The Burden of Poor Household Drinking-Water Quality on HIV/AIDS Infected Individuals in Rural Communities of Ugu District Municipality, Kwazulu-Natal Province, South Africa

This aim of this study was to ascertain whether household container-stored drinking water might play a role in the diarrhoeic conditions of HIV/AIDS patients and non-HIV-infected individuals of the rural communities who attended the Ugu District Municipal hospitals. Water samples were collected from the standpipes and household containers, and stool specimens were obtained from HIV/AIDS-positive and non-HIV/AIDS patients with diarrhoea. Significant correlations were established between the incidence of potentially pathogenic bacteria isolated from chlorinated household-stored water, and in stool specimens of HIV-positive patients with diarrhoea (r = P < 0.05). A combination of molecular analysis targeting the 16S rRNA gene and the restriction fragment length polymorphism and sequence analysis of the amplified gene for differentiating between species and strains of the bacterial pathogens was also applied to isolates obtained from stored-water samples and stool specimens. Similar sequences of Klebsiella spp., K. pneumoniae, Escherichia coli, E. coli O55: H7, Proteus mirabilis, and Shigella boydii were identified in both stored water and stools of HIV/AIDS-positive patients with diarrhoea. With the exception of Proteus mirabilis, none of these pathogens were identified in stool specimens of non-HIV-infected individuals with diarrhoea.


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The water service authority is tasked with the responsibility of improving the health of 35 the general population by providing access to safe water. Lack of access to water and 36 poor water quality may be as detrimental as not having water at all. Failure to provide 37 safe drinking water poses a major threat to human health, while adequate water supply 38 is a fundamental component of primary health. South Africa is classified as a water-39 scarce country and the supply of water does not meet the population's growth [1]. 40 However, the Constitution of the Republic of South Africa [2] states that every citizen 41 has the right to have access to sufficient clean, safe drinking water. It should be a 42 priority to improve and develop water infrastructure to ensure that communities are 43 supplied with potable water. 44 Prior to 1994, 30 to 40% of South Africa's population, which translates to an 45 estimated 14 to 18 million people, had no access to clean or safe water [1;3]. By 2004, 46 about 10 million people had been supplied with drinking water, thereby reducing the 47 backlog that existed in 1994 [4]. By 2008, the estimated number of people who did not 48 have a reliable source of drinking water had been lowered to six million [5]. In 2015, 49 3.64 million people in South Africa still had no access to an improved water supply [6]. 50 Although this shows a fair commitment by the country to improve access to safe 51 drinking water to all, studies have indicated that the focus has been mostly on 52 metropolitan areas where the infrastructure for water treatment and supply to 53 consumers is of a high quality compared to rural areas where it is poor or non-existent 54 [7][8][9][10][11][12]. 55 The implementation of communal standpipes and storage of treated drinking 56 water in the dwellings remains the main mode of drinking water supply in most rural 57 communities of South Africa. However, the provision of treated drinking water through 58 this mode of access is not appropriate to maintain the safety of drinking water. 59 Previous studies conducted on container-stored water worldwide have indicated the  all these studies were based on a combination of culture-based methods and 96 conventional PCR amplification of species-specific genes of pathogenic bacteria.

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More molecular techniques such as restriction fragment length polymorphism (RFLP) 98 and sequencing are therefore required to establish whether the incidence of 99 pathogenic bacteria in household container-stored drinking water plays a crucial role

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The present study investigated whether the quality of drinking water at the point of 106 supply (standpipe) was the first source for the deterioration of container-stored water

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The Boboyi, Bomela and Gamalakhe areas receive their drinking water from 129 the Boboyi Water Purification Plant (S1: Fig.1). This plant abstracts its intake water

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The presence of a chlorine residual in drinking water is to inactivate bacteria and some 303 viruses that can cause diarrhoeal disease and to protect the water from being re-  Fig.4).   were 29%, 4% and 9.1% of, respectively (S3 : Fig.3). The findings of this study 387 revealed high levels of turbidity, which ranged between 1 and 4.7 NTU in standpipe water samples and between 1 and 8.1 NTU in container-stored water samples (S4: 389 Fig.4). In general, the turbidity levels of both standpipe water samples and container- Vibrio spp. were detected at high levels in container-stored water ( Table 1). This 420 means that the water did not comply with the limit for no risk of microbial infection,

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It is well known that the function of the immune system is to protect the host 457 against infection after exposure to bacteria, viruses, fungi, protozoa, and allergens.

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Protection of the host is crucial and occurs in two steps: a process of innate immunity