Potential Exposure to Untreated Sewage-Associated Contaminants through Marine Fish Consumption, with Emphasis on Herbivorous Fish: An Exploratory Study among Kidney Disease Patients in Zliten, Libya

Abstract

Background: Untreated sewage represents an important source of coastal pollution that may alter marine environmental quality and create potential pathways for contaminant transfer to aquatic organisms, including fish that constitute an important component of coastal diets. This issue is particularly relevant to kidney disease patients, who may warrant greater consideration when evaluating potential exposure to environmental contaminants.

Problem and Objective: This study investigated the potential exposure of kidney disease patients in Zliten, Libya, to contaminants associated with untreated sewage through marine fish consumption, with particular emphasis on herbivorous fish. The study aimed to determine the level of potential exposure, examine the relationship between marine fish consumption patterns and potential exposure, compare potential exposure between consumers of herbivorous and other marine fish, and assess the relationship between pollution-risk awareness and exposure-avoidance behaviors.

Methodology: A descriptive-analytical exploratory design was adopted. Data were collected using a structured questionnaire administered to 315 dialysis patients attending the Zliten Kidney Services Center. The questionnaire addressed marine fish consumption patterns, potential exposure indicators, awareness of pollution-related risks, and exposure-avoidance behaviors. Descriptive and inferential statistical procedures were used to examine the study dimensions and test the proposed statistical relationships.

Main Findings: The estimated results indicated a high level of marine fish consumption (M = 3.82), high awareness (M = 4.18), and high exposure-avoidance behavior (M = 3.79), while the overall potential-exposure score was moderate (M = 3.36). A statistically significant positive relationship was identified between marine fish consumption patterns and potential exposure (r = .640, p < .001). Significant differences were also observed between consumers of herbivorous fish and other marine fish, while awareness was positively associated with exposure-avoidance behavior (r = .520, p < .001).

Conclusion and Recommendations: The findings provide preliminary evidence supporting the plausibility of a potential dietary exposure pathway linking untreated sewage, coastal contamination, fish, and consumption among dialysis patients. However, the study does not establish actual chemical exposure or a causal relationship between fish consumption, sewage-associated contaminants, and kidney disease. Future research should therefore prioritize direct analysis of seawater, sediments, and edible fish tissues from sewage-affected and reference sites, combined with dietary and clinical assessments. Strengthening seafood-safety awareness and providing reliable information on fish sources and fishing locations are also recommended.