MATERIALS AND METHODS: A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.
RESULTS: Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.
CONCLUSION: Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.
OBJECTIVE: Hence, the present review aims to provide an understanding of drinking water (tap water, groundwater, gravity feed system) quality and its potential implications on policy, human health, and drinking water management law and identification of potential direction of future drinking water research and management needs in Malaysia.
METHODS: This study utilized a scoping review method. PRISMA Extension for Scoping Reviews was used for search strategy. Relevant studies were screened using the selected keywords and databases.
RESULTS: A total of 26 drinking water quality studies involving tap water, groundwater, and gravity feed systems have been selected for review. These studies found that the majority of Malaysian Drinking Water and WHO Drinking Water standards have been met. High levels of Cu, Cd, Fe and Pb were attributable to galvanized plumbing and pipe material corrosion. Variation of fluoride in tap water depends on dosage planning and operational processes of the public water supply. Pollutants (nitrate and ammonia) in groundwater and gravity feed system water have been linked to agricultural practices in rural areas. Microbiological quality in tap water is associated with growing biofilms inside the pipelines while in groundwater is caused by shallow surface events. However, only eight studies have reported about the human risks of chemical pollutants in tap water.
IMPACT STATEMENT: The review discusses the state of drinking water quality in Malaysia and its impact on public health. It suggests that policymakers can use this information to improve the quality of drinking water and enforce restrictions, while also raising public awareness about the importance of safe drinking water. The study can guide future research and initiatives in Malaysia, ultimately contributing to efforts to ensure access to clean and dependable drinking water.