Water contaminated with pathogens (tiny organisms that cause disease, ex.-bacteria, viruses, parasites) is a major source of illness in South Africa. Infection with water-borne illness occurs through drinking contaminated water, contact with contaminated water such as bathing or swimming, eating food that is contaminated or washed with contaminated water, poor personal and hand hygiene, and lack of availability of clean water and proper handwashing facilities. Water-related diseases commonly seen in South Africa include dysentery, cholera, hepatitis A, E. coli, typhoid fever, salmonellosis, viral gastroenteritis, campylobacter, cryptosporidiosis, giardiasis, shigellosis, schistosomiasis, polio, and even insect-borne diseases such as malaria and Dengue fever.
Water pollution with potentially toxic chemicals such as arsenic, fluorine, and lead is also a major health concern. Many water-borne diseases can be deadly. Preventative measures (finding ways to obtain clean, non-contaminated water) are the best defence against these diseases, but medical management with hydration, supportive care, and medications is possible and lifesaving in many cases.
Rehydration and Electrolyte Replacement is possibly the most important treatment for water-related illnesses because dehydration from vomiting and diarrhoea is a major cause of death with these diseases, especially in young children. The goal of treatment is to replace lost body fluid and electrolytes/salts. Severe cases of dehydration may need intravenous (IV) fluids at a hospital or other healthcare facility with 0.9% sodium chloride (normal saline/NS), dextrose 5% in water (D5W), or lactated ringer’s solution (LR). Electrolytes such as magnesium or potassium may be added to IV fluids to replace those lost from vomiting or diarrhoea.
Oral rehydration solutions are a good option to treat dehydration from water-related diseases. Even if water is clean, it does not contain the electrolytes your body needs, and fruit juices and sports drinks can be too sugary for a sensitive stomach. Premixed bottled oral rehydration solutions are best if they are available, but rehydration powder mixtures are easier to find. They should be mixed with properly cleaned and treated, or preferably, bottled water.
Are not always necessary, and the preferred treatment is to allow the disease to run its course and ensure adequate hydration. Vomiting, diarrhoea, and fever are ways the body works to rid itself of a pathogen, and the immune system will fight the infection within a few days or weeks. However, some water-borne illnesses will require anti-infective treatment, sometimes depending on the severity of the illness or other health-related factors.
Anti-diarrhoeals can be used to decrease the frequency and severity of diarrhoea symptoms and help decrease the risk of hydration in some water-related diseases. However, they are not recommended for mild illness, as diarrhoea is one way the body rids itself of pathogens, and they should not be used in bloody diarrhoea, as they could make symptoms worse. These medications work by targeting receptors in the gut that slow down the muscle movements in the intestines, or by decreasing inflammation in the intestine. Examples include loperamide, diphenoxylate-atropine, and bismuth subsalicylate (this medication should not be used in children).
Antiemetics treat symptoms of nausea and vomiting associated with water-related disease by blocking receptors in the body that induce vomiting. Like many other medications, it is not recommended to use these when illness is mild. However, antiemetics can help decrease the risk of dehydration and the need for rehydration therapy. Examples of medications recommended for use in infectious gastroenteritis include ondansetron, prochlorperazine, and metoclopramide.
Pain Relievers and Fever Reducers are used to treat headaches, body aches, and fevers associated with water-related infections. These are recommended for patient comfort. Examples include NSAIDs (non-steroidal anti-inflammatory drugs)- ibuprofen, naproxen, and acetaminophen.
Nutritional Supplements may be used to help treat malnutrition associated with these illnesses, which could contribute to the duration and severity of symptoms. Zinc supplements have been found to be particularly beneficial, especially in children.
Chelation Therapy may be used when there is toxic exposure to a chemical such as lead or arsenic through water. These medications work by binding to chemical ions in the bloodstream to eliminate them from the body. Examples include dimercaprol, D-penicillamine, and 2,3-dimercaptosuccinic acid (DMSA).
Are expected with many medications and may often include nausea, drowsiness/dizziness. Headache, diarrhoea, and/or constipation. It is important to note that although nausea and diarrhoea are common medication side effects, in the case of these diseases, most medications can help decrease these symptoms. More serious side effects are discussed below.
Clostridium difficile (C. diff) infection is a rare, but serious side effect of anti-infectives, especially antibiotics, as they can kill the “good” bacteria in the gut and allow for “bad” bacteria to grow. If you are taking an antibiotic for water-related infection and experience an increase in severity of diarrhoea or new onset bloody diarrhoea, you should seek medical advice right away. This is a serious and very contagious infection, but it can be treated with a new course of antibiotics.
Antimicrobial Resistance is an increasing concern in many of these illnesses. Pathogens can mutate to develop ways to avoid being killed/inhibited by anti-infective medications. It is important to take your medications exactly as prescribed and to finish the entire course, even if you are feeling better. If you experience continued symptoms that are not getting better after a few days of treatment, you may need to see a healthcare provider to get a prescription for a new, different medication.
Organ Failure/Dysfunction can occur with many medications because the body metabolizes and eliminates them through the kidneys and liver, especially. It is important to notify your doctor immediately if you notice a decrease in urine or yellowing of the skin or whites of your eyes. If you must take medication for longer than a few days, it is important to follow up with your doctor for monitoring of therapy and routine bloodwork, which can detect organ dysfunction.
Clean water for drinking, handwashing, and bathing is the best way to avoid water-related diseases. Many organizations may provide safe, bottled water to your family. If this is not an option, there are ways to treat water to make it healthier for you. Water obtained from the tap or a tanker should be boiled for at least 3 minutes before use. Water from the environment, such as streams, rivers, or pooled water on the ground, should be filtered and then boiled for at least 5 minutes before use. It is important to know that commercial water filters made to collect very tiny particles can remove a few pathogens, but not all of them, and running the water through a cloth will not catch any pathogens, just larger objects such as dirt, gravel, insects, etc. Adding 5 ml (one teaspoon) of chlorine bleach to 20-25 litres of water, stirring, and waiting for 30 minutes before use can kill many pathogens. It is also important to store clean water covered because mosquitoes will breed in clean water, which can be a source of illnesses such as malaria and Dengue fever.
Other ways to prevent contracting a water-related disease include proper, frequent handwashing with soap and clean water (wet hands, add soap, rub for at least 20 seconds, being sure to include between fingers, palms, and backs of hands, wrists, and fingernails, then rinse and dry with a clean towel). You should wash your hands before eating and drinking, after using the toilet, after changing your baby’s diaper, and after contact with animals or other people. You should avoid eating uncooked foods, or only eat prepackaged foods or fruits and vegetables that can be peeled before eating. You should also avoid swallowing water when swimming and avoid contact with people who are sick.