Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
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This achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
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We are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
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Thank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"8362",leadTitle:null,fullTitle:"Time Series Analysis - Data, Methods, and Applications",title:"Time Series Analysis",subtitle:"Data, Methods, and Applications",reviewType:"peer-reviewed",abstract:"This book aims to provide readers with the current information, developments, and trends in a time series analysis, particularly in time series data patterns, technical methodologies, and real-world applications. This book is divided into three sections and each section includes two chapters. Section 1 discusses analyzing multivariate and fuzzy time series. Section 2 focuses on developing deep neural networks for time series forecasting and classification. Section 3 describes solving real-world domain-specific problems using time series techniques. The concepts and techniques contained in this book cover topics in time series research that will be of interest to students, researchers, practitioners, and professors in time series forecasting and classification, data analytics, machine learning, deep learning, and artificial intelligence.",isbn:"978-1-78984-779-6",printIsbn:"978-1-78984-778-9",pdfIsbn:"978-1-78984-786-4",doi:"10.5772/intechopen.78491",price:119,priceEur:129,priceUsd:155,slug:"time-series-analysis-data-methods-and-applications",numberOfPages:130,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"7e98dd03d921c19cc2324e91845d5160",bookSignature:"Chun-Kit Ngan",publishedDate:"November 6th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/8362.jpg",numberOfDownloads:11643,numberOfWosCitations:4,numberOfCrossrefCitations:23,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:36,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:63,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 7th 2018",dateEndSecondStepPublish:"June 28th 2018",dateEndThirdStepPublish:"August 27th 2018",dateEndFourthStepPublish:"November 15th 2018",dateEndFifthStepPublish:"January 14th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"227503",title:"Dr.",name:"Chun-Kit",middleName:null,surname:"Ngan",slug:"chun-kit-ngan",fullName:"Chun-Kit Ngan",profilePictureURL:"https://mts.intechopen.com/storage/users/227503/images/system/227503.jpeg",biography:"Dr. Chun-Kit Ngan is an Assistant Teaching Professor of Data Science Program at Worcester Polytechnic Institute (WPI) since January 2018. Before joining WPI, he was an Assistant Professor in the Division of Engineering and Information Science at the Pennsylvania State University-Great Valley (PSU-GV). His research interests are Decision Guidance and Support Systems (DGSS), including Decision Optimization Models, Computational Algorithms, Machine/Deep Learning, Data Analytics and Visualization, Natural Language Processing, Computer Vision, and related DGSS Applications, to guide domain-specific decision makers to make better decisions and provide them with actionable recommendations. He has published over 30 articles in various books, journals, and conferences. He received the Best Paper Award and the Best Student Paper Award at the 2013 and 2011 International Conference on Enterprise Information Systems respectively. His co-authored paper was selected as the Best Presentation Award in the Information Theory and Technology Session at the 2019 International Conference on Information System and Data Mining. He was the recipient of the 2013-2014 Seed Money Research Grant and 2015-2016 Early Career Award for Research and Scholarship Excellence at PSU-GV. He is also the Co-PI of the funded 2019-2023 NSF REU Site Data Science for Healthy Communities in the Digital Age at WPI and the PI of the Clinical Decision Support System (CDSS) for Pediatric Hypertension project funded by Diameter Health, Inc in Spring 2022. The CDSS project team has won the first runner-up prize of the Student Poster Contest at the 2022 New England HIMSS Annual Spring Conference. In Summer 2022, he joined the Software Engineering team as a Visiting College Educator at Microsoft Corporation. Other DGSS-related research projects have been technically supported by Vodafone GmbH and John Snow Labs, Inc. Publications: (1) ResearchGate - https://www.researchgate.net/profile/Chun-Kit-Ngan and (2) Google Scholar - https://scholar.google.com/citations?hl=en&user=CaNoXysAAAAJ&view_op=list_works&alert_preview_top_rm=2&sortby=pubdate",institutionString:"Worcester Polytechnic Institute",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Worcester Polytechnic Institute",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"977",title:"Mathematical Modeling",slug:"mathematics-statistics-mathematical-modeling"}],chapters:[{id:"66836",title:"Process Fault Diagnosis for Continuous Dynamic Systems Over Multivariate Time Series",doi:"10.5772/intechopen.85456",slug:"process-fault-diagnosis-for-continuous-dynamic-systems-over-multivariate-time-series",totalDownloads:1657,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Fault diagnosis in continuous dynamic systems can be challenging, since the variables in these systems are typically characterized by autocorrelation, as well as time variant parameters, such as mean vectors, covariance matrices, and higher order statistics, which are not handled well by methods designed for steady state systems. In dynamic systems, steady state approaches are extended to deal with these problems, essentially through feature extraction designed to capture the process dynamics from the time series. In this chapter, recent advances in feature extraction from signals or multivariate time series are reviewed. These methods can subsequently be considered in a classical statistical monitoring framework, such as used for steady state systems. In addition, an extension of nonlinear signal processing based on the use of unthresholded or global recurrence quantification analysis is discussed, where two multivariate image methods based on gray level co-occurrence matrices and local binary patterns are used to extract features from time series. When considering the well-known simulated Tennessee Eastman process in chemical engineering, it is shown that time series features obtained with this approach can be an effective means of discriminating between different fault conditions in the system. The approach provides a general framework that can be extended in multiple ways to time series analysis.",signatures:"Chris Aldrich",downloadPdfUrl:"/chapter/pdf-download/66836",previewPdfUrl:"/chapter/pdf-preview/66836",authors:[{id:"238414",title:"Prof.",name:"Chris",surname:"Aldrich",slug:"chris-aldrich",fullName:"Chris Aldrich"}],corrections:null},{id:"65010",title:"Fuzzy Forecast Based on Fuzzy Time Series",doi:"10.5772/intechopen.82843",slug:"fuzzy-forecast-based-on-fuzzy-time-series",totalDownloads:1596,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter mainly uses fuzzy time series for interval prediction and long-term significance level analysis. In this study, the Taiwan Shipping and Transportation Index (Taiwan STI) is used to illustrate the prediction process. Nine steps have been used to establish the interval prediction of the Taiwan Shipping and Transportation Index (Taiwan STI), and ΔS is called a long-term significance level (up/down/stable) is used to illustrate the long-term prediction significance level. By means of interval prediction and long-term prediction significance level, the future trends for this index and more internal messages related to this index can be provided to relevant researchers.",signatures:"Ming-Tao Chou",downloadPdfUrl:"/chapter/pdf-download/65010",previewPdfUrl:"/chapter/pdf-preview/65010",authors:[{id:"262691",title:"Prof.",name:"Ming-Tao",surname:"Chou",slug:"ming-tao-chou",fullName:"Ming-Tao Chou"}],corrections:null},{id:"66346",title:"Training Deep Neural Networks with Reinforcement Learning for Time Series Forecasting",doi:"10.5772/intechopen.85457",slug:"training-deep-neural-networks-with-reinforcement-learning-for-time-series-forecasting",totalDownloads:2753,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:1,abstract:"As a kind of efficient nonlinear function approximators, artificial neural networks (ANN) have been popularly applied to time series forecasting. The training method of ANN usually utilizes error back-propagation (BP) which is a supervised learning algorithm proposed by Rumelhart et al. in 1986; meanwhile, authors proposed to improve the robustness of the ANN for unknown time series prediction using a reinforcement learning algorithm named stochastic gradient ascent (SGA) originally proposed by Kimura and Kobayashi for control problems in 1998. We also successfully use a deep belief net (DBN) stacked by multiple restricted Boltzmann machines (RBMs) to realized time series forecasting in 2012. In this chapter, a state-of-the-art time series forecasting system that combines RBMs and multilayer perceptron (MLP) and uses SGA training algorithm is introduced. Experiment results showed the high prediction precision of the novel system not only for benchmark data but also for real phenomenon time series data.",signatures:"Takashi Kuremoto, Takaomi Hirata, Masanao Obayashi, Shingo Mabu and Kunikazu Kobayashi",downloadPdfUrl:"/chapter/pdf-download/66346",previewPdfUrl:"/chapter/pdf-preview/66346",authors:[{id:"14090",title:"Prof.",name:"Masanao",surname:"Obayashi",slug:"masanao-obayashi",fullName:"Masanao Obayashi"},{id:"15895",title:"Assistant Prof.",name:"Takashi",surname:"Kuremoto",slug:"takashi-kuremoto",fullName:"Takashi Kuremoto"},{id:"208510",title:"Prof.",name:"Shingo",surname:"Mabu",slug:"shingo-mabu",fullName:"Shingo Mabu"},{id:"208511",title:"Prof.",name:"Kunikazu",surname:"Kobayashi",slug:"kunikazu-kobayashi",fullName:"Kunikazu Kobayashi"},{id:"283417",title:"Dr.",name:"Takashi",surname:"Kuremoto",slug:"takashi-kuremoto",fullName:"Takashi Kuremoto"}],corrections:null},{id:"64216",title:"CNN Approaches for Time Series Classification",doi:"10.5772/intechopen.81170",slug:"cnn-approaches-for-time-series-classification",totalDownloads:3394,totalCrossrefCites:20,totalDimensionsCites:28,hasAltmetrics:1,abstract:"Time series classification is an important field in time series data-mining which have covered broad applications so far. Although it has attracted great interests during last decades, it remains a challenging task and falls short of efficiency due to the nature of its data: high dimensionality, large in data size and updating continuously. With the advent of deep learning, new methods have been developed, especially Convolutional Neural Network (CNN) models. In this paper, we present a review of our time series CNN approaches including: (i) a data-level approach based on encoding time series into frequency-domain signals via the Stockwell transform, (ii) an algorithm-level approach based on an adaptive convolutional layer filter that suits the time series in hand, and (iii) another algorithm-level approach adapted to time series classification tasks with limited annotated data, which is a global, fast and light-weight framework based on a transfer learning technique with a source learning task similar or different but related to the target learning task. These approaches are implemented on identifying human activities including normal movements of typical subjects and disorder-related movements such as stereotypical motor movements of autistic subjects. Experimental results show that our approaches improve performance of time series classification.",signatures:"Lamyaa Sadouk",downloadPdfUrl:"/chapter/pdf-download/64216",previewPdfUrl:"/chapter/pdf-preview/64216",authors:[{id:"257943",title:"Ph.D.",name:"Lamyaa",surname:"Sadouk",slug:"lamyaa-sadouk",fullName:"Lamyaa Sadouk"}],corrections:null},{id:"66426",title:"Forecasting Shrimp and Fish Catch in Chilika Lake over Time Series Analysis",doi:"10.5772/intechopen.85458",slug:"forecasting-shrimp-and-fish-catch-in-chilika-lake-over-time-series-analysis",totalDownloads:1188,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Chilika lagoon (a Ramsar site) is a large source of fish production and biodiversity situated in the east coast of India, Odisha. Shrimp landings contribute an average of 4185 MT (Metric Ton) around 35% of total fish production. In this study, SARIMA (Seasonal Auto Regressive Integrated Moving Average) model has been developed on quarterly time series shrimp catch data during the year 2001–2015 and forecasted up to 2018. The best model was selected on Akaike Information Criteria (AIC) and Bayesian Information Criterion (SBC). Results showed that maximum average shrimp landings were observed in the first quarter period (summer season), whereas maximum variation in catch was observed during second quarter Q2 (monsoon season) and lowest variation in the fourth quarter Q4 (winter season) catch during the year 2001–2015. The developed time series SARIMA (0,1,1)(0,1,1)4 model was found to be the best fitted model for the shrimp landings in the lagoon. This article also delineates the application of SARIMAX model (SARIMA with regressors) using monthly catch prediction of fisheries in the Chilika Lake. The developed model is validated with less than 10% errors showing increasing fish catch in the upcoming years by maintaining the present lake condition.",signatures:"Rohan Kumar Raman and Basanta Kumar Das",downloadPdfUrl:"/chapter/pdf-download/66426",previewPdfUrl:"/chapter/pdf-preview/66426",authors:[{id:"265048",title:"Dr.",name:"Rohan",surname:"Raman",slug:"rohan-raman",fullName:"Rohan Raman"},{id:"265049",title:"Dr.",name:"Basanta",surname:"Das",slug:"basanta-das",fullName:"Basanta Das"}],corrections:null},{id:"65250",title:"Using Gray-Markov Model and Time Series Model to Predict Foreign Direct Investment Trend for Supporting China’s Economic Development",doi:"10.5772/intechopen.83801",slug:"using-gray-markov-model-and-time-series-model-to-predict-foreign-direct-investment-trend-for-support",totalDownloads:1055,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Foreign direct investment (FDI) is one of the important factors affecting China’s economic development, the prediction of which is the basis of its development and decision-making. Based on elaborating the significant role in China’s economic growth and the status quo of utilizing foreign investment over the period between 2000 and 2016, this chapter attempts to construct Gray-Markov model (GMM) and time series model (TSM) to forecast the trend of China’s utilization of FDI and then compares the precision of two different prediction models to obtain a better one. Results indicate that although it is qualified, traditional Gray model needs to be optimized; GMM is built to help modify the result, improve Gray-related degrees, and narrow the gap with real value. Comparing the accuracy of GMM with that of TSM, we can conclude that the fitting effect of GMM is better. To increase the credibility of these results, this chapter is based on the data of Beijing and Chongqing from 1990 till 2016, also verifying that the fitting effect of GMM is superior to that of the TSM. Then, we can safely draw a conclusion that the prediction model of GMM is more credible, which has a certain referencing value for the utilization of FDI.",signatures:"Yanyan Zheng, Tong Shu, Shou Chen and Kin Keung Lai",downloadPdfUrl:"/chapter/pdf-download/65250",previewPdfUrl:"/chapter/pdf-preview/65250",authors:[{id:"262190",title:"Prof.",name:"Tong",surname:"Shu",slug:"tong-shu",fullName:"Tong Shu"},{id:"262200",title:"Dr.",name:"Yanyan",surname:"Zheng",slug:"yanyan-zheng",fullName:"Yanyan Zheng"},{id:"262201",title:"Prof.",name:"Shou",surname:"Chen",slug:"shou-chen",fullName:"Shou Chen"},{id:"262202",title:"Prof.",name:"Kin Keung",surname:"Lai",slug:"kin-keung-lai",fullName:"Kin Keung Lai"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"5856",title:"Statistical Approaches With Emphasis on Design of Experiments Applied to Chemical 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1. Introduction
Diarrheic diseases are a serious public health issue in the entire world [1, 2]. Cholera is among the deadliest gastrointestinal diarrheic maladies in tropical areas [3, 4, 5], resulting almost exclusively from ingestion of water contaminated with Vibrio cholerae, but any fecal-oral pathway can potentially transmit the disease [6]. When untreated, the disease rapidly results in death, and transmission is quick within the community [2]. It is a problem because many developing countries lack resources and time necessary for confirmation and management of cholera outbreaks [7].
