| Abstract|| |
Background: Evaluation of the microbial quality of drinking water can prevent the waterborne diseases outbreak that is one of the most important challenges in the world. Objective: The aim of this study was to assess the seasonal variation of waterborne diseases prevalence associated with the microbial quality of drinking water and the comparison between rural and urban areas in Kangavar city, West of Iran. Materials and Methods: To accomplish this, the results of the microbial quality of drinking water and cases of simple diarrhea, dysentery, typhoid, and hepatitis A were received from all rural and urban health centers of the city during 5 years (2006–2010). To determine the relationship between diseases and microbial quality of water, correlation instruction, and Pearson's correlation coefficient were used. Results: The results showed that except hepatitis A, the incidence of all diseases in different areas (urban or rural) and seasons had significant relationship with microbial contamination of drinking water (P < 0.05). The stronger relationship was observed in rural areas than in urban areas (except simple diarrhea) and in warm seasons than in cold seasons. Conclusion: With respect to the impact of the microbial quality of water on the incidence of dysentery and typhoid diseases, keeping up the quality of drinking water in places and times with high sensitivity (rural areas and warm seasons) should be considered strongly.
Keywords: Disease, drinking water, Kangavar, microbial quality
|How to cite this article:|
Pirsaheb M, Sharafi K, Ahmadi E, Moradi M. Prevalence of the waterborne diseases (diarrhea, dysentery, typhoid, and hepatitis A) in West of Iran during 5 years (2006–2010). Ann Trop Med Public Health 2017;10:1524-8
|How to cite this URL:|
Pirsaheb M, Sharafi K, Ahmadi E, Moradi M. Prevalence of the waterborne diseases (diarrhea, dysentery, typhoid, and hepatitis A) in West of Iran during 5 years (2006–2010). Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 23];10:1524-8. Available from: http://www.atmph.org/text.asp?2017/10/6/1524/222662
| Introduction|| |
Drinking water resources containing pathogenic microorganisms can cause water-borne diseases among the consumers.,, Overall, microbial contamination risk of drinking water is related to fecal contamination as a result of discharging sewage to water resources., According to the World Health Organization in 2008, the mortality rate associated with waterborne diseases was more than 5 million people a year.
The cases of diarrhea caused by contaminated drinking water were estimated to be 15%–20% of waterborne-associated diseases. Therefore, due to the low levels of sanitation and unsafe water resources, children, especially in rural communities of developing countries are at risk from waterborne diseases. Annually, about 1.6 million children (<5 years old) die due to waterborne diseases of which 84% live in rural areas. It has been estimated that 1.7 billion rural residents do not have access to safe drinking water and appropriate sanitation levels in 2015.,
Considering that drinking water should not contain unacceptable levels of hazardous chemicals and infectious risk to the health of consumers, it is essential to promote the provision of safe and clean water., Evaluation of microbial quality of drinking water can protect consumers from illnesses transmitted due to the consumption of water containing pathogens such as bacteria, viruses, and protozoa. It can prevent the waterborne diseases outbreak that is one of the most important global health challenges.,,
This study was designed to determine the prevalence of waterborne diseases and its relation to drinking water microbial quality as well as comparison between rural and urban areas of Kangavar County in the west of Iran.
| Materials And Methods|| |
Kangavar County with coordinated of 34°29'N and 47°56'E is located in the west of Iran and has a population of 79,690 people (50,150 and 29,540 people dwell in urban and rural, respectively). The total number of households in the county is 19,715 (12,256 and 7,459 of them live in urban and rural area). This country consists of one city of Kangavar city and many villages. Water supplies of the Kangavar city include 11 wells of which five wells are located in Suleiman Abad village, and other wells are located in Ali Abad village.
