Background
Safe drinking-water is an essential resource for human life, a basic human right and one of the key components of effective health protection policy [
1,
2]. It is known that drinking-water is one of the main transmission pathways for diarrheal diseases [
2]. It is also established that improving the bacteriological quality of drinking-water significantly reduces the risk of waterborne diseases [
3]. Thus, every effort should be made to achieve a satisfactory drinking-water supply to all in terms of adequacy, safety and accessibility [
2].
Most developing countries face high population growth which poses a considerable challenge for local authorities who are not able to meet basic needs of populations whose most crucial problem is sustainable access to save drinking-water [
2,
3]. Ensuring availability and sustainable management of water sources and sanitation for all, remains one of the most important Sustainable Development Goals governments need to achieve [
4]. According to the World Health Organization (WHO), safe drinking-water does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur between life stages [
2]. Therefore, microbial, chemical and other acceptability aspects of drinking-water should feet with WHO guidelines for drinking-water quality [
2].
Supply of safe drinking-water for human is a critical problem in African countries [
5‐
7], more importantly in remote areas due to the hyper centralization of public management services [
8,
9]. As in other parts of the country, but less in the Central or Littoral regions, the West Cameroon does not have a continuous water supply system, leading to majority of people to use surface, well, borehole and river water as alternative source of drinking-water and for other water needs [
8,
10]. Studies carried out in similar areas of Cameroon have highlighted the poor bacteriological quality of these water sources [
11‐
14].
Waterborne diseases are the second leading cause of death and infant morbidity after malaria in Bafoussam and in other main cities of the West Cameroon [
15], indicating the non-achievement of bacteriological standards of drinking-water standards for human consumption [
16]. Morbidity and mortality rates of diarrheal diseases are more prevalent among children under 5 [
15]. Among the top 10 diseases in children under 5 including malaria, infection of the lower respiratory tract, upper respiratory tract infection, meningitis, typhoid fever, bloody diarrhea, diarrhea (non-bloody diarrhea), dysentery, parasitic worm infection and gastritis, 4 of them are related to the consumption of unsafe water and/or food [
15,
16]. The germs responsible for these diseases are generally transmitted by feco-oral route and represent a major concern in public health risk [
16]. Microbiological contamination of water occurs in a context of poor waste management including faeces [
17]. Contaminated water with bacteria should not be intended for human consumption. Coliforms can be used as indicator to monitor the microbiological quality of drinking-water [
18,
19] and their rapid detection is therefore crucial and should be easy to perform in order to evaluate water quality especially in resource limited countries, such as Cameroon. Preventive public health approaches for safe drinking-water must include rapid assessment of microbiological quality of water to guide monitoring of water quality and treatment. In line with this point of view, this study aimed to assess the potability of water points using Micro Biological Survey Hazard Analysis Critical Control Point (MBS-HACCP) & water Easy test® [
20] in the West Cameroon.
Discussion
Safe drinking water is essential for life. This study aimed at analyzing the presence of bacteria, through quantitative detection of Total Coliforms in both improved and unimproved water sources in the West region of Cameroon. Inhabitants of the study area are in majority poor with limited capacities including financial to afford pipe borne water [
8,
15], they turn to health threatening and potentially highly polluted water sources which could explain why diarrheal diseases mostly occur in populations with limited financial means. This has been described by a study conducted in South Africa, which highlighted that cholera outbreak does not on results from inadequate sanitations, but also due to poverty [
22].
According to the WHO guidelines for drinking-water quality, the microbial safety of drinking-water includes the prevention of the drinking-water contamination by the microorganisms or the reduction of contamination to levels not injurious to human health [
2]. While ingestion of microorganisms from contaminated water and food is the main cause of diarrheal diseases [
23], lack of safe drinking-water is one of the leading causes of death especially in children under 5 [
15,
16]. Total Coliforms are used as indicators of faecal pollution, the effectiveness of water filtration or disinfection, the integrity and cleanliness of water distribution systems [
24,
25]. The WHO guideline for drinking-water quality recommends the absence of Total Coliforms in drinking-water [
2]. This study highlights poor quality of the water due to the presence of Total Coliforms in high concentration. In fact, of the 22 water samples collected, 20 contained coliforms which could be associated with high risks of diarrheal diseases outbreaks, such as cholera as suggested by previous studies that stipulate fecal coliform-contaminated water may contain
Vibrio Cholerae [
26,
27]. Both types of water sources (improved and unimproved) were contaminated indicating a possible human or animal faecal pollution of these water points.
The minimal recommended distance between latrine and water source to avoid external contamination ranged between 15 and 50 m [
2,
28]. The average distance found in this study did not feet with this recommendation. Even though improved water sources were more closely to latrines, unimproved water points which are open water sources showed greater concentration of Coliforms. This may be explained by the nature of the improved water sources construction satisfactorily protects the water from any external contamination [
29]. This is consistent with previous studies which suggest that unprotected water sources have high probability of being contaminated by fecal material carried out by run-off water mainly during rainy season [
22,
30]. Globally, the results of this study reveal poor quality of water sources used by the population. Our results are consistent with previous studies carried out in the West Cameroon and similar areas which indicated an alarming lack of safe drinking-water [
8,
11‐
14]. Water samples with a small amount of germs turned pathogenic after 24 h of incubation. This maximum incubation time does not deviate from the WHO recommendations whose procedures include membrane, filtration followed by incubation of the membranes on selective media at 35–37 °C and counting of colonies after 24 h [
2].
There is no pH guide value but an optimum between 6.5 and 9.5. The average water pH found in this study was 6.5 which correspond to the lower value recommended by WHO [
2]. The temperature of the samples varied between 22 and 26 °C. This indicator needs to be monitored to support preventive public health to control measures, as it has been established that outbreaks of waterborne diseases such as cholera are consistent with a rise in temperature during the dry season and the peaks are reached in the rainy season [
30]. Monitoring temperature and pH variations during the seasons could help in the planning and implementation of outbreaks prevention measures.
Microbial and other water constituents can affect the appearance of the water [
2]. Most samples were clear (90.91%), suggesting their good quality and acceptability based of this criterion, but the Total Coliforms analysis have shown another case of figure indicating that changes in the normal appearance of water is not a sufficient signal of the water quality.
Conclusions
This study revealed the poor microbiological quality of the water sources used by inhabitants of West Cameroon. These poor water sources could be at the origin of waterborne disease outbreaks. Even though qualitative analysis was not performed, the MBS method detected the presence of Coliforms in almost all the water samples collected. It is also important to emphasis that the quantity of Coliforms found in the samples could indicate the presence of disease-causing bacteria such as Vibrio Cholerae. The average distance (8.7 m) between the water point and the nearest latrine doesn’t meet up with WHO recommendations (15–50 m to the nearest latrine), showing groundwater high risk of contamination by faeces infiltration. There is need for the local public health services and rural council to establish local water management committees to help in monitoring and ensure water sources do not represent a risk of waterborne disease outbreak. In addition, local populations need to be trained on simple and cost-effective of water treatment techniques. Additional qualitative microbiology studies need to be conducted to isolate germs involved in diarrheal diseases.
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