In the African continent, cholera has been a significant cause of morbidity and mortality [3, 6]. The disease was introduced in Mozambique from the Indian subcontinent in 1970 and became a major cause of infectious diarrhea [4, 8, 9]. Since then, the country has been facing outbreaks, particularly in Nampula Province [6]. The most severe happened during the 1990s, resulting in one third of all cases in Africa [5]. All diarrheic diseases together are the fourth major cause of death of <5-year-old children, causing in average 13,105 demises per annum. Cholera’s epidemiological profile is changed from epidemic to endemic due to the frequent outbreaks [6]. In general, there is a virtually countrywide epidemics every 5 years, but Nampula and Cuamba cities register annual cases [1], usually during the rainy season (December to June) [8]. According to Chissaque et al. [10], the last major outbreak was in 2015. Furthermore, some issues have been worsening the situation and raising increased concern. For instance, diarrhea-causing enteric bacteria are developing resistance to antibiotics [11], possibly because of overprescription.
Cholera is endemic in Mozambique, but there is very limited research on the matter. There is little information on transmission patterns and how risk factors such as non-potable water, improper sanitation, and hygiene affect the incidence, prevalence, and severity of the disease [4, 9]; there is no local protocol for treating acute diarrhea in children, the only reference being from the World Health Organization (WHO) [4, 12, 13]; little is known about the challenges, success cases, and the extent of the impact of the struggle against cholera in Mozambique [2] and the operational cost to implement a vaccination campaign against cholera [14]. If such information gaps are filled, it will be possible to substantially improve the strategy to mitigate the disease.
Gujral et al. [15] wrote an important contribution to the overall understanding of cholera epidemiology in Mozambique up to 2013, based on the national surveillance data. Though it is a good reference for researchers and scholars, there were some updates published in at least three journal articles [9, 10, 16], reports from the United Nations [17] or other organizations, and 17 presentations [1, 2, 3, 4, 5, 6, 7, 8, 11, 14, 18, 19, 20, 21, 22, 23, 24] at the XVI Scientific Journeys organized by the Mozambican National Institute of Health [25]. This chapter aims to summarize the contributions of such publications for the current knowledge of cholera in Mozambique.
2. Sources and reviewing process
The current analysis is based on updates presented during the XVI National Health Journeys, 17–20 September 2018, in Maputo City, in Mozambique. National Health Institute organized the event under the motto “Promovendo a intersectorialidade e a participação comunitária para o alcance dos Objectivos de Desenvolvimento Sustentável” [Promoting the multi-sectoral collaboration and community participation to meet the Sustainable Development Goals]. Since the beginning, in 1976, the journeys have been arguably the country’s most relevant event on the matter, hosting presentations from leading health researchers in Mozambique [26].
Summaries of all presentations were then compiled to Revista Moçambicana de Ciências de Saúde [Mozambican Journal of Health Sciences]. There were 19 presentations directly or indirectly related to cholera. Some content was a follow-up of other previously published international journals, and it facilitated their interpretation. ATLAS.ti 8.1 (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) was used to analyze most information and Jamovi 0.9 (The Jamovi Project, Amsterdam, Netherlands) for meta-analysis when necessary.
Most studies on cholera in Mozambique conducted during the last decade were complementary, connected as part of a multidisciplinary approach for accompanying control campaigns led by the Ministry of Health, targeted to susceptible groups in areas where annual outbreaks occur during the rainy season [16]. At least half of the studies used data from Nampula City [23], but there were also studies in Tete, Moatize, Quelimane, Mocuba, Guruè, Metangula, Cuamba, and the country in general [1, 2, 5, 19, 20, 21]. Chissaque and Deus [20] presented, in the journeys, content directly related to a journal article published the same year [10].
It is perhaps important to mention the group that contributed the most with presentations about cholera during the Scientific Journeys. It was the team of Baltazar and Baloi [23], from the National Institute of Health, mostly reporting on different aspects of the immunization campaign in Nampula City, 2016. Their particular presentation was focused on the vaccine coverage and acceptability, but the same group also analyzed local media coverage and people’s reaction [21], evaluated environmental determinants [4] and post-campaign adverse effects [18], validated a rapid test to monitor the efficacy of the vaccine [7], and evaluated the economic cost of the vaccine [14].
3. The current situation of cholera in Mozambique
Since most publications are interconnected, based on the same campaigns and projects, they shared some constraints and limitations. They might not be explored in full depth in the following subsections. Section 5.7.3 presents more details and respective analyses on the limitations and constraints.
3.1 Etiology
The main causes of diarrhea in Mozambique, especially in children, are V. cholerae, rotavirus, Shigella spp., Escherichia coli, Cryptosporidium spp., and Aeromonas spp. [20]. At this stage, V. cholerae is well-known as the cholera-causing microorganism, even outside scholarly or scientific circles. Etiological studies are now focused on peculiarities or diversity of endemic strains in Mozambique, and how to rapidly distinguish cases of cholera from other forms of diarrhea, especially during emergency situations. The more accurate the diagnostic, the more appropriate the treatment.
According to Langa et al. [16], Mozambican V. cholerae O1 isolates from 2012 to 2014 outbreaks are genetically closely related to strains of pandemic worldwide, unlike the Indian-born found 20 years ago. Garrine et al. [9] went one step forward by analyzing how related 75 isolated were from patients in Manhiça District Hospital from the start of the millennium up to 2012 and 3 from the Komati River. They were able to reveal four unrelated genotypes and two clonal complexes with 22 genotypes by using a multilocus variable-number tandem-repeat analysis (MLVA), and through whole genome sequencing (WGS), they detected recombination and four isolates genetically unable to produce cholera toxin. The investigators were also able to deduct that Wave 3 of the seventh pandemic [27, 28, 29] remained in the area for at least 8 years, originating 67 of the isolates analyzed.
It is worth mentioning Aeromonas spp., as Chitio and Langa [24] demonstrated that these microorganisms cause symptoms easy to confuse with cholera’s, particularly during outbreaks. They detected Aeromonas spp. in 30 (10.4%) of 289 samples of rectal swabs from patients with suspicion of cholera during outbreaks in 2014 and 2015. The species were Aeromonas sobria (57%), Aeromonas hydrophila (20%), Aeromonas caviae (13%), Aeromonas veronii (7%), and Aeromonas salmonicida ssp. salmonicida (3%).
3.2 Risk factors and health determinants
Environmental sanitation is important to control disease for the benefit of public health [19]. For several natural, sociopolitical, cultural, and economic reasons, Mozambique is spatially heterogeneous in terms of distribution of resources, including water, housing, their conditions [30], and certainly other features potentially affecting the transmission of cholera. Thus, one shall expect to see substantial differences in terms of risk factors and health determinants in different areas throughout the country. Yet, it is possible to draw some comparisons on how one or another factor affects the dynamics of cholera transmissibility, from different authors’ points of view.
Marrufo et al. [4] evaluated water, sanitation, and hygiene in the area with more cases of cholera in Nampula City and found that 42% had improved latrines and 90% of the inhabitants had access to at least one improved water source, as defined by the World Health Organization and the United Nations Children’s Fund (UNICEF) [31]: with potential to deliver safe water by nature of its design and construction. The authors did not specify their sample size (n) in the summary for the presentation, but their sample was certainly representative because they followed the guidelines of the United Nations High Commissioner for Refugees, and they were the same research team as Baltazar et al. [23] (n = 636), besides the fact that they covered a very wide area and used a statistical treatment of the data. A major health determinant is likely the lack of drainage and sewage through the entire suburban area covering six neighborhoods, particularly when it rains [4, 8, 20]. According to Ramos et al. [19], residents of Bairro Novo [New Neighborhood], Quelimane City, claimed to frequently observe human stool and trash floating when it rains and water accumulates through the streets. This area also lacks a sewage system and has a shortage of latrines.
A different research team [22] interviewed 59 patients with suspicion of cholera in the rural community of Casacone and found the same percentage as Marrufo et al. [4] of households with latrines (42%), but there were differences: 64% used well water, and none treated it before consuming. Besides the differences in the settings (suburban and rural), the study groups were fundamentally different, as Paulo et al. [22] worked with people having acute diarrhea, while Marrufo et al. [4] worked with populations from a risky area. The former group was by definition people who had contact with contaminated water; thus it is not surprising that all used untreated water, unlike the latter group.
Borges et al. [5] found that people in Metangula District (Niassa Province) prefer using untreated water from the lake, even when they have access to potable water, and they could not find any explanation, particularly because most (98%) were aware of cholera and the associated risks. Adding to that fact, Francisco and Chindia [3] stated that in this particular area, temperature and precipitation do not seem to be major health determinants, and it reinforces the idea that the issue is led by behavior. There are perhaps sociocultural or religious reasons. For instance, the Zion Christian Church is well-known in Mozambique, and it is the third largest (17.5% of the population), only surpassed by Catholicism (23.8%) and Islam (17.8%) [32]. One notable ritual of this church is the “Jordan” baptism, performed in rivers, lakes, and sometimes the sea. Such level of exposition to waterborne pathogens is highly concerning, particularly in hotspots of cholera endemism. Furthermore, virtually all over Mozambique, there are people who believe that malicious individuals intentionally created cholera to harm others [2, 6, 33]. Thus, it is important to debunk such self-destructive mentality and the resulting attitudes.
3.3 Epidemiology
3.3.1 Geographical distribution
The World Health Organization [34] identifies Mozambique among the African countries most affected by cholera epidemics. In the first decade of the millennium, cholera had an incidence of 12 to 127 per 100,000 inhabitants, especially in the rainy season [20]. The variant of V. cholerae O1 (El Tor strains) active in the country then came from the Indian subcontinent, and it can be found, for instance, in Bangladesh [16, 35]. Between 25 December 2014 and 22 March 2015, there was a sequence of outbreaks through 5 provinces and 18 districts, resulting in 7073 cases reported and 53 deaths (fatality rate was 0.7%) [17]. Genetic analyses suggest that strains found in Mozambique since 2012 are also common in several other parts of the world [16], indicating the existence of different waves of contamination converging in the country.
Chitio and Langa [24] and several other presenters in the XVI National Health Journeys seemed to agree that cholera has been more widespread throughout the central and northern provinces (Figure 1), particularly Niassa and Nampula in the north, where outbreaks occur annually, in contrast to the rest of the country, where it occurs every 5 years [1, 4, 22].
Figure 1.
Draft of Mozambican map showing the areas where research and interventions related to cholera occurred since 2013. Image adapted from Wikimedia Commons [36] under public domain. Data was compiled from the XVI National Health Journeys [1, 2, 3, 4, 5, 6, 7, 8, 11, 14, 18, 19, 20, 21, 22, 23, 24], Chissaque et al. [10], and Vanormelingen et al. [17].
Vanormelingen et al. [17] included Sofala in the list of affected provinces, and Chissaque et al. [20] mentioned V. cholerae among the causes of diarrhea in the country’s south. The main cause is the lack of potable water and proper sanitation such as improved latrines [4], though behavioral factors also contribute to the incidence and prevalence of cholera [6, 8, 21].
