WHO-EWCEW094/E/L Distribution: Limited REPORT ON AFESDICEHA REGIONAL TRAINING COURSE FOR TRAINING TRAINERS ON DETECTION AND ENUMERATION OF NEMATODE EGGS IN INFLUENT, EFFLUENT AND SLUDGE Amman, Jordan 20-25 November 1999
World Health Organization Regional Otlice for the Eastern Mediterranean Centre for Envil-onmental Healtll Activities (CEIIA) Amman, Jordan 200 1
(C) World Health Orgr~iization2001
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CONTENTS I.
INTRODUCTION ...................................................................................................... I TECHNICAL PRESENTATION .3 2.1 Introduction to sanitary par 3 2.2 Factors influencing the fate of hellninth eggs: physical, chemical and biological.. 3 2.3 Theoretical review of diFerer~tlnethods available for parasitic eggs enumeration in wastewater and sludgc 4 2.4 Deternlination of liel~ni~lt .4 a~ld relnoval of Ilel~nintl~ eggs from raw wastewater and sludge 2.5 Occ~rrrence 4 . . indicators of pathoyens i n wastewater and sludgc ............ 2.6 Laboratoly skills . . . . . . . . . . . . . . 4 2.7 Introducing WHO'S health guidelines for the use of wastewater in agriculture and aqi~acult~rre .4 5 2.8 Monitoring and surveillance of the final effluent and sludge ................................ EVALUATlON OF PRE COUlZSE AND POST-COURSE KNOWLEDGE 6
2.
3.
4.
EVALUATION OF COURSE ........................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 CONCLUSlON AND RECOblMENDATIONS 7
5.
Annexes I . AGENDA .8 2. PROGRAMME... ... . . . . . . . ... . .. . . . . . . . .. . . . . .. .... .... .. .., , ,.. ,,.. ,., , ,..., . . . . . . . . .. . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . .. 11 . . . . . . . ....... . . . ... . . . . . .. 3 . LIST OF PARTICIPANTS . . . . . . . . 4. PRE-COURSE AND POST-COURSE KNOWLEDGE EVALUATION FORMS.. . . . . . . . I5 5 . POST-COURSE EVALUATION FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . .. ... ... ... . . . 19 , , , ,
1.
INTRODUCTION
The Regional Centre for Environmental Health Activities (CEHA) of the World Health Organization Regional Office for tile Eastern Mediterranean (WHOEMRO) organized a Regional Training Course for Training Trainers on Detection and Enumeration of Nematode Eggs in Influent, Effluent and Sludge from 20 to 25 November 1999. The training course agenda and programme are given in Annexes 1 and 2 respectively. The training course was attended by participants R-om ten countries. A list of participants is given in Annex 3 . Technical support was provided by Environmental Research Centre staff at the Royal Scientific Society of Jordan. The specific objectives of the training course were to: disseminate knowlcdye on tile regionally reco~n~nendcd procedure for testing of IIOIIIBLULII: eggs (ASCCII?.~ and 7i~ichrrri.vspccics and hookworms) in raw sludges and treated wastewater and introdt~ceperiodic programmes regarding the frequency of sampling, times, days, and numbers of samples to ensure better safety and foster community health during wastewater reuse in agriculture; introduce the WHO'S health g~~idelirles for the use of wastewater in agriculture and aquaculture; acquaint the pa~licipants with the equipment and consumables needed for the parasitological analysis of wastewater to be reused in agriculture; disseminate knowledye 0 1 1 the monitoring and sun~eillanceof reclaimed water and use sludge for agriculti~re Dl- M . Z . Ali ICIinn, Coordinator, Rcgionill Centre for Environmental Health Activities
.
