Qualité de l’eau, endémicité typhoïdique et santé publique dans l’espace urbain de Buea, Région du Sud –Ouest, Cameroun
Ediamam Epalle Guy Marcel, Usongo Patient & Eleme Clara Namondo
Abstract: Typhoid a water borne disease cause by Salmonella typhi, remains a major public health concern in Africa and Asia. The aim of this study was to examine the correlation between water quality and typhoid endemicity within Buea urban space. The methodology used was based on the ECOHEALTH approach and bacteriological analysis of water samples. Questionnaires were administered to 200 persons randomly selected and semi-structured interviews were conducted with some hospital workers. Data analyses were done using SPSS device, QGIS, ARCGIS and GPS for maps building. Our results revealed the presence of faecal coliforms in water samples Bokwango (40 UFC), Small Soppo (90UFC). Also, Salmonella typhi presence in water samples like in Molyko (40), Bokwango (250) and Biaka (600). In addition, typhoid represents 83.89% of waterborne diseases. There is therefore, a strong correlation between bacteriological quality of water consumed and typhoid endemicity in Buea town. Controlling the bacteriological quality of water and adopting sanitation measures is the way forward.
Keywords: Water, Typhoid, Public health, Buea town
Résumé : La fièvre typhoïde, maladie hydrique causée par la bactérie Salmonella typhi est un problème majeur de santé publique en Afrique. L’objectif de ce travail est d’examiner la corrélation entre la qualité de l’eau et l’endémicité typhoïdique. Nous avons utilisé l’approche ECOSANTE et l’analyse bactériologique des échantillons d’eau, les entretiens semi-dirigés et l’administration de 200 questionnaires. Les analyses de données ont été effectuées à l’aide des logiciels SPSS, ARCGIS. Les données GPS ont été importées dans ARCGIS pour la confection des cartes. Les résultats montrent la présence de coliformes fécaux dans les échantillons d’eau notamment à Bokwango (40 UFC) et à Small Soppo (90 UFC). La présence de Salmonella typhi a été signalée à Molyko (40), à Small Soppo (240), et à Biaka (600). La typhoïde représente 83,89% des maladies d’origine hydrique. Il existe une corrélation entre la qualité bactériologique de l’eau consommée et l’endémicité typhoïdique dans la ville de Buea.
Mots clés: Eau, Typhoïde, santé publique, ville de Buea
Plan
Introduction
Materials and Methods
Study area
Criteria for site and water sources selection
Data collection methods, Collection of water samples and Analysis of water quality parameters
Results
Indicators of faecal contamination
Typhoid prevalence within the Buea urban area
Frequency of typhoid in households
Discussion
Conclusion
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Introduction
Globally, some 2.2 billion people lack portable water and 1 in 3 people do not have access to safe water (United Nations Funds for Children (UNICEF) and World Health Organization (WHO), 2019). About 785 million people in 2019 lacked portable water and 144 million of them have to use surface water. Hence, the international community has since 2010 recognized that access to quality water and sanitation facilities is a fundamental human right as highlighted in Objective 6 of the Sustainable Development Goals (SDGs) which emphasize access to drinking water and sanitation by 2030.
Availability of good quality water sources nowadays is limited and the impact of pathogens on human health is expected to be significant (Suresh & Smith, 2004). It is therefore essential to understand the contribution of available water sources in the transmission of pathogenic microorganisms in tropical areas particularly in Buea urban space (Cameroon). Typhoid fever, a transmissible disease caused by the bacteria Salmonella typhi (Puran et al. 2009), is an acute, fatal and feverish illness. Without treatment, the case fatality rate is 10-30%, dropping to 1-4% with appropriate therapy (Global Burden of Disease, 2016). Typhoid and paratyphoid fevers occur in both epidemic and endemic form, and remain a major public health problem in underdeveloped countries (DeRoeck, Jodar, & Clements, 2007). The widespread presence of Salmonella in fresh water is evidence that for many years water has been a carrier of Salmonella disease (Kramer, Herwaldt, Craun, Calderon & Juranek, 1996; Jenkins, Endale & Fisher, 2008).
There are an estimated 11-21 million cases of typhoid fever worldwide and an estimated 128,000 to 161,000 deaths annually (WHO, 2018). According to the Mérieux Foundation (2007), it is a disease that kills as many people as cervical cancer and even more than meningitis or Japanese encephalitis. However, it is not mainstreamed as a priority of the World Health Organization (WHO).