In Niassa Province, the most frequent reports have arisen from in two municipalities: Metangula, where the majority of the cases occur [5], and Cuamba [1]. Besides similar causes as in Nampula City, a major risk factor for cholera contamination in Niassa is the insistence on using untreated fresh water to wash dishes, take a bath, and drink, especially the population of Metangula who live at the Niassa lakeshore [5]. In their presentation, Borges et al. [5] stated that choice of fresh water is not necessarily related to the access to potable water, as there were sufficient wells for the community.
In Nampula, the six most severely affected neighborhood cities are Carrupeia, Muatala, Murrapaniua, Mutauanha, Napipine, and Natiquiri, with 193.403 inhabitants [1, 4, 18]. Other neighborhoods under risk are Namicopo, Namutequeliua, and Belenenses, especially considering a recent observation that some residents showed very low awareness on how cholera is transmitted [6]. In this decade, the city had annual outbreaks recorded at least from 2013 to 2018 [4], and it is confirmed that an outbreak is happening as this article is being written [37], but this topic will be briefly discussed in the post-conclusion note (Section 7). There was another outbreak notified 17 November 2017 in Nampula Province, Nacarôa District [22]. The most affected areas were Munana and Casaconde neighborhoods, in the administrative area also called Nacarôa, within the district.
Zambezia was another province studied, and there were studies from cities of Quelimane, Mocuba, and Gurúè [1, 2, 19]. Vanormelingen et al. [17] added Nicoadala District. First, regarding “Bairro Novo” [New Neighborhood] in Quelimane City, Ramos et al. [19] mentioned the rapid expansion of the city, hardly complying with proper urbanization planning, thus resulting in improper sanitation and hygiene. The authors decided to investigate the frequency of waterborne diseases, including diarrheic maladies, by interviewing members of 21 households, and analyzing records from the Healthcare Center from 24 July 2014 to 2017. Cholera was mentioned among the most frequent diseases, although the authors did not specify the prevalence. In general, they included the disease among the diarrheic, with 564 cases (47.3%) in 1193 recorded in the healthcare center’s registry. In Mocuba, Mesa et al. [1] analyzed 128 processes of patients carrying diarrheic diseases. Although the authors did not specify the diseases, they suspected that most had cholera considering the symptoms recorded, the fatality rate of 4% (plausible, according to the World Health Organization [38]), and the fact that there was an outbreak as they were conducting their investigation. The most affected neighborhoods were Samora Machel (33%), Marmanelo (15%), CFM (11%), carreira de tiros (10%), and Tomba de Água (8%). Carlos [2] said that various minor towns of Gurúè District have been registering outbreaks of diarrheic diseases and cholera, but in 2015 there was an outbreak in its main city, also called Gurúè.
There are other areas where cholera is endemic, but the scholarly publications from the last decade did not explore in depth the epidemiologic point of view, but they are worth mentioning. For instance, the 2015 outbreaks in the country’s north and center seemed interconnected and occurred during the same period, and they reached areas including the cities of Tete, Moatize, and Sofala Province [17]. There are also studies from the south, though in different time and context. Salomão et al. [21] presented results of a 2-year study (2017–2018) related to immunization campaigns in the cities of Tete and Moatize, after an outbreak in 2017. As the outbreaks were stabilizing in the provinces mentioned so far, in Sofala it was spreading, with reports from Beira City, Caia, and Nhamatanda. Manhiça District Hospital keeps isolates of cholera [9], and it reflects the history of the disease there and in the areas nearby. Garrine et al. [9] worked with these isolates in their research and added three from the Komati River.
3.3.2 Prevalence, impact, and susceptible groups
Since most studies presented at the XVI Health Journeys were follow-ups of ongoing studies, they all tended to miss some details, and some were complementary to each other. For instance, the studies after the 2015 outbreak of cholera in Nampula explored different perspectives on the problematics [4, 6, 7, 8, 14, 18, 22, 23]. Table 1 shows some epidemiological data recorded after 2013. These are just some examples because it would be redundant to include some papers, particularly the studies conducted in Nampula. Still, there is plenty of information worth sharing.
Confirmed cases/suspected cases in children recorded in healthcare institutions; ns, non-specified.
The studies did not explain the dynamics of how the disease is spread during non-epidemic periods because virtually all were conducted during outbreaks, or at least based on them, though it might not differ much from times of outbreak, especially because the area is endemic. Phenomena such as heavy rain and natural catastrophes certainly work as amplifiers of the disease severity by increasing people’s exposition to untreated water [3, 20, 39, 40, 41, 42]. Yet, it would be a good idea to study the risk factors and disease determinants during times of low prevalence because it would, for instance, minimize the need for researchers to work under pressure or “under budget” because of non-research-driven priorities [43], avoid panic or undesirable reactions from study subjects, and perhaps be easy to prevent outbreaks or lower considerably their impact on public health. On the other hand, outbreak investigations are crucial to ensure proper intervention. Thus, the information below represents outbreak-related scenarios but somehow the best lead so far of the country’s reality with or without an outbreak.
According to Table 1, the country’s cholera fatality rate (CFR) in 2015 was 0.7%. This value is low, within the range 0–15.8% of the Global Health Observatory (GHO) in 2016, published by the World Health Organization [38]. According to the GHO, 22 countries had CFR > 1%, and only Niger, Zimbabwe, and Congo had CFR > 5%. Even the global (1.8%) was higher than Mozambique the previous year during the outbreak. Such low fatality rate was likely due to a very fast and effective response in terms of vaccination, treatment [11, 23], and other measures such as health education and support in sanitation [8, 17]. Cholera is highly virulent but also easy to treat and there is vaccine [44]. The fatality rate observed in Nacarôa (2%) was not far from the global, and it seems reasonable to expect such kind of fluctuations in a considerably small sample. It should be also reasonable to expect a value slightly higher than average in endemic areas.
It is general knowledge that cholera is spread through water and improper sanitation is a major risk factor for transmission. Thus, the disease deeply related to poverty in several ways including obviously the lack of resources for prevention or treatment and limitations in education or information. It is intuitive that the most susceptible are people living in highly crowded suburban areas when people have little access to clean water, or in rural settings, when people directly consume water from lakes or rivers without any treatment. People living around Lake Niassa use it for domestic purposes [5]. This is the reality in several areas of Mozambique. This must be understood on top of any specificity of the studies explained or discussed in this subsection. It must be implicit that all the studies’ target populations were susceptible to cholera.
The research team of Baltazar et al. [23] belongs to the National Institute of Health, and they conducted most studies related to the vaccination campaign in Nampula City, 2016. In the particular study cited, they focused on inhabitants over 1 year old living in the city’s six most susceptible neighborhoods, mentioned in Section 5.4.1 (Geographical distribution). People from surrounding areas are also at risk [4] because of mobility and interaction with residents of the endemic neighborhoods or exchange of food or drinks coming from such zones.
Children are the most susceptible to diarrheic diseases in general [11, 20] perhaps because of their immunity still under development, their unawareness of the bacterial load in the untreated water, and their behavior. In reality, they have always been the priority and focus of the vaccination campaigns [10, 45]. Among 1910 children hospitalized with acute diarrhea from May 2014 to December 2017, Salência et al. [11] found that <1-year-olds were the most affected and 19 infants (2.4%) had V. cholerae. The majority (58%) were male, but it seems that the proportion male/female always gravitates around 1:1 [1, 11, 22]. Mesa et al. [1] analyzed 128 processes of patients with acute diarrhea in Mocuba District Hospital, admitted during June and July 2015 in the local hospital. According to the authors, all patients presented symptoms consistent with cholera, but, despite their convictions, there was no confirmation, and they based their conclusions on clinical data (aqueous stool, vomit, and fever). In any case, all were below 16 years old in which 41% were below 5 years and 4% of the cases ended in decease. Differently, Paulo et al. [22] found 68% of individuals over 15 years old among 135 cases of cholera in the Center for Treatment of Diarrheic Diseases in Nacarôa District, recorded from 12 to 28 November 2017. The difference is likely due to a fact mentioned by the authors that none treated the water before consuming and the majority (64%) used well water. One has to imagine that the entire household uses the same water source and all the members have nearly the same level of exposition if it is contaminated, independently of the age and behavior of each individual. The age or sex differences might be a reflection of the actual sociodemographic profile of the community.
3.4 Diagnosis
There is little novelty on diagnosis in Mozambique since the beginning of the decade. It is perhaps worth mentioning that during the 2016 massive vaccination campaign in Nampula, Dengo-Baloi et al. [18] performed a rapid test to verify if it could be an alternative to the culture-based standard, as the latter takes 48 to 72 hours and the rapid test would take approximately 6 hours. They used an alkaline peptone water (APW) enrichment method, but they did not specify the origin of the kit. It was likely Crystal VC RDT (Span Divergent, Mumbai, India), previously used by George et al. [46] in Bangladesh and Ontweka et al. [47] in South Sudan. According to the latter, it is also considerably inexpensive. Dengo-Baloi et al. [18] observed exactly the same results using the standard method and the rapid test for 75 samples, demonstrating its efficacy as a good alternative for the standard in areas with limited resources.
3.5 Control strategies
3.5.1 Overview, prophylaxis, and awareness
Cholera control strategies in Mozambique have been changing over time, perhaps due to governmental priorities, an increasing knowledge, or resources available. Regarding Mozambique, it is important to keep in mind that Mozambique has undergone major political changes, there have been conflicts, including armed, natural calamities such as drought, floods, typhoons, economic crises, and fluctuations. All these phenomena resulted in mobility or affected people’s livelihoods, changing the dynamics of access to resources, including potable water, ultimately impacting public health. This ever-changing environment has been determining, at a certain extent, the way the government deals with the epidemics of infectious diseases, including cholera. Chissaque et al. [20] mentioned some key actions of the government’s strategy: vaccination, health education, introduction of zinc and salts for oral hydration, improvement of basic sanitation (construction of latrines and access to potable water), and organization of national health weeks. Dengo-Baloi et al. [18] added vigilance among the measures, and Vanormelingen et al. [17] said that the government coordinated a real-time mapping of the epidemic and supported social mobilization with the assistance of the United Nations Children’s Fund, World Health Organization, and Médecins Sans Frontières (MSF).
The most relevant actions in the last decade are perhaps related to the Ministry of Health’s implementation of vaccination campaigns using Shanchol™ (BivWC, Shantha [48], Ranga Reddy District, Telangana, India) in Nampula City’s six most vulnerable neighborhoods, in October 2016 and also the subsequent years [4, 10, 21]. It was in response to the outbreak in 2015, and the strategy was to deliver the vaccine door to door in two rounds [23]. Paulo et al. [22] mentioned another outbreak in November 2017, but it did not seem as severe. The 2016 campaign was strategically set to cover 193,403 individuals and prevent the expansion of cholera to less affected areas [4, 18]. Though the first round only covered 69.5% of the target population, and the second covered 51.2%, Baltazar et al. [23] considered the experience as a success and shared the belief that similar strategies can have more adherence in urban settings when there is no emergency. Considerably low adherence was mostly because many people were not at home during the campaign, and 17.3% of 636 people enquired said that they were unaware of the campaign. The situation was similar in the following 2 years [21]. Thus, it is important to improve or use more effectively the channels to communicate with the residents.
After vaccination, there were adverse effects such as abdominal pain, nausea, and diarrhea, but none seemed severe enough to require any medical assistance [18]. The National Institute of Health organized a vigilance of postimmunization adverse effects in nine healthcare units, and, according to Dengo-Baloi et al. [18], there were eight cases reported after the first round of vaccination, three during the second, and one case during both rounds. Yet, there were certainly more cases because Baltazar et al. [23] reported adverse effects in 47 people of 451 interviewed after receiving vaccination. A possible explanation for the discrepancy between both studies is the fact that PIAE vigilance recorded mostly cases that occurred 24 h after vaccination, and it was based on records from healthcare units, while the other study was based on inquiries directly to randomly chosen individuals from the community from 2 to 9 November 2016 [18, 23].
Among the 428 interviewees of Borges et al. [5] in Metangula, the level of awareness on cholera was very high (98%), and they said that radio (35%) and lectures at the healthcare center (28%) were the main sources of information about the disease. If the population in general is aware of the disease and still Metangula is the town most affected with cholera in Niassa Province, perhaps most inhabitants lack essential knowledge on how to prevent the disease or have very few alternatives as source of water or means to properly treat it. Yet, the investigators claim that most people from Metangula have access to potable water, but they prefer the untreated from the Lake Niassa and proposed further studies to understand their motivation. They also believe that it is necessary to intensify awareness campaigns on how to prevent cholera. However, such campaigns might not be very effective if people mistrust the authorities, as Victorino et al. [6] said. The latter authors interviewed 30 residents throughout three neighborhoods of Nampula City (the same region of the country), and they unanimously claimed that the government was responsible for the outbreak of cholera. Furthermore, the majority (18 people) did not really understand the concept of cholera (bacterial disease transmitted through water), and 12 did not know how to prevent the disease. In this case, it would be more prudent to approach the residents through authorities they might be more prone to trust, such as teachers at schools, traditional leaders and religious entities.
