MASVINGO POLYTECHNIC

DIVISION OF APPLIED SCIENCES

ENVIRONMENTAL HEALTH DEPARTMENT

A research project Submitted to Masvingo Polytechnic in Partial Fulfilment of the

Requirements for the Diploma in Environmental Health

By

CHINYERUSE DAVIDZO

2022
 MASVINGO POLYTECHNIC COLLEGE

DIVISION OF APPLIED SCIENCES

DEPARTMENT OF ENVIRONMENTAL HEALTH

SPATIAL PATTERNS OF DIARRHOEAL INCIDENCES IN RELATION TO WATER

POINT TYPE AND STATUS IN WARD 7 CHIREDZI DISTRICT

Name CHINYERUSE DAVIDZO

Student Number 1120005C00320

Supervisor Mr. Kazonda H

A project submitted to Masvingo Polytechnic College in partial fulfillment of the National

Diploma in Environmental Health.
 ABSTRACT

The United Nations(UN) and other countries declared access to safe drinking water as a basic
fundamental right to human life and an essential step towards improved living standards. In light
of this sentiment, this study analysed the spatial patterns of diarrhoeal incidences in relation to
water point status and type in ward 7 of Chiredzi district. The data on location of diarrhoeal cases
was sought from Chilonga rural health center from the facility’s Environmental health
investigation reports so as to be able to analyse the relationship between the cases and the water
points status and type. A geospatial study was carried out using Geographical Information
System (GIS) technologies where all the functional water points were mapped.

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 ACKNOWLEDGEMENT

I would like to thank the almight for it is not by my choice that I have paddled so far with my
education, but by his grace, love and wisdom. My extended heartfelt appreciation goes to my
mother and father for their unwavering contributions to ensure that I get the best education.
Words cannot fully describe the power of their love, sacrifice, support and encouragement in
propelling me to this level. I feel great honour to express my gratitude to the most organized,
responsive, patient and supportive supervisor, Mr. Tafadzwa H. Kazonda, I wish to express my
sincere gratitude for your passion in your profession and in educating. I feel so lucky to have a
mentor like you, finding the just right challenge between pushing me to the better, encouraging
me and inspiring me as future public health expert. Your positive attitude and in-depth
explanations for difficult concepts greatly enriches every class you teach you are appreciated and
hope you feel encouraged as an educator and proud of the work I have managed to present.

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 DEDICATON

This piece of information is dedicated to my father, mother, brothers, sisters and my baby girl
Mitchelle. They are all my pillar of strength and motivators. I know that they are very proud of
me right now.

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TABLE OF CONTENTS
Abstract…………………………………………………...i
Acknowledgements……………………………………….ii
Dedication………………………………………………...iii
Table of contents………………………………………… iv
List of Figures……………………………………………..v
List of Tables……………………………………………...vi
List of Appendices………………………………………..vii
List of Abbreviations…………………………………….viii
CHAPTER 1
INTRODUCTION……………………………………….1
1.0 Introduction………………………………………….1
1.1 Background to the Study…………………………….1
1.2 Statement of the Problem……………………………5
1.3 Broad objective……………………………………….6
1.4 Specific Research Objectives………………………...6
1.5 Research Questions…………………………………..6
1.6 Significance…………………………………………...7
1.7 Limitations……………………………………………7
1.8 Delimitations………………………………………….7
CHAPTER 2
LITERATURE REVIEW………………..8
2.0 Introduction………………………………………….8
2.1 Diarrhoeal incidences ………………………………..8
2.2 Diarrhoeal incidences and water point func ………10
2.3 Microbial quality of water ………………………….12
CHAPTER 3

RESEARCH METHODOLOGY………15

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3.0 Introduction…………………………………………15

3.1 Research Design……....……………………………..15

Study Area….……………………………………………..15
Target Population…………………………………………17

3.4 Study Population………………………………………18

3.5 Study Variables….……………………………………..18

3.6 Sampling and Sample size……………………………...18

3.7 Data Collection Tools…….……………………………..19

3.8 Pilot Study…….…………….……………………………19

3.9 Validity…...………………….……………………………19

3.10 Reliability….…………………………………………….19

3.11 Ethical Considerations….………………………………19

3.12 Data Management….……………………………………20

CHAPTER 4

DATA ANALYSIS…………………………….21

4.0 Introduction…….………………………………………….21

4.1 Map showing diarrhoeal cases……………………………23

4.2 Diarrhoeal incidence spatially related……………………24

4.3 Microbial quality…………………………………………..26

CHAPTER 5

CONCLUSION………………………………………………… 28

5.0 Introduction…………………………………………………28

5.1 Discussion….…….………….………………………………28
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CHAPTER 6

RECOMMENDATIONS …….…………………………………29

REFERENCES…………………………………………………30

APPENDICES…………………………………………………..31

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 CHAPTER 1

INTRODUCTION

This chapter gives details of the background of the study, problem statement, research
objectives, research questions, significance of the study as well as the delimitations of the study.

