INVESTIGATION INTO THE PREVALENCE OF ENTEROCOCCI AND COLIFORM BACTERIA IN DRINKING WATER RESOURCES AND ASSOCIATED GASTROENTERIC ISSUES IN ISLAMABAD REGION PAKISTAN
Syed Aun Muhammad*, Shah Z.A., Ahmed O., Tareq A.H., and Ali F.
Riphah Institute of Pharmaceutical Sciences (RIPS), Riphah International University, 7th Avenue, G-7/4 Islamabad, Pakistan.
Keywords: Gastroenteritis, drinkable water sources, coliforms, and enterococci
Abstract

A systematic study was conducted to investigate the causes of gastroenteritis in Pakistan Institute of Medical Sciences, Islamabad during June, 2010. Of 220 individuals, 180 cases of gastroenteritis (81.8%) were recorded, compared to an average 18 monthly cases. Case study revealed that, illness was associated with drinking tap and poor filtered water. Enterococci were recovered from both gastroenteritis patients and water samples. Bacteriological analysis of 50 water samples showed that more than 80% of samples deviate from the WHO standards. This is an issue of public health significance and appropriate steps are required on behalf of authorities to address it.

Article Information

Identifiers and Pagination:
Year:2012
Volume:4
First Page:12
Last Page:25
Publisher Id:JAppPharm (2012 ). 4. 12-25
Article History:
Received:November 6, 2011
Accepted:December 19, 2011
Collection year:2011
First Published:January 15, 2012

INTRODUCTION

Coliform bacteria, including Escherichia spp., Klebsiellaspp., Serratia spp., Citrobacter spp. and Enterobacter spp.,are considered to be an indicator of fecal contamination in feed and water, found in faces of the warm-blooded animals. E.coliis enteropathogenic bacteria associated with gastroenteritis particularly in developing countries. Exposure to fecal contaminated water does not always translate into infection. However, the higher the fecal bacterial levels in water, the higher the chances of pathogens to be present in significant numbers too. Dehydrating diarrhea is of critical importance related with poor microbial water quality, as it could lead to death within 48 hours after the initial symptoms. The diseases associated with fecal contaminated water are gastroenteritis, typhoid and paratyphoid fevers, salmonellosis, cholera, meningitis, hepatitis, encephalitis, amoebic meningoencephalitis, cryptosporidiosis, giardiasis, dysentery, and amoebic dysentery (Jorge et al., 2010).

Similarly, inadequate treatment of gastroenteritis kills 5 to 8 thousand people per year (Kasper et al., 2005) and is a leading cause of death among infants and children under 5 worldwide (King et al., 2003). In the USA, over 200, 000 children of this age have been reported to suffer from acute gastroenteritis (Malek MA et al., 2006).These extreme cases are more predominant in developing countries where overcrowding and poor sanitary conditions are the norm (WHO, 2004).

 

Over large parts of the world, humans have inadequate access to potable water, and use sources contaminated with disease vectors, pathogens or unacceptable levels of dissolved chemicals. The distribution of drinking water is done through municipal water systems, and it has been observed that cross connection between drinking and sewage water pipes has led to contamination of the ground water system. Many of the 3.5 billion people (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2010) having access to piped water receive a poor or very poor quality of service, especially in developing countries where about 80% of the world population lives (WHO/UNICEF, 2010). The WHO/UNICEFF estimates that 500 million diarrhea cases reportedly take place each year in children less than five years in Asia, Africa and Latin America (WHO/UNICEF, 2010). Several community wide outbreaks resulting from contamination of public water systems with coliform and enterococci have been reported (Engberget al., 1998). In subcontinent, especially in Pakistan it has been estimated that each year, more than three million Pakistanis become infected with waterborne diseases as the quality of water supplies in many cities of Pakistan is deteriorating fast (Karachi, supply and sanitation services, 2004).

 

The Rawalpindi/Islamabad Metropolitan area is the third largest in Pakistan with a population of over 4.5 million inhabitants (Frantzeskakis 1995) where 81,996 cases of water related diseases included gastroenteritis were registered during 1994 (Tahir,1994; Din, 1997).