3.5.2 Constraints and limitations
At a first glance, the main constraints seem related to vaccination, improper treatment and potential misdiagnosis of diarrheic diseases, unclear notion on the impact of risk factors, shortage of resources for interventions, and government mistrust. Some constraints might be related, and for this reason they will not be necessarily presented in the same order as mentioned. This subsection might seem redundant in the sense that it recapitulates some limitations from the previous subsections. However, it seems important to discuss them in more detail, as they are likely to be the starting point for future researchers aiming to study the dynamics of cholera epidemiology and control strategies in Mozambique. Furthermore, some ideas are consolidated, and some relationships are explored more critically in this subsection.
According to Baltazar et al. [23], during the 2016 vaccination campaign in Nampula, more than one third missed the vaccine because they were not at home or did not receive any information prior to the campaign, and in the second round, there were less people available, though dropout rates from the first to the second dose up to 13% is not uncommon due to factors such as migration or other reasons leading people to be absent [49, 50]. Salomão et al. [21] stated that it happened again the following year, and, according to them, the main reasons were lack of time, absence, and lack of information. The overall vaccine wastage rate was 10%, and it seems high if compared with the experience in Bangladesh between February and April 2011, where it was 1.2% [49]. Such wastage might be partially related to reasons to be discussed in the following paragraph.
It seems important to discuss the most likely motivation for the vaccination campaign’s suboptimal adherence. Since the strategy was door to door, it seems difficult to suddenly receive someone claiming to be from the government and offering substances to all family members including children. Even if the visitors show credentials, many inhabitants mistrust the government and blame it for the disease [6, 8]. In contrast, Botão et al. [8] interviewed 145 individuals from the target population, and 92% said they were willing to receive the vaccine. It is hard to clarify why they showed interest, but the actions were different, but a possible explanation would be that they just manifested agreement for the convenience of the interview or because they fear the authorities. Such attitude toward the government is not new or exclusive to Nampula or northern Mozambique. For instance, Pool et al. [33] reported a similar behavior during a campaign for immunization against malaria 10 years before in Manhiça District, southern Mozambique. Similarly, rumors stated that the local clinic was trying to poison the children. In Gurúè City, people believe that cholera is sent as spells by evil individuals [2]. It would be an asset to investigate what religious leaders or traditional healers think of cholera and government interventions, because it is common for people in Mozambique to rely on them in matters of health, in some cases even for immunization. The fact that conventional practitioners are a direct competition for their source of income cannot be underestimated, and if people, including their leaders and traditional healers, regard outbreaks of diarrhea as a spiritual matter, they might not understand the governments’ true motivations, and “conspiracy theories” will keep spreading. Botão et al. [8] reported emerging conflicts related to previous cholera interventions between health professionals, community leaders, and health activists, sometimes escalating to episodes of violence. Interventions seem to become more difficult over time as the locals create barriers for the professionals, and both Botão et al. [8] and Salomão et al. [21] believe only the notion that cholera is life-threatening can motivate the population to accept the vaccine. In any case, prior to vaccination, there should be a strong campaign targeting traditional authorities in order to promote their collaboration and influence the adults, and likewise directed to teachers, to influence the children. It would also include, in the strategy, ways to make sure that people are not absent during the campaigns.
Baltazar et al. [23] also stated that 10% of the individuals experienced side effects after vaccination, and it seems a plausible explanation for the decline of 18.3% in adherence between the two rounds. It is possible that such individuals and their families or relatives preferred not to receive the second dose, and it can still be confirmed if the interview records are available. Minor side effects to this vaccine (Shanchol™) should have been expected in some people [48, 51], and it has been observed in Bangladesh [52]. The vaccination campaign in Nampula was certainly carried with informed consent and following the WHO [53] recommendations, but if the side effects in fact led people to withdraw from the second round, it is important to reevaluate the communication with the target population. The Centers for Disease Control and Prevention [54] recommend competent authorities to explain the people to be vaccinated about the “benefits of and risks from vaccines in language that is culturally sensitive and at an appropriate educational level.”
Misdiagnoses should also not be underestimated, especially because it has impact on the choice of treatment. Chissaque et al. [20] reported lack of consistent protocols to directly relate a pathogen with a particular diarrheic profile and also the respective risk factors. Outbreak of a disease can be misleading when there are people carrying diseases with similar symptoms. For instance, Chitio et al. [24] detected Aeromonas spp. in 10.4% of 289 samples of rectal swabs from individuals with symptoms consistent with cholera during outbreaks of the latter. Sometimes even conventional culture methods can fail to detect V. cholerae [55]. Furthermore, Gupta et al. [56] found that clinical conditions of a coinfection cholera-rotavirus and cholera alone can easily be confused. There should be efforts to ensure rigorous differential diagnoses when it is possible.
Salência et al. [11] reported the abusive use of antibiotics to treat acute diarrhea in children, including confirmed cases of cholera (2.4%), between May 2014 and December 2017 in major hospitals from all regions of Mozambique. According to the authors, antibiotics were used to treat 94% of the patients, and this represents a violation of the WHO’s protocol that recommends the use of these compounds when there is cholera, dysentery, and other “recognizable severe cases” [57]. Antibiotic misuse is frequent in developing countries but such level was extreme. For instance, Runesson et al. [58] reported the use of antibiotics in 70% of cases of children with diarrhea, randomly examined in a children’s hospital, from which at least 35% did not really need antibiotics. According to Rogawski et al. [59], antibiotics have the potential to modify the gastrointestinal microbiota and increase the risk of a reduced time to a subsequent diarrhea episode. It is also known that antibiotic abuse frequently results in resistance. In 2007, Mandomando et al. [60] reported a high incidence of resistance to chloramphenicol (57.9%), co-trimoxazole (96.6%), and tetracycline (97.3%), and low for quinolone (4.2%). Salência et al. [11] mentioned the use of ampicillin (45%), gentamicin (39%) combined with therapy, and gentamicin (10%). Thus, there should be efforts to discourage physicians to prescribe antibiotics when it is not necessary. When appropriate, they can use quinolone or third-generation cephalosporins [60].
4. Conclusions
The presentations in the XVI National Health Journeys and the recent articles on cholera offered an invaluable contribution to the current knowledge on the disease in Mozambique, particularly regarding the risk factors, health determinants, and immunization process. Such contributions showed how important the journeys were. The Ministry of Health and related institutions have been active in research and interventions to control cholera in Mozambique. The immunization campaign in 2016 certainly had high impact in reducing the incidence of cholera, as no outbreak has been as wide and severe as 2015’s (the ones this year are not considered because their extent is still to be assessed). Yet, governmental effort cannot achieve the desired results if there is no collaboration from the civil society. The etiology, risk factors, and epidemiology of the disease are fairly known, and, although the government lacks resources to provide proper sanitation, access to clean water, or vaccine coverage for all people at risk, it is now a matter of designing a strategy to tackle each the issue, and if the plan is solid, funds can be acquired and well used.
5. Recommendations
The following recommendations are not simply observations based on findings shared during the XVI Health Journeys. They are supplemental observations on their actual recommendations, in a broader context if necessary. It seemed unnecessary to bring to light ideas of improvements if the authors have already done so, this being a mere enhancement if they seem incomplete.
Environmental determinants such as water, sanitation, and hygiene synergistically impact the extent of severity of cholera. Thus, Marrufo et al. [4] strongly recommended their evaluation during outbreak-related emergencies. It is true, but such evaluation should not solely occur during outbreaks. Proper management of the way people use water is crucial to prevent outbreaks in the first place, although factors such as heavy rainfall, warm air temperature, or low river flows cannot be controlled, and they increase the exposition of humans to V. cholerae [61, 62]. Ramos et al. [19] and Chissaque et al. [20] agreed, but they proposed a more practical approach through construction of specialized improved latrines, adaptable to high levels of the water table, and improved sanitation. Paulo et al. [22] added that it could be done through multi-sectoral groups involving researchers, community leaders, and engineers. It is eventually necessary to act rather than waste plenty of time analyzing the situation, particularly when it urges to make decisions, but Marrufo’s opinion seems more prudent, and it should be the first step, and then the government could consider improvements, still after evaluating their viability. Considering the cost Dengo-Baloi et al. [7] explained the necessity to evaluate how much the Ministry of Health spends for an immunization campaign, but it applies to all forms of intervention and also research. The economic component is crucial, and it should also include how and where to obtain and channel the funds and the best way to manage it in order to prevent unnecessary losses.
Still within the context of health determinants, Borges et al. [5] manifested preoccupations with the people directly using lake water in Niassa, without any treatment, even when they have potable water available. They intended to understand why, and they recommended studies in this direction. They and other authors [6, 22] also think health education campaigns could lead people to understand the risk of such behavior and ultimately take the appropriate measures. The authors are certainly pointing to a constructive direction, but it is a delicate endeavor to convince people to abandon their values and traditions. Niassa Lake, more than a useful water source, is certainly also a source of recreation and economic activities such as fishing or garimpo, and the reasons why people use the lake even with water at home might be the same as why urban populations leave their homes to a swimming pool or to the sea for surfing or fishing. Maybe they are moved by the experience, not merely out of necessity. The disbelief in cholera as a bacterial worldwide pandemic in favor of theories of government conspiracy worsens the situation. In this case, particularly if the lake is a source of so many benefits, positive psychology seems to be a more effective direction to consider: showing the benefits of using alternatives (e.g., consuming only treated water) for the same ends rather than repeating how prejudicial the lake water might be. It still means that community education is necessary because people have to know how to prevent cholera.
Chitio and Langa [24] called for a clear definition of cases of Aeromonas spp. contaminations during cholera outbreaks to prevent improper treatment. This should not be just for the genus mentioned, but in general physicians should require differential diagnostic for suspected cases of cholera, rather than taking rushed decisions based on arbitrary probability during outbreaks, because it might worsen the problem or create new problems for the patients. If they found that 10% of the cases suspected of cholera were actually related to Aeromonas infection, how many might have been related to other causes than Vibrio or Aeromonas? And which were the consequences of their possible misdiagnosis?
After successfully performing the rapid test for cholera, Dengo-Baloi et al. [18] recommended it as an alternative tool, but they believe that the culture method shall remain to confirm the epidemics, to monitor antibiotic sensitivity, and to produce pure isolates for molecular characterization. Considering how critical outbreaks are, the authors provided a very prudent opinion, and, although their results were highly promising, it is perhaps better to keep testing the method and compare the results with others from authors in different settings before it becomes a standard.
Immunization is already a well-developed area because there are very well-crafted guidelines, based on logical, scientific, and empirical sources, and it has been practiced for many years. Still, healthcare professionals have to face contextual issues, and it results in every-evolving strategies. The door-to-door vaccination strategy seems very effective, and Baltazar et al. [23] said it is better to implement as a preventive measure against potential outbreaks. Having said so, they did not put emphasis on the strategy during outbreaks, possibly because it is preferable to manage the disease when it is easier to control. It is perhaps important to consider the Médecins Sans Frontières [63] recommendations for door-to-door strategies, some of which are already fulfilled. First, it is good that people already have experience with this approach, and there is some acceptance [23]. Second, it is important to coordinate the process with the authorities at neighborhood levels or small communities, where information is easy to spread, and it is also easy to record the number of residents or households in order to keep track of individuals absent during each round and organize catch-up rounds. Baltazar et al. [23] also suggested short-term effectiveness studies, but these have been done and reported by Dengo-Baloi et al. [7] from the same research team. Perhaps the results had not yet been analyzed when Baltazar et al. [23] had already completed their report. To maximize adherence, Botão et al. [8] suggested sensibilization of the population through identification of credible leaders and other influential individualities to function as mobilizers during the entire campaign.
Salência et al. [11] discussed about the indiscriminate use of antibiotic to children with acute diarrhea as a violation of WHO guidelines, and the authors appealed for the optimization of prescription of antibiotics for diarrhea. The authors are correct, but the issue requires perhaps more attention, considering that WHO guidelines result from the international consensus and, in general, physicians are expected to be aware of the dangers of antibiotic overprescription, and this practice is often most likely an act of negligence. Thus, there should be penalties to discourage such kind of misconduct because it is a sensitive public health matter.
The National Health Institute and partners shall keep organizing the National Health Journeys and similar events because they are very constructive platforms in which researchers, scholars, and health professionals can share information and broaden their scope regarding the reality of cholera and other diseases in Mozambique. Such events should be more frequent and organized all over the country to give opportunities to people residing in other areas than the capital city. It would perhaps be a very good idea to promote conferences about the control of cholera or diarrheic diseases in areas of high incidence and engage local health professionals or potential actors who can really influence the current situation.