Typhoid is a major public health concern in Asia and Africa, which are the centers of high incidence. In Cameroon, access to drinking water and sanitation services is estimated at 3.9% and 34% respectively. According to WHO (2009) and Ndjepel et al. (2014), the epidemiological profile of typhoid is constantly increasing. In Buea city, access to drinking water is a challenge, and promotes typhoid endemicity. Usongo and Aligenui (2021) observed that portable water delivery in Buea is under threat due to the encroachment of human activities posing serious public health problems in Buea. Inspired by this growing crisis of inadequate potable water supply in Buea, this research, therefore, seeks to analyze the correlation between water quality and typhoid endemicity in Buea. Reducing or eradicating this disease will be, a major step forward in the fight against communicable diseases and the achievement of the Sustainable Development Goals (SDGs).
Materials and Methods
Study area
Buea, the capital of the Southwest Region in Cameroon is situated between latitude 4º 12’ 4º 31’ North of the Equator and longitudes 9º 9’ 9 12’ East. Buea rest at an elevation of 1000 m above sea level on the South-Eastern slopes of Mount Cameroon (Figure 1).
Source: Ediamam Epalle, 2022
Figure 1- Location of the study area showing the sampling points
Bedrock in this area is formed by layers of ash and fine basaltic slag which makes soils extremely conducive to plant growth. In addition, soil structure is fragmentary, nuciform, and grainy with weak cohesion (Sieffermann, 1973). In this evergreen environment where soil porosity is very high, the climate and rainfall pattern are modified by Mount Cameroon which interrupts the movement of air masses from the sea, causing considerable orographic rainfall. According to the classification of Vigneau (2000), the climate of Buea area belongs to that of the well-watered geographical space located north of the equator. Therefore, Buea records an annual rainfall of 3500 mm (IRAD, 1993). Temperatures are considerably high with low annual variations. The mean annual temperature is 23°C while the monthly temperature reveals a minimum of about 20°C in the month of June. As far as population is concerned, besides being the capital of the Southwest Region, Buea is a university and colonial settlement which has grown to attain a population of over 200,000 from 46,000 in 2000 and 90090 people in 2005 (Fombe & Balgah, 2012) and a current population of 300 000 (Buea CVUC, 2019).
Criteria for site and water sources selection
Researchers used a stratified sampling procedure where three main drinking water sources (community water, CAMWATER and boreholes) were identified and ten sampling sites were randomly selected from the three water sources. The criteria used for site selection were; population density and a high dependence on the water sources for domestic and other uses.
Data collection methods, Collection of water samples and Analysis of water quality parameters
The Hypothetico-deductive method and Ecosystem Approach to Human Health (ECOHEALTH) were used in the collection of relevant secondary and primary data for the study. Primary data was collected through direct and indirect observations, structured interviews as well as discussions with resource persons including administrative authorities, institutional actors and traditional healers. A total of 200 questionnaires were administered to household heads in the area. Secondary data was collected from documented sources such as hospital registers of health facilities, the delegation of health as well as from the University of Buea library and the google search engine.
Water samples were collected from the three sources during the dry and rainy season. A Global Positioning System (GPS) was used to take the location of the sampling sites. Water samples were collected using sterilized 500ml glass bottles rinsed with distilled water and dried thereafter. At the collection sites, these bottles were rinsed to eliminate foreign water in the containers. To collect samples from pipe borne water (CAMWATER), the tap was opened and allowed to run for at least one minute. This gave time for the tap to discharge stagnant water in the pipes. The same thing was done with borehole water since it is connected just like pipe borne water. To collect sample from community water (springs), no time was wasted because all the community water sources flowed continuously without being closed. Each sample was codified and transported in an ice-cool container to the laboratory within 24 hours.
Physical and bacteriological analyses of water samples were conducted in the laboratory of the Faculty of Agronomy and Agricultural Sciences of the University of Dschang. Bacteriological quality of water samples was determined by quantitative analysis of E. coli in Sterile Mac Conkey Broth using Most Probable Number (MPN) technique and qualitative determination of salmonella (Munge, 2009). The idea was to distribute 100 ml of water sample (10 ml, 1 ml and 50 ml) in sterilize bottles . Most probable number of coliform bacteria in 100 ml of water samples was estimated. To test salmonella, an agar plate was prepared from SS (salmonella) agar following manufacturer’s instructions (Katte et al.2005).
Results
Indicators of faecal contamination
Physical characteristics
During the rainy season, all water sources appeared clean and clear except for the community water in Bokwai and Bweteva, and CAMWATER in Bokwaongo and Bonaberi Street which were clear but contained tiny whitish debris. During the dry season, all sources of water appeared clean and clear except the community water in Vasingi and Biaka and CAMWATER in Bokwaongo and Bonaberi Street which were clear but contained tiny whitish debris. All drinking water sources were colorless and odorless in both seasons. This is because water sources were not polluted by waste or soil particles.
Bacterial characteristics
Bacteriological analysis was carried to determine the most probable number of feacal coliform bacteria (E. Coli) in sterile Mac Conkey Broth and the results are presented on Table 1.
