Research ArticleDetermination of Bacterial Quality of Water in RandomlySelected Swimming Pools in Kampala City Uganda

Joyce Margaret Ekopai1 Nathan LubowaMusisi2 Howard Onyuth1

Benigna Gabriela Namara3 and Celsus Sente1

1Department of Wildlife and Aquatic Animal Resources (WAAR) School of Veterinary Medicine and Animal Resources (SVAR)College of Veterinary Medicine Animal Resources and Biosecurity (COVAB) Makerere University PO Box 7062 Kampala Uganda2Department of Pharmacology andTherapeutics School of Biosecurity Biotechnical and Laboratory Sciences (SBLS)College of Veterinary Medicine Animal Resources and Biosecurity (COVAB) Makerere University PO Box 7062 Kampala Uganda3Medical Research Council (MRC)Uganda Virus Research Institute (UVRI) Research Unit on AIDS PO Box 49 Entebbe Uganda

Correspondence should be addressed to Celsus Sente csente37gmailcom

Received 6 February 2017 Revised 30 April 2017 Accepted 18 May 2017 Published 14 June 2017

Academic Editor Chrissanthy Papadopoulou

Copyright copy 2017 Joyce Margaret Ekopai et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Swimming pools have becomemajor recreation facilities for leisure and sports in cities across theworld but the standard guidelinesparticularly in developing countries are not adhered to because little is known about the contaminants in the pools and the possiblehealth risks involved This study provides a survey of bacterial quality of water from swimming pools in Kampala A total of 26water samples were collected from 13 outdoor swimming pools in Kampala between January and June 2016 and analysed for totalaerobic plate count (TPC) Escherichia coli coliforms and SalmonellaThe heterotrophic bacterial load ranged between 0 and 635 times105 cfuml where 635 times 105 cfuml was the highest load and 3 times 101 cfuml the least The highest average TPC was 619 times 105 cfumland the lowest 507 times 103 cfuml 308 of the pools had TPC within acceptable limits (le5 times 102 cfuml) whereas 692 werehighly contaminated and did not conform to the UgandaNationalWater and Sewerage Corporation standards of recreational waterquality for both treated (0 cfu100mls) water and untreated (10 cfu100mls) water Although no positive results were yielded for Ecoli coliforms and Salmonella TPC represented the presence of heterotrophic bacteria which are often indicated in opportunisticinfections

1 Background

Swimming pools are increasingly being used by man forswimming and other recreational based activities such ascanoe polo underwater rugby volleyball and sports divingThey are also used in certain cultural practices such asbaptism where the individualrsquos head is submerged for a whileas prayers are being conducted Due to their increasing usesswimming pools are now available atmany recreation centreshotels motels schools beaches universities wildlife parkshomes and many other areas With such an increase in thenumbers of swimming pools high maintenance is necessaryto protect the users from any form of infection

Swimming pools are supplied by the water of environ-mental origin The portability of swimming pool water is

enhanced by frequently changing the water and the use ofdisinfectant such as chlorine The highest possible concen-tration of about 1 part per million (ppm) is advised to bemaintained because higher chlorine concentration irritatesthe eyes [1 2] Some swimming pool operators prefer iodineto chlorine as a disinfectant because its action is less hinderedby organicmatter and there is less eye and skin irritation com-pared to chlorine [1] Although it is known that swimmingpool water should meet potable water standards by being aclean transparent odourless and tasteless liquid having afreezing point of 0∘C and boiling point of 100∘C [3] suchstandards are not normally maintained in many countriesIn developing countries particularly Uganda there are nomaintained standards or regulatory framework to ensure thatswimming pools are not hubs for pathogen infection or other

HindawiNew Journal of ScienceVolume 2017 Article ID 1652598 7 pageshttpsdoiorg10115520171652598

2 New Journal of Science

dangers This coupled with a high rate of system breakdownhigh maintenance costs negligence and ignorance poses ahigh risk to the swimming pools users