Drinking water in the rural area of this country is provided by wells (manual, semi-deep, and deep) and springs. The material of water distribution system pipes is galvanized iron, austenite, PE, asbestos, and JPR constructed. The average water consumption per capita is 170 lpcd. In this study, the results of the microbial quality of drinking water and the number of cases of diarrhea, dysentery, typhoid, and hepatitis A were provided from the rural and urban health centers of the country during 5 years (2006–2010). The data were analyzed by SPSS-16 software (Delaware, USA). Thus, frequency and crosstab instructions were used to describe the data and correlation instruction and Pearson's correlation coefficient were also applied to determine the relationship between disease and microbial quality of water were used. Then, the prevalence (Eq. 1) of the waterborne diseases was measured for this country using the formula:
| Results|| |
Obtained results indicated that the average desirability of microbial quality of drinking water did not differ significant (P > 0.05) in considered years, but there was significant difference between urban and rural areas, health centers, and seasons (P < 0.05) [Table 1]. Furthermore, the results revealed that the highest and lowest point prevalence of simple diarrhea has been recorded in rural health center of Hassan Abad and urban health center 1, respectively. The highest point prevalence of dysentery was observed in rural health center 2 and the lowest rate was observed in rural health center 1. Urban health center 2 and urban health center 1 had the highest and lowest point prevalence of typhoid, respectively. The highest and lowest point prevalence of studied diseases were observed in summer and winter, respectively. For all diseases, point prevalence in rural areas was more than in urban areas [Table 2]. Point prevalence of hepatitis was zero during the study period. Other results of the average desirability of drinking water microbial quality and point prevalence of diseases in Kangavar city during 5 years (2006–2010) are presented in [Table 1] and [Table 2], respectively. The relationship between the prevalence of all diseases (except hepatitis) and microbial contamination of drinking water in different regions (urban or rural) and seasons were significant (P < 0.05) [Table 3].
|Table 1: Average number of microbial quality of drinking water in terms of fecal coliform|
Click here to view
|Table 2: Prevalence of the diseases (in 1000 person) during 5 years (2006-2010)|
Click here to view
|Table 3: Pearson correlation coefficient and P value of waterborne diseases|
Click here to view
| Discussion|| |
The results showed that the mean desirability of microbial quality of drinking water in Kangavar city was not significantly different for the studied years, but differences were significant among seasons. This indicated that the microbial quality of water could be influenced by temperature and atmospheric conditions (precipitation). Since the seasons of the year will repeat next year, there is no significant difference over several years. The results also showed that the highest and lowest desirability of the microbial quality of water were observed in winter and summer, respectively. Low microbial quality of water in summer can be because of increasing of per capita consumption, decreasing of the discharge of water resources, increasing of pathogens in water supplies, remaining of water in pipes providing the growth of microorganisms, and suitable warm weather for the growth of microorganisms in water. The arrangement of the desirability of microbial quality from the highest to the lowest for different seasons is as summer < spring < autumn < winter. These results are consistent with other studies such as Haley et al. study  on the microbial quality of water in villages of Georgia and Oguntoke et al. about the relationship between water quality and waterborne diseases in Ibadan city, Nigeria, and Mahvi and Karyab on the microbial quality of water in villages of Qazvin province. These studies reported the lowest microbial quality of water in summer. However, some other studies reported desirable microbial quality in cold seasons due to the rain and flooding, deficit of health facilities, environmental factors, inappropriate water resources and old water transmission and distribution system, improper drainage of passages, and lack of wastewater collection system.,,, However, in this study, because of using of springs as a source of water supply in most rural areas, the rate of waterborne disease depends on the season and proper conditions for the growth of pathogens at higher temperatures. Microbial contamination was found to be more in warm seasons.
In addition, the results showed significant differences between the mean desirability of drinking water microbial quality in urban and rural areas. Therefore, the quality of drinking water in urban health centers was more desirable than in rural health centers. A field study carried out on the resources of urban and rural water and transmission-distribution systems of urban and rural water showed that the proximity of rural water sources (wells and spring), pollution of transmission-distribution systems with animal waste, sewage, and garbage, low improvement index of bathroom and toilet (unsanitary sewage disposal in pathways), pipe breakage due to corrosion and long track, agricultural activities such as vegetating, disregard of personal and food hygiene, the lack of regular and continuous chlorination, and lack of water treatment facilities cause the lower desirability of microbial quality of water in rural than in urban areas. This was confirmed by other researchers such as Tumwine et al., who reported that sewage discharge as unsanitary reduced the microbial quality of drinking water in East Africa villages. The study of Sadeghi et al. reported that 23% of rural water resources of Iran had microbial contamination due to the high turbidity. The study of Bessong et al. on the incidence of diarrhea in rural communities of South Africa also showed a significant relationship between the type of rural water resources (springs, wells, etc.) and microbial quality, as the microbial contamination in surface resources was more than in groundwater resources. The study of Yassin et al. in assessing the microbial quality of water resources in Gaza Strip, indicated that with regard to water supply, transmission line length, distribution network extent, the lifetime of the piping network, disinfection system, proximity to pollutant sources including sewage collection system and animal waste are different in urban and rural areas. Therefore, the microbial quality of water also varies accordingly.