Pakistan Institute of Medical Sciences, Islamabad recorded 220 cases of gastroenteritis from June 3rd, 2010 to June 25th, 2010 as compared to 60% normal cases that are unusual increase during this period. Therefore, we conducted epidemiological, environmental, and microbiological investigations to determine the scope, the likely cause, and the contributing factors of gastroenteritis associated with the poor quality of drinking water resources in Rawalpindi and Islamabad. The objective of this study is to determine the relationship between the water resource patterns and the prevalence of coliforms and enterococci.

 

MATERIALS AND METHODS

Case population and Epidemiological investigation

The staff of Pakistan Institute of Medical Sciences, Islamabad recorded the data of 220 individuals who visited the hospital because of gastrointestinal symptoms including diarrhea, nausea, vomiting, and abdominal cramps who had illness onset from June 3rd, 2010 to June 25th, 2010.The line list included demographic data, and information about illness onset and symptoms. Of 220 case patients that contacted the PIMS, 180 cases were found positive during investigation (see Table 1). We conducted a case-control study to determine the risk factors to gastroenteritis. A case was defined as an illness with acute gastroenteritis defined as diarrhea with at least three loose stools per 24 hours and/or vomiting and/or abdominal pain in a resident of Rawalpindi/Islamabad since June 2010. Participants were interviewed about symptoms, treatments, consumption of water from various sources (tap water, well water, bottled water), and consumption of poultry, eggs, and unpasteurized milk products. Hospital administration and Microbiology department of said institute approved the gastroenteritis investigation which was conducted by the Laboratory staff and supervised by the head of microbiology department. Verbal consent was obtained from all study subjects. All patients from whom fecal coliform/enterococciwere isolated from their stool cultures were also included in this control study. All controls were matched to cases according to sex, year of birth, and residency in the metropolitan area. A case-control was conducted, wherein 145 controls took part. A questionnaire study was performed 3 days soon after the medical report. All subjects completed the same questionnaire during a personal interview. Specifically, there was an effort to interview as many people as possible and to record the same number of cases and controls. Unfortunately, this was not feasible because of the special characteristics of the incident. From personal interviews and the questionnaires collected, those who had not developed any relevant symptom became 'controls', while all others became 'cases'.

Data recorded included dates of onset, frequency and types of symptoms, duration of illness and consumption of food items.

 

Microbiological samples from patients

The paramedical staff of the hospital obtained stool samples from 105 (58%) of 180 patients who had gastrointestinal symptoms. The samples were analyzed for the presence of fecal Coliform, Enterococci, Salmonella and Shigellaspecies by routine bacteriological methods by using the selective media and identified these species by Gram staining and biochemical tests.

 

Analysis of water samples

To study the risk factors and pattern of gastroenteritis, it was decided to investigate the municipal water supply system. For this investigation, water samples were analyzed for certain physico-chemical and microbiological parameters by using standard methods. To investigate the source of gastroenteritis and study the pattern of infection in the metropolitan area, it was decided to collect water samples from various sites of both cities. For this purpose, a total of 50 samples, 17 sites of residential area were selected where filtration units have been installed by the municipal authorities, 16 household tap water samples were analyzed along with mineral water (250ml) of various brands were also included in this study (Table 5).

 

Site selection and samples collection

Of 50 water samples, 17 samples were collected from municipality installed filtration units from various sites of Rawalpindi/Islamabad, 16 were taken from the wells and hand pumps (tap water) while remaining 17 were of bottled samples of various brands. All these samples were analyzed to investigate the offending microbes for gastroenteritis.  Sites were selected randomly from areas of different use patterns. Water was collected in 1) sterile test tubes 2) autoclaved polystyrene 200ml bottles 3) disposable 50ml falcon tubes in day time. All samples were collected in duplicate. Water temperature was measured at each site using a stream thermometer. All samples were packed, shipped and stored in a safe and sanitary manner, and accurately labeled according to Good Laboratory and Microbiology Practices. Sample label bear all the necessary information including the date and time of the sampling, quantity and source of the sample, area and signature of the collector. Samples were sealed, transported and kept in refrigeration. Rectal samples were collected from the individuals who showed consent to participate.

 

Physico-Chemical Analysis

The physico-chemical tests included the determination of temperature, turbidity, odor, color, pH, acidity, total hardness and chloride content using the methods of FAO (American Public Health Association, 1992; Food and Agriculture Organization, 1997).