The poor management of water supply systems to thepools and the use of unprotected water pose a high risk ofpathogen transfer to humans The microbial safety of swim-ming pool water is highly questionable in countries with poorregulatory framework due to the many existing possiblemicrobial contaminant pathways Microbial contaminationof swimming pools can occur through (a) faecal contam-inated source water or direct defecation from swimmersbirds and animals [4ndash7] (b) nonfaecal human shedding fromvomiting sneezing mucous spitting or skin (c) poorwastewater disposal [8] (d) microbial biofilm formationalong pipedwater networks [9 10] (e) contaminated air dustsoil or rainwater [11 12] and (f) individuals with contagiousdiseases or infectious pathogens [4 8]

A number of common water contaminants grouped asviruses bacteria protozoa and helminths have been studiedworldwide Unless the pool is cleaned and maintained andits water adequately treated contamination may lead to anumber of disease outbreaks such as gastroenteritis conjunc-tivitis keratitis trachoma otitis cholera dysentery eczemaskin rashes typhoid dysentery giardiasis cryptosporid-iosis helminthiasis cholera hepatitis rotavirus infectionsalmonellosis and central nervous systems associated dis-eases [3 13ndash23] The aetiologic agents of some of thesediseases have been isolated from natural and domestic watersources in Uganda and are associated with devastating ill-nesses [9 10 24 25] Notmuch has been studied aboutmicro-bial contamination of swimming pool water in Uganda butavailable data denotes the presence of Streptococcus andEscherichia coli [26 27] Elsewhere in the world a lot ofresearch has been done and pools have been associated withoutbreaks of waterborne infections in humans [4 28ndash31]often leading to severe morbidities and mortalities

Although modern day swimming pools have a recir-culating system for the water to be filtered purified anddisinfected adequately recent studies reveal that neitheradvanced technological systems nor disinfectants can obviatethe colonisation of the pool water with some dangerouspathogens [32ndash34] It has also been reported that the surviv-ing disinfectant tolerant pathogens might also be antibiotic-resistant a fact already documented for bacterial isolatesfrom treated drinking water [4] and purified sewage effluents[35] It is important to continuously test swimmingpoolwaterfor the availability of pathogens that pose public health risksto humans in order to optimise water treatment methods toget the best performing chemicals that can kill or reduce thesepathogens to minimal or nonworrying levels [9 10 24] InUganda there is scanty information on the general hygiene ofswimming pools In 2007 Kampala City Council HealthDivi-sion sounded a warning of the likely poor quality of swim-ming pool water in Kampala Despite such concerns there isno evidence indicating that the problem has been addressedThis is dangerous because research in many areas acrossthe world has shown that swimming pools easily get con-taminated by users and the surrounding environment Theobjective of the present study was to investigate the bacterial

quality of water in randomly selected swimming pools inKampala City Uganda

2 Methods

21 Study Area The study was carried out in Kampala citythe capital and largest city inUganda with an area of 189 km2The city is divided into five Divisions that oversee localplanning Kampala Central Division Kawempe DivisionMakindye Division Nakawa Division and Lubaga DivisionThe city is located at 0∘2010158402519110158401015840 32∘3810158408965810158401015840 with 1223m(4012 ft) elevation above sea level

22 Site Selection and Sample Size A cross-sectional studywas carried out between January and June 2016 A purposivesampling strategy was employed and only outdoor swim-ming pools in the city centre were selected for sampling Thestudy involved sampling of all the 13 outdoor swimming poolsin the city centre

23 Sample Collection Storage and Transportation A total oftwenty-six samples were collected in sterile well-labeled500ml wide-mouthed bottles Water samples were collectedwhen no bathers were in the pools (access was deniedduring the maximum bather density) To dechlorinate thewater samples sodium thiosulphate (100mgl) (Na2S2O3sodium thiosulphate pentahydrate 106509 Merck KGaADarmstadt Germany) was added to each bottle The sampleswere collected from a depth of 30 cm at a point about 50 cmaway from the pool edgeThe sampleswere transported at 4∘Cwithin 1 hour from the collection time using appropriatelyinsulated coolers to the microbiology laboratory at theCollege of Veterinary Medicine and Animal Resources andBiosecurity (COVAB) Makerere University They were pro-cessed immediately after arrival at the laboratory

