Journal Article > ResearchFull Text
Lancet. 2001 December 8; Volume 358 (Issue 9297); DOI:10.1016/S0140-6736(01)06995-1
Shafer J, Falzon D, Small I, Kittle D, Ford NP
Lancet. 2001 December 8; Volume 358 (Issue 9297); DOI:10.1016/S0140-6736(01)06995-1
Journal Article > ResearchFull Text
Environ Health Perspect. 2003 August 1; Volume 111 (Issue 10); 1306-1311.; DOI:10.1289/ehp.5907
Muntean N, Jermini M, Small I, Falzon D, Fürst P, et al.
Environ Health Perspect. 2003 August 1; Volume 111 (Issue 10); 1306-1311.; DOI:10.1289/ehp.5907
A 1999 study heightened long-standing concerns over persistent organic pollutant contamination in the Aral Sea area, detecting elevated levels in breast milk and cord blood of women in Karakalpakstan (western Uzbekistan). These findings prompted a collaborative research study aimed at linking such human findings with evidence of food chain contamination in the area. An international team carried out analyses of organochlorine and organophosphate pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) on samples of 12 foods commonly produced and consumed in Karakalpakstan. Analysis consistently detected long-lasting organochlorine pesticides and their metabolites in all foods of animal origin and in some vegetables such as onions and carrots--two low-cost components of many traditional dishes. Levels of PCBs were relatively low in all samples except fish. Analyses revealed high levels of PCDDs and PCDFs (together often termed "dioxins") in sheep fat, dairy cream, eggs, and edible cottonseed oil, among other foodstuffs. These findings indicate that food traditionally grown, sold, and consumed in Karakalpakstan is a major route of human exposure to several persistent toxic contaminants, including the most toxic of dioxins, 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD). Intake estimations demonstrate that consumption of even small amounts of locally grown food may expose consumers to dioxin levels that considerably exceed the monthly tolerable dioxin intake levels set by the World Health Organization. Data presented in this study allow a first assessment of the risk associated with the consumption of certain food products in Karakalpakstan and highlight a critical public health situation.
Journal Article > ResearchFull Text
Eur J Public Health. 2003 March 1; Volume 13 (Issue 1); 87-89.; DOI:10.1093/eurpub/13.1.87
Small I, Falzon D, van der Meer J, Ford NP
Eur J Public Health. 2003 March 1; Volume 13 (Issue 1); 87-89.; DOI:10.1093/eurpub/13.1.87
The environmental adversities around the Aral Sea in Central Asia have been the subject of recent research. Attempts at sustainable provision of palatable drinking water in low chemical and microbial contaminants for the 4 million people in the two countries around the Aral littoral have been largely unsuccessful. In the last few years, severe drought has further depleted the amount of available water. This shortage has negatively impacted on agriculture, and accentuated the out migration of people. An appeal is made to assist the local population in this arid area to cope with the acute and chronic deterioration of water security.
Journal Article > ResearchFull Text
Environ Health Perspect. 2001 June 1; Volume 109 (Issue 6); 547-549.; DOI:10.1289/ehp.01109547
Small I, van der Meer J, Upshur R
Environ Health Perspect. 2001 June 1; Volume 109 (Issue 6); 547-549.; DOI:10.1289/ehp.01109547
The Aral Sea area in Central Asia has been encountering one of the world's greatest environmental disasters for more than 15 years. During that time, despite many assessments and millions of dollars spent by large, multinational organizations, little has changed. The 5 million people living in this neglected and virtually unknown part of the world are suffering not only from an environmental catastrophe that has no easy solutions but also from a litany of health problems. The region is often dismissed as a chronic problem where nothing positive can be achieved. Within this complicated context, Medecins Sans Frontieres, winner of the Nobel Peace Prize in 1999, is actively trying to assess the impact of the environmental disaster on human health to help the people who live in the Aral Sea area cope with their environment. Medecins Sans Frontieres has combined a direct medical program to improve the health of the population while conducting operational research to gain a better understanding of the relationship between the environmental disaster and human health outcomes. In this paper we explore the health situation of the region and the broader policy context in which it is situated, and present some ideas that could potentially be applied to many other places in the world that are caught up in environmental and human health disasters.
Journal Article > ResearchFull Text
Emerg Infect Dis. 2004 May 1
Cox HS, Orozco JD , Male R, Rüsch-Gerdes S, Falzon D, et al.
Emerg Infect Dis. 2004 May 1
Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. To determine levels of drug resistance within a directly observed treatment strategy (DOTS) program supported by Médecins Sans Frontières in two regions in Uzbekistan and Turkmenistan, Central Asia, we conducted a cross-sectional survey of smear-positive TB patients in selected districts of Karakalpakstan (Uzbekistan) and Dashoguz (Turkmenistan). High levels of MDR-TB were found in both regions. In Karakalpakstan, 14 (13%) of 106 new patients were infected with MDR-TB; 43 (40%) of 107 previously treated patients were similarly infected. The proportions for Dashoguz were 4% (4/105 patients) and 18% (18/98 patients), respectively. Overall, 27% of patients with positive smear results whose infections were treated through the DOTS program in Karakalpakstan and 11% of similar patients in Dashoguz were infected with multidrug-resistant strains of TB on admission. These results show the need for concerted action by the international community to contain transmission and reduce the effects of MDR-TB.