Abstract

The present study was aimed to determine the frequency of water borne diarrheal infections and gastroenteritis in two of the flood affected camps of Karachi and nearby areas. Each year approximately, 579,732 people are adversely affected by this phenomenon, putting Pakistan 9th in terms of flood-affected countries worldwide. Patients and Methods: All patients suffering from diarrhea (more than 3 stools per day for the last 2 days), abdominal pain, vomiting or fever who were residing in the camps were included in the study. After taking consent, a fresh stool sample for D/R and C/S, and 5 ml of venous blood sample for CP and ALT and other viral markers were collected from each patient suffering from any of the symptoms like jaundice, diarrhea, vomiting, fever and abdominal pain during past 2-3 days. Direct microscopy of the stools was done to see any protozoal or bacterial infection. Culture of stool was also set up simultaneously. Hemoglobin % age was noted for each patient. Serology of Hepatitis E and A virus using ELISA (Anti HEV-IgM, and anti HAV IgM) was done in those with more than 2 times raised ALT level. Results: A total of 500 samples collected from refugee camps of flood affected areas near Karachi were included in this study. All patients were mal nourished, having below normal Hb% ages, and were suspected cases or patients of diarrhea with elevated ALT (Alanine Transaminase) values. Occult blood was found positive in 40% (200) specimens; protozoa were also seen i.e., trophozoit stage of Giardia lamblia in 45% (225) of specimens; Entamoeba coli in 95% (475) and Balantidium coli in 20% (100) of stool specimens, while cyst forms of Entamoeba histolytica were present in 35% (175) specimens. Bacteriological analysis showed high bacterial prevalence of E. coli with 63% (315), followed by Enterobacter specie with 55% (275), then 20% (100) and 12% (60) of Klebseilla oxytoca and Klebseilla pneumoniae respectively. Proteus vulgaris and Citrobacter freundii found in the same ratio of 8% (40, 39) with 2% (10) specimens of no microbial growth. Overall

Highlights

  • Sources of drinking water supply in the world as well as in the Pakistan are mostly surface and ground waters

  • The present study reveals the presence of Hepatitis E virus (HEV) and HAV associated viral diarrhea along with the presence of protozoal and bacterial infections in the flood relief camps

  • Direct microscopic evaluation of gram’s iodine preparations of stool showed that protozoa were present in majority of specimens i.e., trophozoits of Giardia lamblia were seen in 45% (225), Entamoeba coli were present in 95% (475), and Balantidium coli were seen in 20% (100), while cyst forms of Entamoeba histolytica were present in 35% (175) of the test samples (Table 1)

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Summary

Introduction

Sources of drinking water supply in the world as well as in the Pakistan are mostly surface and ground waters. Other reasons for rise in water born outbreaks are increasing vulnerable populations, political upheaval and high numbers of refugees in developing countries. Natural disasters such as flooding and droughts due to climatic changes may affect global water quality. A report of 2003 stated that water born infections claim 250,000 deaths each year in Pakistan among which Typhoid fever was the leading cause [1] [2]. Consumption of unsafe drinking water and inadequate sanitary conditions contribute to increase rate of diarrheal infections [3]-[5]. Consumption of safe drinking water can reduce diarrhea and other related diseases in up to 50% cases.

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