(CEHA), read out a Inessase fro111DI- blussein A. Gezairy, W I O Regional Director, to the training course. In his message, Dr Gezai~y stated that tile Eastern Mediterranean Region was the driest in the world with rainfall being low and poorly distributed. Drought and desert defined the Region. Water demand in the Kegion was growing fast and water availability was falling to crisis levels. One of the solutions to the crisis was the reuse of wastewater to augment supply and reduce pollution. The disposal and use of untreated wastewater was causing serious health and environmental problems, as well as polluting surface and groundwater. Treating and reusing wastewater could conserve resources and reduce pollution. Particularly in agriculture, the reuse of treated wastewater and drainage water could release freshwater for higher value use and reduce fertilizer consu~nption
D IGezairy added that I~c~man healtl~aspects and environmental quality were closely connected with the use and final disposal of reclaimed water and sludges. Health statistics showed and elevated prevalence ol' diseases associated with wastewater reuse. There were about one billion cases of intestinal nematode cases in the wu~ldand the prevalence of
WHO-EMICEI-U094IEIL Page 2 intestinal helminth diseases could reach almost 100?6 i n some countries of the Region. So, WHO/EMRO was endeavouring to build capacity in the field of reused wastewater quality. This training course was one endeavour towards bililding the capacity of the individuals and WHOIEMRO in collaboration national institutions in the area of reclaimed water su~veillance. with the Arab Fund for Economic and Social Development (AFESD) planned to carry out two training courses in the participating countries on the health aspects and appropriate treatments necessary to protect health and the environment. Dr Gezairy emphasized that the sul-veillance of effluent quality would be improved and institutionalized in the Region by using the guidelines for the identification and enumeration of helminth eggs in influent, effluent and sludge, as iefined and detailed by the Royal Scientific Society of Jordan, along with tlie providcd equipment, and the knowledge gained from this training course. Because of the water scarcity in our Region, the use of treated wastewater in conjunction w~th adequate health measures [nust become an integral component of water resources management and environmental health protection H. E. Dr Ishaq Maraka. Minister o r Health, Jordan. addressed tlie training course and iniportance t because of their stated that sanitary sewage issues must be ~ i v e nthe ~ ~ t m o s of the environment: water. food and soil. and potential negative impact on the main eletner~ts consequently their impact on the human healtli The intestinal helminths contained in wastewater and sludge were a major health risk because of their ability to survive in the environment. Therefore any treatment which did not consider this was not useful. The wastewater surveillance programme must be focused on these issues. He stated that Jordan hadgiven wastewater treatment the attention it deserved. For the past three decades, Jordan had been constructing wastewater trcatmcnt plants. Currently 17 treatment plants served 60% of the Jordanian population and produce about 70 million ~n'of water per day which was used for various agricultural purposes. Hence, it was necessary to set up an intensive programme CUI the surveillance of wastewater rreatmenr plants, their discharge sites and reuse in order to reduce and control any negative health impact. The programme also raised the awareness of wastewater treatment plant workers and hrmcrs. The enumeration and identification of helminth eggs in laboratories was the cornerstone of the sulveillance programme. The for right decisions. Minister asserted that right information was the foundatiol~
Dr Seyfeddin Muaz, Vce-President of the Royal Scientific Society of Jordan gave a welcome address on behalf of Dr Said Allousl~,President of the Society. He stated that most countries in the Region were suffering from similar environmental problems at differing intensities. The most important problem was water scarcity. Industrial and social development and population growth had increased water usage and had produced a huge amount of wastewater which could create environmental and liealtli problems requiring scientific and economic solutions for its treatment and reuse to protect community health and the environment. It was important to use reclaimed water in a low-cost manner, controlled by health and environmental guidelines and st~iccsurveillance programmes which protected health and the environment. The deficiency of trained human resources was a major obstacle facing the implementation of national programmes and policies and related to combating environmental pollution.
WHO-EMIC:bHIOY4IEIL Page 3
2.
TECHNICAL PRESENTATIONS
Dr Soliba presented an introduction to parasitology covering suhjects related to the classification of worms and their medical importance and relation to sanitation. The word helminth refers to three classes of invertebrates, the cestodes or tapeworms. the trematodes or flukes and rhe nelrra~udesU I I U ~ I I ~ W U I I J I S A . list showed the rangc of hclminths which nre human parasites and in particnlar those which are important in the field of sanitation and water supplies. The main factors that contribute to the effective trans~nissionof pathogens by wastewater irrigation are: long persistence in the envil-onment low minimal inetfective dose short or no imnlunity rninilnal concurrerlt tr-anst71issiorl tllrotrgl~other routes such as food, water and poor personal or domestic hygiene the need for a soil development stage He cover-ed in detail the et~viro~~rnetltal classification of excreta-related infections, using an illustration key to identify the most prevalent hellninth eggs in tropical areas. He also gave ncmatodc cggs related to public health and details on 111c liCc cycles of thc ~iiosti~iipo~tant reuse of wastewater for agriculture 2.2
Factors intluencing tlie rate oSl~elnrintl~ eggs: physical, chemical and biulugical
Dr Mlrtxr Mirtdiyeh. I'I~IIICI/ILII 7i.~rirtei; R O ~ L,(;L.icrtl~~c II Sucie/y of Jordan The survival of parasites outsitle the host's yastro-intestinal tract depends on infection depends to a large extent environmental conditions, e . g tlie epidemiology of A.rctr~*i.s upon the eggs. since they must emb~yonateoutside the body of the host before becoming infectious. There are many abiotic variables, which may affect resistant stages of parasites. In general, the parameters that affect helminth egg survival can be divided into three categories: Physical: temperature (optimu~n, low and high), sunlight, ultraviolet radiation, and desiccation; a brief on the sul.vival of helmi~ltheggs in soil and corps was also given; Chemical: pH, che~r~ical substances, e.g. DDT, alcohol, acids, cyanide, sodium and gases; hypochlorite, oxygen requireme~lts a
Biological: fungi and val-ious invel-teblxtes.
