Child dysentery in the Limpopo Valley: a cohort study of water, sanitation and hygiene risk factors Stephen W. Gundry, James A. Wright, Rona ´ n M. Conroy, Martella Du Preez, Bettina Genthe, Sibonginkosi Moyo, Charles Mutisi and Natasha Potgieter ABSTRACT Stephen W. Gundry (corresponding author) Water and Health Research Centre, University of Bristol, Merchant Ventures Building, Woodland Road, Bristol BS8 1UB, UK Tel.: +44 117 331 5296 Fax: +44 117 331 5297 E-mail: stephen.gundry@bristol.ac.uk James A. Wright Department of Geography, University of Southampton, Highfield, Southampton SO17 1BJ, UK Rona ´ n M. Conroy Department of Epidemiology and Preventive Medicine, Royal College of Surgeons in Ireland, Mercer Building, Dublin 2, Ireland Martella Du Preez Natural Resources and the Environment, CSIR, PO Box 395, Pretoria 0001, South Africa Bettina Genthe Natural Resources and the Environment, CSIR, PO Box 320, Stellenbosch 7599, South Africa Sibonginkosi Moyo Institute of Water and Sanitation Development, PO Box MP 422 Mount Pleasant, Harare, Zimbabwe Charles Mutisi Department of Animal Science, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe Natasha Potgieter Department of Microbiology, University of Venda, Thohoyandou, Limpopo Province, South Africa The objective of this cohort study was to assess risk factors for child dysentery and watery diarrhoea. The study participants consisted of 254 children aged 12–24 months in rural South Africa and Zimbabwe in households where drinking water was collected from communal sources. The main outcome measure was the most severe diarrhoea episode: dysentery, watery diarrhoea or none. For dysentery, drinking water from sources other than standpipes had a relative risk ratio of 3.8 (95% CI 1.5–9.8). Poor source water quality, as indicated by Escherichia coli counts of 10 or more cfu 100 ml 21 , increased risk by 2.9 (1.5–5.7). There were no other significant risk factors for dysentery and none for watery diarrhoea. In this study, endemic dysentery is associated only with faecal contamination of source water. Sources other than standpipes, including improved groundwater, are of greater risk. Remediation of water quality by treatment at source or in the household will be required to achieve access to safe drinking water in accordance with the 7th Millennium Development Goal. Key words | diarrhoea, dysentery, risk factors, Southern Africa, water microbiology INTRODUCTION Dysentery and watery diarrhoea together account for 2.5 million child deaths per year in developing countries (Kotloff et al. 1999; Kosek et al. 2003). Epidemics of dysentery are caused by Shigella dysenteriae type 1, but endemic dysentery, caused by S. flexneri and other enteric bacteria, has a higher mortality rate (Bennish & Wojtyniak 1989; WHO 1994) and greater impact on child growth (Victora et al. 1993; Alam et al. 2000). Watery diarrhoea, which has a lower case fatality, is caused by a variety of pathogenic protozoa, bacteria and viruses. doi: 10.2166/wh.2009.032 259 Q IWA Publishing 2009 Journal of Water and Health | 07.2 | 2009 Downloaded from https://iwaponline.com/jwh/article-pdf/7/2/259/397143/259.pdf by guest on 23 May 2020