The results showed that with the exception of hepatitis, there is a significant relationship between the disease type (simple diarrhea, dysentery, and typhoid) and season and area of residence (urban or rural) (P < 0.05). Therefore, the most prevalence of these diseases occurred in summer and in rural areas. It can be due to the low desirability level of microbial quality in summer and in rural areas, so it is expected that the incidence of these diseases is high., However, Pearson's correlation coefficient of simple diarrhea with microbial contamination of drinking water in the rural area was less than in urban area. This indicates that microbial contamination of drinking water in rural areas has played a less important role in the incidence of simple diarrhea and the outbreak of it in rural areas can be related to other reasons such as contaminated food, poor personal hygiene, and other similar factors. However, high Pearson's correlation coefficient of other diseases (dysentery and typhoid) with microbial contamination of drinking water in rural areas was higher than in urban areas. The results showed that the amount of Pearson's correlation coefficient of disease type (simple diarrhea, dysentery, and typhoid) with microbial contamination of water from the highest to the lowest in different seasons was as winter < autumn < spring < summer. Since the microbial quality of drinking water and food is affected by ambient temperature.,,, Thus, with increasing of the ambient temperature, the desirability of microbial quality of water and food reduces, so its Pearson's correlation coefficient with disease type (simple diarrhea, dysentery, and typhoid) increases., These results are consistent with studies from other researchers, as the study of Mahvi and Karyab  demonstrated that the prevalence of diarrhea in villages with safe and contaminated water was 5.3% and 8.3%, respectively. The study of Bessong et al. also showed the outbreak of waterborne diseases caused by microorganisms such as cholera, Salmonella, and Shigella in rural communities of Tshikuwi in South Africa due to undesirability of water quality. Furthermore, the study of Haley et al. showed that 79.2% of water samples from villages of Georgia were contaminated by Salmonella and the prevalence in summer was more than in other seasons.
| Conclusion|| |
From the data presented in this study, it can be concluded that the microbial quality of drinking water in term of causing of dysentery and typhoid diseases is more effective in rural than in urban areas. Regarding the prevalence of simple diarrhea, it is more effective in warm seasons than in cold seasons. Therefore, keeping up the quality of drinking water in places and times with high sensitivity (rural areas and warm seasons) in term of waterborne diseases should be given special attention.
This article is the result of an undergraduate class project, [Mrs. Elham Ahmadi's project]. The authors would like to thank all health centers to carry out this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharafi K, Fazlzadeh M, Pirsaheb M, Sharafi H, Khosravi T. Determining parasite presence in raw municipal wastewater by Bailenger method in Kermanshah, Iran. Water Qual Expo Health 2015;7:525-30.
Sharafi K, Pirsaheb M, Khosravi T, Dargahi A, Moradi M, Savadpour MT. Fluctuation of organic substances, solids, protozoan cysts, and parasite egg at different units of a wastewater integrated stabilization pond (full scale treatment plant): A case study, Iran. Desalin Water Treat 2016;57:4913-9.
Mirzaei N, Ghaffari HR, Karimyan K, Mohammadi Moghadam F, Javid A, Sharafi K. Survey of effective parameters (water sources, seasonal variation and residual chlorine) on presence of thermotolerant coliforms bacteria in different drinking water resources. Int J Pharm Technol 2015;7:9680-9.
Yassin MM, Amr SS, Al-Najar HM. Assessment of microbiological water quality and its relation to human health in Gaza governorate, Gaza strip. Public Health 2006;120:1177-87.