WHO-EMICEHI094IEIL Page 4 2.3
Theoretical review of different methods available for parasitic eggs enumeration in wastewater and sludge Dr Mzlncr Hindieyeh, Prhici/)ol T;.tri~rer: Roytrl Scie/tf(fic Socir/)i
A 1 1 methods for the quantitative determination of lhel~nintheggs in wastewater were summarized and references made to principle, volume settling, buffering, centrihgation andlor flotation procedures, calculation and recovely rates.
2.4
Determination of helminth egg viability U r Ml~wcz Hindieyeh, Prhrcipol l?crine!: I?oytrl ,(;Cie~r/~fic Sociel)~
Information concerning the viability of Asccrrt.\ eggs is of considerable importance. Detailed information about the techniques used for assessing the viability included morphological criteria, ~ncubatlonmethod, vital stains, the diff'erential Hotation method, and infectivity test.
2.5
Occurrence and removal of 11clmi11tIi eggs from raw wastewater and sludge indicators of pathogens in wastewater and sludge D r Mtrwa Hindie.yeh, Princij,nl 7ioi11e1: 1tr;ytrl Scietr/jfic SocieLy The presenter summarized counts of nematc~de eggs in raw wastewater and sludge from
a range of different countries Reference was also made to tlie effects of conventional
treatment plants and different treatment processes for the rcnioval of hellninth eggs from wastewater (using clarifiers, flotation. llnhoff tanks, trickling filters, activated sludge, cxtcndcd acration and routine chlorination) Methods for tlie reinoval of hellninth eggs from anaerobic ponds and the different types of waste stabilization ponds were covered, as was the influence of sludge treatment processes on parasite eggs 2.6 Laboratory skills D r M u n o Hirrdieyeh. P r i n c i p l TIZrinet: cr~td M.Y M e r l ~ Ktrniel, r~ Poiner: R ( y n l S'cient~j?~ Society
Microscope calibration Centrifuge use 2.7
Introducing WHO'S health guidelines for the use of wastewater in agriculture and aqurculture
Dr Saqrr A1 Salem, Itlfonlitr/torr Exchange curd 7L;cl111olog~i lizur.$er Advr.sor; I'EHA The WHO Henlfh C ; ~ ~ ~ d e l ~ t r c /he . ~ ,if i r h of Wct.\/eivtr/ei./ I , A ~ ~ I C I I / / /and I I Z Aqzrtrcilllrrre Technical Report Series No 778 was introduced The following ~naintopics were introduced in detail Detailed information on the prevailing diseases in tlie Region associated with inappropriate treated wastewater use.
Wt-IO-ENVCEH/094/E/L
Page 5 The health aspects of wastewater reuse including:
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infections caused by excreted pathogens pathogen s~rrvival measures of health risk fi.orii wastewater use Td~tul~s i ~ ~ v ~ l iv n tdiseilsc d transmission epide~niologicalevidence
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Health protection rneastrres i n wastewater reuse
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etfluent quality guidelines for agriculture wastewater treatnielit crop selection wastewatcr application human
rxposurc control
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various integrated measures
Planning and implernentiny health safeyuards Monitoring i ~ n d s ~ ~ ~ ~ v e i of lli t l~~~ e final ~ c eemuent and sludge L ) , 'Sc2c/el' A / ,~L;LI/~?WI, /ll~iil'lll~l/li~ll /!kl'/lllll~~l! ~1111~ EC~IIO/OD fi'(1113fC1' A ~ ~ ) I J c I(1EHA ; Pollutants and guidelines Sludge application guideliries to agriculture chemical guidelines for reclaimed wastewater and sewage sludge application in agl.iculture Monitoring frcqucncy Surveillance and reporting requirements Typical industrial regulatory requir-ements containing the following: -
sample collection methods establishing surveillance conditions
-
WHO-EMICEHI0')4IEIL Page 6
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analytical methods.
