Thesis (PhD)--Stellenbosch University, 2003. / 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. / AFRIKAANSE OPSOMMING: Die Plankenbrug Rivier vloei verby die digbewoonde nedersetting van Kayamandi aan die
buitewyke van Stellenbosch. Hierdie plek is gekies as studie-area om die impak te
bestudeer van waterbesoedeling wat van formele en informele dorpsontwikkeling afkomstig
is, asook die geassosieerde gesondheidsfaktore.
Doel van die studie: (1) Om sommige basiese epidemiologiese eienskappe van die
blootgestelde populasie, hulle sanitasieprobleme en redes vir die swak higiene te bepaal; (2)
Om die mikrobiologiese en chemiese besoedelingspatrone in die Plankenbrug Rivier oor tyd
te bepaal; (3) Om die spektrum van organismes teenwoordig in die rivier (anders as E. coli)
te bepaal asook hulle epidemiologiese implikasies op gesondheid; (4) Om vas te stel, as
indikatore van omgewingsgevaar, of daar moontlik organismes teenwoordig is wat
weerstandig is teen chloriene en antibiotika in die rivier onder Kayamandi.
Metodes: Gedurende die afgelope vier jaar is mikrobiologiese en chemiese ontledings elke
6 weke uitgevoer van watermonsters wat van verskeie punte op die Palnkenbrug Rivier
verkry is. Twee groot opnames is in die gemeenskap van Kayamandi ondemeem (n=2196
persone en n=3568 persone) en deur-tot-deur opvoedingsveldtogte is uitgevoer met die hulp
van plaaslik opgeleide gemeenskapsgesondheidswerkers.
Resultate: Onder Kayamandi bevat die rivier gevaarlike vlakke van fekale besoedeling en
dit hou gesondheidsgevare in vir alle persone war daarmee in aanraking kom. Op tot 13
miljoen Escherichia coli per 100 ml water is genoteer (boonste grens van veiligheid vir die
mens is 1000 organismes per 100 ml water). Nie al die fekale kontaminasie is afkomstig van
Kayamandi nie. Substansiele hoeveelhede kontaminasie dring die rivier binne op
verskillende punte ver onder Kayamandi. Hierdie besoedelingslading is soms groter as wat
van die hele Kayamandi afkomstig is.
Watermonsters geneem onder Kayamandi is ondersoek om vas te stel watter ander
siekteveroorsakende organismes ook teenwoordig was. Onder die organismes gevind was
(3 hemolitiese Streptococcus Groep A en B, Mycobacterium intracellulare, Staphylococcus
spp., Klebsiella spp., Pseudomonas spp. en baie ander. Die lys van patogene wat gevind is,
het sulke emstige implikasies dat 'n vertroulike gesondheidswaarskuwing uitgestuur is na
gesondheidsdienspunte en ander geaffekteerde organisasies in die gebied. (3 hemolitiese
Streptococcus Groep B is nog nie vantevore aangemeld as lewensvatbaar geisoleer uit vryvloeiende natuurlike waters nie. Tekens is gevind dat daar organismes in die rivier
voorkom wat weerstandig is teen chloorbehandeling en ook teen algemeen gebruikte
antibiotika. Die E. coli organisme wat verskillende konsentrasies van chloorbehandeling
oorleeef het, het ook verhoogde weerstand teen amoksisilien getoon wanneer hulle vergelyk
was met onbehandelde E. coli organisme wat van die Plankenbrug Rivier gemonster was.
Gedurende die gemeenskapsfase van die projek is daar 'n verlaging van
besoedelingsvlakke in die rivier gevind gedurende die somers van 2000 en 2001 (let op dat
"verbetering" hier nog glad nie "veilig" beteken nie). Dit kan toegeskryf word aan die
veelvlakkige benadering wat die projek gevolg het. Aandag is geskenk aan diens en herstel
van sanitasiegeriewe met 'n sterk klem op deur-tot-deur opvoedingsveldtogte met die oog op
beter sanitasiegedrag, skepping van 'n sentrale aanmeldpunt vir blokkasies en brekasies, en
opleiding van ambagslui (loodgieters, messelaars, ens) uit die gemeenskap om te help met
onderhoud. Die gemeenskap het bemoedigende tekens getoon dat hulle beter sanitasie
opvoeding verlang. Die verbetering in die besoedelingsvlakke in die rivier loop egter gevaar
om terug te val na die vorige gevaarlike vlakke as daar nie beter ondersteuning en
samewerking van die onderhawige owerhede verkry kan word nie. Daar was 16.9% van
huishoudings wat een of meer gevalle van diarree aangemeld het gedurende die 5 weke van
die opnameperiode - 'n baie hoe prevalensie siende dat die opname uitgevoer was
gedurende 'n nat en koue winterperiode.
Gevolgtrekkings: Aktiewe beplanning en ander stappe om die riool-indringing in die rivier
die hoof te bied is gebiedend noodsaaklik en behoort sonder versuim ingestel te word. Die
waterkwaliteit van die Plankenbrug Rivier stroomaf van Kayamandi is baie swak. Die water
hou emstige gesondheidsgevare in en is ook 'n bedreiging vir die ekonomiese aktiwiteite
stroomaf. Die nedersetting van Kayamandi demonstreer ook dat opvoeding, wanneer
gekoppel aan onderhoud en herstel van bestaande toiletgeriewe in verlaging teweeg kan
bring van besoedelingsvlakke, maar dat dit 'n voortgesette program moet wees en nie net
sporadiese pogings nie.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/53646 |
| Date | 03 1900 |
| Creators | Barnes, J. M. (Johanna Maria) |
| Contributors | De Villiers, B., Liebowitz, L. D., Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine. Community Health. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 246 p. : ill. |
| Rights | Stellenbosch University |
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