Contribution of water pollution from inadequate sanitation and housing quality to diarrheal disease in low-cost housing settlements of Cape Town, South Africa.

OBJECTIVES: We investigated the effects of failing sanitation, poor housing conditions, and fecal pollution in runoff water on the health-particularly the incidence of diarrheal disease-of residents of low-cost housing settlements in Cape Town, South Africa. METHODS: In November 2009, we conducted a cross-sectional survey with structured interviews in 4 communities (n = 336 dwellings; 1080 persons). We used Colilert defined-substrate technology to determine Escherichia coli levels in runoff water samples taken from the study communities. RESULTS: Almost 15% of households disposed of soiled products in storm water drains and 6% disposed of soiled products in the street. In only 26% of the dwellings were toilets washed daily. Approximately 59% of dwellings lacked a tap near the toilet for hand washing, and 14% of respondents suffered 1 or more attacks of diarrhea in the 2 weeks preceding their interview. E.coli counts of runoff environmental water samples ranged from 750 to 1 580 000 000 per 100 milliliters. CONCLUSIONS: A holistic and integrated approach is needed to improve housing quality and sanitation among Cape Town's low-income citizens.

Living in low-cost housing settlements in cape town, South Africa-the epidemiological characteristics associated with increased health vulnerability.

The aim of this study was to assess the epidemiological characteristics of a representative sample of subsidized low-cost housing communities in the City of Cape Town in relation to their living conditions and their health status. Four subsidized low-cost housing communities were selected within the City of Cape Town in this cross-sectional survey. Structured interviews were administered in 336 dwellings on 173 plots. Data was obtained from 1,080 persons with a response rate of 100%. Almost all of the state-subsidized houses had one or more shacks in the backyard, increasing the occupation density and putting the municipal sanitation infrastructure under pressure. In 40% of main houses, one or more cases of diarrhea were reported during the two weeks preceding the survey, in contrast to 23% of shacks (p < 0.0007). Of the total group, 1.7% willingly disclosed that they were HIV positive, while 3.5% reported being tuberculosis (TB) positive. One of them reported having multiple drug-resistant TB. None of the HIV positive or TB positive persons was on any treatment. A reported 6.3% of the families admitted regularly eating only one meal per day, whereas 18.5% reported having only two meals per day. The shack dwellers had significantly higher education and employment status (p < 0.01), since they had to pay rent. Improvements in health intended by the rehousing process did not materialize for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities had considerable implications for the curative health services. Sanitation failures, infectious disease pressure, and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks, in addition, has municipal service implications and needs to be better managed. Urgent intervention is needed to allow the state-funded housing schemes to deliver the improved health that was envisaged at its inception.

Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic.

BACKGROUND: The performance of spirometers is often evaluated under ideal conditions with computer-generated waveforms or in vivo testing with healthy subjects. Real-life conditions are less ideal because of comorbidities, age of the subjects, and a variety of air flow limitations. Evaluation of new spirometry equipment can also be performed under these less favorable conditions. The Spirospec is a new desktop spirometer that is commercially available, but its accuracy has not been evaluated in a clinical setting. OBJECTIVE: Test the Spirospec with subjects with normal and pathologic pulmonary function. METHODS: A group of 45 patients (mean age 38.4 years, 27 male) booked for evaluation in the pulmonary function laboratory of a tertiary care university hospital were tested with both a Spirospec and a standard Jaeger Masterlab 4.0 spirometer, according to the guidelines of the American Thoracic Society. Three subgroups (normal spirometry, obstructive air flow limitation, and restrictive air flow limitation) of 15 consecutive subjects each underwent spirometry. RESULTS: Pulmonary function measurements from the Spirospec correlated closely (r = 0.95-0.99) with those from the Masterlab 4.0, showing good limits of agreement and differences between the 2 devices: forced vital capacity 0.03 L, forced expiratory volume in the first second (FEV(1)) -0.01 L, peak expiratory flow -0.41 L/s, peak inspiratory flow 0.43 L/s, forced expiratory flow at 50% of total lung capacity 0.13 L/s, and forced expiratory flow at 75% of total lung capacity 0.12 L/s. With the exception of forced vital capacity and FEV(1), these differences were statistically significant (p < 0.05). CONCLUSION: The Spirospec is comparable to the Masterlab 4.0, with high accuracy for FEV(1) and forced vital capacity and clinically acceptable differences in the measured flow variables.