 

Bacteriological Analysis

Bacteriological characteristics were determined as described by Bezuidenhout (2002) and Jolt (1994). The media used for the bacteriological analysis of water include nutrient agar (NA), lactose broth (LB), and Eosin Methylene blue agar (EMB). All the media used were weighed out and prepared according to the manufacture’s specification, with respect to the given instructions and directions. A serial dilution method was used for total viable count and the presumptive test for coliforms. The Most Probable Number technique was used for coliform enumeration. All plates were incubated at 37?C for 24-48hrs. Presumptive colonies were confirmed by gram staining and biochemical reactions as described by Jolt (1994) and each plate was given a positive or negative score. The sterility of each batch of test medium was confirmed by incubating one or two un-inoculated tubes or plates along with the inoculated tests. The un-inoculated tubes or plates were always examined to show no evidence of bacterial growth.

 

RESULTS

Case population and Epidemiological investigation

In our study results, out of 220 individuals, 180 case patients of gastroenteritis (81.8%) were diagnosed during the month of June 2010 who visited the Pakistan Institute of Medical Sciences Islamabad compared with the baseline of an average 18 monthly cases of gastroenteritis. Attack ratio (AR) among male and female cases has been calculated (See Table 2). Most cases of infection were found in 40-60 years of age groups followed by the cases below 80, and 52% were women (Table 3). The symptoms were typical for gastroenteritis, predominantly diarrhea (38.8%) followed by the abdominal pain, nausea (16%) and fever (Figure 1). The case-control study questionnaire was sent to 220 cases and 250 controls. One hundred and eighty cases (response rate, 81.8%) and 145 controls (response rate, 58%) completed the questionnaire. Treatment was prescribed to 100 (55.5%) cases, and 80 (44.4%) received antibiotics. Of 180 case patients, 125 (69%) reported having drunk un-boiled tap water at home or outside the home during the two weeks before onset of illness compared with control subjects followed by the case patients found after using the municipality filtered water (30.5%). Drinking bottled brands and boiled water was all associated with decreased likelihood of illness (see table 4).

 

 

 

Microbiological samples from patients

Coliform and Enterococciwere cultured from 45 (42.8%) of 105 stool samples submitted for examination from patients with gastroenteritis. No other pathogens were isolated. These cultures were identified by standard morphological Gram staining and biochemical methods.

 

Analysis of water samples

During survey, it was observed that the water filtration units installed in Rawalpindi/Islamabad area are equipped with UV disinfection system, but it was found that at many filtration plants, this system was not working properly and bacterial contaminations were passing through the filtered water. Similarly, a compost heap for household wastes was also located near filtration units of both cities. A questioner filled by the citizens indicated that about 55% of the residents received tap water, 41% have access of filtered water while just 4% belongs to elite class used mineral water. The Rawal Lake and Simli dam are used as sources to supply water to cities, which were not fenced, allowing people and animal’s access to the area.

 

Physico-Chemical Analysis

As Table 6 indicated that physico-chemically mineral water samples were within set limits defined by the World Health Organization (WHO) and US Environmental Protection Agency (EPA). The 100% pH deviation and 35% slight discoloration observed in water samples taken from filtration units diverging the WHO standards while rest of the parameters were under control limits. Similarly, tap water samples showed deviation against WHO standards in following parameters pH (100%); discoloration (56%); chloride ions (12.5%) and turbidity measured by nephelometer (12.5%).

 

Table 1: Distribution of Laboratory-confirmed cases of Gastroenteritis by sex and clinical manifestation

 

Symptoms

Female

Male

 

Total cases

 

p-value

Cases

%

Cases

%

Bloody Diarrhea

15

60

10

40

25

2.866x10-7

Diarrhea

37

53

33

47

70

2.965x10-17

Nausea

18

60

12

40

30

2.160x10-8

Abdominal pain

10

33

20

67

30

2.160x10-8

Fever/Vomiting

13

52

12

48

25

2.866x10-7

 

 

Table 2: Attack Ratio (AR) among exposed infected male and female cases

 

 

Symptoms

Infected Female

Infected Male

 