Odeyemi OA. Bacteriological safety of packaged drinking water sold in Nigeria: Public health implications. Springerplus 2015;4:642.
World Health Organization (WHO). Guidelines for Drinking-Water Quality: World Health Organization, Distribution and Sales, Geneva 27, CH-1211. Switzerland; 2004.
Gwimbi P. The microbial quality of drinking water in Manonyane community: Maseru district (Lesotho). Afr Health Sci 2011;11:474-80.
Dehghan A, Mirzaei N, Rezaei S, Karami MA, Adabi S, Kaseb P. Microbial quality of drinking water in rural areas of Marivan city, Iran. J Chem Pharm Res 2015;7:894-9.
Payment P, Waite M, Dufour A. Introducing parameters for the assessment of drinking water quality. Assessing Microbial Safety of Drinking Water. Vol. 4. London, UK: IWA; 2003. p. 47-77.
Liguori G, Cavallotti I, Arnese A, Amiranda C, Anastasi D, Angelillo IF, et al.
Microbiological quality of drinking water from dispensers in Italy. BMC Microbiol 2010;10:19.
Craun GF, Brunkard JM, Yoder JS, Roberts VA, Carpenter J, Wade T, et al.
Causes of outbreaks associated with drinking water in the United States from 1971 to 2006. Clin Microbiol Rev 2010;23:507-28.
Blackburn BG, Craun GF, Yoder JS, Hill V, Calderon RL, Chen N, et al.
Surveillance for waterborne-disease outbreaks associated with drinking water – United States, 2001-2002. MMWR Surveill Summ 2004;53:23-45.
Yousefi N, Bagheri A, Mirzaei N, Khazaei M, Niri MV. Microbiological quality of drinking water in rural areas of a city. Arch Hyg Sci 2013;2:73-8.
Haley BJ, Cole DJ, Lipp EK. Distribution, diversity, and seasonality of waterborne salmonellae in a rural watershed. Appl Environ Microbiol 2009;75:1248-55.
Oguntoke O, Aboderin OJ, Bankole AM. Association of water-borne diseases morbidity pattern and water quality in parts of Ibadan city, Nigeria. Tanzan J Health Res 2009;11:189-95.
Mahvi A, Karyab H. Risk assessment for microbial pollution in drinking water in small community and relation to diarrhea disease. Am Eurasian J Agric Environ Sci 2007;2:404-6.
Nichols G, Lane C, Asgari N, Verlander NQ, Charlett A. Rainfall and outbreaks of drinking water related disease and in England and wales. J Water Health 2009;7:1-8.
Chippaux JP, Houssier S, Gross P, Bouvier C, Brissaud F. Pollution of the groundwater in the city of Niamey, Niger. Bull Soc Pathol Exot 2002;95:119-23.
Charron D, Thomas M, Waltner-Toews D, Aramini J, Edge T, Kent R, et al.
Vulnerability of waterborne diseases to climate change in Canada: A review. J Toxicol Environ Health A 2004;67:1667-77.
Tumwine JK, Thompson J, Katua-Katua M, Mujwajuzi M, Johnstone N, Porras I, et al.
Diarrhoea and effects of different water sources, sanitation and hygiene behaviour in East Africa. Trop Med Int Health 2002;7:750-6.
Sadeghi GH, Mohammadian M, Nourani M, Peyda M, Eslami A. Microbiological quality assessment of rural drinking water supplies in Iran. J Agric Soc Sci 2007;3:31-3.
Bessong PO, Odiyo JO, Musekene JN, Tessema A. Spatial distribution of diarrhoea and microbial quality of domestic water during an outbreak of diarrhoea in the Tshikuwi community in Venda, South Africa. J Health Popul Nutr 2009;27:652-9.
Nala N, Jagals P, Joubert G. The effect of a water-hygiene educational programme on the microbiological quality of container-stored water in households. Water SA 2003;29:171-6.
World Health Organization (WHO). Guidelines, Standards and Health: Assessment of Risk and Risk Management for Water-Related Infectious Disease. Geneva, Switzerland: World Health Organization; 2001.
Ashbolt NJ. Microbial contamination of drinking water and disease outcomes in developing regions. Toxicology 2004;198:229-38.
Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]