If you sometimes find it difficult to make sense of your child’s behaviour, it has nothing to do with your parental skills, instead blame it on the water they drink.
Most Batswana parents’ dream of strapping, smart and well nourished children may be turning into a nightmare. Indications are that Batswana may actually be gradually diminishing in stature and becoming less intelligent. The country’s recurring diarrhea problem linked to contaminated water is likely to result in a generation of shorter and duller men and women.
“In Botswana, as well as other sub-Saharan countries, long periods of diarrhea not only causes death but also leads to stunting and cognitive impairments,” said Peter Rothschild, President of BioGaia at the Infectious Disease Week in San Diego, USA, on October 10 2015.
Four years ago government reported 183 deaths over a period of three months due to diarrheal outbreak. Responding to a question in Parliament, the then Assistant Health Minister Gaotlhaetse Matlhabaphiri revealed that a total of 171,280 diarrhoea cases were recorded between 2006 and 2011. Within that period, about 1,820 children under the age of five succumbed to the disease. The highest death toll was registered in 2006 when 54,296 cases were reported along with 649 deaths.
Diarrhoea is a leading cause of morbidity and mortality in Botswana, the majority of deaths occurring in this same age group. A number of researches have established that in northern Botswana, seasonal, acute diarrhoea in children under five years of age has occurred across years, coinciding with major hydrological phenomena occurring in the area (rainfall/flood recession). The research was able to isolate a number of important protozoan waterborne pathogens associated with diarrheal disease outbreaks in the area, but could not reach a conclusion on causality of this disease syndrome in the region.
The case against contaminated portable drinking water pumped by Water Utilities Corporation and the now disbanded Department of Water Affairs is, however, stacking up.
In an interview during one of the numerous outbreaks, Kutloano Leshomo, Communications Officer for the United Nations Children’s Fund (UNICEF), said laboratory tests of samples from Francistown, conducted by the Centres for Disease Control (CDC) in Atlanta, USA, suggested the outbreak had come from various sources. Leshomo placed “contaminated water” first in the list.
Key evidence, however, came from a confidential letter from former Permanent Secretary in the Ministry of Health, Dr Koolatamo Malefho, addressed to the Permanent Secretary in the Ministry of Minerals, Energy and Water Resources dated 6th July 2012 which states, “This serves to draw your attention to the worrying trend of contaminated drinking water throughout the country. As you are well aware, microbiological contamination contributes to water borne diseases such as diarrhoea, especially among children”.
In the letter, a copy of which was passed to the Managing Director of Water Utilities Corporation, Godfrey Mudanga, Dr Malefho blames scores of deaths and diseases during the last year’s diarrhoea outbreak in the Ngami area on contaminated water: “We are currently experiencing an outbreak in the North West District (Ngami) that has resulted in unnecessary morbidity (diseases), and mortality (deaths). Water contamination has been identified as a contributor to the increased cases of diarrhoea in these districts.
Dr Malefho’s letter paints a grim picture: “From 24th to the 28th of April 2012 there was a localised outbreak of diarrhoea in Omaweneno Village in Kgalagadi South. This outbreak affected mainly the primary school children but our weekly report did indicate that children under five were also affected. This localised outbreak was due to a contaminated water tank supplying the village and the contamination was indeed confirmed at the food laboratory. We have also received reports of increased cases of diarrhoea from the districts, notably Kweneng East, mainly Molepolole, as well as Chobe.”
A Botswana Bureau of Standards audit on the microbiological status of Water Utilities Corporation portable water conducted in 41 towns and villages in Botswana, including Gaborone, also offers a rare glance into Botswana’s drinking water safety. The audit revealed that the extent of unsafe drinking water in Botswana has reached crisis proportions. On a scale of zero to 100, with zero being totally unfit to drink and 100 being fit to drink, the average for all the 41 towns and villages was 28.
