MICROBIAL FLORA OF THE RESPIRATORY TRACT AND SKIN OF ARTISANAL MUNICIPAL SOLID WASTE HANDLERS IN ABA, ABIA STATE, NIGERIA.
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Municipal solid waste handling carries occupational risk for waste handlers due to exposure to diverse microorganisms and hazardous substances that cause respiratory and skin infections. A cross-sectional study was carried out, and 150 respondents were recruited using a simple random sampling technique. The sociodemographic characteristics, health-related complaints, health-seeking behaviour, and the bacterial and fungal microflora of the respiratory tract and skin of artisanal municipal solid waste handlers and some controls in Aba, Nigeria, were determined using a mixed-methods research design involving the use of interviewer-administered structured questionnaires and conventional culture techniques. We analysed the data using IBM SPSS version 25. The majority of artisanal municipal solid waste handlers in Aba are males (95%). Their mean age is 30 years, and the age group of 21–40 years constitutes the highest proportion (65%) of the workforce. Health-related complaints were higher (95%) among the waste handlers compared to the control subjects (4%). Findings show a high prevalence of respiratory (57%), eye (34%), and skin (87%) complaints among the waste workers compared to 6%, 0%, and 2%, respectively, among the control subjects. 78 (78%) of the waste handlers indulge in self-medication via over-the-counter (OTC) drugs; 17 (17%) access diagnostic laboratories; and only 4 (4%) visit hospitals for treatment, as compared to the control subjects, who recorded 1 (2%) for OTC drugs, 46 (92%) laboratories, and 2 (4%) hospitals. Acquisition 15 (15%) and use 3 (3%) of personal protective equipment (PPE) were very low amongst the waste handlers. 704 bacterial isolates and 191 fungal organisms were isolated from the study subjects. Among the waste handlers, the percentage distribution of bacteria was almost the same in both sites: respiratory tract 241(49.9%) and skin 242(50.1%), compared to the control subjects’ respiratory tract 105(47.5%) and skin 116(52.5%), which showed a slight difference between the sites. S. epidermidis (24%), and B. cereus (13%), whereas S. aureus (29%), and S. epidermidis (19%) predominated in the respiratory tract and skin of the waste handlers, respectively. Similarly, S. aureus (34.3%), and B. cereus (20.9%), while B. cereus (37.9%) and S. epidermidis (18.1%) predominated the respiratory tract and skin of the control subjects, respectively. Candida spp. was the most predominant fungus in the respiratory tract (81.4%) and skin (42.9%) of the waste handlers, as well as in the respiratory tract (85%) and skin (78%) of the controls. The presence of the isolated bacteria and fungi in increased proportions in the waste handlers may be attributed to occupational exposure through direct contact with waste and via inhalation of organic dust laden with biological agents and the poor working conditions of the waste handlers. Health education and improvement in working conditions are necessary to mitigate the occupational challenges of waste handlers.
