ and increased gut permeability in IBD patients [127]. Gut permeability decreases during oestrous phase whereas it is increased during dioestrus phase of rats and this increase in intestinal permeability during dioestrus phase can be prevented by treatment with oestradiol which upregulate the expression of occludin [128]. Estrogen and progesterone treatment decreases gut permeability and thus prevent secretion of inflammatory cytokines in IBD models [129]. LA prevents leaky gut in various diseases as discussed above and thus it can be possible that LA is effective in preventing leaky gut induced bone loss also. In summary we can say that by maintaining immune homeostasis and regulating both gut permeability and dysbiosis LA prevents bone resorption (Figure 4).
Proposed mechanism of LA in bone health. In normal healthy condition there is no dysbiosis and no alteration in gut permeability which prevents gut inflammation and thus bone loss. During osteoporosis gut permeability increases which leads to dysbiosis and bone loss. LA regulate Tregs/Th17 cell axis, prevents dysbiosis and maintains gut permeability. Altogether, LA treatment prevents leaky gut and dysbiosis thereby restoring gut immune homeostasis in osteoporosis which inhibit bone loss.
In the last few years, several studies have delineated the role of LA in preventing a number of inflammatory and metabolic disorders. LA prevents these disorders through various mechanism such as by modulating the host immune system, by maintaining the gut permeability along with preventing dysbiosis. The role of LA in suppressing bone loss also highlights the importance of LA in regulating bone health. LA enhances bone mass and prevents several bone diseases like osteoporosis, arthritis and periodontitis via regulating the immune homeostasis. Thus, immunomodulatory property of LA is of utmost importance in management of various bone pathologies. LA can also prevent bone resorption by regulating the leaky gut and dysbiosis. Thus, LA has immense potential as a probiotic and can be used as a medical therapy for treatment of bone loss in humans but before that a lot of research is further needed to be done on the efficacy along with the associated pros and cons of LA on human health.
This work was financially supported by projects: DST-SERB (EMR/2016/007158), Govt. of India, Intramural project from All India Institute of Medical Sciences (A-798), New Delhi-India and AIIMS-IITD collaborative project (AI-15) sanctioned to RKS. AB, LS, BV and RKS acknowledge the Department of Biotechnology, AIIMS, New Delhi-India for providing infrastructural facilities. AB thank DST SERB project for research fellowship, LS thank UGC for research fellowship.
The authors declare no conflicts of interest.
RKS contributed in conceptualization and writing of the manuscript. AB, LS and BV participated in writing and editing of the review. RKS suggested and AB and LS created the illustrations. Figures are created with the help of https://smart.servier.com.
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As a consequence, plants have acquired several sophisticated regulatory mechanisms that allow them to cope with such adverse conditions. Epigenetic regulation plays a key role in the mechanisms of plant response to the environment, without altering DNA sequences. Epigenetics refers to heritable alterations in chromatin architecture that do not involve changes in the underlying DNA sequence but alter gene expression through DNA methylation or histone modifications. The epigenetic regulation of the plant genome is a highly dynamic process that fine-tunes the expression of a pertinent set of genes under certain environmental or developmental conditions. Over the past two decades rapid advancements in the field of high throughput sequencing unveil epigenetic information at genome wide level in various plant species. In view of the adverse effects of global climatic change, utilizing epigenetic differences for developing improved crop varieties is of paramount importance.",book:{id:"7995",slug:"epigenetics",title:"Epigenetics",fullTitle:"Epigenetics"},signatures:"Garima Singroha and Pradeep Sharma",authors:[{id:"142882",title:"Dr.",name:"Pradeep",middleName:null,surname:"Sharma",slug:"pradeep-sharma",fullName:"Pradeep Sharma"},{id:"281215",title:"Dr.",name:"Garima",middleName:null,surname:"Singroha",slug:"garima-singroha",fullName:"Garima Singroha"}]},{id:"32799",doi:"10.5772/33525",title:"GC3 Biology in Eukaryotes and Prokaryotes",slug:"gc3-biology-in-eukaryotes-and-prokaryotes",totalDownloads:1969,totalCrossrefCites:7,totalDimensionsCites:15,abstract:null,book:{id:"1723",slug:"dna-methylation-from-genomics-to-technology",title:"DNA Methylation",fullTitle:"DNA Methylation - From Genomics to Technology"},signatures:"Eran Elhaik and Tatiana Tatarinova",authors:[{id:"95992",title:"Dr.",name:"Tatiana",middleName:"Valerievna",surname:"Tatarinova",slug:"tatiana-tatarinova",fullName:"Tatiana Tatarinova"},{id:"105570",title:"Dr.",name:"Eran",middleName:null,surname:"Elhaik",slug:"eran-elhaik",fullName:"Eran Elhaik"}]},{id:"63488",doi:"10.5772/intechopen.80874",title:"Nontransformative Strategies for RNAi in Crop Protection",slug:"nontransformative-strategies-for-rnai-in-crop-protection",totalDownloads:2010,totalCrossrefCites:5,totalDimensionsCites:13,abstract:"RNAi in crop protection can be achieved not only by plant-incorporated protectants through plant transformation (transgenic) but also by nontransformative strategies such as formulations of sprayable dsRNAs used as direct control agents, resistance factor repressors, or developmental disruptors. Therefore, the RNAi-based biopesticides are expected to reach the market also in the form of nontransgenic strategies such as sprayable products, stem injection, root drenching, seed treatment, or powder/granule. While the delivery of dsRNA by transgenic expression is well established, it requires generations of crop plants and is costly, which may take years and delays for practical application, depending on the regulatory rules, plant transformability, genetic stability, and public acceptance of genetically modified crop species. DsRNA delivery as a nontransgenic approach was already published as a proof-of-concept work, so it is time to point out some directions on how the real potential for agriculture and crop protection is.",book:{id:"7331",slug:"modulating-gene-expression-abridging-the-rnai-and-crispr-cas9-technologies",title:"Modulating Gene Expression",fullTitle:"Modulating Gene Expression - Abridging the RNAi and CRISPR-Cas9 Technologies"},signatures:"Deise Cagliari, Ericmar Avila dos Santos, Naymã Dias, Guy Smagghe\nand Moises Zotti",authors:null},{id:"64396",doi:"10.5772/intechopen.81847",title:"MiRNA-Based Therapeutics in Oncology, Realities, and Challenges",slug:"mirna-based-therapeutics-in-oncology-realities-and-challenges",totalDownloads:1727,totalCrossrefCites:4,totalDimensionsCites:11,abstract:"As master modulators of the human genome, miRNAs are involved in all cancer hallmarks, disrupting the normal function of their targets. By gaining or losing the function, miRNAs lead to the validation of tumor phenotype, its progression, and metastasis as well as to drug resistance. Increasing the evidence suggests that the modulation of miRNAs in cancer cells, by suppressing the oncogenic miRNAs (oncomiRs) and substituting the deficient tumor suppressive miRNAs (TS-miRNAs), could become a reliable tool for improving the cancer therapy. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/135453",hash:"",query:{},params:{id:"135453"},fullPath:"/profiles/135453",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()