24 Laboratory Analysis

241 Total Aerobic Plate Count The total plate count (TPC)agar media was prepared according to the manufacturerrsquosinstructions [36] and poured into Petri dishes It was thenincubated at 37∘C for 18 hours to determine the sterility Thesamples were 10-fold serially diluted in 9ml of sterilised pep-tone water contained in each of the tubes by transferring 1mlof water in the first test tube and mixed then 1ml of the firstdilution was drawn out into the second tube This was con-tinued until the 4th tubeThen 100120583l of two sample dilutionsof 10minus2 and 10minus4 including the neat (undiluted sample) wasplated onto the plate count agar and the surface spread usinga sterilised glass spreader for uniform inoculationThe plateswere incubated at 37∘C for 48 hours Following appropriatelength of incubation all visible colonies were counted and theresults were calculated bymultiplying the number of colonieson each plate by the reciprocal of the dilution factor of sampledilution plated and multiplied by ten which was reported ascolony forming units per ml

242 Determination of Total Coliform and E coli CountPeptone water was prepared according to the manufacturerrsquos

New Journal of Science 3

Table 1 Water sample bacterial counts

Pool number Sample number Total plate count Coliform Escherichia coli Salmonella

F F1 102400 0 0 0F1H 301480 0 0 0

F2 F2 301320 0 0 0F2T 635000 0 0 0

R RN 300000 0 0 0RS 300000 0 0 0

T TIH 100000 0 0 0TIT 100000 0 0 0

M MH 30 0 0 0MT 400000 0 0 0

K K1T 300000 0 0 0K1H 40 0 0 0

K2 K2T 0 0 0 0K2H 0 0 0 0

M2 M2H 0 0 0 0M2T 0 0 0 0

J JIH 4000 0 0 0JIT 2140 0 0 0

J2 J2H 1020 0 0 0J2T 100000 0 0 0

G GIH 0 0 0 0GIT 0 0 0 0

R2 R3H 400000 0 0 0R3T 504000 0 0 0

G2 G2H 0 0 0 0G2T 0 0 0 0

instructions [36ndash38] and 9ml was dispensed into test tubesand sterilised by autoclaving Additionally MacConkey agarmedia was prepared according to the manufacturerrsquos instruc-tions and sterilised by autoclaving [36] The MacConkeyagar was cooled dispensed in Petri dishes and incubatedovernight to test for sterilityThe samplewas diluted and withthe aid of a sterile tip of 100120583l of the sample a homogenatefrom the serial dilution was transferred to the surface of theMacConkey agar and inoculated by surface spreading usingsterile spreaders and then incubated at 37∘C for 18 hours Allpink colonies were counted as coliforms and E coli colonieswere identified as pink flat dry surfaces with small-to-medium-sized colonies Biochemical tests were conducted toconfirm the presence of E coli using indole for the formationof a pink ring on sides of the tube at the top of inoculatedpeptone water [37 38]

243 Isolation of Salmonella Water samples were inoculatedin buffered peptone water and incubated overnight at 37∘Cas the preenrichment stageThen 1ml of the enriched samplewas transferred to 9ml of selenite (Merck Germany) brothand incubated at 42∘C overnight Thereafter it was mixedcarefully and cultured on prepared Xylose Lysine Deoxy-cholate (Oxoid UK) by surface spreading using sterilespreaders and incubated for 24 hours at 37∘C Salmonella

colonies were identified as pink medium-sized colonies withblack centres due to the production of hydrogen sulphide gasConfirmation of Salmonella was done through the TripleSugar Iron test for yellow butt and red slant with hydrogensulphide gas production It was also nonmotile citrate andurease-negative