Other considerations in establishing monitoring requirements:
3.
monitoring municipal sludge records and periodic reporting req~~irenlents
EVALUATION OF PRE-COURSE AND POST-COII RSE KNOWLEDGE
Two questionnaires were used. The first was prcpared by Dr Muna Hindiyeh of the Royal Scientific Society and the second was prepared by Dr Saqcr Al Salem, ITAICEHA. The results of the ouestionnaires were as follows. The evaluation of the RSS questionnaire fbr pre-course knowledge revealed that the knowledge nf tlie participants was rated belo\u average at 4 4 S % post-course knowledge was 98%, representing an increase in knowledge of 5 1.2%. The evaluation of CEHA's qucstionnairc rcvealcd that prc-course knowledge was 28.6% post-course knowledge was 53.38%, representing an increase of 24.7%. The average precourse knowledge for the two questionnaires was 36.7% and the post-course average was 75.7%. Main evaluation points focused on capacity-building among the trainers and their countries' institutional capabilities in reclaimed water laborato~y analyses. The participants were asked if the required equipment and human skills were available to carry out the tests to identi5 and enumerate I~elmintlieggs in the final emuent; 8 out of I I representatives answered afirmatively For testing the viable I~elminth eggs in sludge 7 countries out of I I answered that the eiluipmcnt and the skills we available For .Snlninnr?llfl testing of sludge, 6 countries out of 1 I had the capability, wliile for the virus testing of sludge 1 country out of 11 had this capability. Six representatives stated that according to their knowledge routing testing was done for Ihcltninth eggs while the other five stated that such tests were usually not carried out. r~uas~ic~r~r~aire, e six representatives answered that According to the post-training c o ~ ~ t s their countries do not have the required equipment for helminth egg detection in wastewater. Seven representatives answered that they do not carry out the required testing suggested by WHO'S guidelines. The main objective of the course was to transfer testing knowledge for helminth eggs (enumeration and screening) in reclaimed water and sludge to tlie participants and to develop their skills so as to become trainers in the filtul-c 111 this respect only two participants answered that before the course they co~lldcarry O L I ~ such tests while after the course all of
WHO-EM/CEW094/E/L Page 7
them stated that they could carry out the test. All of them stated that they were capable of transferring the knowledge to (training) otliel- people in their countries. Regarding familial.ity with W110 guidelines. the pre-course evaluation showed that only 21% of the participants were familiar with WHO'S guidelines but after the course the percentage rose to 75% All of the ~xirticipantsare working in the field of reclaimed water surveillance in their countries and the pre-course test indicated that familiarity with WHO'S guidelines for the use of wastewater in agriculture is low generally.
4.
EVALUA'I'ION OF COURSE
All participants expressed their satisfaction from the overall arrangement and set-up of the course. Only I out of 12 stated that the course had not achieved its objective. One said that the objectives were pal-tially :~chievedwhile I0 (83%) stated that the course had achieved its objectives well or excellcntly. All of the pal-ticipants stated that the knowledge that they had gained would improve their work perl'orniance; I I o ~ of ~ t12 stated that the training course was relevant to thcir work, job, institution and country. The only negative answer was regarding tlie duration of the course, particularly the hands-on pan. Past experience intlic;~tesi l l i i t ~cgilldlcssof course durations this is a typical response. I t should be noted that some participants asked for an increased number of with laborato~y coats during the training. microscopes and to be s~~pplied
5.
CONCLUSION AND RECOMMENDATIONS
The course achieved all of its objectives and tlie participants secured the required knowledge to become trainers. Techniques developed for tlie standard testing of nematode eggs in raw waslewa(e~,t~eatcdwastcwater, and sludgc wcrc disseminated well. It was obvious from the pre-course and post-course questionnaires that professionals in the Region There is a need to com~nunicate with all countries are not familiar with the W-I0 g~~idelines. of the Region to pronlote tlie adoption of the WHO guidelines in the field uCwaslewate~ reuse and to build institutional capacity in the field of monitoring and surveillance. Most of the countries do not have the necessaly equipment to check reclaimed water and sludge to ensure that they are within the reco~nmelidetlguidelines. It is recommended that the same course be given for other countries i n the Region who are not beneficiaries of the project.