A number of major villages among them Kanye, Tlokweng , Moshupa, Tsabong, Good Hope, Hukuntsi and Bokspits scored zero indicating that their portable water supplied by Water Utilities Corporation was very unsafe to drink. Other villages that scored zero were East Hanahai, Metsimantsho, Ncojane, Charles Hill, Karakubis, New Xanagas, Digawana, Rahuna, Takatokwane, Ditshegwane, Moshaneng, Hatsalatladi, Monwane, Lekgwabe, Tshane, Lehututu and MiddlePits also scored a zero.
The BOBS audit report also revealed that Kang portable water, which scored a hundred, was safer to drink compared to the Gaborone portable water, which scored 75, making it barely safe to drink.
A Monthly Compliance Report compiled by WUC’s Technical Services Department (Water Quality Section) in December 2012 suggests that the situation is worsening. None of the sampled 15 management centres (towns and villages) attained 100 percent compliance. In fact, some villages which previously complied with the BOBs quality standard had dropped in compliance ratings.
Areas such as Lobatse and Molepolole had scored 100 from samples taken early 2012 but by December 2012 their compliance ratings had gone down to as low as 44.4 percent. Gaborone’s compliance was the highest at 90 percent from samples taken at Diremogolo reservoir, followed by Selibe Phikwe at 80.6 percent. Francistown’s compliance stood at 72.4 percent followed by Masunga at 60.6 percent.
The rest were as follows: Kanye 52.4 percent, Kasane 42.3 percent, Mahalapye 58.6 percent, Mochudi 41.2 percent, Palapye 55.9 percent and Serowe 50 percent.
The report further indicated that areas such as Letlhakane, Gantsi and Tsabong were not rated because no sampling was done in those areas. Even though WUC has always justified its exorbitant tariffs and pointed to the ‘expensive’ chemicals used to clean the water, the Corporation’s Water Quality Section found out that the water supplied to customers had insufficient chlorine. All the sampled areas failed microbiological parameters. It was recommended that the areas needed disinfection and a boost of chlorine levels to above 0.6 mg/l.
The bad news is that with Water Utilities Corporation crippled by acute cash flow problems, there are fears that the country’s water safety may be compromised. The good news however is that Botswana may be saved from the effects of diarrhoea cased by contaminated water.
Results from a randomized, controlled pilot study in 76 Batswana infants with acute diarrhea show that rapid diagnostic testing and Lactobacillus reuteri Protectis supplementation for 60 days resulted ina significant increase in 60-day adjusted standardized height and significantly less recurrent diarrhea compared to standard care and placebo treatment.
The study was conducted in Botswana and the preliminary results were presented at the Infectious Disease Week in San Diego, USA, on October 10 2015.
“These results are very exciting. Our trial has shown that the administration of L. reuteri DSM 17938 shows real promise to mitigate the devastating effects of diarrhea disease in sub-Saharan Africa. Previous probiotic trials have focused on outcomes such as duration of diarrhoea, which are somewhat relevant for families and clinicians, but not nearly as important as a hard outcome such as standardized height, which has been directly linked to stunting, cognitive deficiencies, and eventual adult accomplishment”, says Associate Professor Jeffrey Pernica at McMaster Children’s Hospital in Hamilton, Canada, who conducted the study.
Diarrhoea kills and disables children. Diarrhoea is the second leading cause of mortality in the world among children under the age of five, as well as a major cause of both growth failure and delayed cognitive development. There is a clear need for improvements in diarrhoeal disease management in resource-limited settings.
The pilot study demonstrated that the use of rapid enteric diagnostics (permitting timely targeted antimicrobial therapy) and L. reuteri Protectis were both feasible in a resource-limited sub-Saharan African context. These interventions led to significant increases in growth and decreases in recurrent diarrhoea. The next step will be to validate these findings in a trial with a much larger number of children.
BioGaia is a healthcare company that develops markets and sells probiotic products with documented health benefits. The products are primarily based on the lactic acid bacterium Lactobacillus reuteri, which has probiotic, health-enhancing effects.