Doctoral Degrees (Health Systems and Public Health)

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Browsing Doctoral Degrees (Health Systems and Public Health) by browse.metadata.advisor "De Villiers, B."

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    The impact of water pollution from formal and informal urban developments along the Plankenbrug River on water quality and health risk / J.M. Barnes.
    (Stellenbosch : Stellenbosch University, 2003-03) Barnes, J. M. (Johanna Maria); De Villiers, B.; Liebowitz, L. D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine. Community Health.
    ENGLISH ABSTRACT: The Plankenbrug River runs past the dense settlement of Kayamandi, on the outskirts of Stellenbosch. This site was chosen to study the impact of water pollution from formal and informal urban developments on water quality and associated health factors. Aims of the study: (1) To determine some basic epidemiological characteristics of the exposed population of Kayamandi, their sanitation problems and reasons for poor hygiene; (2) To determine the microbiological and chemical pollution load patterns in the Plankenbrug River over time; (3) To investigate the spectrum of organisms present in the river (other than the indicator E. coli) and their epidemiological implications for health; (4) To establish the possible presence of organisms resistant to chlorine or to antibiotics in the river below Kayamandi as indicators of environmental hazard. Methods: During the period 5 May 1998 to 10 February 2003 microbiological and chemical analyses have been carried out every 6 weeks on water samples obtained at various points along the Plankenbrug River. Two large surveys (n=2196 persons and n=3568 persons) of the community of Kayamandi have been undertaken and door-to-door education campaigns were carried out with the aid of trained community health workers. Results: Below Kayamandi the river contains dangerously high levels of faecal contamination and it constitutes a health hazard to all persons coming into contact with the water. Up to 13 million Escherichia coli per 100 ml water was recorded (cut-off level as indicator of human safety is 1000 organisms per 100 ml water). Not all the faecal contamination originated from Kayamandi. Substantial amounts of faecal contamination sporadically entered the river at different points below Kayamandi. The pollution load resulting from these intrusions were sometimes larger than that contributed by the whole of Kayamandi. Water samples below Kayamandi were screened to ascertain what other pathogens were present. Amongst the organisms were 0 haemolytic Streptococcus Group A and B, Mycobacterium intracellulare, Staphylococcus spp, Klebsiella spp., Pseudomonas spp. and many others. The list of pathogens found had such serious implications that a confidential health warning was sent out to health care centres and other affected organisations in the area. |3 haemolytic Streptococcus Group A has never before been reported as isolated in viable form from free-flowing natural waters. Signs of increased resistance to chorine were found in organisms isolated from the river water. There were also organisms showing signs of resistance to commonly used antibiotics. The E. coli organisms that survived various levels of chlorine treatment also showed increased resistance to amoxycillin when compared to untreated E. coli organisms sampled from the Plankenbrug River. During the community phase of the project in Kayamandi a reduction in the pollution levels occurred over the summers of 2000 and 2001 (note that "improved" does not yet mean "safe" by any means). This can be ascribed to the multi-pronged approach of the project. Attention was given to service and repair of sanitation facilities, a strong accent on door-todoor community education about better sanitation behaviour, creation of a central reporting point for blockages and breakages, and training of artisans (plumbers, bricklayers, etc) from the community to help with upkeep. The community showed encouraging signs of wanting better sanitation education. The improvement in pollution levels is however in danger of reverting back to the previous dangerous situation if better support and co-operation cannot be obtained from the relevant authorities. There were 16.9% of households who reported one or more cases of diarrhoea during the survey period (5 weeks) - a very high prevalence seeing that the survey was carried out during a wet and cold winter period. Conclusions: Active planning and other steps to cope with the sewage intrusions into the river should be instituted without delay. The water quality of the Plankenbrug River downstream from Kayamandi is extremely poor. The water constitutes a serious health hazard and a threat to downstream economic activities. The settlement of Kayamandi demonstrated that education, when coupled with maintenance and repairs of existing toilet facilities, can bring about a reduction in pollution loads, but that this should be an ongoing process and not be reduced to sporadic attempts.