Total infected cases

 

Attack Ratio (AR)*

Cases

Attack Ratio (AR)

Cases

Attack Ratio (AR)

Bloody Diarrhea

15

0.068

10

0.045

25

0.114

Diarrhea

37

0.168

33

0.15

70

0.318

Nausea

18

0.081

12

0.055

30

0.136

Abdominal pain

10

0.045

20

0.090

30

0.136

Fever/Vomiting

13

0.059

12

0.055

25

0.114

Gender specific cases

93

0.423

87

0.395

180

0.818

*Total exposed persons: 220

 

 

Table 3: Age wise sub-classification of Gender cases

 

Gender

Age Sub-groups (Years)

 

Total Gender cases

1-20

20-40

40-60

60-80

80-100

Female cases

10

22

28

20

13

93

Male cases

10

15

25

22

15

87

Total cases

20

37

53

42

28

180

 

 

Table 4: Frequency of exposure among infected and control cases

 

Risk factors

Infected cases

Control cases

 

Odds Ratio

Exposed

Not

exposed

% exposed

Exposed

Not exposed

%

exposed

Tap water

102

20

57%

35

25

24%

3.64

Municipal  filtered water

78

20

43%

65

38

36%

2.18

Bottled water

0

0

0

45

42

40%

0

Total cases (n)

180

40

100%

145

105

100%

 

 

 Figure 1: Frequency of symptoms among case patients of gastroenteritis recorded during the month of June 2010.


Table 5: Collection of random water samples from various sites of Rawalpindi/Islamabad metropolitan area recorded during the month of June 2010

 

 

Sources of samples

Location/city

No. of samples/Codes

Islamabad

No. of samples/Codes

Rawalpindi

 

Water filtration system installed by Capital Development Authority Islamabad and City Government Rawalpindi, Punjab

 

Quantity of water collected  = 200ml

S-1

G-6/1-4 sector

S-12

Askari 7

S-2

G-6/1-2 sector

S-13

Baber colony

S-3

G-9/4 sector

S-14

Dhamial camp

S-4

G-8/1 sector

S-15

Dhokli Akbar

S-5

G-11/3 sector

S-16

Aviation base

S-6

RIU, I-14 sector

S-17

MH Peshawar road

S-7

F-10/2 sector

 

 

S-8

F-10/1 sector

 

 

S-9

G-10/2 sector

 

 

S-10

G-11/1 sector

 

 

S-11

G-10/1 sector

 

 

 

 

Tap water (Hand pump, well, stream and Electric pump)

 

Quantity of water collected  = 200ml

S-18

RIU, Haji camp I-14

S-25

Askari 11

S-19

ICB G-6/3 sector

S-26

Askari 7

S-20

F-10/1 sector

S-27

Westridge III

S-21

G-8/1 sector

S-28

Sadiqabad

S-22

G-11/3 sector

S-29

Dhamial camp

S-23

G-10/2 sector

S-30

Dhokli Akbar

S-24

G-10/1 sector

S-31

Satellite town, D-block

 

 

S-32

Baber colony

 

 

S-33

T.W. Hostel Pakistan town

 

 

 

 

Mineral Water 250ml bottled Brand of various companies

S-34

G-6/1-3 café Irum market

S-47

Dhamial camp

S-35

G-6/1-3 cooperative market

S-48

Dhamial camp

S-36

D.Watson Blue area

S-49

Saddar cant

S-37

G-7/4 IIMC Café

S-50

Saddar cant

S-38

G-7/4 IIMC Café

 

 

S-39

G-7/4 IIMC Café (1)

 

 

S-40

G-7/4 IIMC Café (2)

 

 

S-41

G-7 khada market (1)

 

 

S-42

G-7 khada market (2)

 

 

S-43

G-6/2 café Irum market

 

 

S-44

G-6/2 café Irum market (1)

 

 

S-45

G-6/2 café Irum market (2)

 

 

S-46

D.Watson Blue area

 

 

Table 6: Physicochemical Analysis of water samples of positive fifty case patients of gastroenteritis recorded during the month of June 2010.

