Diarrhoeal Disease in Relation to Possible Household Risk Factors in South African Villages

Abstract

Diarrhoeal disease is a significant contributor to child morbidity and mortality, particularly in the developing world. Poor sanitation, a lack of personal hygiene and inadequate water supplies are known risk factors for diarrhoeal disease. Since risk factors may vary by population or setting, we evaluated the prevalence of diarrhoeal disease at the household level using a questionnaire to better understand household-level risk factors for diarrhoea in selected rural areas in South Africa. In a sub-sample of dwellings, we measured the microbial quality of drinking water. One in five households had at least one case of diarrhoea during the previous summer. The most widespread source of drinking water was a stand-pipe (inside yard) (45%) followed by an indoor tap inside the dwelling (29%). Storage of water was common (97%) with around half of households storing water in plastic containers with an opening large enough to fit a hand through. After adjusting for confounders, the occurrence of diarrhoea was statistically significantly associated with sourcing water from an indoor tap (Adjusted Odds Ratio (AOR): 2.73, 95% CI: 2.73, 1.14–6.56) and storing cooked/perishable food in non-refrigerated conditions (AOR: 2.17, 95% CI: 2.17, 1.44–3.26). The highest total coliform counts were found in water samples from kitchen containers followed by stand-pipes. Escherichia coli were most often detected in samples from stand-pipes and kitchen containers. One in four households were at risk of exposure to contaminated drinking water, increasing the susceptibility of the study participants to episodes of diarrhoea. It is imperative that water quality meets guideline values and routine monitoring of quality of drinking water is done to minimise diarrhoea risk in relevant rural communities. The security of water supply in rural areas should be addressed as a matter of public health urgency to avoid the need for water storage.

Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia

“…Moreover, using water collected from unprotected (unimproved) sources for cooking/washing or for other domestic purposes was also a risk factor for childhood diarrhea in this study. This study finding is similar to studies done in northwest Ethiopia, Tamale Metropolitan Area of Ghana, South African Villages and Nigeria [32,[38][39][40].…”

Climatic Factors in Relation to Diarrhoea Hospital Admissions in Rural Limpopo, South Africa

“…We surmise that in Limpopo, South Africa, the warmer and drier conditions may lead to water shortages, lower availability of safe water sources [33] and increased water storage (perhaps not hygienically maintained), reducing personal use (and cleaning) of outdoor pit latrines, thereby reducing sanitation quality and personal hygiene. In addition, the wetter conditions may lead to increased risks of water contamination.…”

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

“…Water collected from a communal tap and stored in an open bucket has been found to have levels of Escherichia coli far exceeding WHO standards. [36] Air pollution is increasingly recognised as a significant risk factor for ill health, with more than 90% of children worldwide breathing in polluted air. [37] Although SA has experienced major societal and political changes over the past two decades, the majority of the population still live in suboptimal environmental circumstances, with significant exposure to both indoor and outdoor air pollution, [38,39] compounded by a high prevalence of primary and secondary tobacco exposure.…”