WHO-EMICEHI094IEIL Page 8
AGENDA Objectives and scope of the course
Review different methods available in tlie literature on parasitic egg enumeration in wastcwatcr and sludgc Review different methods available in tlie literat~lreon tlie determination of helminth egg viability Compare available methods in the literature according to:
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recovery rate type of nematode eggs various quality of effluent size of the samples
-
Introduce a routine monitoring programme regarding frequency of sampling, time of sampling Hands-on training on parasitic egg enumeration ill
wastewater and sludge
Hands-on tralnlng on paras~t~c egg deterlnlnat~on ot'lielniintli egg viability Introduce know-how regarding the surveillance of reclaimed wastewater for agriculture use Conclusions and recommendations
PROGRAMME
Saturday, 20 Nove~iiber 1999 Registration Openi~ig ceremony Welco~neaddress by Dr Said Alloush, President, Royal Scientific Society Message of Dr Hussein Gezairy, Regional Director, WOIEMRO Inau&~~ral address by H.E. Dr Ishaq Maraka, Minister of I lealth, Jordan RSS tlocu~nenta~y, and introduction to EKC activities, hy Dr tvlu~laHindiyeh, Royal Scientific Society Pre-evaluation questionnaire I~it~.oductio~l to sanitary parasitology, by Professor Elias Saliba. Vice-President at Al-Hashemite University Factors intluencing the fate of hellninth esgs: physical, cherr~icaland hiological. by Dr Hindiyeh Introduction to ERC laboratories and environ~nental micl-obiology laboratory, by Dr Hindiyeh Ecll~iplnent and consu~nables used for parasitological analysis of wastewater reuse in agriculture, by Dr Ilindiyeh Preparatioli of solutions. by Dr FIindiyeh and Ms Mervat Ka~liel,Royal Scientific Socicty Basic laboratory skills: by Dr Hindiyeh and Ms Ka~nel Microscope calibration - Use of sedgwick-rafier slide Use of centrifi~ges
Sunday, 2 1 Novelilbel. 1999 08:30 - 09:30 09:30 - 10:45 11:OO- l1:30 14:OO -
16:OO
Theoretical review of different methods available for parasitic egg en~~meration in wastewater and sludge, by Dr Hindiyeh The ~rlodified bailen~er method, advantages and disadvantages, by Dr fiindiyeh Microscopical identification of hellninth eggs (permanent slides), by Dr Flindiyeh Microscoy ial identification of helminth eggs (permanent slides), by Dr Ilindiyeh
WIO-EWCEWO94IEIL Page 10 Monday, 22 November 1999
08:30 09:30 09:30 - 10:30 -
11:30 - 12:30 12:30 - 13:OO 14:UU - 16:UU
Determination of Iielmintll egg viability, by Dr Hindiyeh Occurrence and survival of Ilelminth eggs in raw wastewater, by Dr Hindiyeli Wastewater treatment facilities Ibr pathogen removal, by Dr Hindiyeh Discussion Demonstrate the recommended WIIO method for the parasitic eggs enumeration in wastewater, results and calculations, by Dr Hindiyeh and Ms Kaniel
Tuesday, 23 November 1999
Field trip visits for wastewater and s l ~ ~ d sampling. ge Abu-Nussier Collventional Wastewater Treatment Plant NSalnra Waste Stabilization Pond Near Zarqa City Wednesday, 24 November 1999
Delnonstrate the method for parasitic e&g enumeration in sludge, by Dr Hindiyeh and Ms Kaliicl Demonstrate tlie neth hod For parasitic eSg enurneration in sludge, by Dr Hindiyeh and Ms Kalnel Practical training on the procedure Results and calculation Discussion by Dr Saqer Al Saleni, I'I'NCEHA, Dr Hindiyeh and Ms T<a~iicl Thursday, 25 November 1999
08:30 - 09:OO 09:OO - 1O:OO 10:30 - 11:30 12:OO 13:OO -
13:OO - 13:30