Sources of Samples

No. of samples/

Codes

Test Parameters

 

pH

Color (HU)

Odor

Turbidity

Acidity

Hardness

Chloride

 

 

 

 

 

Water samples collected from water filtration units

S-1

7.77

7

U

3.5

0.2

85

150

S-2

7.84

5

U

3.5

0.2

85

130

S-3

7.88

6

U

3.5

0.1

90

150

S-4

7.85

5

U

3.5

0.1

85

150

S-5

7.56

6

U

3.4

0.1

70

110

S-6

7.70

7

U

3.5

0.2

75

115

S-7

7.95

5

U

3.7

0.1

90

155

S-8

7.82

7

U

3.6

0.2

85

145

S-9

7.56

5

U

3.4

0.1

50

105

S-10

7.90

7

U

4.0

0.2

90

155

S-11

7.56

5

U

3.4

0.1

70

110

S-12

7.37

5

U

3.3

0.1

40

70

S-13

7.30

5

U

3.3

0.2

45

70

S-14

7.66

5

U

3.4

0.1

65

75

S-15

7.85

7

U

4.2

0.1

90

80

S-16

7.78

7

U

4.0

0.1

90

100

S-17

7.32

5

U

3.2

0.1

45

60

 

 

 

 

Tap water (Hand pump, well, stream and Electric pump)

S-18

7.75

6

U

3.9

0.2

80

155

S-19

8.07

9

U

7.1

0.1

140

220

S-20

7.82

7

U

4.5

0.2

110

170

S-21

7.80

7

U

4.5

0.1

120

180

S-22

8.05

8

U

7.0

0.2

150

230

S-23

7.60

7

U

4.0

0.1

115

190

S-24

7.67

7

U

4.0

0.1

90

180

S-25

7.45

6

U

4.0

0.1

90

110

S-26

7.76

7

U

4.1

0.2

100

150

S-27

7.54

6

U

4.2

0.2

90

100

S-28

7.64

6

U

4.5

0.1

85

115

S-29

7.59

6

U

4.0

0.1

100

100

S-30

7.53

6

U

4.0

0.2

95

100

S-31

7.58

6

U

4.5

0.2

105

100

S-32

7.78

7

U

5.0

0.2

120

120

S-33

7.88

7

U

5.0

0.1

110

170

 

 

 

Mineral Water 250ml bottled Brand of various companies

S-34

7.08

4

U

2.5

0.05

40

57

S-35

7.08

4

U

2.8

0.05

45

60

S-36

7.15

4

U

2.9

0.1

40

55

S-37

7.30

5

U

3.2

0.1

40

50

S-38

7.25

5

U

2.8

0.1

40

60

S-39

7.26

5

U

2.8

0.1

35

45

S-40

7.45

6

U

3.5

0.1

35

45

S-41

7.50

6

U

3.5

0.1

65

60

S-42

7.50

6

U

3.5

0.1

60

60

S-43

7.25

4

U

2.2

0.1

38

55

S-44

7.20

4

U

2.0

0.05

40

45

S-45

7.30

5

U

2.8

0.1

40

45

S-46

7.29

4

U

2.1

0.05

40

45

S-47

7.21

4

U

2.0

0.1

40

55

S-48

7.04

4

U

1.9

0.1

40

45

S-49

7.35

4

U

2.5

0.05

40

40

S-50

7.27

4

U

2.8

0.1

30

50

WHO standard

-

6.5

6

U

6.0

0.3

500

200

EPA  standard

-

6.5-8.5

15

U

0-5

0.3

500

250

U=Unobjectionable; HU=Hazen units; NTU=Nephelometric Turbidity Units, Total Hardness= (Mg/L)

 


Table 7: Bacteriological (Microbial Examination) Analysis of water samples

Sources of Samples

No. of samples/

Codes

Bacteriological Count (Lab tests)

 

Total Heterotrophic Count

Total Coliform

Enterococci Count

 

 

 

 

 

Water samples collected from water filtration units

S-1

3.0 x 101

>240

>30

S-2

1.0 x 102

<2

Not dectected

S-3

3.0 x 102

2

25

S-4

5.0 x 101

2

22

S-5

2.0 x 101

<2

15

S-6

5.0 x 101

26

35

S-7

1.0 x 102

8

30

S-8

2.0 x 102

8

15

S-9

6.0 x 101

17

35

S-10

3.0 x 102

<2

Not dectected

S-11

1.0 x 102

<2

10

S-12

2.0 x 102

33

>50

S-13

4.0 x 102

5

Not dectected

S-14

7.0 x 102

94

>60

S-15

2.0 x 102

<2

Not dectected

S-16

2.0 x 102

8

20

S-17

4.0 x 102

11

08

 

