The Double Onslaught of Poverty and

Systems Failures in South Africa on

Microbiological Pollution in Rivers

Jo M Barnes

Dept of Community HealthFaculty of Health SciencesUniversity of StellenboschTYGERBERG

"If our foresight were as good as

our hindsight, we'd be a damn sight

better off..."Robert J Burdette

Pollution due to failing sanitation

Most poor countries located in regions with the most droughts and variation in rainfall

These countries also face rapid population growth

Most of Africa subsist on the hydrological edge

Poor progress in water resource management, sanitation and hygiene cause a slow disaster:

Deteriorating water quality

Water crisis

Population and water resources - a delicate balance

Who is most at risk of water- related disease?

Newborns, babies and children

Pregnant women and their developing foetuses

Old people

Individuals with compromised immunity such as those with TB, HIV/AIDS

Persons who are chronically malnourished

Patients undergoing chemotherapy (e.g. for cancer)

Persons with pre-existing chronic diseases such as diabetes, kidney failure, liver failure

Failures of design and usage

40 - 60 persons per toilet

Animal and human feet bring contamination into homes

Overflowing sewers contaminate the streets

Poor solid waste removal causes contamination

Alien vegetation slows flow and allows sedimentation

Low flow in summer, alien vegetation and solid waste cause stagnant conditions

No place to discard washing water - runs into stormwater drains

Industrial pollution (detergent and disinfectant)

Coal depot on the banks of the Berg River

Rat-tailed maggot (Syrphid fly larva)Biological indication of polluted conditions

Tentative identification as Eristalis or Eristalinus tenax by Mr L Brown, Dept Entomology

Most recent E. coli counts in Plankenbrug(Note: Contact should be avoided at >2000 E. coli per 100 ml water)

9 200 00016 000 00023-01-2006

34 540 00042 560 00023-02-2004

10 800 00010 800 0004-04-2005

>560 000 000>560 000 00009-02-2004

4 560 00010 860 00010-02-2003

1 086 0003 290 00011-03-2002

E. coli per 100 mlwater

Faecal coliforms per 100 ml water

Sampling date

Recent E. coli counts in Berg River(Note: Contact should be avoided at >2000 E. coli per 100 ml water)

2 212At Wellington Sewage Works23-01-2006

1 724 000Mbekweni Ditch 328-06-2004

17 000 000Mbekweni Ditch 324-05-2004

7 000Bridge on R4409-02-2004

11 724At Lady Loch Bridge09-02-2004

2 440 000 000Mbekweni Ditch 309-02-2004

34 770 000Mbekweni Stormwater ditch 209-02-2004

129Oosbosch St Bridge09-02-2004

E. coli /100 ml waterSample siteSampling date

920 800Plankenbrug below Kayamandi

08-12-2005

11 199Below Malmesbury Sewage Works

22-12-2005

92 080Franschhoek below confluence with Stiebeuel

22-11-2005

19 890Below Wellington Sewage Works

06-12-2005

E. coli /100 ml waterSample siteSampling date

Recent E. coli counts from DWAF(Note: Contact should be avoided at >2000 E. coli per 100 ml water)

Organisms identified from bioslimes on stones 11-2-2002

Beta hemolytic streptococcus Group A (sepsis, scarlet fever, respiratory infections, endocarditis, rheumatic fever, kidney disease)

Alpha hemolytic streptococci Enterococcus faecalis (resistant to antibiotics)

Staphyloccocus spp. amongst which S. aureus, S. epidermidis (septicaemia, pneumonia, skin and wound infections. S. enterocolitis high fatality rate)

Klebsiella, amongst which K. pneumoniae. K. ozaenae (pneumonia)

Escherichia coli (at least 4 'variants') (diarrhoea, urinary tract, HUS)

Acinetobacter spp. (usually resistant to most antibiotics)

Pseudomonas spp. amongst which P. aeruginosa (grows in detergents, resistantto disinfectants, sepsis, wound infections, eye infections)

Proteus mirabilis, P. vulgaris (diarrhoea especially in children)

Providencia rettgeri (related to Proteus)

PREDICTION: Vibrio cholerae or typhoid only a matter of time

Viruses detected in the Plankenbrug River

Analyses done by Prof M Taylor, Pretoria University

Enterovirus (untypable at present) - contain such viruses as hepatitis A, polio, coxsackie and echo

Rotavirus (both in the river water and in the bioslimes on the stones) - reovirus causing gastroenteritis (especially in children). Clinically more severe than diarrhoea caused by Norwalk virus and is a leading cause of infant death in poor communities

Adenovirus - causes pharingitis, upper and lower respiratory tract disease and external eye disease

Antibiotic resistance and chlorination resistance

34% of E. coli organisms isolated from the river water resistant to widely used antibiotic

Many organisms resistant to chlorination -downstream water users unable to 'clean up' water safely

Those organisms resistant to chlorination showed DOUBLED resistance to antibiotics as well. This creates two vicious problems instead of only one, as thought before.

Direct costsHospital: R614 237 (19%)Clinic: R190 687 (6%)

Indirect costsLost income: R1 977 987 (63%)Self-treatment: R368 614 (12%)

TOTAL COSTS: R3 151 544• 7% financed by local government• 32% by provincial government • 61% by population in settlement

Costs of diarrhoea in dense settlement - 2001

67%

33%

Males

Females

Diarrhoea in informal settlements

"In nature there are neither rewards nor punishments

- there are consequences"

R J Ingersoll

Flemish Government, Danish Government, Water Research Commission, Harry and Doris Crossley Foundation for financial assistance

University of Stellenbosch for ethical clearance, research assistance and permission to publish

Ms Marie Slabbert for technological support

People of Kayamandi for their co-operation

Prof M Taylor, Univ Pretoria for viral typing and Mr Leslie Brown, Univ Stellenbosch for tentative identification of rat-tailed maggot

The guards from the University Security Services for protection during sampling

Acknowledgements