Video on "CEI-IA Sta11dal.d Prese~itation" Introducing WHO'S health guidelines for the use of wastewater in agriculture and aquaculture, by Dr N Salem Monitoring and surveillance of final effluent and sludge, by Dr Al Salem Conclusions and reconime~~dations Training course evaluation Closing ceremony
WI 10-EM/CEH/U94/h/L Page I I
1,lSTOF PARTICIPANTS
EGYPT Chemist Sanaa Sayed Hassanien First Specialist, Water Bactel-ioloyical Diagnosis Labol-atory Environmental Monitorins Centl-e Cairo Tel: +202-3 1 19693 - 3 1 1969 1 Fax: +202-3 1 18978 Email: Sherif-mohsen@usa.net JORDAN Mr Mohalned Khair Abazid Environmental Health Directorate Ministry of Health Amman Tel: +962-6-5662080 Fax: +962-6-5666 147
KUWAIT Mrs Fatilr~a Mulla~rrmcdMal-Allill? Chief of Microbiology Section Water Pollution Depa~tment Environment Publlc Autlior~ty P.O. Box 24395 Safilt 13 104 Tel: -t965-4835503 Fax: +965-4835483 MOROCCO Mr Mae-Eddin Gati Parasitology Department National Institute of Hygiene Avenue Ibn Batouta Ri~b;~l
Tel: +2 12-7-77 1902 OMAN Ms Zahra A1 Hajri Public Health Label-ato~y Ministry of Health
Musc:it Tel. +968-705740 - 705943 Fax: +968-793899
WHO-EMICEf~l094IEIL Page 12
SAUDI ARABIA Mr Osama Mohammed A l Molla The Regional Laboratory Ministry of Health P 0. Box 17040 Jeddah21484 Tel: 1966-2-6375233 Fax: +966-2-638 132 SUDAN Dr Abdel Moniem Hassan Mohd Hilali Assistant Professor Parasitology Department National Health Laboratory P.O. Box 1304 Khartoum Tel: +249-11-779246 Email. tropmed@st~danmailnet SYRIAN ARAB REPUBLIC Ms Ruba A-Homsi Parasitology Laboratory Public Health Directorate Ministry of Health P.O. Box 25 17 Damascus Tel: +963-11-445 1177 Fax: +963-11-4442153 TUNISIA Mr Lotfi Helaoui Chef de Service de Controle des Eaux Direction de \'Hygiene du Milieu et de la Protection de I'Environnement Ministere de la Sante Publique Tunis Tel: +216-1-575849 - 577292 Pax: 1216-1-576010
Email: lotfi.helaoui@rns.tn
W t 1U-ENI/CEI-V094/E/L
Page 13
REPURLIC OF YEMEN Dr Musaid Ahlned Mosleh Nasi Director. National Schistosomiasis and Other Endemic Diseases Control Programme Ministry of Public Health P.O. Box 1191 Snnil'a
Tel: +967- 1-6 15296
F a x , +967-1-615382 Observers
Ms OIa Abdel Razaq Al~ni~rlell Microbiologist, Water Authority of Jordan Ministry of Water and Irrigation Alrllr~an Jordan Tel: +962-6-5864361 - 362 Fax: +962-6-5825275 Ms Jalnila Mahllloud Mulia~iledOtie
Lab Technician. Water A~~thority of'Jorda11 Ministry of Water and 1r1,igation A~IIII~I~ Jordan Tel: +962-6-5864361 - 362 Fax: +962-6-5825275
WHO-EMICEHlO94IEIL Page 14
WHO Secretariat
Dr. M. Z. Ali Khan, Coordiantor, WHO Regional Centre for Envil-onmental Health Activities, CEHA, Amman, Jordan, Tel: +962-6.5524655, Fax: + 9 6 9 6 S S 16591. Elnail: CEHA@,whoceha.orgjo ..... ..
Dr S a q e ~ A l - S ~ ~ GIIICUI III, I I I ~ L ~ U iu~d I I T e ~ l ~ ~ ~ o'flallsfel l o p y advise^, W I ( 0 Regional Cenrre for Environmental Health Activities, CEI-IA,Amman, Jorda~i, Tel: -+962-6-5524655, Fax: +969-65516591. Email: CEHAmwho-ceha.0rg.i~ Dr Muna Hindiyeh, Principal Trainer, Environmental Research Centl-e, Royal Scientific Society, Amman, Jordan, Tel: +962-6-5344701, Fax: +969-6-5344806. Elnail. rnuna@?rss.ao.v.jo
Ms Mervat Kamel. Trainer. Enviror~~nental Research Centre. Royal Scientific Society, Amman, Jordan, Tel: t962-6-5344701, Fax: +969-6-5344806, Email: ri_ui@rss.~ov.io Professor Elias Saliba, Lecturer. Vice-President, t-lasheniite University. Mafraq. Jordan
WHO-EWCEfU094/E/L
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