 

 

 

Tap water (Hand pump, well, stream and Electric pump)

S-18

1.0 x 103

220

>80

S-19

2.0 x 102

2

25

S-20

8.0 x 102

2

20

S-21

2.0 x 103

350

>120

S-22

4.0 x 102

<2

15

S-23

6.0 x 104

<2

Not dectected

S-24

4.0 x 103

17

45

S-25

2.0 x 104

17

32

S-26

3.0 x 102

240

>70

S-27

6.0 x 102

2

35

S-28

5.0 x 103

1600

>450

S-29

4.0 x 104

>2400

Uncountable

S-30

3.0 x 103

17

10

S-31

2.0 x 104

<2

Not dectected

S-32

4.0 x 103

2

10

S-33

4.0 x 103

<2

5

 

 

 

Mineral Water 250ml bottled Brand of various companies

S-34

1.0 x 102

<2

Not dectected

S-35

2.0 x 101

<2

Not dectected

S-36

1.0 x 101

<2

Not dectected

S-37

4.0 x 101

00

Not dectected

S-38

4.0 x 101

00

Not dectected

S-39

8.0 x 101

<2

Not dectected

S-40

2.0 x 102

<2

Not dectected

S-41

1.0 x 102

00

Not dectected

S-42

1.0 x 101

<2

Not dectected

S-43

1.0 x 101

00

Not dectected

S-44

2.0 x 102

<2

Not dectected

S-45

1.0 x 102

<2

Not dectected

S-46

3.0 x 102

00

Not dectected

S-47

2.0 x 101

<2

Not dectected

S-48

4.0 x 101

2

5

S-49

5.0 x 101

<2

10

S-50

9.0 x 101

2

4

WHO standard

-

1.0 x 102

Zero per 100mL

0 CFU

EPA  standard

-

1.0 x 102

Zero

0 CFU

 

 

Bacteriological Analysis

Water samples were also microbiologically investigated showing desperate results regarding filtered and taps water samples. All filtered and tap water samples contained coliform which were as high as 240 most probable number (MPN)/ml in former case and above 2400 MPN/ml in the later, which must be zero as defined by the WHO and EPA standards. Similarly, enterococci (CFU) were observed in 76% and 81% filtered and tap water samples respectively deviating the standards. It was found that mineral water brand samples S-48 to 50 (brand AbehyyatR) also showed coliform and enterococcias bacterial contaminants (Table 7).

 

DISCUSSIONS

On the basis of evidence from epidemiological and microbiological investigations, the prevalence of coliform and enterococci in Rawalpindi/Islamabad was caused by contaminated municipal water supply system. In the case study, illness was significantly associated with drinking tap and poor filtered water. Enterococci and coliform strains were recovered from both gastroenteritis patients and water samples. Isolation of the microbes from both the water and the patients, and finding an association between consumption of municipal water samples and illness in an analytical study, provides strong evidence that the issue was waterborne (see Table 2 and 4).

 

Although the exact mechanism for contamination remained unknown, investigation of the water supply system suggested several contributing factors including the accumulation of contaminants near Rawal Lake, deposition of household wastes near filtration units, nonfunctional UV rods and unchanged/old filters in filtration plants. Tahir in (1989) reported that the water supply system of Islamabad and Rawalpindi is polluted. It was found that 76% samples in Islamabad and 82% samples in Rawalpindi were contaminated due to bacterial presence. Though community wide waterborne outbreaks caused by coliform species have been reported previously, however the associated study conducted in multicultural federal capital area of Pakistan explored the filtered and ground tap water systems, showing higher water coliform number and enterococciin this study.

