Identifying the prevalence of and pathways to diarrhoeal disease in rural KwaZulu-Natal and the implications for evaluating the impact of water supply schemes on community health.
Since the establishment of a democratic South Africa in 1994, a number of rural water supply schemes have been implemented. A specific aim of these schemes is to improve the health of the population. The underlying assumption is that a supply of reticulated water will improve the quality of water used by the community, reduce the exposure of the community to contaminated water supplies, and reduce water related diseases, in particular diarrhoea. This research thesis focuses on two rural water supply schemes in KwaZulu-Natal: Mpolweni and Vulindlela, both being developed by Umgeni Water, the regional water utility. These communities depended variously on rivers, rain harvesting, and springs for their water supply. For sanitation, the majority of people used unimproved pit latrines. This research thesis is based on information gathered from the communities prior to the installation of the water supply schemes. It focuses on the linkage between water supply and health by examining diarrhoeal morbidity as a measurable disease outcome and by identifying possible pathways to the prevalence of diarrhoea. Questionnaire and observational surveys were undertaken of 181 households in Mpolweni and 100 households in Vulindlela. From these surveys, the prevalence of diarrhoea in Vulindlela households was found to be 40.4% and in Mpolweni to be 49%. Children under the age of five years old are the most vulnerable, with 20.1% of children in Mpolweni and 21 .3% of children in Vulindlela reported as having had diarrhoea in the recall period prior to the surveys. The Mpolweni study considered eighty exposure variables, finding an association between diarrhoeal disease and sixteen of these variables (p value < 0.05). The Vulindlela study considered fifty-five exposure variables, of which eight were considered significant (p value < 0.05). In regard to water and diarrhoea: • no association was found between the prevalence of diarrhoea and the source of water in either Mpolweni or Vulindlela. • using water to wash nappies was associated with diarrhoeal disease in Vulindlela. However, it is postulated that it is the faecal contamination in the nappy, rather than the water, that is problematic. No association between water use and diarrhoea was established in Mpolweni. • poor disinfection of stored water supplies was associated with diarrhoeal disease in both Mpolweni and Vulindlela. In addition, the use of plastic storage containers to store water at the household provided additional risk in Mpolweni. However, once the reticulated system is installed, the communities are likely to continue to store water due to a distrust of the reliability of water supply. The above surveys form the baseline for additional studies currently being undertaken by Umgeni Water that are intended to measure the effectiveness of the water supply schemes on community health. However, from this thesis, it is concluded that many of the risk factors associated with diarrhoeal disease in both Vulindlela and Mpolweni will not directly be addressed by the introduction of the water supply schemes.