The impact of densification by means of informal shacks in the backyards of low-cost houses on the environment and service delivery in cape town, South Africa.

This paper investigates the state-sponsored low cost housing provided to previously disadvantaged communities in the City of Cape Town. The strain imposed on municipal services by informal densification of unofficial backyard shacks was found to create unintended public health risks. Four subsidized low-cost housing communities were selected within the City of Cape Town in this cross-sectional survey. Data was obtained from 1080 persons with a response rate of 100%. Illegal electrical connections to backyard shacks that are made of flimsy materials posed increased fire risks. A high proportion of main house owners did not pay for water but sold water to backyard dwellers. The design of state-subsidised houses and the unplanned housing in the backyard added enormous pressure on the existing municipal infrastructure and the environment. Municipal water and sewerage systems and solid waste disposal cannot cope with the increased population density and poor sanitation behaviour of the inhabitants of these settlements. The low-cost housing program in South Africa requires improved management and prudent policies to cope with the densification of state-funded low-cost housing settlements.

The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is one of the most serious complications of neonatal mechanical ventilation. Early diagnosis may influence treatment options such as early steroid administration. OBJECTIVE: To assess the role of US of the lungs in predicting the development of BPD in infants with hyaline membrane disease (HMD) and to determine the earliest possible age at which the diagnosis of BPD could be made with certainty. PATIENTS AND METHODS: Consecutive premature newborn infants requiring assisted ventilation during 1997-1998 who were admitted because of HMD were studied prospectively. US of the lungs was performed within 3 days of birth and three times a week thereafter until discharge from the neonatal intensive care unit. Each patient was also clinically and radiographically evaluated for the presence or absence of BPD at day 28 of life. Lung US scans were correlated with the development of BPD. RESULTS: Retrodiaphragmatic hyperechogenicity (RH) was initially observed in 28 of the 36 patients with HMD, but resolved completely in 24 (96%) of 25 infants who had an uncomplicated clinical course. In eight of the ten infants who developed BPD, RH persisted. Day 9 was the earliest day where persistence of abnormal RH was observed with the highest predictor values for the development of BPD. CONCLUSIONS: Lung US is a valuable technique for predicting the development of BPD.

Human metapneumovirus infection in hospital referred South African children.

Human metapneumovirus (hMPV) was first described in Dutch children with acute respiratory symptoms. A prospective analysis of the epidemiology, clinical manifestation, and seroprevalence of hMPV and other respiratory viruses in South African children referred to hospital for upper or lower respiratory tract infection were carried out during a single winter season, by using RT-PCR, viral culture, and enzyme-linked immunosorbent assays. In nasopharyngeal aspirates from 137 children, hMPV was detected by RT-PCR in 8 (5.8%) children (2-43 months of age) as a sole viral pathogen, respiratory syncytial virus (RSV) in 21 (15%), influenza A virus in 18 (13%) and influenza B virus in 20 (15%). Pneumonia was diagnosed in seven children and upper respiratory tract infection in one of the hMPV-infected children. One hMPV-infected child was admitted to the intensive care unit in need of mechanical ventilation and one child was infected with human immunodeficiency virus (HIV). No statistically significant differences were found between hMPV, RSV, and influenza virus infected groups with regard to clinical signs and symptoms and chest radiograph findings. The seropositive rate of hMPV specific IgG antibodies was 92% in children aged 24-36 months, the oldest seronegative child in our study was 7 years and 6 months of age. In conclusion, hMPV contributes to upper and lower respiratory tract morbidity in South African children.