1.0 BACKGROUND OF THE STUDY

Diarrhoea is a global problem, but is especially prevalent in developing countries in conditions

of poor environmental sanitation, inadequate water supplies, poverty and limited education.
According to WHO (2014), approximately one billion cases of diarrhea occur each year
worldwide causing a burden that was about 99.2 million daily lost. It is well known that diarrheal
disease is one of the leading causes of illness and death in young children in developing
countries.

Access to adequate clean water supply and sanitation services is fundamental human right and is
essential to life and health dignity. UN, ECOSOC (2002). According to the latest UNICEF/WHO
(2015), the report on sanitation and drinking water on a global perspective revealed that over 663
million people still lack access to safe drinking water and about 159 million people rely on
surface water as their source of water to meet their household water needs.79% of the people
depending on unimproved drinking water sources and 93% depending on surface water resides in
rural areas. UNICEF/WHO (2015). The lack of this adequate water supply in areas is a major
cause of diarrhoeal disease which kills nearly 760000 children under the age of 5 years globally.
Suri and Kumar, (2015)

Diarrhoea has long been reported as a major public health problem in low income countries
leading to morbidity and mortality among the children under the age of 5. An estimate of 11% of
the child mortality occurred in India, diarrhoea being the cause of mortality MDG, India country
report, (2014)

Diarrhoeal disease is a second leading cause of death in children under the age of 5, killing about
525000 children each year (WHO 2017). Diarrhoea is the passage of three or more loose or
liquid stools per day or more frequent than is normal for the individual (WHO, 2015).
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Children are affected by diarrhea mainly due to poor environmental sanitation and hygiene,
inadequate water supply and poverty (Boschi-Pinto et al, 2008). It is both preventable and
treatable. A significant proportion of diarrhoeal disease can be prevented through the use of safe
drinking water and adequate sanitation and hygiene.

Diarhoea is also leading cause of malnutrition in children under five years of age. It can last
several days and can leave the body without the water and salts that are necessary for survival
(WHO 2017). In the past for most people, severe dehydration and fluid loss were the main causes
of diarrheal deaths. Now other causes such as septic bacterial infections are likely to account for
an increasing proportion of all diarrhoea associated deaths. Children who are malnourished or
have impaired immunity as well as people living with HIV are mostly at risk of life threatening
diarrhea (Nwaoba et al, 2016). Diarrhoea infection is spread through contaminated food or
drinking water. It can also be transmitted from one person to another as a result of poor hygiene.

Globally, as population increases and development activities demand for increased allocations of
ground water and surface water for domestic, agriculture and other sectors demand for water, this
would also be intensified leading to tensions, conflicts among users and excessive pressure on
the environment (Henne et al, 2012). The increasing stress on fresh water resources brought
about by ever-rising demand, profligate use as well as by growing population worldwide is of
serious concern. Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every
year (WHO, 2017). In 2017, almost 1.6 million people died from diarrheal diseases globally.
Overall, the highest death rates are in the sub Saharan Africa and South Asia where the rate
typically ranged from 50 to 150 per 100000. In the Central African Republic and Chad rates are
estimated to be over 150 per 100000. (Bernadette (2019)

The death rate from diarhoeal diseases is highest in the world’s poorest countries by 100 annual
deaths per 100000 children. In those countries with the worst health including Madagascar, Chad
and the Central African Republic, the rate is higher than 300 per 100000. In high income
countries, the death rate is very low such as the European countries (Bernadette, Hannah and
Marx, 2019)

Over a billion of the world’s people remains without access to safe drinking water.
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Millions of lives are at risk from preventable disease and the future of millions of the world’s
children are blighted by the multiple deprivation of poverty, lack of education and ill health that
often accompany poor water and sanitation (COHRE et al 2008). Sub Saharan Africa lags other
regions in the world as far as provision of safe water is concerned. The water crisis in this region
is illustrated by the fact that only 56% of its population has access to safe water (Manzungu et al
2012).

In 2015 the total number of people in rural Malawi lacking access to an improved water supply
was 3.64 million. It is mostly estimated that 61% of the population had an access to an improved
water source in that year (WHO, 2016). The provision of clean drinking water and improving
public health standards conferred to the state. Most deaths from diarrhoea among children occur
in Africa, where diarrhoea is the largest cause of death among children under five years of age
and also a major cause of childhood illness (Black et al, 2003, Walker et al 2012). Worldwide,
780 million individuals lack access to improved drinking water and 2.5 billion lack improved
sanitation hence diarrhea due to infection is widespread throughout the developing countries.
(WHO 2017)

Like in other sub-Saharan countries, diarrhoea remains a major public health concern in
Botswana, particularly among children despite strengthened surveillance and launching of
programs such as Integrated Management of Childhood Illness(IMCI). Although 95% of
Botswana’s population is reported to have access to treated safe water supply, dependency on
untreated open water sources in un-gazetted rural communities presents serious health risks.
Unlike in gazette settlements are the responsibility of individual households. As such, outbreaks
of water related diseases diarrhea are rampant mostly in the Ngamiland district in the northern
part of the country where many settlements are ungazetted and have ample access to open
surface water.