Response rates among both cases and controls were high, and therefore non-response bias probably did not affect the results of the case control study. Controls were from the same postal code area as cases, and mostly had the same source of household water, leading to risk of overmatching with possible underestimation of drinking water as risk factor. The case-control study questionnaire was sent to 175 cases and 250 controls. One hundred and fifty cases (response rate, 85.7%) and 190 controls (response rate, 74%) completed the questionnaire. This study highlights the coliform and enterococcias an important waterborne pathogen. Of 220 individuals, 180 cases were found with gastroenteritis, which visited the hospital compared with monthly 60% average cases of gastroenteritis. This problem caused considerable impact, and direct and indirect costs because of consultations, treatments, and loss of productivity. Ako AA et al., in (2009) studied the water-borne diseases and their causes in the Douala, Cameroon. Water-borne disease occurrence was observed to follow a seasonal pattern with peaks occurring between the months of January and May followed by drops between June and October and rose again from November. Children below 5 years were found to be more vulnerable to diarrhea, gastroenteritis, amoebic dysentery while persons between 15-44 years were more vulnerable to typhoid and cholera. Physico-chemically, water samples had turbidities varying between 5.5-86 NTU, pH values between 4.2 and 7.1 and zero residual chlorine. Bacteriological analysis showed that the total coliform count was averagely 74/100 ml, the faecal coliform count was 43/100 ml and the faecal streptococci count was 27/100 ml.

 

Similarly all filtered and tap water samples contained coliform, which were as high as 240 Most Probable Number/ml in former cases and above 2400 Most Probable Number/ml in the later. Enterococci were counted in 76% and 81% filtered and tap water samples respectively. As it has been reported that the major carriers of water borne bacterial gastroenteritis are the members of the Enterobacteriaceae that include the genera Escherichia, Salmonella, Shigella, and Yersinia, therefore sanitary and unhygienic conditions may remain a potent threat. Rotaviruses present the greatest threat of the viruses with Hepatitis A and E viruses. Waterborne protozoan disease, that can be endemic in many developing countries, is caused predominantly by Cryptosporidium parvum, Entamoebahistolytica and Giardia duodenalis.

 

CONCLUSIONS

As it is evident from this work that gastroenteritis is caused by water borne pathogens including prevalence of coliforms and enterococci which may be due to improper disposal of refuse, contamination of water by sewage, surface runoff, therefore programmes must be organized to educate the general populace on the proper disposal of refuse, treatment of sewage and the need to purify our water to make it fit for drinking because the associable organisms are of public health significance being implicated in one form of infection or the other. As it has been investigated from this study, in areas lacking in filtered and fresh water as in rural dwelling, educative programmes must be organized by researchers and government agencies to enlighten the villagers on the proper use of surface water. Similarly, the safety of these systems should clearly be improved including construction of offence around the lake, control of human activities to prevent sewage from entering water body, sterilization of water with ultraviolet light, installation of new filters or routine chlorination of the water to prevent the prevalence of bacterial pathogens and further cases of gastroenteritis in the city.

 

REFERENCES

1.      Ako AA, Nkeng GE and Takem GE. (2009) Water quality and occurrence of water-borne diseases in the Douala 4th District, Cameroon. Water Science andTechnolology, 59(12), pp. 2321-9.

  1. Bezuidenhout CC, Mthembu N, Puckree T and Lin J. (2002) Microbiological evaluation of the Mhlathuze River, Kwazulu-Natal (RSA). Water S.A. 28, pp. 281-286.
  2. Din M, Hussain FH, Naila A, Shabbir H, Rana NN, Anwar K, Saeed D and Zumra S.(1997) The Quality Assessment of Drinking Water Supplied to Islamabad, Environmental Pollution. Proceedings of Third National Symposium on Modern Trends in Contemporary Chemistry Islamabad, Pakistan, pp.75.
  3. Engberg J, Gerner-Smidt P and Scheutz F. (1998) Water-borne Campylobacter jejuni infection in a Danish town a 6-week continuous source outbreak. Clinical Microbiology Infection,4, pp. 648–56.
  4. Chemical analysis manual for food and water.(1997), 5th edition,1, pp. 20-26. Food and Agriculture Organization (FAO), Rome.
  5. Frantzeskakis JM. (1995) Configuration, Hierarchy and Spacing of the Urban Road Network in Islamabad, Ekistics, No 373-75, pp. 236-241.
  6. Jolt JG, Krieg NR, Sneath PHA, Stanley JT and Williams ST. (1994) Bergey’s manual of systematic bacteriology 9th edition, Williams & Wilkins Co. Baltimore, pp. 786.
  7. Jorge W, Santo Domingo, Nicholas J, AshboltAvanish K and Panikkar. (2010) Fecal pollution of water. In Encyclopedia of Earth. Cutler J. Cleveland (eds), National Council for Science and the Environment, Washington DC.

