title: Assessment of the relationship between bacteriological quality of dug-wells, hygiene behaviour and well characteristics in two cholera endemic localities in Douala, Cameroon.
abstract: BACKGROUND
  Access to potable water is grossly inadequate in Douala-Cameroon. The situation is worse in slum areas, compelling inhabitants to obtain water from sources of doubtful quality. This has contributed to frequent outbreaks of water-borne diseases particularly cholera, which results in severe morbidity and mortality. Shallow wells are a major source of water in these areas. We analyzed the influence of some factors on the bacteriological quality of well water in Bepanda and New Bell, cholera endemic localities in Douala to generate data that would serve as basis for strengthening of water and health policies.
  
  
  METHODS
  Questionnaires were administered to inhabitants of study sites to appraise their hygiene and sanitation practices, and level of awareness of waterborne diseases. The bacteriological quality of water was determined by investigating bacterial indicators of water quality. Relationship between well characteristics and bacteriological quality of water was determined using χ² test. The Kendall tau_b nonparametric correlation was used to measure the strength of association between well characteristics and bacteriological parameters. Statistics were discussed at 95% confidence level. Antibiotic susceptibility of isolates was investigated by the Kirby-Bauer and broth dilution techniques. Multidrug resistant species were tested for extended β-lactamase production potential.
  
  
  RESULTS
  Inhabitants demonstrated adequate knowledge of waterborne diseases but employed inappropriate method (table salt) for well disinfection. Well construction and location violated guidelines. Indicator bacterial counts greatly exceeded the WHO guidelines. Variation in bacteriologic parameters between sites was not significant (P > 0.05) since well characteristics and hygiene and sanitary practices were similar. Differences in bacteriologic quality with respect to state of well, and presence of molded casing and lid, and height of casing were not significant (P > 0.05). Well distance from sanitary structure negatively correlated with bacteriological characteristics indicating it could be a major contributory factor to poor water quality. Bacteria isolated were predominantly enteric organisms. Ciprofloxacin was the most active agent. Extended β-lactamase producers were detected among Salmonella species, Citrobacter fruendii and E. coli.
  
  
  CONCLUSIONS
  Poor well location, construction, and hygiene and sanitary practices were among the factors affecting water quality. There is an urgent need for education of inhabitants on effective water disinfection strategies and for regular monitoring of wells.
authors.affiliation: Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon. jakoachere@yahoo.com
authors.forename: Jane-Francis Tatah Kihla
authors.initials: JF
authors.lastname: Akoachere
authors.forename: Lundi-Anne
authors.initials: LA
authors.lastname: Omam
authors.forename: Thomas Njinuwo
authors.initials: TN
authors.lastname: Massalla
mesh_terms: D000328:Adult; D001431:Bacteriological Techniques; D002163:Cameroon / Q000453:epidemiology; D002771:Cholera / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D060766:Drinking Water / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000209:etiology / Q000635:transmission; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene / Q000592:standards*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012499:Sanitation / Q000592:standards; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D060986:Water Wells / Q000382:microbiology* / Q000592:standards; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D060766:Drinking Water; D001618:beta-Lactamases
references.citation: Diagn Microbiol Infect Dis. 2002 Jun;43(2):91-7
references.pmid: 12088614
references.citation: Appl Environ Microbiol. 2001 Jul;67(7):3328-30
references.pmid: 11425764
references.citation: East Afr Med J. 2002 Nov;79(11):588-92
references.pmid: 12630492
references.citation: J Perinatol. 1999 Sep;19(6 Pt 1):462-5
references.pmid: 10685281
references.citation: Rev Environ Health. 1997 Apr-Jun;12(2):63-80
references.pmid: 9273923
references.citation: Infect Immun. 1998 Dec;66(12):5819-25
references.pmid: 9826360
references.citation: Appl Environ Microbiol. 1984 Aug;48(2):361-6
references.pmid: 6385848
references.citation: Foodborne Pathog Dis. 2009 Jan-Feb;6(1):49-56
references.pmid: 18991540
references.citation: J Infect Dis. 1996 May;173(5):1176-83
references.pmid: 8627070
references.citation: Sante. 2007 Apr-Jun;17(2):63-8
references.pmid: 17962152
references.citation: Int J Environ Res Public Health. 2010 Oct;7(10):3628-43
references.pmid: 21139853
references.citation: J Clin Microbiol. 1995 Oct;33(10):2715-22
references.pmid: 8567912
references.citation: BMC Res Notes. 2012 May 07;5:219
references.pmid: 22564344
references.citation: Med Trop (Mars). 2008 Oct;68(5):507-13
references.pmid: 19068985
references.citation: J Urban Health. 2007 Nov;84(6):829-38
references.pmid: 17551841
references.citation: Med Trop (Mars). 2006 Jun;66(3):283-91
references.pmid: 16924824
references.citation: Indian J Med Res. 2007 Jul;126(1):63-7
references.pmid: 17890826