In Zimbabwe mid-2008 to 2009 a water crisis occurred and resulted in severe cholera outbreak
accounting for over 4000 deaths (Mason 2009). This outbreak was attributed to lack of clean
water for domestic purposes such as cooking and drinking. Zimbabwe has experienced several

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cholera outbreaks since the early 1970s. Cases have been reported in both urban and rural
communities.

According to a study published by Manzungu and Chioreso (2012) for Zimbabwe, the Harare
city health department revealed that the proportion of water samples that failed to meet with the
WHO standards rose from about 8% in 2001 to about 20% by 2005 in Harare. The incidence of
water related disease which often manifest as diarrhoea increased as a consequence.

The shortage of water supply services in rural areas of Zimbabwe causes a massive disease
burden. The Zimbabwe demographic health survey (2010) reported about 29,5% of rural
households that do not have an improved sources of drinking water and most of the water
sources

Affordable access to a sufficient quantity of safe water is fundamental to the health and dignity
of all. In rural areas, many people collect water of dubious quality from unprotected wells of
surface water sources, often at a great distance from their homes deterring them from collecting
sufficient quantities. Water is a common good, a free gift from nature. Traditionally everyone
has free right to water in Zimbabwe. It is against this background that the crisis in Zimbabwe
coalition (2010) argues the right to water contains both freedom and entitlements. Freedoms
include the right to maintain access to existing water supplies (Steve 2004). Entitlements include
the right to a system of water supply and management that provides equality of opportunity for
the people to enjoy the right to water.

Moreover, the elements of the right to water must be adequate for human dignity, life and health
(Crisis in Zimbabwe Coalition, 2010) Water is essential for maintaining livelihood and healthy
ecosystem (Manzungu et al, 2012) whilst the various techniques have been used in the studying
of the relationships of water and sanitation facilities and population dynamics, geographic
information system has become a widely used technique as highlighted.

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1.2 STATEMENT OF THE PROBLEM

Diarrhoea is the second leading cause of death among children under five years of age in the
world, affecting approximately 1.5 million children per year (Masukawa et al, 2014). In many
developing countries such as Zimbabwe, diarrhoea is the leading cause of morbidity and
mortality among children. Every child aged below five years in the developing countries
experiences five incidents of diarrhoea each year (Tambe et al, 2015).

Like most rural communities in region 5 of Zimbabwe, Chilonga of ward 7 Chiredzi district has
a low coverage supply of water points of sound status with a total of seventy-eight (78) water
points of which some are either functional, abandoned, collapsed and /or non-functional. There is
a total of twenty-six (26) protected deep wells, three (3) shallow wells, and forty-nine (49)
protected and functional boreholes. Relative to this reality, ward 7 has had an increase in
diarrhoeal cases between year 2018, 2019 and 2020 partly attributed to people drinking water
from contaminated sources (Environmental health service annual reports for 2018 to 2019).The
diagram showing the diarrhoeal cases at Chilonga rural health centre

Fig 1.1: Incident cases of diarrhoea in Ward 7 Chilonga from 2018-2020.

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 Source: MOHCC,2021

1.3 RESEARCH OBJECTIVES

1.3.1 Broad research objective

To analyze the spatial patterns of diarrhoeal incidences in relation to water points status and type
in ward 7 chiredzi district

1.3.2 Specific objectives

The specific objectives of the study are as follows:

i. To map the incidence of diarrhoeal cases in ward 7 in year 2020.

ii. To determine the spatial relationship between diarrhoeal incidences and water point
functional status and type in ward 7 of Chiredzi district.

iii. To spatially analyse the microbial quality of water from water points in ward 7 of Chiredzi
district.

1.4 RESEARCH QUESTIONS

1.4.1 Broad research question

What is the spatial pattern of diarrhoeal incidences in relation to water point status and type in
ward 7 Chiredzi district?

1.4.2 Specific research questions

i. What is the spatial distribution of diarrhoeal cases in ward 7 in 2020?

ii. How are the diarrhoeal incidences spatially related to water point functional status
and type in ward 7 of Chiredzi district?

iii. What is the spatial distribution of water points in ward 7 of chiredzi according to their
microbial status?

1.5 SIGNIFICANCE OF THE STUDY

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 In pursuit of the deeper understanding of stakeholder participation, the spatial analysis of
the community’s water points and diarrhoeal incidences may serve as a plank board for
further academic analysis to the scientific community and local authority structure (ward,
district and perhaps provincial) as the issues around public health are evolving, dynamic
and subject to change. It may also contribute to stakeholder capacity development
process such as trainings, re-orientation, strategic planning, team building and for
organizational internal systems strengthening process such as organizational development
within the government structure as well as a formulation of public health committees
within the ward.

1.6 LIMITATIONS OF THE STUDY

The researcher had limited time to collect the required data due to the tight covid 19
restrictions of movement, though she finally managed to collect some when the
restrictions were a bit loosened

1.7 DELIMITATIONS OF THE STUDY

The research is going to be centered on villages of Chilonga ward 7 of Chiredzi district

because the incidences of diarrhoeal disease is increasing each year. The research is going to
focus on the relationship of diarrhoeal disease in relation to water points status and type.

