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A nested case–control study was used to assess the risk factors of diarrhoeal episodes.Two hundred and thirty-two pairs of cases and controls were identified and exposure information related to wastewater, human and animal excreta, personal hygiene practices, and food and water consumption was collected.Improve personal hygiene practices and use of relevant treated wastewater and excreta as the public health measures to reduce these exposures will be most effective and are urgently warranted. Wastewater use in agriculture has substantial benefits, but can also pose substantial risks to public health, in particular when untreated wastewater is used for crop irrigation.Farmers often have no alternative but to use untreated wastewater because there is no wastewater treatment and freshwater is either unavailable or too expensive.The number of inhabitants was about 10,500 (2,700 households) and 5,700 (1,600 households) in Nhat Tan and Hoang Tay communes, respectively.Most households raise livestock in their compounds (e.g., chickens, ducks, and pigs).

Several pumping stations are located along the river and a system of open and closed canals distribute the water to the local fields and fish ponds.The participants were followed from enrolment to the end of the study, or until their withdrawal due to various reasons (i.e., deaths, morbidity, or not willing to continue).Each participant was assigned an identification number.First, we assessed the incidence of diarrhoeal episodes among adults living and working in an agricultural community, where human and animal excreta and wastewater is intensively used to irrigate field and fish feeding.Then, risk factors, including sanitary conditions, drinking water, food consumption, and personal hygiene practices were identified with a nested case–control study.).

Wastewater from households (grey water from kitchens and bathrooms and effluent from septic tanks and sanitation facilities) is directly discharged into the small irrigation canals.

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