Monday, July 4, 2022

Inside Botswana’s biggest man-made disaster ever

Kitso Mokaila must be finding it hard to hide that smirk on his face. As Gaborone keeps its kitchen taps running despite an American Embassy warning that the city’s water is not safe to drink, the Minister of Minerals, Energy and Water Resources must be congratulating himself on his successful handling of the battle for public opinion.

Local newspaper desks were snowed under press releases from the Water Utilities Corporation and the Ministry of Water Resources. Reporters were briefed on how Botswana water is subjected to BOBs quality control standard and the minister took the script to the parliament floor to drive home the point that, “Botswana water is one of a few in developing countries that you could drink directly from the tap without fear of contracting waterborne diseases.”

This, he said, was made possible by the state of the art treatment facilities that the water utility had established to meet the set quality standards.

Stung by the US embassy memo which took up a chunk of local newspapers’ column centre meters, Mokaila kicked the government PR machine into action, and the truth was lost in the spin. At stake is the link between hundreds of infants who have been dying from regular diarrhea outbreaks and Water Utilities Corporation’s contaminated drinking water.

Sunday Standard investigations have turned up information that for many years government officials were aware that the water they were pumping into kitchens and public stand pipes throughout the country was contaminated and is believed to have killed hundreds of people over the years.

Death by water

Two years ago government reported 183 deaths over a period of three months due to diarrhea outbreak. Responding to a question in Parliament, Assistant Health Minister Gaotlhaetse Matlhabaphiri revealed that a total of 171,280 diarrhea 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.

Diarrhea 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 diarrhea in children under five years of age has occurred across years, coinciding with major hydrological phenomena occurring in the area (rainfall/flood recession, Alexander unpublished data). 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, comes from a confidential letter from the 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 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.”

More damning evidence

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 indicates 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.

PMTCT programme unravels

Among the biggest casualties of the ministry’s questionable handling of the drinking water safety crisis has been Botswana’s prevention of mother to child HIV/AIDS transmission programme PMTCT. At the height of the 2006 diarrhoea outbreak, the Ministry of Health (MOH) had difficulties attributing the outbreak to any one pathogen, but most of the cases appeared to be associated with bottle feeding. Assistance from the US Centres for Disease Control (CDC) was sought and the results of the CDC/MOH investigation were presented at the PEPFAR (President’s Emergency Plan for AIDS Relief) meeting in Durban, 2006. The main findings disrupted the initial plan to wean breastfeeding children from their mothers and enrol them on formula milk to avoid mother to child transmission of the virus.

The CDC found widespread water contamination in four northern districts of the country. The public water supply, which has long been considered safe, was contaminated in 26 villages tested. A variety of pathogens causing the outbreak were identified, including cryptosporidium, enteropathogenic e coli (classic ‘bottle diarrhea’) and salmonella, amongst others. The CDC conducted a closer evaluation of 154 children hospitalized for diarrhea. Most (96 percent) of the children were under 2 years of age, median age 9 months.

The CDC investigators consider the true extent of the mortality from this outbreak remains unknown but may exceed the figures reported above, since many infants died outside of the health facilities. In three districts alone, there were 547 excess deaths reported (four times the historical under fives mortality rate). In one village visited, 30 percent of their formula-fed babies (and no other babies) died during the outbreak. Among formula-fed newborns CDC started following in January before the outbreak, preliminary data indicated 10 percent dead when re-visited at age 3-4 months. On the strength of these findings, CDC recommended a formula policy review and promotion of breastfeeding.

“The investigators reiterate that it is essential to ensure formula-fed infants have enough formula and safe water, and there needs to be improved training for health staff and mothers in nutrition and management of diarrhea. They also called for a study on the impact of point-of-use water treatment, safe water vessels, soap and handwashing promotion. The investigators recommended that the programmes offering formula should ensure clean water, uninterrupted supply of formula, growth monitoring, and nutrition counselling and that health staff should be taught that formula fed infants are at risk.

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