 

  1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL and Jameson JL. (2005) Harrison's Principles of Internal Medicine. McGraw-Hill, New York, pp. 140-1.
  2. King CK, Glass R, Bresee JS and Duggan C. (2003) Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 52, pp. 1–16. 
  3. Managing Karachi's water supply and sanitation services. (2004), In Water and Sanitation Program, pp.3.Tahir MA (1994). Survey of Drinking Water Quality in the Rural Areas of Rawalpindi District. Pakistan Council of Research in Water Resources, Islamabad.
  4. Tahir MA. (1989) Pollution Problems in the Water Supply Systems of Islamabad and Rawalpindi. Pakistan Council of Research in Water Resources, Islamabad.
  5. Standard methods for the examination of water and wastewater. (1992) 18th edition, American Public Health Association/Water Environment Federation, Baltimore.
  6. WHO. (2004) Burden of disease and cost-effectiveness estimates.
  7. WHO/UNICEF, Progress on Sanitation and Drinking-water update. (2010) Joint Monitoring Programme for Water Supply and Sanitation. 


© 2016 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license. You are free to: Share — copy and redistribute the material in any medium or format Adapt — remix, transform, and build upon the material for any purpose, even commercially. The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. No additional restrictions You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits
Editor in Chief
Prof. Dr. Cornelia M. Keck (Philipps-Universität Marburg)
Marburg, Germany

Bibliography

Welcome to the research group of Prof. Dr. Cornelia M. Keck in Marburg. Cornelia M. Keck is a pharmacist and obtained her PhD in 2006 from the Freie Universität (FU) in Berlin. In 2009 she was appointed as Adjunct Professor for Pharmaceutical and Nutritional Nanotechnology at the University Putra Malaysia (UPM) and in 2011 she obtained her Venia legendi (Habilitation) at the Freie Universität Berlin and was appointed as a Professor for Pharmacology and Pharmaceutics at the University of Applied Sciences Kaiserslautern. Since 2016 she is Professor of Pharmaceutics and Biopharmaceutics at the Philipps-Universität Marburg. Her field of research is the development and characterization of innovative nanocarriers for improved delivery of poorly soluble actives for healthcare and cosmetics. Prof. Keck is executive board member of the German Association of Nanotechnology (Deutscher Verband Nanotechnologie), Vize-chairman of the unit „Dermocosmetics“ at the German Society of Dermopharmacy, active member in many pharmaceutical societies and member of the BfR Committee for Cosmetics at the Federal Institute for Risk Assessment (BfR).

Journal Highlights

Subject & Scope
  • Pharmaceutics
  • Physical Pharmacy 
  • Dosage Forms Science 
  • Pharmaceutical Microbiology & Immunology 
  • Industrial Pharmacy 
  • Bio-Pharmaceutics 
  • Pharmaceutical Chemistry 
  • Pharmaceutical Instrumentation 
  • Medicinal Chemistry 
  • Pharmacognosy 
  • Physiology &Histology 
  • Anatomy & Pathology 
  • Pharmacology & Therapeutics 
  • Pharmacy Practice 
  • Pharmaceutical Mathematics   
  • Biostatistics 
  • Dispensing 
  • Community Social & Administrative Pharmacy 
  • Hospital Pharmacy 
  • Clinical Pharmacy 
  • Pharmaceutical Quality Management 
  • Forensic Pharmacy 
  • Pharmaceutical Technology 
  • Pharmaceutical Management & Marketing

Consortium Publisher is an online publisher that enjoys global presence with International Journals

Follow Us

©2009 - 2019 Consortium Publisher Canada

Contact Info

6252 Lisgar Dr Mississauga Ontario L5N7V2 Canada
+1 (647) 526-0885
office@consortiumpublisher.ca
http://www.consortiumpublisher.ca/