244 Data Management and Analysis The results were re-corded in a laboratory book and later entered into MicrosoftExcel The data was then double entered in Excel for qualitycontrol purposes Tables were drawn for total plate counts(TPC) E coli coliform and Salmonella counts A bar graphof averaged TPC for each swimming pool was drawn to showthe trends of the contamination

3 Results

31 Total Aerobic Load of Pool Water The results of the lab-oratory analysis are presented in Table 1 and Figure 1 Watersample F2T from pool F2 had the highest TPC with 635 times105 cfuml Water sample MH from pool M had the lowestTPC count with 3 times 101 cfuml Similarly pool F2 had thehighest average TPC (619 times 105 cfuml) and pool J the lowest(507 times 103 cfuml) (Figure 1) Six water samples K2T K2HM2H M2T G2H and G2T from swimming pools K2 M2

4 New Journal of Science

Table 2 Summary of positive and negative samples and pools

Number Positive NegativeSwimming pools (119899 = 13) 9 (692) 4 (308)Samples (119899 = 26) 18 (692) 8 (38)

0

100000

200000

300000

400000

500000

600000

700000

F F2 R T M K K2 M2 J J2 G R2 G2

Aver

age t

otal

pla

te co

unt (

cfu

ml)

Swimming pools

Figure 1 Average bacterial counts for 13 swimming pools

G and G2 exhibited no growth on the media that is fourswimming pools (308) were free from microbial contam-ination whereas 9 (622) had contamination (Table 2)Eighteen swimming pool samples (692) had TPC aboveacceptable limits of the UgandaNationalWater and SewerageCooperation standards of recreational water quality for bothportable treated water (0 cfu100mls) and untreated water(10 cfu100mls) Eight samples (308) out of the twenty-sixwater samples analysed had TPC within the acceptable limit(le5 times 102 cfuml) (Table 1)

32 Total Coliform and E coli Count of the Pool Water Afterseparate repeat runs of these tests using peptone water andMacConkey agar there was a failure to demonstrate coliformand E coli in the water samples analysed Dilutions of watersamples were analysed (ie 10minus2 and 10minus4) as well as theundiluted ones but none of them had growth in the media

33 Isolation of Salmonella Following all the appropriateprocedures and ample length of incubation periods using buff-ered peptone water for enrichment stage selenite broth andXylose Lysine Deoxycholate agar for incubation Salmonellagrowth did not occur

4 Discussion

The total coliform and E coli tests yielded no positiveresults an indication that faecal contamination of these poolswas unlikely since E coli a quite potent indicator of faecal

contamination was not detected The total aerobic platecount (TPC)which is a nonspecific test for everything includ-ing coliforms (if they are present) yielded positive resultsTPC does not give an indication of the types of organismspresent or their probable sources but indicates the culturableorganisms present which could be low or high total bacteriapresent [39]

In the present study the results of the investigationaccording toTPC indicated an overall highmicrobial count inthe swimming pool water Seventeen (68) of the swimmingpool samples collected hadTPC above the acceptable limits ofNational Water and Sewerage Corporation (NWSC) andWorld Health Organisation (gt5 times 102 cfuml) There is nomaximum acceptable concentration (MAC) specified forTPC microbes in water supplied by public or semipublicwater systems but an increase in TPC concentrations abovebaseline levels (gt5times 102 cfuml) iswhat is considered undesir-able or unsafe [39] A number of reasons could be attributedto this level of contamination Kampala City swimming poolowners have little adherence to the national swimming poolor portable water standards because of poor enforcement oflaws ignorance and negligenceThis has resulted in all kindsof uncouth practices in the pool water There is always veryhigh bather density and often the water appears dirty Thiscoupled with the probability of soil contamination fromrainfall runoff and bacterial biofilm formation along thepipelines or other organic matters could be responsible forthe contamination Swimming pool contamination as a resultof high bather density and organic matter contamination iscommon especially in poorly maintained pools [40 41] Ifswimming pools adhered to theNationalWater and SewerageCooperation guidelines there would be minimal microbialcontamination Studies by previous researchers have shownthat swimming pools in major hotels and cities in developednations have lowmicrobial contamination ranging from 0 to25 (38ndash43) However the results from the swimming poolsin Kampala indicate absolutely very high microbial contam-ination with heterotrophic bacteria Our results concur withfinding elsewhere in developing countries where total platecounts exceeded the WHO limit (gt5 times 102 cfuml) [4 5 42]