The final recommendation is based on the words of Chissaque et al. [10] in their summary: the key to control cholera and other diarrheic diseases is a deep understanding of the local epidemiology. Such comprehension would facilitate predictions and planning on how to prevent outbreaks and manage them if they eventually happen. Mozambique could study carefully experiences from other countries where cholera is endemic, such as India or Bangladesh, and understand how they deal with the matter or at least draw some comparisons and interact with foreign scientists. The contexts are surely different, but the problem is similar, and solutions might arise from unexpected variables.
6. Post-conclusive note
There will be soon more updates on cholera in Mozambique because there were two major outbreaks [40, 64, 65], one still ongoing as this manuscript is under preparation [66]. They are related to the intense tropical cyclones Idai and Kenneth that made landfall in Mozambique’s central and northern provinces, respectively [67]. According to Miller and Adebayo [37], Kenneth it is the strongest cyclone recorded in the country, and together the tragedies certainly caused the biggest losses since the flood in 2000 [68]. Briefly, Devi [40] said that up to April 20, the Ministry of Health had declared an outbreak due to Idai, and there had been at least 4979 cases of cholera and 6 deaths. Regarding Kenneth, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) [64] declared that as of 12 May, there were 149 confirmed cases of cholera in Pemba, Metuge, and Mecufi.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"cholera, diarrhea, Mozambique, update, epidemiology",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/68460.pdf",chapterXML:"https://mts.intechopen.com/source/xml/68460.xml",downloadPdfUrl:"/chapter/pdf-download/68460",previewPdfUrl:"/chapter/pdf-preview/68460",totalDownloads:610,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:1,impactScore:0,impactScorePercentile:35,impactScoreQuartile:2,hasAltmetrics:1,dateSubmitted:"June 17th 2019",dateReviewed:"July 6th 2019",datePrePublished:"May 22nd 2020",datePublished:"May 27th 2020",dateFinished:"August 6th 2019",readingETA:"0",abstract:"Cholera is endemic in Mozambique and, together with other diarrheic diseases, is a major cause of infant death. There are yearly outbreaks in the northern provinces. The last major review of cholera in the country was published in 2013, but there have been major events since then, such as the 2015 outbreak in central and northern Mozambique and others in the following years. Plenty of related information were shared during the XVI National Health Journeys, 17–20 September 2018, in Maputo City. This chapter aims to summarize and discuss the most relevant information on cholera from the journeys, and other recent publications, in order to update the information from the latest major review. Regarding etiology, new strains of V. cholerae irradiating from several areas have been replacing the original from the Indian subcontinent. Water and sanitation are major challenges but, in some instances, sociocultural features play a significant role in people’s reluctance to use untreated water, even when they have access to potable sources, and mistrust toward government interventions. Vaccination campaigns seemed effective but there is a need to promote more adherence and collaboration from people at risk, perhaps by involving more the local government and religious and traditional authorities.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/68460",risUrl:"/chapter/ris/68460",book:{id:"8036",slug:"healthcare-access-regional-overviews"},signatures:"Edgar Manuel Cambaza, Edson Mongo, Elda Anapakala, Robina Nhambire, Jacinto Singo and Edsone Machava",authors:[{id:"300135",title:"Dr.",name:"Edgar",middleName:"Manuel",surname:"Cambaza",fullName:"Edgar Cambaza",slug:"edgar-cambaza",email:"accademus@protonmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Eduardo Mondlane University",institutionURL:null,country:{name:"Mozambique"}}},{id:"308847",title:"Dr.",name:"Edson",middleName:null,surname:"Mongo",fullName:"Edson Mongo",slug:"edson-mongo",email:"eddsonmongo@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"308848",title:"Ms.",name:"Robina",middleName:null,surname:"Nhambire",fullName:"Robina Nhambire",slug:"robina-nhambire",email:"robinanhambire2015@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Eduardo Mondlane University",institutionURL:null,country:{name:"Mozambique"}}},{id:"308967",title:"Dr.",name:"Elda",middleName:null,surname:"Anapakala",fullName:"Elda Anapakala",slug:"elda-anapakala",email:"elda.muianga07@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"308968",title:"Mr.",name:"Jacinto",middleName:null,surname:"Singo",fullName:"Jacinto Singo",slug:"jacinto-singo",email:"gersonmateus0@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Eduardo Mondlane University",institutionURL:null,country:{name:"Mozambique"}}},{id:"308969",title:"Ms.",name:"Edsone",middleName:null,surname:"Machava",fullName:"Edsone Machava",slug:"edsone-machava",email:"khasillamachava@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Eduardo Mondlane University",institutionURL:null,country:{name:"Mozambique"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Sources and reviewing process",level:"1"},{id:"sec_3",title:"3. The current situation of cholera in Mozambique",level:"1"},{id:"sec_3_2",title:"3.1 Etiology",level:"2"},{id:"sec_4_2",title:"3.2 Risk factors and health determinants",level:"2"},{id:"sec_5_2",title:"3.3 Epidemiology",level:"2"},{id:"sec_5_3",title:"3.3.1 Geographical distribution",level:"3"},{id:"sec_6_3",title:"Table 1.",level:"3"},{id:"sec_8_2",title:"3.4 Diagnosis",level:"2"},{id:"sec_9_2",title:"3.5 Control strategies",level:"2"},{id:"sec_9_3",title:"3.5.1 Overview, prophylaxis, and awareness",level:"3"},{id:"sec_10_3",title:"3.5.2 Constraints and limitations",level:"3"},{id:"sec_13",title:"4. Conclusions",level:"1"},{id:"sec_14",title:"5. Recommendations",level:"1"},{id:"sec_15",title:"6. Post-conclusive note",level:"1"},{id:"sec_19",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Mesa F, Simbine E, Faranguana AC. 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Antimicrobial resistance of Vibrio cholerae O1 serotype Ogawa isolated in Manhica District Hospital, Southern Mozambique. The Journal of Antimicrobial Chemotherapy. 2007;60(3):662-664'},{id:"B61",body:'Jutla A, Whitcombe E, Hasan N, Haley B, Akanda A, Huq A, et al. Environmental factors influencing epidemic cholera. The American Journal of Tropical Medicine and Hygiene. 2013;89(3):597-607'},{id:"B62",body:'Camacho A, Bouhenia M, Alyusfi R, Alkohlani A, Naji MAM, de Radiguès X, et al. Cholera epidemic in Yemen, 2016-2018: An analysis of surveillance data. The Lancet Global Health. 2018;6(6):e680-e690'},{id:"B63",body:'Médecins Sans Frontières. Chapter 4: Strategies for epidemic response. 2018 [cited 7 June 2019]. In: Management of a Cholera Epidemic: Practical Guide for Doctors, Nurses, Laboratory Technicians, Medical Auxiliaries, Water and Sanitation Specialists and Logisticians [Internet]. Geneva, Switzerland: Médecins Sans Frontières; 7 June 2019. Available from: https://medicalguidelines.msf.org/viewport/CHOL/english/4-7-vaccination-strategies-23448968.html#'},{id:"B64",body:'Anjichi-Kodumbe T, Abreu S, van Vliet T. Southern Africa: Tropical Cyclone Kenneth Flash Update No. 13: United Nations Office for the Coordination of Humanitarian Affairs (OCHA). 2019. Available from: https://reliefweb.int/report/mozambique/southern-africa-tropical-cyclone-kenneth-flash-update-no-13-12-may-2019'},{id:"B65",body:'Isbell T, Bhoojedhur S. Cyclones add to Mozambique’s Public Health Challenges. 2019. Available from: https://www.afrobarometer.org/publications/ad297-cyclones-add-mozambiques-public-health-challenges'},{id:"B66",body:'United Nations Office for the Coordination of Humanitarian Affairs. Southern Africa: Tropical Cyclone Kenneth: United Nations Office for the Coordination of Humanitarian Affairs (OCHA). 2019. Available from: https://reliefweb.int/report/mozambique/southern-africa-tropical-cyclone-kenneth-flash-update-no-8-3-may-2019'},{id:"B67",body:'Isbell T, Bhoojedhur S. Cyclones add to Mozambique\'s Public Health Challenges/Ciclones aumentam os desafios de saúde pública em Moçambique South Africa: Centre for International Governance Innovation, South African Institute of International Affairs. 2019. Available from: https://www.africaportal.org/publications/cyclones-add-mozambiques-public-health-challenges-ciclones-aumentam-os-desafios-de-sa%C3%BAde-p%C3%BAblica-em-mo%C3%A7ambique/'},{id:"B68",body:'Filipe J. In: Muiambo P, editor. Moçambique 2000: As Águas da Morte. 1st ed. Maputo: Moçambique Editora Lda.; 2003. 191p'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Edgar Manuel Cambaza",address:"accademus@protonmail.com",affiliation:'
Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Mozambique
Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Mozambique
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1. Introduction
Milk is a whitish liquid containing protein, carbohydrates, fat, vitamin and trace mineral elements, which are produced by mammary gland of all mature female mammals. Milk production in India increased at a growth of 6.2% in 2020–2021 reaching 209.96 million tonnes [1]. Milk products include butter, ice cream, cheese, paneer etc. These are very important components of human diets because they contain good nutritive value and are thus widely consumed by children and adults, particularly elderly people all over the world. The advancement of industry and agriculture has resulted in the release of numerous heavy metals into the environment which is harmful to the health of both animals and humans. Animals ingest heavy metals from a variety of sources including soil, water, feed and fodder. Because the mammary gland is the most physiologically active component of an animal that resulted into heavy metals are reflected in milk (Figure 1). Central Pollution Control Board found that the presence of higher levels of mercury (above Environmental Protection Agency (EPA) permissible limits) in water from several Indian states and its highly toxic heavy metal & poison with a long retention time in the human body poses a threat to the body. Metals of various types of minerals can be divided into two categories based on their relative abundance in our bodies. i.e., macro minerals are those that the human body requires in relatively large quantities such as sodium, potassium, chlorine, calcium, phosphorus, magnesium and sulfur whereas micro/trace minerals such as selenium, iron, zinc, copper, cobalt, fluorine, iodine, manganese and molybdenum are required in little amounts. These are found in nearly all cells of the human body where they help to maintain general homeostasis and are necessary for our bodies to function normally. The excess mineral can have a negative impact on human health e.g., daily intake of high levels of sodium can lead to hypertension (Blood pressure).
Figure 1.
Source of heavy metal in milk.
2. Heavy metals
A heavy metal is any metallic element with a relatively high density (5 g/cm3) that is unsafe or poisonous even at low. Heavy metal is a broad term that refers to a class of metals and metalloids with atomic densities greater than 5 g/cm3 or five times that of water [2]. Heavy metals are cumulative toxins that can cause harm even at very low levels. The toxicity of these metals is divided into two categories
They have really no known metabolic function but when present in the body, they disrupt the normal cellular processes which causes toxic effects in a variety of organs.
Bioaccumulation or the ability to accumulate in biological tissues [3].
The growth in a chemical concentration in a biological organism over time in relation to the chemical concentration in the environment is referred to as bioaccumulation. The World Health Organization (WHO), CODEX and the Food Safety and Standard Authority of India (FSSAI) have determined metal maximum residual limit (MRL) values in food products. Heavy metals that exceed the MRL level in any food or food product harm human health.
3. Heavy metal problems in milk and milk products
Because it contains nutrients such as protein, fat, carbohydrate and minerals in which milk is considered nearly a complete food in our daily diet [4]. As industrial and agricultural processes expand, which result in the concentration of physical, chemical and biological hazards in the environment grows [5]. A significant quantity of heavy metals found in plants & animals eventually finds their way into food harming both the quality of final products and human health.
Metal levels in cow or buffalo milk are currently being examined intensively, particularly in industrialized & polluted areas of both developing and developed countries. According to reports, the basic ingredients in cow and buffalo milk are rather consistent and only alter slightly based on a variety of conditions such as lactation phase, nutrition quality and environmental conditions, all of which are primarily chemical contaminants.
Because milk and milk products are primarily consumed by infants and children, residues of lead, cadmium, arsenic and mercury are of great concern. As a result, their levels in food and food products must be monitored and controlled. Heavy metal level measurement is useful not only for determining risk to human health and assessing environmental quality but also for maintaining the high quality of final food and food products [6]. Many studies have been published on heavy metals in milk and their presence in milk and various milk products has been connected to lactating cows being exposed to pollution, consuming polluted feed and water and the manufacturing process of various milk products. Lead, mercury, arsenic and cadmium levels in milk from cows grazing in open fields in Kaduna were found to be higher than the WHO recommended limit daily intake (50 ppb) [7].
Heavy metal residues such as lead (Pb), arsenic (As), mercury (Hg) and cadmium (Cd) which pose a chemical hazard are described below.
