The objective of this cohort study was to assess risk factors for child dysentery and watery diarrhoea. The study participants consisted of 254 children aged 12-24 months in rural South Africa and Zimbabwe in households where drinking water was collected from communal sources.The main outcome measure was the most severe diarrhoea episode: dysentery, watery diarrhoea or none. For dysentery, drinking water from sources other than standpipes had a relative risk ratio of 3.8 (95% CI 1.5-9.8). Poor source water quality, as indicated by Escherichia coli counts of 10 or more cfu 100 ml 21 , increased risk by 2.9 (1.5-5.7). There were no other significant risk factors for dysentery and none for watery diarrhoea. In this study, endemic dysentery is associated only with faecal contamination of source water. Sources other than standpipes, including improved groundwater, are of greater risk. Remediation of water quality by treatment at source or in the household will be required to achieve access to safe drinking water in accordance with the 7th Millennium Development Goal.
The appropriateness of indicator organisms as surrogates for human pathogens in water quality modeling is dependent on similarities in both presence and transport behavior; however, very little data relating indicator and bacterial pathogen transport behavior in receiving waters is available. In this study observations of presence, partitioning behavior (i.e. association with settleable particles) and removal by upland detention basins were used to assess the suitability of six indicator organisms as surrogates for Salmonella spp. bacteria in an urban watershed.The fecal indicator bacteria (fecal coliforms, E. coli and enterococci) were most closely correlated with Salmonella in terms of presence and partitioning behavior (25-35% associated with settleable particles on average); however, further resolution of the variability associated with Salmonella partitioning is required. Higher removal of particle-associated microbes relative to the total microbial concentration by the detention ponds suggests that sedimentation may be an important removal mechanism. However, large fluctuations in pond performance between storm events and occasional net microbial exports in effluents indicate that these best management practices (BMPs), as currently implemented, will be unlikely to achieve water quality objectives.
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