Child dysentery in the Limpopo Valley: a cohort study of water, sanitation and hygiene risk factors

Abstract

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.

Diarrheagenic Escherichia coli in sub-Saharan Africa: Status, Uncertainties and Necessities

“…Vargas et al found that sporadic Shigella infections are more common in the dry than in the rainy season in Tanzania (P = 0.02) [21], a feature that agrees with the association of poor-quality water as the most significant risk factor for dystentery in the Limpopo Valley of southern Africa [138]. Shigella have a low infection dose, in part conferred by acid resistance that also makes survival in low-pH foods possible, and these bacteria have been isolated from a variety of street-vended foods in Addis Ababa, Ethiopia [139] and Accra, Ghana [140].…”

Coliform Bacteria as Indicators of Diarrheal Risk in Household Drinking Water: Systematic Review and Meta-Analysis

“…[30], [31] Four studies included the presence of blood or mucus in stool as part of their definition of diarrhea, [15], [17], [18], [32] and two studies [15], [17] reported dysentery as an outcome separate from “general” diarrhea; we did not include dysentery as a separate outcome in our review. Cohort studies in low-resource settings relied primarily on household surveillance and self-reported symptoms (e.g., maternal recall) for outcome assessment, using a range of recall periods (daily, up to one month; Tables 3 and 4); the two Canadian studies relied on monthly calendars maintained in the household and reported by telephone.…”

Pollution physico-chimique et microbiologique de l’eau des puits dans la Commune d’Abomey-Calavi au Bénin en 2009

“…Des résultats d'analyses ponctuelles conformes ne peuvent assurer à eux seuls la qualité de l'eau de boisson en tout temps. Il faut donc prendre les précautions nécessaires pour assurer la salubrité et le bon fonctionnement d'un système individuel d'approvisionnement en eau de boisson (Gundry et al, 2009).…”

“…Un manquement à ces mesures de prudence pourrait favoriser la prolifération des bactéries. Pour assurer une désinfection efficace, l'eau qui alimente les systèmes de traitement pour l'élimination des microorganismes doit être claire et limpide (Gundry et al, 2009).…”

“…Dans notre étude, les diarrhées endémiques sont associées à la contamination fécale de l'eau des puits qui constituent de grands risques pour le consommateur. C'est aussi le constat fait par Gundry et al (2009) dans leur région.…”