3.1 Lead as heavy metal pollutant
Lead is one of the most dangerous metals for humans, plants and animals and it is among the most common metals in the environment due to human activities. Lead mines, coal combustion, wastewater applications, industrial waste & farmyard manure are the primary reason sources of lead in the environment [8]. Lead is a non-ferrous metal that is widely used in a variety of industries including the manufacture of plastics, storage battery alloys, ceramics, cable sheathing and even paints. The production of anti-knock compounds from petrol results in increased air pollution in the environment. Vehicle exhausts are a major source of lead contamination in the environment affecting the quality of food and food products as well as the health of animals [9]. Inhalation, ingestion and skin contact are the three main routes through which lead enters the human body system. Long-term doses of lead may cause thalassemia, pale skin, decreased muscle activity, stomach pain, vomiting, wrist joint paralysis and decreased fertility and birth abnormalities (Table 1). Prolonged exposure may also cause kidney damage, liver problems, nervous system damage and eventually death in humans [14]. The maximum acceptable concentration of lead for milk and milk products is 250 ppb according to FSSAI and WHO.
Heavy metals
Application
Human health consequences
Reference
Mercury
Metallurgy industries chemical manufacturing and metal finishing, use in thermometer
Arsenic can be found in water that has been contaminated with industrial or agrochemical waste. Ingestion of arsenic at low doses through food or water is the main route of this metalloid into the organism with absorption taking place in the human stomach and intestines and release into the bloodstream (Table 1). Arsenic can be found in both natural and man-made environments. Arsenic contamination has been documented in a variety of foods and food items including tap water, air, foods and beverages (Table 1). Drinking water contamination is increasing as a result of industrial operations and excessive groundwater withdrawal for irrigation [15].
3.3 Mercury as heavy metal pollutant
Almost all mercury compounds are extremely toxic and can harm human and animal health even at very low levels. Mercury is subject to bioaccumulation which is the process by which organisms (including humans) absorb toxins faster than their bodies resulting in mercury levels in their bodies building up over time and causing adverse health effects in humans [16].
Human activities such as the use of fossil fuels particularly coal for heat and energy, the production of metals, cement, caustic soda, the disposal of mercury-containing waste materials etc. are the main sources of mercury in food and the food chain. Human activities that contribute to contaminated air include increased industrialization and small-scale coal burning for heat and automobiles [17]. In many state areas, mercury concentrations have increased as a result of increased atmospheric deposition which harms both humans and animals (Table 1).
3.4 Cadmium as heavy metal pollutants pollutant
Cadmium is a poisonous element that can harm your health. Its existence in water, soil, beverages, herbal medications, milk products and other places has gained recent notice. Phosphate fertilizers, nonferrous smelters, sewage sludge application and fossil fuel combustion are all sources of cadmium in soil and plants. According to FSSAI, the MRL level of heavy metals in milk and various milk products should not exceed 1.5 ppm.
Cadmium is used in plating, alloying, pigments, polymers and batteries among other things which is poisonous to people and animals (Table 1) [18].
4. Heavy metal standard for various milk products
The Food Safety and Standard Authority of India (FSSAI), CODEX and WHO tolerable weekly intake of heavy metals established standards for heavy metals in milk and milk products such as lead, arsenic, mercury and cadmium (Table 2).
Heavy metals
Standard for milk and milk product
FSSAI (mg/l)
CODEX (mg/l)
WHO weekly tolerance toxic heavy metal intake (mg/l)
Mercury
1000
500
5
Arsenic
110
20
15
Lead
250
140
25
Cadmium
150
200
25
Table 2.
Food Safety and Standards Authority of India (FSSAI), CODEX standard and WHO Weekly tolerance intake for milk and dairy products.
High Sn and Ni contents of some milk products samples from this Arak, iran might be potentially hazardous to consumers [19].
A total of 65 cow and 126 buffalo milk samples were collected from various Haryana districts, covering both industrial and non-industrial areas, and it was discovered that the milk samples collected from various Haryana districts contained Pb, Cd, As, and Hg levels below the maximum contamination level, making them safe for human consumption [20].
The amount of iron, copper, manganese, zinc, lead, cadmium and chromium in cow milk yoghurt had fallen by 0.40–15% and buffalo milk yoghurt had decreased by 0.50–15% according to a study. Nickel, cobalt and tin levels in cow milk yoghurt were down 50–100% while buffalo milk yoghurt was down 25–50%. The level of these metals in yoghurt is dramatically reduced as a result of the high acidity and bacterial activity in the production process [4]. Another study looked at heavy metals like cadmium, mercury, lead and arsenic in milk samples collected from the Livestock Production and Management Production Department at NDRI Karnal. They discovered that higher levels of lead, cadmium and mercury in various milk products could be due to high exposure to heavy metal sources in the soil and water near hazardous waste sites while higher levels of arsenic in various milk products were mainly due to use in veterinary medicine for the eradication of tapeworms in cattle (Table 3) [21].
Type of products
Type of heavy metal (ppb)
Milk
Paneer
Dahi
Cheese
Khoa
Milk powder
Lead
4.55–8.16
3.97–6.28
4.12–9.79
3.16–10.93
11.69–13.89
3.99–5.01
Cadmium
9.96–11.89
3.38–9.53
7.84–11.50
9.16–10.90
16.91–26.41
7.73–10.2
Mercury
4.48–7.23
4.23–8.53
4.04–8.04
4.87–8.68
7.46–10.68
3.34–5.55
Arsenic
4.87–8.94
3.77–8.98
4.05–11.32
5.01–7.73
14.61–21.04
6.7–9.7
Table 3.
Concentration of heavy metal in milk and milk products.
Many studies have looked at removing heavy metal pollution from many sources particularly water sources and this method can be used to disinfect a range of various dairy products mineral absorbents like smectite and Palygorsctite were used to absorb heavy metals in recent times [22]. Some other study was using sepiolite minerals and zeolites as heavy metal adsorbent materials and corrective agents [23]. Another study used a modified rice husk with different sodium bicarbonate concentrations to absorb low levels of cadmium in aquatic settings [24]. Penaud et al. [25] discovered that lactobacilli as probiotic agent could absorb heavy metals from products such as yoghurt.
Nurdin et al. [26] investigated the effect of medicinal herbs in the diet on the quantity of lead excreted in cow’s milk where researcher discovering that cumin, white turmeric and mango turmeric reduced the amount of lead in various milk products by 98.36, 99.33, and 99.37% respectively.
Heavy metals bind to lactobacilli-specific proteins (LAB) and are then biologically absorbed and removed [27].
6. Analytical methods for estimation of heavy metals in various milk products
6.1 Atomic absorption spectroscopy
Atomic Absorption Spectroscopy (AAS) became available for the first time in 1962. Since then, there have been several rapid developments such as a variety of fuels and oxidants in atomic absorption and emission spectroscopy such as flame atomic absorption spectroscopy (FAAS), graphite furnace atomic absorption spectroscopy (GFAAS), vapour atomic absorption spectroscopy (CVAAS) and hydride vapor atomic absorption spectroscopy (CVAAS).
AAS which measures ppb levels in various milk product samples which are exceedingly sensitive. The spectra formed when the sample is excited with radiation from a hollow cathode lamp. Transitions to higher energy levels occur as a result of absorbing ultraviolet or visible light and then measure the amount of energy in the form of photons of light absorbed by the sample and sends the signal to the detector. In this procedure, the wavelengths of light transmitted by the sample are measured and compared to the wavelengths that passed through it originally (Figure 2). Atomic absorption spectroscopy is a technique for identifying an element\'s concentration in a sample by measuring the intensity of external absorbed radiation by a sample atom at a wavelength characteristic of the element. The absorption of electromagnetic radiation by well-separated atoms or ions in the gaseous state is quantified using atomic absorption spectroscopy (AAS). The emission of radiation from atoms stimulated by heat or other methods is measured using atomic emission spectroscopy (AES).
Figure 2.
Atomic absorption spectroscopy.
6.2 Basic principle of AAS
In this system, the atoms of various elements absorb light at different wavelengths. When analyzing a sample containing a given element, light from excited atoms produces the proper wavelength combination to be absorbed by any elements present in a sample. A lamp containing atoms emits light from excited atoms resulting in a spectrum of wavelengths absorbed by any atoms in the sample is a way to find determining atom concentration in samples (Figure 2). Atomic Absorption Spectroscopy (AAS) atomizes the sample by converting ground state free atoms to a vapour state and passing a beam of electromagnetic radiation generated by excited atoms through the vaporized sample. The sample unique atoms absorb some of the radiation because more light is absorbed the maximum number of atoms are in the vapor which transfers the signal to the detector (Figure 3).
Figure 3.
Basic principle of atomic absorption spectroscopy.
6.3 Techniques of AAS
There are various techniques which can be used in AAS for the estimation of heavy metal residue in milk and milk products, which are described below:
Flame Atomic Absorption Spectroscopy is a widely used technique for estimating or detecting heavy metals, metalloids etc. in samples (ppb). A hollow cathode lamp emits radiation from a line source of the element of interest and samples are often delivered into the flame using a sprayer or nebulizer that creates minute sample droplets. The sample particles vaporize and break down into atoms, ions and electrons as the solvent in the droplets evaporates quickly. The power of the source is reduced because atoms in the sample absorb radiation released by the identical atom in the hollow cathode lamp. A monochromator is typically used to separate a spectral line of interest from any flame source background radiation. The monochromator for sodium is adjusted to pass radiation with a wavelength of 589 nm. A liquid sample is inhaled and combined as an aerosol with flammable gases in this approach (acetylene and air or acetylene and nitrous oxide). A flame with a temperature ranging from 2000°C to 3000 °C is used to ignite the mixture (depending on which fuel gas is used). An emitted light from a lamp with a cathode made of the elements to be evaluated is carried into a monochromator where it is converted to a signal and supplied to the detector via the flame (Figure 4).
Figure 4.
Flame atomic absorption spectroscopy (FAAS).
Graphite Furnace Atomic Absorption Spectroscopy (GF AAS) – Graphite furnace atomic absorption spectroscopy is a highly sensitive spectroscopic technique for measuring various metal concentrations in aqueous and liquid samples with outstanding detection limits (ppb). GFAAS has a number of advantages over conventional analytical processes including increased sensitivity and lower limit of detection, less spectrum interference and the ability to use very small sample quantities. These all contribute to enhanced heavy metal detection or estimation accuracy. The graphite furnace is a 3000°C capable high-temperature electro-thermal atomizer system. The thermal energy of the heated graphite furnace is used to break chemical bonds inside the sample which releases free ground-state atoms capable of absorbing light energy and sending a signal to the detector & displaying the results.
Metals in solution or samples can be easily recognized using graphite furnace atomic absorption spectrophotometry (GFAAS). The approach is simple, quick and may be used to estimate metals in a variety of environmental samples including groundwater, household & industrial wastes, extracts, soils, sludge, sediments and other wastes. Except for dissolved ingredient analyses, all samples in this system must be digested before being analyzed.
Graphite Furnace Atomic Absorption Spectroscopy is similar to flame AA in that the cloud of atoms is generated by heating a tiny electrically heated graphite tube or cuvette to a temperature of 3000–3200°C. The increased atom density and tube residence length improve furnace AAS detection limits allowing detection in the ppb or level range (Figure 5). A comparative study between the Flame Atomic Absorption Spectroscopy (FAAS) and Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) is described in Table 4.
Figure 5.
Graphite furnace atomic absorption spectroscopy.
Flame atomization
Graphite atomization
Amount of sample required
1 ml
5–20 μL
Atomization principle
Atomized through the heat of flame
Atomized by heat generated when a current is passed through a resistance bulb
Sample usage (Atomization efficiency)
Approx. 10%
Approx. 90%
Shape of adsorption signal
Stationary signal
Peak shaped signal
Reproducibility
<RSD 1%
Approx RSD 2–5%
Sensitivity
PPM Level
PPB Level
Measuring timing
Short (10–30 seconds)
Long (1–5 min)
Table 4.
Difference between flame atomic absorption spectroscopy (FAAS) and graphite furnace atomic absorption spectroscopy.
Vapour Generation Atomic Absorption Spectroscopy (VG AAS) – It consists of Hydride Generation Atomic Absorption Spectroscopy (HGAAS) or Cold Vapor Atomic Absorption Spectroscopy (CVAAS). This typical approach for analyzing or estimating different mineral elements, metals and some metalloids is atomic absorption spectroscopy (AAS). However, due to interferences, poor repeatability and detection limitations, hydride generation atomic absorption spectroscopy is frequently used to analyze metalloids such as antimony, arsenic and selenium. The hollow cathode lamp, air/acetylene flame, optical system and its detector utilized in AAS are all the same in HGAAS. Materials react with sodium borohydride and hydrochloric acid to produce a volatile hydride in this process for example Arsenic interacts with sodium borohydride to form H3AS (Arsenic sodium hydride). The functions of the hydride generating system are as follows:
Aspiration of the liquid sample followed by mixing with sodium borohydride (NaBH4) and hydrochloric acid (HCL).
The reaction produces a volatile hydride of the analyte metalloid.
Fill the optical cell system with gaseous hydride.
Atomic Absorption Spectroscopy (AAS) is a widely used technique for determining mineral elements in samples. However, some elements mostly metalloids have been developed due to interferences, low repeatability and inadequate detection methods. However, it is more expensive than atomic absorption spectroscopy (Figure 6). In AAS, a nebulizer is required but not in HGAAS.