The results of this study asserted that a high number ofswimming pools in Kampala City did not conform to inter-nationally and nationally acceptable standards as is in mostother developing countries Lack of appropriate maintenanceequipment and lack of well-trained human resources are thecommonest reasons for increased contamination of swim-ming pools in Kampala According to CDC [13 43ndash45] lackof proper pool hygiene could lead to building up of path-ogenic organisms

The commonly isolated swimming pool organisms suchas coliforms or E coli and Salmonella species were absent inall the samples analysed in this survey in spite of following allthe procedures and giving ample length for incubation Thiscould be attributed to consistent chlorine and iodine use indisinfecting the pools which may have low-to-moderate ef-fectiveness in killing other microbes According to CDC [4344] and Craun et al [46] E coli coliforms and Salmonellashould be absent in 100ndash500ml sample following appropriate

New Journal of Science 5

disinfection of swimming pools The disinfection may noteliminate certain highly resistant organisms and often differ-ent disinfectants have to be used at varying doses It is possiblethat the TPC represented the presence of water-dwellingorganisms such as Acinetobacter Aeromonas Chryseobac-terium (Flavobacterium)KlebsiellaMoraxella SerratiaPseu-domonas and Xanthomonas Bacillus Mycobacterium tuber-culosis Mycobacterium avium Pseudomonas aeruginosa andLegionella pneumophila that are emerging and reemergingpathogens capable of causing severe opportunistic infectionsespecially in immunocompromised individuals [8 39 47]

In developed nations swimming pools with efficient cir-culation systems have strainer baskets which continuouslyfilter off solid materials to prevent contamination [48]Unfortunately most pools in Uganda do not have an efficientwater circulation systemWater is changed when it is deemedas dirty by the pool attendants and this is based on mereobservation instead of having a standard testing system torely onThe pool attendants believe that once a disinfectant isused the pool is automatically safe They do not look at thisin terms of quantity of the disinfectants and the time lagMuch as a number of the swimming pool owners and users(bathers) are aware that contaminated pools are a source ofserious infections there has beenminimal change in their usein ways that are likely to be safe It is a big puzzle to explainthis but probably these individuals still require more sensiti-sation about swimming pools and diseases cycles Increasedawareness and sensitisation in terms of risk factors leadingto disease acquisition is a good pathway towards efficientcontrol and preventive mechanisms

5 Conclusions

The study established that most popular swimming pools(68) around Kampala City were contaminated Neverthe-less 32 yielded growth within the acceptable limitsThe tar-geted organisms coliforms E coli and Salmonella were notpresent in the pools however this did not guarantee the safetyof the pools since there was a high total aerobic plate countthat consisted of othermicrobes capable of causing infectionsin humans

Additional Points

To be able to protect swimming pool users from the risk ofacquiring a number of pathogens it is high time the govern-ment of Uganda enforced the adoption of existing nationalstandards for recreational waters The government shouldbe tasked to build more effective portable water managementand sanitation policies There should be a commitment fromthe government to supply clean potable water to the commu-nities and this initiative must be of high priority Communityprograms must be initiated to educate people on water safetymeasures personal hygiene and water treatment processesAccess to improved water sources should be corroboratedwith access to improved sanitation and hygiene (personalhygiene regular cleaning of vessels proper storage andtreatment)

Conflicts of Interest

The authors declare that they have no conflicts of interest

References

[1] A L Smith Principles of Microbiology CVMosby London 5thedition 1977

[2] V Chongsuvivatwong and L Mo-suwan ldquoEvaluation of villagepiped water a case study in southern Thailandrdquo The SoutheastAsian Journal of Tropical Medicine And Public Health vol 24no 4 pp 631ndash635 1993