CHAPTER 2
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 LITERATURE REVIEW

2.0 Introduction

This chapter focuses on literature that has been developed in relation to the area of study.
According to Hart (1988), a literature review is the selection of available documents, both
published and unpublished on a given topic which contains information, ideas, data and evidence
written from a particular standpoint. This is done to fulfil certain aims or express certain views
on the nature of the topic, how the topic is to be investigated and the effective evaluation of these
documents is in relation to the research being proposed. The researcher assets that a review of
literature informs the reader that the researcher knows the area of study and is abreast of the
major issues at play.
Neumann (2014) further insists that a good review assists in enhancing the researcher`s
knowledge and how the current research study is linked to it. Creswell (2012) further
complements that a good literature review places the research in a context and demonstrate its
relevance by making connections to a body of knowledge. It integrates and summarizes what is
known in an area whilst concurrently collating and synthesizing different results. In order to
build a framework upon which this review of literature is based, the following areas shall be
analysed:
i. Diarrhoeal incidence
ii. Diarrhoeal incidences and water point functional status and type
iii. Microbial quality of water from different water points

2.1 Diarrhoeal incidence

Almost everyone can become ill, or will be affected by diarrhoea at some point in their lives.
Diarrhoea can occur as a symptom of many different illness, as a side effect of some drugs or
may be due to anxiety among other things (WHO, 2017). Diarrhoea results from an imbalance in
the absorption and secretion properties of the intestinal tract, if absorption decreases or secretion
increases beyond normal, diarrhoea results (Fink et al, 2011). It can range in severity from an
acute, self-limited annoyance to a severe, life threatening illness.

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Infectious diarrhoea is acquired by faecal oral transmission that includes consumption of
contaminated food or water (Marjatta et al, 2003). With regard to water-borne diarrhoea,
transmission patterns occur when in-house water storage facilities and/or water sources are
contaminated (Jensen et al, 2004). Lack of access to safe drinking water, together with
inadequate sanitation services and hygiene have been identified by various authors as the major
contributors to diarrhoeal diseases and deaths globally. According to Pruss-Ustun and Corvalan
(2006), sanitation and hygiene represent an important health problem in the Philippines. WHO
(2009) reported that approximately 15000 of annual diarrhoeal deaths in Philippines are
attributed to poor Water and Sanitation Hygiene services (WASH). In three (3) out of the five (5)
regions of Mindanao, the second largest island of the Philippines, more than 20% of children rely
on unimproved sanitation facilities (UNICEF, 2009).

According to Chambers (2009), lack of adequate water supply and open defecation had adversely
affected around 2 billion people living in rural areas. Young et al (1988) revealed that in Malawi,
children living in households with sufficient quality water sources and latrines are at 20%
reduced risk of diarrhoea as compared to those who do not have the sanitation facilities. Cronin
et al (2016) also add that the risk of diarrhoeal disease in Indonesia is substantially higher in
households participating in unsafe disposal of child faeces than in those participating in safe
disposal. Gil et al (2004) supported that the unsafe disposal of faeces has raised the risk of
diarrhoea by 23% and he alluded that it is a risk factor for soil-borne infections of helminthes
like hookworms, ascaris and trichuriasis, Central Statistical Agency, Humphrey (2009)

Fewtrel (2005) argued that around 2 billion people, however, still do not have adequate
sanitation services worldwide such as toilets or latrines. According to WHO (2019) among those,
673 million still defecate outdoors, for instance in the street gutters, behind trees or in open
bodies of water. Ethiopia is a vast country where there is still very restricted access to better
water supply and sanitation services in rural areas where the majority of households defecate in
bushland or open fields. By so doing the nation has the highest infant deaths associated with
diarrhoea (Central Statistical Agency, 2016). Shrestha et al (2020), however alluded that the
water quality and latrine use are a risk factor for childhood diarrhoea.

The other factors that lead to causation of diarrhoea are demographic factors as many studies
have established that the diarrhoea prevalence is higher in younger children. Molbak et al (2000).
9
The prevalence is highest for the children who are 6-11 months of age, remain at a high level
among the one-year-old children (Molbak et al. ,2000). Other demographic factors like maternal
education, high number of siblings, younger age were significantly associated more diaarrhoea
occurrence in children less than five (Woldemicael, 2001). According to Acceding Bolarinwa et
al (2014), maternal education is an important determinant of health status of the under five
children. According to Telkemariam et al (2001), diarrhoea is prevalent among children of
women who have no formal education and mothers living in the north east region of Nigeria
experienced the highest prevalence of about 26,4%. Children whose mothers had no formal
education are more likely to have diarrhea as compared to those who had higher education.
Maternal education is an important predictor of diarrhoea among children aged 0-24 months in
Nigeria. Diarrhoea can also be associated with socio-economic factors like poor housing,
crowded conditions, low income and higher rate of diarrhoeal cases was statistically significant.