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After review of the revised submission, it seems that many of the points raised by myself and the reviewers have not been addressed. Please be sure to respond to all of the following points and make corresponding changes in the text. Please note that additional submissions of the revised manuscript without adequate revisions that address all of the following comments may be considered grounds for dismissal from consideration for publication. -Details on the calculation of the percent incidence need to be added to the methods -Requested changes to the usage of the term "abundance" have not been made -The skin swabs and nasal swabs need to be described in more detail. For skin, there are several known sites of sampling such as groin, axilla etc. and this needs to be specified, especially if there is not uniformity in sampling, as there …
After review of the revised submission, it seems that many of the points raised by myself and the reviewers have not been addressed. Please be sure to respond to all of the following points and make corresponding changes in the text. Please note that additional submissions of the revised manuscript without adequate revisions that address all of the following comments may be considered grounds for dismissal from consideration for publication. -Details on the calculation of the percent incidence need to be added to the methods -Requested changes to the usage of the term "abundance" have not been made -The skin swabs and nasal swabs need to be described in more detail. For skin, there are several known sites of sampling such as groin, axilla etc. and this needs to be specified, especially if there is not uniformity in sampling, as there is beta diversity between sites. The nasal swab is to general a term to be used, this should either be "Anterior nares" or Nasopharyngeal" which are different anatomical and microbiological sites. -What temperature were samples kept at during incubation in peptone water? -Specify what media was used for fungal culture - "mycological media" is not acceptable -More detail on the " cultural characteristics and biochemical identification tests" is needed. What characteristics were studied and what tests were performed? -The discussion is unnecessarily long and should be condensed. -The term 'bacterial diversity among subjects' should be removed and a term like 'differences between bacteria isolated across subjects' used instead as diversity is a specific term which could imply whole genome analysis and beta diversity which has not been employed here. -The phrase "two and a half times more colonized by different bacteria compared to the control subjects." is problematic, as metagenomics have not been used, so it cannot be said for sure that they have been more colonized by other bacteria, as the whole microbiome has not been sampled and sequenced. Instead use a term such as "we detected two and a half times more different bacterial species by the conventional culture techniques described here in x population compared to y population." -Use the term "incidence" or "frequency" rather than occurrence, as incidence refers to the species being present in the individual, rather than quantitative analysis within an individual. -"Cross-tabulation" should have a hyphen. -The formatting in Table 1 is off in the Control subject columns, all data is shifted up slightly in this column and therefore does not align correctly with the row heading and data for the waste worker column. -It would be useful to include the details of major endotoxins produced by the bacteria you have isolated in table 3 -It would also be good to know what PPE is available/used- this information might be in the the questionnaire so I definitely think that it would be good to add this to the manuscript.
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Comments to Author
Dear Authors, Thank you for submitting your revised manuscript for review. Following my review I have a few comments and questions: 1. Please make sure names (including those of pathogens) are correctly italicised and that where there are words in between the names of species are also correctly formatted, throughout the manuscript. 2. The formatting in Table 1 is off in the Control subject columns, all data is shifted up slightly in this column and therefor dose not align correctly with the row heading and data for the waste worker column. 3. I think inclusion of the question potentially as a supplementary table would be useful. 4. As you talk about bacterial endotoxins in the introduction and discussion I think it would be useful to include the details of major endotoxins produced by the bacteria …
Comments to Author
Dear Authors, Thank you for submitting your revised manuscript for review. Following my review I have a few comments and questions: 1. Please make sure names (including those of pathogens) are correctly italicised and that where there are words in between the names of species are also correctly formatted, throughout the manuscript. 2. The formatting in Table 1 is off in the Control subject columns, all data is shifted up slightly in this column and therefor dose not align correctly with the row heading and data for the waste worker column. 3. I think inclusion of the question potentially as a supplementary table would be useful. 4. As you talk about bacterial endotoxins in the introduction and discussion I think it would be useful to include the details of major endotoxins produced by the bacteria you have isolated in table 3? or separately if this would make this too complicated. 5. I'm not sure I completely understand how the percentages have been calculated in table 4? For example how does a total frequency of 59 equate to 31%? Is this as a result of multiple organisms being isolated from the same individual? 6. With your existing data would it be possible to add a figure/table outlining where multiple organisms have been isolated from the same individuals and the common organisms that are isolated together? For example how often fungal pathogen A is isolated from the same individual who is also colonised with fungal pathogen B or bacterial pathogen A? Additionally, is it possible to link the isolation of pathogens to the clinical symptoms identified? I think this could be a really interesting figure/table. 7. You state in the manuscript that there is limited access to or use of PPE, do you think your study will be able to influence an increased use of PPE amongst waste handlers? It would also be good to know what PPE is available/used- this information might be in the the questionnaire so I definitely think that it would be good to add this to the manuscript. Thanks again for your time, Best wishes.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Please revise the manuscript in line with the reviewer comments below. Additionally, please take care to make sure that terminology related to microbial diversity, abundance, etc. is used correctly, as their interchangeable use has resulted in some quite bold statements. I would also request clarification on how the percent of incidence was determined, with a figure/table added if the authors feel that would be helpful to readers.