Source: Eleme 2021
Table 1: Bacterial concentration in different water sources in Buea urban area during the rainy and dry season and their various classifications according to WHO, 2006
– Faecal bacteria indicator (Faecal coli form):
Results showed that during the rainy season, no concentration of faecal coliforms were found in the CAMWATER source in Bonaberi Street and it was regarded as A-Excellent (No risks), while water sample from the community water in Biaka was regarded as B-Acceptable (Low risk). Samples from borehole in Molyko and Bokwaongo and community water in Vasingi, Small Soppo and Bonduma were regarded as C-Unacceptable (High risk). Samples from CAMWATER in Bokwaongo, community water sources in Bokwai and Bwiteva were regarded as D-Unaccepted (Grossly polluted).
In the dry season, the bacterial concentration of CAMWATER in Bokwaongo was A-Excellent (No risks), the community water sources in Small Soppo, Bwiteva, Bokwai and Bonduma were regarded as B-Accepted (Low risk). Samples from boreholes in Molyko and Bokwaongo and community water in Vasingi and CAMWATER in Bonaberi Street were regarded as C-Unacceptable (High risk) and the community water source in Biaka was regarded as D-Unacceptable (Grossly polluted). Bacteriological analyses showed that faecal coliforms were present in water samples in both seasons.
Specific pathogens
Qualitative and quantitative analysis of salmonella isolates from water samples (culture in SSA) are presented on Table 2.
Source: Eleme 2021
Table 2: Salmonella bacteria in water sources in the Buea urban area during the rainy and dry season
During the rainy season, E. coli and Salmonella typhi were present within water sources at nine sites examined except CAMWATER in Bonaberi Street. In the dry season, Salmonella typhi was present within six sites. Exceptions were community water in Bwiteva, Bokwai and Small Soppo and CAMWATER in Bokwaongo (Table 3).
+ = presence, – = absence
Source: Eleme 2021
Table 3: Purification of colonies by sub culturing on ssa and identification of different isolates (using Gram Staining, Catalase and Biochemical Testing)
Typhoid prevalence within the Buea urban area
The study considered diseases linked to pathogenic agents, bacteria and protozoa (Viland et al. 2001). The said diseases are presented in the table 4 below.
Source: Eleme 2021
Table4: Records of typhoid and other waterborne diseases in the Buea urban area (2009-2019)
From table 4 above, it is observed that typhoid is the most prevalent waterborne disease in the Buea urban area with 83.89%, followed by dysentery with 14.18%, diarrhea with 1.92% and cholera with 0.002%. The distribution of typhoid within the Buea urban area is presented on Figure 2.
Source: Eleme 2021
Figure2: Distribution of typhoid cases in the Buea urban area
Based on results from hospitals records, cases of typhoid varied from one hospital to another. The IHC in Bokwaongo had the highest cases of typhoid (5000) in the Buea urban area and, IHC in UB the lowest number of typhoid cases (300). The causes of typhoid are well known by the households. The knowledge of household members on the causes of typhoid was sought and the results are seen on Figure 3.
Source: Eleme 2021
Figure 3: Household Knowledge on typhoid
In fact, 81% of households were of the view that typhoid is caused by contaminated water; 17% identified poor hygiene and 2% attributed the cause as being mystical.
Frequency of typhoid in households
Typhoid frequency within households in Buea urban was determined and the results presented on Table 5.
Source: Eleme 2021
Table 5: Frequency of typhoid
From Table 5, 10.5% respondents were of the opinion that, people get sick of typhoid every month, 26.5% said every three months, 41% every six months and 1% indicated once a year.
Discussion
Bacteriological analyses revealed the presence of salmonella typhi for the borehole in Molyko was 30/C-Unacceptable (High risk); Community water in Small Soppo, 40/C-Unaccepted (High risk); Community water in Vasingi-Buea;35/C-Unaccepted (High risk), community water in Bonduma 10/C-Unacceptable (High risk). Almost all water samples collected from CAMWATER Bokwango, presented a risk. The presence of salmonella typhi is a risk factor to typhoid occurrence. This result is in line with studies relating to typhoid fever outbreaks, and epidemiological studies on risk factors for typhoid fever in Asia which have confirmed the association between this disease and the use of poor water quality (Gasem et al., 2001; Sharma et al., 2009; Srikantiah et al., 2007; Tran et al., 2005). Epalle, 2018, while studying waterborne diseases in Santchou town also attested that the presence of salmonella typhi in water sources, was the main cause of typhoid in the area. The presence of Salmonella typhi in the water sources and sampling sites explain the prevalence and endemicity of typhoid in Buea town. Indeed, from the results obtained, typhoid represents 83.89% of waterborne diseases, followed by dysentery 14.18%, Diarrhea 1.93% and cholera 0.002%. The presence of these pathogens in these water sources is in line with studies conducted by (Kramer, Herwaldt, Craun, Calderon, & Juranek, 1996); Jenkins, et al. (2008) argued that the widespread presence of Salmonella in fresh water is an indication of the fact that, for many years water has been a carrier of Salmonella bacteria.
