The association between acute childhood diarrhoea and diarrhoeagenic E.coli present in contaminated soil in informal settlements in Durban

Abstract

In South Africa, under-five childhood morbidity and mortality rates have increased due to diarrhoea with acute diarrhoea posing a major public health threat especially, in informal settlements. Therefore this study sought to, a) investigate community knowledge, attitudes, behaviour and practices (KABP) regarding domestic waste and childhood diarrhoeal management, b) to enumerate and identify diarrhoeagenic E.coli species from soil samples extracted from open waste dump sites and c) to investigate any association(s) with diarrhoeagenic E.coli and potential risk of contracting diarrhoea. This two-phased cross-sectional study in six informal settlements in the greater Durban area constituted, respectively, of the administering of questionnaires to 360 primary caregivers and; sampling the prevalence of diarrhoeagenic E.coli (DEC) in waste dumps using quantitative polymerase chain reaction methodologies. Relationships between socio-demographic and educational status to determine potential household risk factors towards under-five diarrhoea prevalence were assessed. The KABP results identified domestic waste and greywater disposal, mother and child method of sanitation, personal and domestic hygiene practices and mechanical vectors as significant contributory risk factors. Of concern is that more than 80% of under-five children played in or near faecally-contaminated waste dump sites. The recovery of four DEC pathotypes including enterohaemorrhagic E.coli, enteropathogenic E.coli, enterotoxigenic E.coli and enteroaggregative E.coli suggest that its persistence in waste-dump soil has the ability to cause under-five diarrhoea in both sporadic and endemic settings. This commonly transmitted hand-to-mouth illness will necessitate and place huge demands on the primary catalysts of change i.e. local governmental role players and caregivers. These change agents have to ensure highly consistent levels of domestic and personal hygiene and implement feasible reduction strategies to waste-dump exposure of diarrhoeal-causing pathogens, particularly among under-five children living in Durban’s informal settlements.