Heavy metals are frequently thought to be extremely hazardous and harmful for the environment. People nowadays are concerned about food safety issues such as microbial, chemical, and physical risks. Heavy metal residues such as cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg) and others are major pollutants in chemical hazards. Heavy metals do not naturally arise in milk as a consequence of human activities such as industrial and agricultural processes, but they can naturally occur in milk as a result of human activities such as industrial and agricultural processes. Polluted soils are a major source of Cd and Pb which can build up in milk through the food chain. Heavy metals have become pollutants in food for a variety of reasons resulting in a concern of health issues. Atomic Absorption Spectroscopy was used to determine the amount of heavy metal contamination in milk and milk products.
Acknowledgments
Sincere thanks are extended to the Institution of Eminence (IoE) scheme, Banaras Hindu University, Varanasi (U.P.) India for support under Incentive to Seed Grant under IoE Scheme (Devt Scheme No 6031 & PFMS Scheme No 3254).
\n',keywords:"minerals, heavy metal, maximum residual limit, FSSAI, CODEX and Atomic absorption spectroscopy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/82436.pdf",chapterXML:"https://mts.intechopen.com/source/xml/82436.xml",downloadPdfUrl:"/chapter/pdf-download/82436",previewPdfUrl:"/chapter/pdf-preview/82436",totalDownloads:2,totalViews:0,totalCrossrefCites:0,dateSubmitted:"April 9th 2022",dateReviewed:"April 20th 2022",datePrePublished:"June 28th 2022",datePublished:null,dateFinished:"June 28th 2022",readingETA:"0",abstract:"Milk and milk products are an essential part of the human daily diet, and their consumption is steadily increasing. Milk is regarded as a complete food because it contains all of the macronutrients including protein, carbohydrates, fat and vitamins. Milk also has a high concentration of mineral elements (metals) such as sodium, potassium, iron, calcium, magnesium, selenium, copper and zinc. They are critical for proper body growth and maintenance but excess in these metals, particularly, heavy metals cause disturbances and pathological conditions. People nowadays are concerned about food safety issues involving microbial, chemical and physical hazards. Heavy metal residues such as cadmium (Cd), lead (Pb), arsenic (As) and mercury (Hg) pose a chemical hazard. These are the main contaminants. Heavy metals are any metallic chemical elements with a relatively high density (5 g/cc) whose levels must be monitored. Atomic absorption spectroscopy can be used to estimate the heavy metal contamination in milk and milk products.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/82436",risUrl:"/chapter/ris/82436",signatures:"Ankur Aggarwal, Tarun Verma and Sumangal Ghosh",book:{id:"11741",type:"book",title:"Trends and Innovations in Food Science",subtitle:null,fullTitle:"Trends and Innovations in Food Science",slug:null,publishedDate:null,bookSignature:"Prof. Yehia El-Samragy",coverURL:"https://cdn.intechopen.com/books/images_new/11741.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80356-066-3",printIsbn:"978-1-80356-065-6",pdfIsbn:"978-1-80356-067-0",isAvailableForWebshopOrdering:!0,editors:[{id:"81644",title:"Prof.",name:"Yehia",middleName:null,surname:"El-Samragy",slug:"yehia-el-samragy",fullName:"Yehia El-Samragy"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Heavy metals",level:"1"},{id:"sec_3",title:"3. Heavy metal problems in milk and milk products",level:"1"},{id:"sec_3_2",title:"3.1 Lead as heavy metal pollutant",level:"2"},{id:"sec_4_2",title:"3.2 Arsenic as heavy metal pollutant",level:"2"},{id:"sec_5_2",title:"3.3 Mercury as heavy metal pollutant",level:"2"},{id:"sec_6_2",title:"3.4 Cadmium as heavy metal pollutants pollutant",level:"2"},{id:"sec_8",title:"4. Heavy metal standard for various milk products",level:"1"},{id:"sec_9",title:"5. Reducing the contaminations",level:"1"},{id:"sec_10",title:"6. Analytical methods for estimation of heavy metals in various milk products",level:"1"},{id:"sec_10_2",title:"6.1 Atomic absorption spectroscopy",level:"2"},{id:"sec_11_2",title:"6.2 Basic principle of AAS",level:"2"},{id:"sec_12_2",title:"6.3 Techniques of AAS",level:"2"},{id:"sec_14",title:"7. Conclusion",level:"1"},{id:"sec_15",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Economic Survey. 2022. Available from: https://www.indiabudget.gov.in/economicsurvey/ [Retrieved 31 March 2022]'},{id:"B2",body:'Sani U. Determination of some heavy metals concentration in the tissues of Tilapia and Catfishes. Biokemistri. 2011;23(2):73-80'},{id:"B3",body:'Al-Maylay IK, Hussein HG. Determination of some heavy metals concentrations in canned tomato paste. Research Journal in Engineering and Applied Sciences. 2014;3(3):216-219'},{id:"B4",body:'Enb A, Donia MA, Abd-Rabou NS, Abou-Arab AAK, El-Senaity MH. Chemical composition of raw milk and heavy metals behavior during processing of milk products. Global Veterinaria. 2009;3(3):268-275'},{id:"B5",body:'Farid S, Baloch MK, Ahmad SA. Water pollution: Major issue in urban areas. International Journal of Water Resources and Environmental Engineering. 2012;4(3):55-65'},{id:"B6",body:'Martín JR, De Arana C, Ramos-Miras JJ, Gil C, Boluda R. Impact of 70 years urban growth associated with heavy metal pollution. Environmental Pollution. 2015 1;196:156-163'},{id:"B7",body:'Lawal AO, Mohammed SS, Damisa D. Assessment of levels of copper, cadmium and lead in secretion of mammary gland of cows grazed on open fields. Science World Journal. 2006;1(1):7-10'},{id:"B8",body:'Purves D. Trace-element Contamination of the Environment. Amsterdam: Elsevier; 2012'},{id:"B9",body:'Reilly C. Metal Contamination of Food: Its Significance for Food Quality and Human Health. John Wiley & Sons; 2008'},{id:"B10",body:'Zahir F, Rizwi SJ, Haq SK, Khan RH. Low dose mercury toxicity and human health. Environmental Toxicology and Pharmacology. 2005;20(2):351-360'},{id:"B11",body:'Kapaj S, Peterson H, Liber K, Bhattacharya P. Human health effects from chronic arsenic poisoning–a review. Journal of Environmental Science and Health Part A. 2006;41(10):2399-2428'},{id:"B12",body:'Duruibe JO, Ogwuegbu MOC, Egwurugwu JN. Heavy metal pollution and human biotoxic effects. International Journal of Physical Sciences. 2007;2(5):112-118'},{id:"B13",body:'Bernard A. Cadmium and its adverse effects on human health. Indian Journal of Medical Research. 2008;128(4):557'},{id:"B14",body:'Tong S, Schirnding YEV, Prapamontol T. Environmental lead exposure: A public health problem of global dimensions. Bulletin of the World Health Organization. 2000;78(9):1068-1077'},{id:"B15",body:'Abernathy CO, Liu YP, Longfellow D, Aposhian HV, Beck B, Fowler B, et al. Arsenic: Health effects, mechanisms of actions, and research issues. Environmental Health Perspectives. 1999;107(7):593'},{id:"B16",body:'Bhan A, Sarkar NN. Mercury in the environment: Effect on health and reproduction. Reviews on Environmental Health. 2005;20(1):39-56'},{id:"B17",body:'Igwe JC, Nwokennaya EC, Abia AA. The role of pH in heavy metal detoxification by biosorption from aqueous solutions containing chelating agents. African Journal of Biotechnology. 2005;4(10):1113-1116'},{id:"B18",body:'Jarup L. Hazards of heavy metal contamination. British Medical Bulletin. 2003;68(1):167-182'},{id:"B19",body:'Arianejad M, Alizadeh M, Bahrami A, Arefhoseini SR. Levels of some heavy metals in raw cow’s milk from selected milk production sites in Iran: Is there any health concern? Health Promotion Perspectives. 2015;5(3):176'},{id:"B20",body:'Roy D, Bharathidhasan S, Mani V, Kaur H, Kewalramani N. Heavy metal contents in cow and buffalo milk samples from Haryana. Indian Journal of Animal Nutrition. 2009;26(1):29-33'},{id:"B21",body:'Singh M, Sharma R, Ranvir S, Gandhi K. Assessment of contamination of milk and milk products with heavy metals. Indian Journal of Dairy Science. 2020;72(6):608-615'},{id:"B22",body:'Farrah H, Pickering WF. The sorption of lead and cadmium species by clay minerals. Australian Journal of Chemistry. 1977;30(7):1417-1422'},{id:"B23",body:'Shirvani M, Kalbasi M, Shariatmadari H, Nourbakhsh F, Najafi B. Sorption–desorption of cadmium in aqueous palygorskite, sepiolite and calcite suspensions: Isotherm hysteresis. Chemosphere. 2006;65(11):2178-2184'},{id:"B24",body:'Shahmohammadi HZ, Moazed H, Jafarzadeh HNE, Haghighat JP. Removal of low concentrations of cadmium from water using improved rice husk. Water and Wastewater. 2008;19(6):27-33'},{id:"B25",body:'Penaud S, Fernandez A, Boudebbouze S, Ehrlich SD, Maguin E, Van De Guchte M. Induction of heavy-metal-transporting CPX-type ATPases during acid adaptation in Lactobacillus bulgaricus. Applied and Environmental Microbiology. 2006;72(12):7445-7454'},{id:"B26",body:'Nurdin E, Putra DP, Amelia T. Analysis of heavy metal lead (Pb) levels with Aas in cow’s milk by giving cumin (Cuminum cyminum L.), white turmeric (Curcuma zedoaria Rosc.) and mango turmeric (Curcuma mangga Val). Pakistan Journal of Biological Sciences. 2013;16(21):1373'},{id:"B27",body:'Kinoshita H, Sohma Y, Ohtake F, Ishida M, Kawai Y, Kitazawa H, et al. Biosorption of heavy metals by lactic acid bacteria and identification of mercury binding protein. Research in Microbiology. 2013;164(7):701-709'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Ankur Aggarwal",address:null,affiliation:'
Department of Dairy Science and Food Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Department of Dairy Science and Food Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Several food plant products with massive consumption and within the reach of the population are products such as artichoke, leek, hot chili pepper, coriander, kiwifruit, sweet orange, highbush blueberry, and maracuyá to name a few. They have many beneficial properties principally by its content of phytochemicals with high impact on human health, beyond nutritional support. The phytochemicals are bioactive compounds such as vitamins, carotenoids, phenolic acid, and flavonoids, which contribute to antioxidant capacity and as a whole prevent chronic nontransmissible diseases such as: diabetes, high blood pressure, high cholesterol in blood, cardiovascular risks, among others. 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Many studies have focused on berry development and have pointed out the hormonal regulation on the three phases, from early development to maturity. Grapevine fruit has been classified as non-climacteric based on the low levels of ethylene present around véraison, although recent evidence has suggested a role for this hormone during grape berry ripening. The control of different physiological processes depends on a complex integration between environmental cues and endogenous factors, which is mediated by a phytohormone crosstalk. 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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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The present chapter will discuss some insights of the role of microorganisms in BFT, main water quality parameters, the importance of the correct carbon-to-nitrogen ratio in the culture media, its calculations, and different types, as well as metagenomics of microorganisms and future perspectives.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Maurício Gustavo Coelho Emerenciano, Luis Rafael Martínez-\nCórdova, Marcel Martínez-Porchas and Anselmo Miranda-Baeza",authors:[{id:"146126",title:"Dr.",name:"Maurício Gustavo Coelho",middleName:null,surname:"Emerenciano",slug:"mauricio-gustavo-coelho-emerenciano",fullName:"Maurício Gustavo Coelho Emerenciano"},{id:"186970",title:"Prof.",name:"Marcel",middleName:null,surname:"Martínez-Porchas",slug:"marcel-martinez-porchas",fullName:"Marcel Martínez-Porchas"},{id:"186971",title:"Prof.",name:"Anselmo",middleName:null,surname:"Miranda-Baeza",slug:"anselmo-miranda-baeza",fullName:"Anselmo Miranda-Baeza"},{id:"195101",title:"Dr.",name:"Luis Rafael",middleName:null,surname:"Martínez-Córdoba",slug:"luis-rafael-martinez-cordoba",fullName:"Luis Rafael Martínez-Córdoba"}]},{id:"53194",doi:"10.5772/66561",title:"Impact of Wastewater on Surface Water Quality in Developing Countries: A Case Study of South Africa",slug:"impact-of-wastewater-on-surface-water-quality-in-developing-countries-a-case-study-of-south-africa",totalDownloads:7694,totalCrossrefCites:67,totalDimensionsCites:129,abstract:"Wastewater effluents are major contributors to a variety of water pollution problems. Most cities of developing countries generate on the average 30–70 mm3 of wastewater per person per year. Owing to lack of or improper wastewater treatment facilities, wastewater and its effluents are often discharged into surface water sources, which are receptacles for domestic and industrial wastes, resulting to pollution. The poor quality of wastewater effluents is responsible for the degradation of the receiving surface water body. Wastewater effluent should be treated efficiently to avert adverse health risk of the user of surface water resources and the aquatic ecosystem. The release of raw and improperly treated wastewater onto water courses has both short‐ and long‐term effects on the environment and human health. Hence, there should be proper enforcement of water and environmental laws to protect the health of inhabitants of both rural and urban communities. This study reports major factors responsible for the failing state of wastewater treatment facilities in developing countries, which includes poor operational state of wastewater infrastructure, design weaknesses, lack of expertise, corruption, insufficient funds allocated for wastewater treatment, overloaded capacities of existing facilities, and inefficient monitoring for compliance, among others.