Outbreaks of disease caused by Salmonella in water provide evidence that the presence of Salmonella strains in environmental sources influences human health (Corby et al. 2005; Safranek et al., 2009; Van Houten et al., 1998). In addition, reports on typhoid and paratyphoid fever epidemics in Asia consistently indicate that contamination of well water (Farooqui et al., 2009), running water (Bhunia et al., 2009; Kim et al.., 2003; Lewis et al., 2005; Mermin et al., 1999) and unboiled spring water (Swaddiwudhipong & Kanlayanaphotporn, 2001) was the main source of outbreaks. Overall, the occurrence of diarrheal disease in low income countries has been associated with a wide variety of faecal pathogens, such as rotaviruses, pathogenic strains of Escherichia coli, Vibrio cholerae, Shigella spp., Salmonella enterica serotype Typhi, hepatitis E virus and soil transmitted helminths (Schwarzenbach et al. 2010; Afema et al., 2016; Freeman et al … 2017). In addition to this, most of the articles (Kim, 2010; Lewis et al., 2005; Mermin et al., 1999; Swaddiwudhipong & Kanlayanaphotporn, 2001) clearly show the involvement of MDR typhoid strains in waterborne epidemics. Typhoid is rife throughout the year in the Buea town. However, it is in the rainy season that it is more aggressive with 59. 62% of cases recorded. This is due to the fact that recurrent torrents promote the transport of pathogenic germs, especially Salmonella, from one water source to another. Rainwater and irrigation water can seep into the soil or run off. Bacteria have been shown to enter both groundwater and surface water during flooding (Gentry et al., 2007; Goss & Richards, 2008; Joy, Lee, Reaume, Whiteley & Zelin, 1998; Stoddard, Coyne and Grove, 1998; Unc and Goss, 2003; Vinten et al., 2002).
In addition, stagnant and persistent ponds are factors of vulnerability to typhoid because they provide sites of exposure to pathogens and constitute reproduction sites for anthropoid vectors (Lall et al. 2016). Poor stormwater drainage can lead to flooding that can damage water supply or sanitation infrastructures. Additionally, where drainage and sanitation are inadequate, runoff can carry fecal matter through the soil and contaminate drinking water sources (Ngugi et al. 2017) posing a risk factor.
During the rainy season, in the study area, fruits abound, the Buea dwellers often consume these fruits without washing them or washing them with salmonellae water, because untreated, potential source of typhoid contamination. There is a potential for contamination of fresh agricultural produce by pathogens (Franz and van Bruggen, 2008; Holden, Pritchard and Toth, 2009; Teplitski, Barak and Schneider, 2009; Berger et al. 2010; Critzer et al. 2010; Critzer et al. Doyle, 2010, Epalle, 2022). The consumption of food irrigated by wastewater in some cases poses health risks since it can be the vector of pathogens associated with excreta, including the bacteria responsible for typhoid fever, Salmonella typhi (Bos et al. 2011; WHO, 2012; Epalle 2022).
Conclusion
Results of the bacteriological analyzes of water samples collected show a hyper presence of faecal coliform, also Salmonella typhi in water samples and a strong correlation between bacteriological quality of water consumed by the population and typhoid endemicity in the Buea town. This study reveals that typhoid endemicity, is a real obstacle to the achievement of the Millennium Development Goals (MDGs) and the Health Sector Strategy (SSS) in Cameroon. Typhoid is a real public health problem in Buea town. Solving this endemicity involves treating water sources before consumption. Households must be trained in water purification techniques before consumption. In addition, the environment must be sanitized and hygiene respected. Controlling the bacteriological quality of water and adopting sanitation measures is the way forward.
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To cite this article
Electronic reference
Ediamam Epalle Guy Marcel, Usongo Patient & Eleme Clara Namondo (2023). « Water quality, typhoid endemicity and public health issues within Buea Urban Space, South-West Region of Cameroon ». Canadian journal of tropical geography/Revue canadienne de géographie tropicale [Online], Vol. (9) 1. Online May 10, 2023, pp. 1-6. URL: https://revuecangeotrop.ca
Authors
Ediamam Epalle Guy Marcel
Lecturer
Department of Geography
University of Buea, Cameroon
Email: ediamamepalle2005@yahoo.fr
Usongo Patient
Lecturer
Department of Geography
University of Buea, Cameroon
Eleme Clara Namondo
PhD candidate
Department of Geography
University of Buea, Cameroon