Diarrhea and malnutrition, alone or together, constitute major causes of morbidity and mortality
among children throughout the tropical world. Malnutrition can lead to increased frequencies and
duration of diarrheal illnesses in malnourished children is very high (Mata, 1992). In developing
countries, lack of exclusive breastfeeding among infants of 0-5 months of age and absence of
breastfeeding among children of 6-23 months of age are associated with increased diarrhoea
morbidity and mortality (Victora, 2011). Breastfeeding reduces exposure to contaminated fluids
and foods and contributes to ensuring adequate nutrition and thus non-specific immunity.

According to Hutton et al (2007), lack of water, basic sanitation and hygiene may account for as
much as 88% of the disease burden of diarrhoea and sanitation provision in most cities is
deficient in Sub-Saharan Africa. Most people do not have access to hygienic toilets so large
quantities of faecal waste are discharged into the environment without adequate treatment and
this is likely to have major impacts on infectious disease burden and quality of life, Takanashi et
al, (2009).

2.2 Diarrhoeal incidences and water point functional status and type

Water touches every part of our lives, from drinking to food preparation to bathing to cleaning.
Because of this, access to safe, clean water is critical. However, in the developing world where
infrastructure may be lacking, people are more likely to be exposed to water contaminated with

10
pathogens including bacteria, viruses and parasite from human and animal waste. Exposure to
contaminated water puts people especially children, at risk of diarrhoeal disease and other
illness.

Inadequate supply of quality drinking water as well as poor sanitation are among the world’s
major causes of diarrhoeal diseases. According to the World Health Organization (WHO, 2004),
estimates on basic hygiene-related diseases have a significant impact on human health. The type
and status of a water point thus its hygienic state (cleanliness, presence of protective fence where
applicable), intactness of the protective compartments of water point (absence of cracks), its
reliability, microbial, chemical or aesthetic/acceptability aspects have a major contribution to
diarrhoeal incidence, (Murphy et al, 2017). Diarrhoeal incidences alone causes 2.2 million of 3.4
million water related deaths per year. These deaths are mostly in children under five years of age
and the poorest households and communities (WHO, 2021).

Waterborne disease caused by contaminated water consumption can affect numerous people in a
short time (WHO, 2000). Nearly 1000 children die daily because of preventable diarrhoeal
diseases related to water and sanitation (Obi et al, 2004). According to WHO, (2014 diarrhoeal
diseases can be significantly prevented through safe drinking water and adequate sanitation and
hygiene, while the sustainable development goal 6 aims to ensure access to water and sanitation
for all by 2030. (SADWAF, 1996). Oswald et al (2007) reviewed that although the occurrence of
diarrhoea is caused by single water sources, there is also a combination of water sources
impacting on diarrhoea.

Drinking water supplies in developing countries are often devoid of treatment and the
communities make use of the most convenient water supply (Sobsey, 2002). Many of these
supplies are unprotected and susceptible to external contamination of surface runoff, windblown
debris, human and animal faecal pollution and unsanitary collection methods (WHO, 2008). In
many developing countries, people living in rural areas collect water from communal sources
which are either exposed such as unprotected wells, unprotected springs and rivers or improved
sources such as protected wells, boreholes and public stand pipes (Sobsey, 2002).

According to Obi et al (2004), many rural areas of South Africa such as Venda region, clean
potable water and sanitation are either lacking or inadequate. Village communities depend on

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untreated water from shallow wells, rivers and other surface water for drinking, laundry and
recreational purposes.

Safe drinking water is defined by WHO as that water having acceptable quality in terms of its
physical, chemical and bacteriological parameters. WHO (2007) also add that, quality water
requires guidelines and standards-setting permissible limits for each parameter. The World
Health Organization (WHO) guidelines are generally adopted as the international reference point
for standards by those countries that do not have their own. Water is essential in sustaining life
and a satisfactory (adequate, safe and accessible) supply must be available to all. Shrestha et al,
(2013) also posits that improving access to safe drinking water can result in tangible benefits to
health and wellbeing of population. Every effort should be made to achieve drinking water that is
as safe as practicable. As defined by WHO guidelines of drinking water 2011, safe drinking
water does not present any significant risk to health over a life time of consumption, including
different sensitivities that may occur between life stages. Safe drinking water is required for all
for the use in domestic purposes including drinking, food preparation and personal hygiene.

2.3 Microbial quality of water

Microbial quality is one of the primary indicators for the safety of a drinking water supply. Of all
contaminants in drinking water, human and/or animal faeces present the greatest danger to public
health, Tubatsi et al, (2014). Alexander et al, (2012) purports that pathogenic or disease-causing
microorganisms (including certain protozoa, bacteria or viruses) may be found in untreated water
supplies. Bacteriological monitoring or testing is a way of detecting this and thereby control
pathogenic bacteria in treated drinking water supplies (Nevondo et al,2012). Harwood et al
(2014) reviewed that the presence of water borne disease-causing microorganisms in drinking
water may result in gastrointestinal illness or diarrhea.