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Joshua N. Edokpayi, John O. Odiyo and Olatunde S. Durowoju",authors:[{id:"187867",title:"Dr.",name:"Joshua",middleName:null,surname:"Edokpayi",slug:"joshua-edokpayi",fullName:"Joshua Edokpayi"},{id:"189690",title:"Prof.",name:"John",middleName:null,surname:"Odiyo",slug:"john-odiyo",fullName:"John Odiyo"},{id:"194678",title:"Dr.",name:"Olatunde",middleName:"Samod",surname:"Durowoju",slug:"olatunde-durowoju",fullName:"Olatunde Durowoju"}]},{id:"52639",doi:"10.5772/65744",title:"Metals Toxic Effects in Aquatic Ecosystems: Modulators of Water Quality",slug:"metals-toxic-effects-in-aquatic-ecosystems-modulators-of-water-quality",totalDownloads:4288,totalCrossrefCites:21,totalDimensionsCites:48,abstract:"The topic of this work was based on the assessment of aquatic systems quality related to the persistent metal pollution. The use of aquatic organisms as bioindicators of metal pollution allowed the obtaining of valuable information about the acute and chronic toxicity on common Romanian aquatic species and the estimation of the environment quality. Laboratory toxicity results showed that Cd, As, Cu, Zn, Pb, Ni, Zr, and Ti have toxic to very toxic effects on Cyprinus carpio, and this observation could raise concerns because of its importance as a fishery resource. The benthic invertebrates’ analysis showed that bioaccumulation level depends on species, type of metals, and sampling sites. The metal analysis from the shells of three mollusk species showed that the metals involved in the metabolic processes (Fe, Mn, Zn, Cu, and Mg) were more accumulated than the toxic ones (Pb, Cd). The bioaccumulation factors of metals in benthic invertebrates were subunitary, which indicated a slow bioaccumulation process in the studied aquatic ecosystems. The preliminary aquatic risk assessment of Ni, Cd, Cr, Cu, Pb, As, and Zn on C. carpio revealed insignificant to moderate risk considering the measured environmental concentrations, acute and long-term effects and environmental compartment.",book:{id:"5355",slug:"water-quality",title:"Water Quality",fullTitle:"Water Quality"},signatures:"Stefania Gheorghe, Catalina Stoica, Gabriela Geanina Vasile, Mihai\nNita-Lazar, Elena Stanescu and Irina Eugenia Lucaciu",authors:[{id:"186964",title:"Dr.",name:"Stefania",middleName:null,surname:"Gheorghe",slug:"stefania-gheorghe",fullName:"Stefania Gheorghe"},{id:"194072",title:"Dr.",name:"Catalina",middleName:null,surname:"Stoica",slug:"catalina-stoica",fullName:"Catalina Stoica"}]},{id:"42035",doi:"10.5772/55354",title:"Arsenic in Groundwater: A Summary of Sources and the Biogeochemical and Hydrogeologic Factors Affecting Arsenic Occurrence and Mobility",slug:"arsenic-in-groundwater-a-summary-of-sources-and-the-biogeochemical-and-hydrogeologic-factors-affecti",totalDownloads:6170,totalCrossrefCites:6,totalDimensionsCites:45,abstract:null,book:{id:"3491",slug:"current-perspectives-in-contaminant-hydrology-and-water-resources-sustainability",title:"Current Perspectives in Contaminant Hydrology and Water Resources Sustainability",fullTitle:"Current Perspectives in Contaminant Hydrology and Water Resources Sustainability"},signatures:"Julia L. Barringer and Pamela A. Reilly",authors:[{id:"163098",title:"Dr.",name:"Julia",middleName:null,surname:"Barringer",slug:"julia-barringer",fullName:"Julia Barringer"},{id:"167449",title:"M.Sc.",name:"Pamela",middleName:"A.",surname:"Reilly",slug:"pamela-reilly",fullName:"Pamela Reilly"}]}],mostDownloadedChaptersLast30Days:[{id:"58138",title:"Water Pollution: Effects, Prevention, and Climatic Impact",slug:"water-pollution-effects-prevention-and-climatic-impact",totalDownloads:21489,totalCrossrefCites:18,totalDimensionsCites:36,abstract:"The stress on our water environment as a result of increased industrialization, which aids urbanization, is becoming very high thus reducing the availability of clean water. Polluted water is of great concern to the aquatic organism, plants, humans, and climate and indeed alters the ecosystem. The preservation of our water environment, which is embedded in sustainable development, must be well driven by all sectors. While effective wastewater treatment has the tendency of salvaging the water environment, integration of environmental policies into the actor firms core objectives coupled with continuous periodical enlightenment on the present and future consequences of environmental/water pollution will greatly assist in conserving the water environment.",book:{id:"6157",slug:"water-challenges-of-an-urbanizing-world",title:"Water Challenges of an Urbanizing World",fullTitle:"Water Challenges of an Urbanizing World"},signatures:"Inyinbor Adejumoke A., Adebesin Babatunde O., Oluyori Abimbola\nP., Adelani-Akande Tabitha A., Dada Adewumi O. and Oreofe Toyin\nA.",authors:[{id:"101570",title:"MSc.",name:"Babatunde Olufemi",middleName:null,surname:"Adebesin",slug:"babatunde-olufemi-adebesin",fullName:"Babatunde Olufemi Adebesin"},{id:"187738",title:"Dr.",name:"Adejumoke",middleName:"Abosede",surname:"Inyinbor",slug:"adejumoke-inyinbor",fullName:"Adejumoke Inyinbor"},{id:"188818",title:"Dr.",name:"Abimbola",middleName:null,surname:"Oluyori",slug:"abimbola-oluyori",fullName:"Abimbola Oluyori"},{id:"188819",title:"Mrs.",name:"Tabitha",middleName:null,surname:"Adelani-Akande",slug:"tabitha-adelani-akande",fullName:"Tabitha Adelani-Akande"},{id:"208501",title:"Dr.",name:"Adewumi",middleName:null,surname:"Dada",slug:"adewumi-dada",fullName:"Adewumi Dada"},{id:"208502",title:"Ms.",name:"Toyin",middleName:null,surname:"Oreofe",slug:"toyin-oreofe",fullName:"Toyin Oreofe"}]},{id:"24941",title:"Tsunami in Makran Region and Its Effect on the Persian Gulf",slug:"tsunami-in-makran-region-and-its-effect-on-the-persian-gulf",totalDownloads:7384,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"406",slug:"tsunami-a-growing-disaster",title:"Tsunami",fullTitle:"Tsunami - A Growing Disaster"},signatures:"Mohammad Mokhtari",authors:[{id:"52451",title:"Dr.",name:"Mohammad",middleName:null,surname:"Mokhtari",slug:"mohammad-mokhtari",fullName:"Mohammad Mokhtari"}]},{id:"24552",title:"Geology and Geotectonic Setting of the Basement Complex Rocks in South Western Nigeria: Implications on Provenance and Evolution",slug:"geology-and-geotectonic-setting-of-the-basement-complex-rocks-in-south-western-nigeria-implications-",totalDownloads:20768,totalCrossrefCites:2,totalDimensionsCites:24,abstract:null,book:{id:"1882",slug:"earth-and-environmental-sciences",title:"Earth and Environmental Sciences",fullTitle:"Earth and Environmental Sciences"},signatures:"Akindele O. Oyinloye",authors:[{id:"68497",title:"Prof.",name:"Akindele",middleName:null,surname:"Oyinloye",slug:"akindele-oyinloye",fullName:"Akindele Oyinloye"}]},{id:"66437",title:"Detection of Underground Water by Using GPR",slug:"detection-of-underground-water-by-using-gpr",totalDownloads:3027,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Water is the human vital requirement for life; in these days, decreasing of the fresh water increases the importance of the aquifer water. However, Upper Egypt is higher than north Egypt, so the water map continually changes daily, and the aquifer water is deeper than 10 m. The ground penetrating radar (GPR) system is used for underground water detection. GPR is a promising technology to detect and identify aquifer water or nonmetallic mines. One of the most serious components for the performance of GPR is the antenna system. The technology of the remote sensing and radar is rapidly developing, and it has led to the ultra-wideband electronic systems. All of these factors, such as miniaturized, low cost, possible compromise solution between depth and resolution, scanning in real time, easy to interpret, and decreased the false alarm, are important in designing the ground penetrating system. The electrical properties of the sand and fresh water layers are investigated using laboratory measurement and EM simulation. Different types of antenna may be used in GPR to operate over a frequency range for different penetration depth. Frequency-modulated continuous wave is also used for GPR and for through-the-wall applications. However, most of these kinds of antennas are limited by their large volume for certain applications. Therefore, a compact Vivaldi antenna with EBG and a compact planar printed quasi-Yagi antenna with meandered ground plane are designed to fulfill all above requirement.",book:{id:"6836",slug:"groundwater-resource-characterisation-and-management-aspects",title:"Groundwater",fullTitle:"Groundwater - Resource Characterisation and Management Aspects"},signatures:"Dalia N. Elsheakh and Esmat A. Abdallah",authors:[{id:"111813",title:"Dr.",name:"Dalia",middleName:null,surname:"Elsheakh",slug:"dalia-elsheakh",fullName:"Dalia Elsheakh"},{id:"111867",title:"Prof.",name:"Esmat",middleName:null,surname:"Abdallah",slug:"esmat-abdallah",fullName:"Esmat Abdallah"}]},{id:"57345",title:"Safe Drinking Water: Concepts, Benefits, Principles and Standards",slug:"safe-drinking-water-concepts-benefits-principles-and-standards",totalDownloads:6107,totalCrossrefCites:11,totalDimensionsCites:23,abstract:"Water is connected to every forms of life on earth. As a criteria, an adequate, reliable, clean, accessible, acceptable and safe drinking water supply has to be available for various users. The United Nation (UN) and other countries declared access to safe drinking water as a fundamental human right, and an essential step towards improving living standards. Access to water was one of the main goal of Millinium Development Goals (UN-MDGs) and it is also one of the main goal of the Sustainable Development Goals (SDGs). The UN-SDG goal 6 states that “Water sustains life, but safe clean drinking water defines civilization”. Despite these facts, there are inequalities in access to safe drinking water in the world. In some countries, sufficient freshwater is not available (physical scarcity); while in other countries, abundant freshwater is available, but it is expensive to use (economic scarcity). The other challenge is the increasing population of the world at an alarming rate, while the available freshwater resources almost remains constant. This chapter presents aspects of safe drinking water - background information, definition of water safety and access, benefits, principles and regulations, factors challenging the sustainable water supply and water quality standards and parameters.",book:{id:"6157",slug:"water-challenges-of-an-urbanizing-world",title:"Water Challenges of an Urbanizing World",fullTitle:"Water Challenges of an Urbanizing World"},signatures:"Megersa Olumana Dinka",authors:[{id:"206964",title:"Dr.",name:"Megersa Olumana",middleName:null,surname:"Dinka",slug:"megersa-olumana-dinka",fullName:"Megersa Olumana Dinka"}]}],onlineFirstChaptersFilter:{topicId:"125",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"13",title:"Veterinary Medicine and Science",doi:"10.5772/intechopen.73681",issn:"2632-0517",scope:"Paralleling similar advances in the medical field, astounding advances occurred in Veterinary Medicine and Science in recent decades. These advances have helped foster better support for animal health, more humane animal production, and a better understanding of the physiology of endangered species to improve the assisted reproductive technologies or the pathogenesis of certain diseases, where animals can be used as models for human diseases (like cancer, degenerative diseases or fertility), and even as a guarantee of public health. Bridging Human, Animal, and Environmental health, the holistic and integrative “One Health” concept intimately associates the developments within those fields, projecting its advancements into practice. This book series aims to tackle various animal-related medicine and sciences fields, providing thematic volumes consisting of high-quality significant research directed to researchers and postgraduates. It aims to give us a glimpse into the new accomplishments in the Veterinary Medicine and Science field. 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After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"3",title:"Bacterial Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/3.jpg",isOpenForSubmission:!1,annualVolume:null,editor:null,editorTwo:null,editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,annualVolume:11400,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,annualVolume:11401,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,annualVolume:11402,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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