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Comments to Author
It is good to read this study which provides insight into the demographics and incidence of microbiota found on the skin and nasal cavity of waste handiling workers in Nigeria. It is possible that this is part of a wider body of work such as a thesis, as the discussion portion discusses aspects of microbiological pathogenesis which is informative but not central to the research conducted. The study provides a scoping of relevant demographical and microbiological trends in the above areas, and may be useful to direct further more detailed studies of the microbiomes involved. The publication of discoverable data sets as the authors have done is a good example of transparency and discoverability. While comments on nomenclature have been made on specific sections below, the need for changing …
Comments to Author
It is good to read this study which provides insight into the demographics and incidence of microbiota found on the skin and nasal cavity of waste handiling workers in Nigeria. It is possible that this is part of a wider body of work such as a thesis, as the discussion portion discusses aspects of microbiological pathogenesis which is informative but not central to the research conducted. The study provides a scoping of relevant demographical and microbiological trends in the above areas, and may be useful to direct further more detailed studies of the microbiomes involved. The publication of discoverable data sets as the authors have done is a good example of transparency and discoverability. While comments on nomenclature have been made on specific sections below, the need for changing microbiological terms made below in one section applies to the article as a whole The following amendments would make this a more concise and sound piece of research: 1. Methodology - The skin swabs and nasal swabs need to be decribed in more detail. For skin, there are several known sites of sampling such as groin, axilla ect and this needs to be specified, especially if there is not uniformity in sampling, as there is beta diversity between sites. The nasal swab is to general a term to be used, this should either be "Anterior nares" or Nasopharhngeal" which are different anatomical and microbiological sites. Furthermore, stating the methodology for bacterial culture as "according to the methods described...by Okerere" is insufficient and should include all of the details of incubation and growth including media, temperatures, time periods ect. It is stated that fungi were placed on "mycological media" - this also will require further clarification prior to approval for publication. 2. Discussion. The discussion is uneccessarily long and should be condensed. a. The term 'bacterial diversity among subjects' should be removed and a term like 'differences between bacteria isolated across subjects' used instead as diversity is a specific term which could imply whole genome analysis and beta diversity which has not been employed here. b. The portion of the discussion "Most of the bacteria isolated in this study are known pathogenic agents" to "which are identified as nonhemolytic enterotoxin (Nhe), hemolysin BL (Hbl), and cytotoxin K (CytK)" is not directly relevant to this study and should be removed. c. The phrase "two and a half times more colonised by different bacteria compared to the control subjects." is problematic, as metagenomics ahve not been used, so it cannot be said for sure that they have been more colonised by other bacteria, as the whole microbiome has not been sampled and sequenced. Instead use a term such as "we detected two and a half times more different bacterial species by the conventional culture techniques described here in x population compared to y population." 3. Results. a. Use the term "incidence" or "frequency" rather than occurence, as incidence refers to the species being present in the individual, rather than quantitative analysis within an individual. b. "Cross-tabulation" should have a hyphen. c. Similar to use of the words "diversity" and "colonised" the word "abundant" cannot be used, as it suggests that you have quantitatively sequenced all of the samples for each bacteria using whole genome sequencing - abundance cannot be measured by these techniques. Instead use "More frequently detected" or had a higher incidence." References The reference style should be vancouver. References of laboratory handbooks such as Cheesbrough, M. (2000) should be used following a description of the methodology.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Before this manuscript can proceed to peer review, the correct Figshare information where the complete dataset is deposited must be listed. The current DOI in the manuscript does not properly link to the mentioned dataset. Please ensure that the full Figshare DOI link is correctly written in the manuscript. This can be found by going to the dataset on Figshare, selecting the "cite" option, and copying the full DOI. A careful proofreading of this manuscript is also needed. There are several grammatical and language errors throughout that can make the submission difficult to understand at points. The help of a native English speaker is recommended. If needed, we offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information).
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