The greatest risk to public health from microbes in water is associated with the consumption of
drinking water that is contaminated with human and animal excreta, although other sources and
routes of exposure may also be significant Wolf et al, (2014). Infectious diseases caused by
pathogenic bacteria, viruses and parasites (for example protozoa and helminths) are the most
common and widespread health risk associated with drinking water. (Gruber et al, 2014).
According to WHO (2014) bacteriological parameters especially Escherichia coli (E coli) and

12
total coliform have been used to determine the general quality of drinking water worldwide. The
E coli in particular, has been found to be the most specific indicator of faecal contamination in
drinking water. Its presence indicates contamination of water with faecal waste that may contain
other harmfull of disease causing organisms including bacteria, viruses and parasites.

Obi et al (2016), reviewed that the microbial quality of river water used by the Venda rural
communities of South Africa showed that water from the sources was unsafe for human
consumption. The South Africa Department of Water Affairs and Forestry (SADWAF)
guidelines alluded that the Escherichia coli, shigella and salmonella were the predominant
potential pathogens that were isolated. SADWAF added that the microbial counts for faecal
coliforms, total coliforms, heterotrophic counts and enterococci exceeded the acceptable limits.

UNICEF/WHO (2015) reported that, over 663 million individuals still lack access to safe
drinking water and 159 million persons rely on surface water as their source of water to meet
their household water needs. Among those relying on surface water, 93% of them reside in rural
areas (UNICEF/WHO, 2015).

Drinking water or potable water is defined as water that can be consumed without concern for
adverse health effects (WHO, 2009). Potable water does not have to taste good, likewise, water
may be palatable but not necessarily safe to drink. It is also defined as water having acceptable
quality in terms of its physical, chemical, bacteriological parameters so that it can be safely used
for drinking and cooking (WHO, 2004). WHO (2011) defined drinking water to be safe if and
only if no significant health risks during its life span of the scheme and when it is consumed.
WHO (2006) recommended that E. coli or thermos tolerant coliform and total coliform bacteria
should not be detected in any 100ml sample of water intended for drinking. According to
Southern African water guidelines, including Zimbabwe guideline (SAZ, 2004) potable water
should contain zero E. coli per 100ml of water and zero total coliform bacteria per 100ml of
water.

Water quality monitoring is a continuous process of domestic water sampling and testing to
ensure that it complies with WHO guidelines in terms of taste, turbidity, chemical and
bacteriological contents (MoHCC Standard Operating Procedures, 2002). WHO guidelines
stipulate that all water intended for drinking should not contain Escherichia coli or thermo

13
tolerant coli forms in any 100 ml sample of treated or untreated water. In addition, total coli
forms should not be detected in any 100ml sample. The requirements are stricter for treated
water entering the distribution system Mwendera, (2009). Many epidemiological studies and
diarrhoeal disease outbreak investigations found an association between poor water quality and
infectious diarrhoea. In the Philippines, Moe et al., (1991) reported an odds ratio (OR) of 1.92
for diarrhoea following consumption of faecal contaminated water.

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 CHAPTER 3

RESEARCH METHODOLOGY

3.0 INTRODUCTION

Nare (1999) described methodology as, “a theory and analysis about the kind of method and
general research approach most appropriate for a given body of theory or research questions”.
This chapter outlines the research design, study area, target population, inclusion criteria,
exclusion criteria, study variables, sampling and sample size, data collection tools, pilot study,
validity, reliability, ethical considerations as well as data analysis.

3.1 RESEARCH DESIGN

The research design refers to the overall strategy chosen by the researcher to integrate the
different components of the study in a coherent and logical way, thereby ensuring that the
researcher will effectively address the research problem. (De Vaus 2001). It constitutes the
blueprint for the collection, measurement and analysis of the data. (Trochim 2006). A research
design will typically include how data is to be collected, what instruments will be employed,
how the instrument will be used and the intended means for analyzing data collected.

An empirical survey was used in this research to collect samples from water points which are to
be analysed in the laboratory. Empirical survey was conducted through the use of the cost
effective and a Garmin extret handheld device. Empirical survey is a type of research whose
findings and conclusions are based on valid data or evidence. These pieces of evidence are
collected using either or both qualitative research and quantitative research. In quantitative
research the numerical data is used to collect information or any other quantifiable process while
qualitative research focuses more on meaning of the data collected. Empirical survey was used
by the researcher because it increases the credibility of findings thereby keeping work authentic,
formal, verifiable and It is also flexible.

3.2 Study area

Chiredzi is a district in Zimbabwe which is found in Masvingo province. It is located 128km

south east of Masvingo city and at the 18.9167 degrees S, 29,8167 degrees E. coordinates. The
district is found in the natural farming region 5 in which the study area is also found.
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The research is going to be carried out in ward 7 of Chiredzi district which is found in Chilonga
area about 32km south of Chiredzi town. Chiredzi district constitutes a total of 30 health
facilities, thus 2 hospitals and 28 rural health centers (RHCs) as well as 13 wards. The district
has an estimated population of about 275759 (Zimbabwe statistical agency 2012.
Geographically, the area is characterized by forestry for wild animals and pastures. Some of the
land is reserved for sugar cane plantation which is Hippo valley and Triangle limited.
Economically, people earn their living through subsistence farming though the climate is always
characterized by low rainfall and high temperatures. Socially during the summer time, the people
in the area mostly they practice initiation ceremonies since the area is dominated by Shangani
speaking people, some Shona speaking people, they hold some local churches at different
settings for spiritual satisfaction. The landscape is mostly covered with mopane trees and the
main activities in the district are cattle ranching and subsistence farming.

The demography of the study area notes that the ward has a total population of about 275759,
with most of the families are female and children dominated. This is as a result of males
searching for greener pastures like going to neighboring countries like South Africa and
Mozambique so that they support their families economically.

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THE MAP OF CHIREDZI DISTRICT

3.3 Target population

Target population refers to the entire group of individuals or subjects to which the researcher is
interested in generalizing the conclusions (Myers, 2013). In this study, the researcher is going to
target all the water points in ward 7 Chiredzi.

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3.3.1 Study population

In research, population refers to a group of individual persons, objects or items from which the
samples are taken for measurement. this study the study population is of all the water points in
ward 7 of chiredzi district

3.3.2 Inclusion criteria

The researcher included all the water points in ward 7 of Chiredzi

3.3.3 Exclusion criteria

The researcher excluded all collapsed and non-functional water points in ward 7

3.4 Study variables

3.4.1 Dependent variables

In the research, the researcher used the diarrhoeal incidences as the dependent variables

3.4.2 Independent variable

The spatial distribution of water points in ward 7 is going to be the independent variable for the
researcher.

3.5 Sampling and sample size

Sampling according to Neela (2010) is the process of selecting units (people, objects) from a
population of interest so that by studying the sample we may fairly generalize our results back to
the population from which they were chosen. Sampling refers to the statistical process of
selecting and studying the characteristics of a relatively small number of items from a relatively
large population of such items, to statistically draw valid inferences about the characteristics
about the entire population Krishna (2010)

In this study the researcher will focus on all the functional water points within the ward that are
of significance to the community in terms of water quality monitoring.

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3.6 Data collection tools

The Geographic Information System(GIS) device was used for capturing coordinates of water
points according to their status and type as well as secondary data from the District Health
Information(DHI) on diarrhoeal incidences that occurred previous year within the ward. The GIS
is a system designed to capture, store, manipulate, analyses, manage and present all types of
geographical data. GIS is more than just a software, it can enable the spatial analysis, manage
large datasets and display information in a map/ graphical form. GIS can be used as a tool in
both problem solving and decision making processes as well as for visualization of data in a
spatial environment.

3.7 Pilot study

According to De Vos (2002), a pilot study is a mall study conducted to the research
participants/objects prior to a large piece of the research. Pilot study deals with data collection
tools and it enables the researcher to make some refinements if need be. In this research, pilot
study is going to be done in ward 25 of Masvingo district (Nyajena area) where the GIS is going
to be pre-tested for its validity and reliability.

3.8 Validity

Brinks (1996) described validity as the review of each research tool and checking whether it
measures what it should measure

3.9 Reliability

Reliability is the ability to constantly measure what is supposed to be measured by the data
collection tool (Brinks 1996) The researcher tools are to be clear and concise with simple
instructions that the respondents could understand and could be able to gather the most required
information required by the researcher.

3.10 Ethical considerations

Privacy and confidentiality was ensured for the results to be obtained from the study experiments
and also permission to carry out the study was sought from the District Health Officer (DEHO)

19
for Chiredzi district. A letter from Masvingo polytechnic served as assurance that the study
carried out was for academic purposes

3.11 Data management analysis

Data is presented in tables, maps and pictures and then analysed using descriptive statistics.
Cleaned descriptive data was computed and analysed for frequency distribution of responses
using Microsoft excel computer package. The analysed data was presented in graphs and tables

20
 CHAPTER 4

DATA PRESENTATION, ANALYSIS AND DISCUSSIONS

4.0 Introduction

Chapter 3 discussed the research methodology. Chapter 4 focuses on presentation and analysis of
study findings.

4.1 Map showing diarrhoeal cases

Fig 4.1: Spatial distribution of diarrhoeal cases

Fig 4.1 above shows the spatial distribution of diarrhoeal cases from 2018 to 2020. The map
highlights that there is a higher distribution of diarrhoeal cases mainly in the northern region of
the ward. The distribution of diarrheal cases is dependent on the high frequency of non-
functional and unprotected water sources in the northern region compared to the other parts of
the ward. This finding agrees with Murphy (2017) who argued that there is a direct relationship
21
between the distribution of diarrhoeal cases and the frequency of unprotected and non-functional
water sources.

4.2 Diarrhoeal incidences spatially related to water point functional status and type

Fig 4.2: Spatial distribution of water points

Fig 4.2 shows the spatial distribution of water points in the ward. The map shows that the
northern region of the ward which was reported as having a higher incidence of diarrhoeal cases
in Fig 4.1 is mainly served by river water. This could possibly be explained by poor sanitation
and hygiene practices which have the potential to promote faecal to oral diarrhoeal diseases. A
study by Smith (2016) confirms that poor sanitation and hygiene practices in communities with
river water had high cases of diarrhoeal diseases. However, Dale (2014) posits that poor

22
sanitation and hygiene also has the potential to pollute underground water sources leading to
high incidence of diarrhoeal cases.

4.2.1 Diarrhoeal incidences in relation to spatial distribution of water point functional

status

Table 4.1: Distribution of diarrheal incidence in relation to water point functional status

Functional status Diarrhoeal incidences proportion/%

Fully functional 23

Non-functional 77

Table 4.1 above shows the frequency of diarrheal cases in relation to water point functional
status. The table depicts that non-functional water points were associated with a greater
proportion of diarrhoeal cases (77%) in comparison to fully functional water sources (23%).
These findings dovetail with the assertion by Obi et al (2004) that mostly non-functional water
sources become contaminated with fecal coliforms as a result of poor sanitation and hygiene
leading to high diarrhoeal incidence.

4.2.2 Diarrhoeal incidences spatially related to water point type

Table 4.2: Distribution of diarrhoeal cases in relation to water point type

Water point type Proportion of Diarrhoeal cases/%

Borehole 13

Deep well 26

Shallow well 46

River 15

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Table 4.2 above shows the distribution of diarrheal cases in relation to water point type. The
table depicts that unprotected water sources which are shallow wells and rivers have a higher a
proportion of diarrhoeal cases than protected water sources which are boreholes and deep wells.
These findings are in agreement with the assertion by Oswald et al (2007) who argue that
unprotected water sources are more susceptible to contamination in comparison to protected
water sources. However, WHO (2008) is of the view that unprotected water sources which are
well protected are associated with a low incidence of contamination and diarrhoeal cases.

4.3 Spatial Distribution of microbial quality

4.3.1 Distribution of fecal coliforms in relation to water point status

Table 4.3: Fecal coliform count in relation to water point status

Functional status of water point Average Fecal coliform count per ml

Protected water sources 0

Unprotected water sources 17

The table above shows the average fecal coliform count in relation to water point function status.
The table depicts that non-functional water points are associated with a higher fecal coliform
count in comparison to functional water points. Alexander confirms that this is because non-
functional water sources are not properly taken care of and therefore are susceptible to fecal
contamination due to poor waste disposal practices.

4.3.2 Distribution of fecal coliforms in relation to water point type

Table 4.4: Fecal coliform count in relation to water point type

Water point type Average Fecal coliform count/per ml

Borehole 0

Deep well 0

Shallow well 4

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River 9

Table 4.4 above shows fecal coliform count in relation to water point type. The table highlights
that unprotected water sources in the form of shallow wells and rivers are associated with higher
fecal coliform composition as compared to protected water sources in the form of deep wells and
boreholes. This trend is explained by Tubatsi et al (2014) who posits that lack of sanitation
facilities in communities promotes poor human waste disposal practices that leads to fecal
pollution of unprotected water sources such as rivers and shallow wells. This partly explains the
high fecal coliform content in such water sources.

25
 CHAPTER 5

CONCLUSION

5.0 Introduction

Chapter 4 focused on presentation, analysis and discussion of study findings. Chapter 5 outlines
the conclusions emanating from study findings.

5.1 Conclusions

The conclusions arising from the study findings are:

 There is high distribution of diarrhoeal cases around non-functional water points in

comparison to functional water points.

 There is high distribution of diarrhoeal cases close to shallow wells and rivers as
compared to boreholes and deep wells

 There is high coliform content in unprotected water points as compared to protected

water points

 There is high coliform content in shallow wells and rivers as compared to boreholes and
deep wells

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 CHAPTER 6

RECOMMENDATIONS

6.0 Introduction

Chapter 6 focused on recommendations, as from the study findings. Chapter 6 outlines the
recommendations emanating from study findings.

6.1 Recommendations

The recommendations emanating from the study are:

 There should be a WASH policy to improve the functional status of all non-functional
water sources.
 There is need to periodically disinfect shallow wells to eradicate coliforms using chlorine
based disinfectants.
 There should be hygienic handling of water points and as a matter of priority all cracked
aprons and perimeter fences need to be fixed and water points cleaned frequently. The
community needs to also engage the government to assist in the treatment of
contaminated water points at source.
 There should be a policy to improve the functional status of all non-functional water
sources.

 The community needs advocate for training of local pump minders through the District
Development Fund to assist in rehabilitation of water points within the community.

 The EHT should intensify the water point inspections as well as taking water samples
from the water sources periodically like three time per quarter for bacteriological analysis

 There should be provision and use of GIS in WASH and RWIMS field force for easy
reporting about dis-functioning of the boreholes at any time.

27
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APPENDICES

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32