[3] S C Cairncross D G Curtis R L Feahem and G H BradleyEvaluation for village water supply planning Chichester JohnWiley and Sons 2000

[4] C Papadopoulou V Economou H Sakkas et al ldquoMicrobi-ological quality of indoor and outdoor swimming pools inGreece investigation of the antibiotic resistance of the bacterialisolatesrdquo International Journal of Hygiene and EnvironmentalHealth vol 211 no 3-4 pp 385ndash397 2008

[5] G Masoud A Abbass A Abaza andW Hazzah ldquoBacteriolog-ical quality of some swimming pools in Alexandria with specialreference to Staphylococcus aureusrdquo Environmental Monitoringand Assessment vol 188 no 7 article no 412 2016

[6] T Kumar S Onichandran Y A L Lim et al ldquoComparativestudy on waterborne parasites between Malaysia andThailanda new insightrdquo The American Journal of Tropical Medicine andHygiene vol 90 no 4 pp 682ndash689 2014

[7] S Onichandran T Kumar C C Salibay et al ldquoWaterborneparasites a current status from the Philippinesrdquo Parasites ampVectors vol 7 no 1 article 244 2014

[8] WHO Guidelines for Safe Recreational Water EnvironmentCoastal And FreshWaters World Health Organization GenevaSwitzerland 2003

[9] C Sente J Erume I Naigaga et al ldquoXenic cultivation andgenotyping of pathogenic free-living amoeba from public watersupply sources in Ugandardquo New Journal of Science vol 2016Article ID 6358315 9 pages 2016

[10] C Sente J Erume I Naigaga et al ldquoOccurrence and geneticcharacterisation ofAcanthamoeba spp from environmental anddomestic water sources in Queen Elizabeth Protected AreaUgandardquo Parasites amp Vectors vol 9 article 127 2016

[11] R Cruickshank J P Duguid B P Marmion and R H ASwain Medical Microbiology A Guide to Laboratory DiagnosisAnd Control of Infections Churchhill Livingstone EdinburghScotland 12th edition 1975

[12] MM A El-Salam ldquoAssessment of water quality of some swim-ming pools A case study in Alexandria Egyptrdquo EnvironmentalMonitoring andAssessment vol 184 no 12 pp 7395ndash7406 2012

[13] CDC ldquoDomestic water sanitation and hygiene epidemiologyUSA center for disease control united states of Americardquohttpwwwcdcgovnceziddfwedwaterbornedomestichtml2015

[14] CDC ldquoNeglected parasitic infections (NPIs) in the UnitedStates [internet] centers for disease control and preventionrdquohttpwwwcdcgovparasitesnpi 2014

[15] CDC Parasites - Fascioliasis (Fasciola Infection) Center forDisease Control and Prevention 2013

New Journal of Science 3

Table 1 Water sample bacterial counts

Pool number Sample number Total plate count Coliform Escherichia coli Salmonella

F F1 102400 0 0 0F1H 301480 0 0 0

F2 F2 301320 0 0 0F2T 635000 0 0 0

R RN 300000 0 0 0RS 300000 0 0 0

T TIH 100000 0 0 0TIT 100000 0 0 0

M MH 30 0 0 0MT 400000 0 0 0

K K1T 300000 0 0 0K1H 40 0 0 0

K2 K2T 0 0 0 0K2H 0 0 0 0

M2 M2H 0 0 0 0M2T 0 0 0 0

J JIH 4000 0 0 0JIT 2140 0 0 0

J2 J2H 1020 0 0 0J2T 100000 0 0 0

G GIH 0 0 0 0GIT 0 0 0 0

R2 R3H 400000 0 0 0R3T 504000 0 0 0

G2 G2H 0 0 0 0G2T 0 0 0 0

instructions [36ndash38] and 9ml was dispensed into test tubesand sterilised by autoclaving Additionally MacConkey agarmedia was prepared according to the manufacturerrsquos instruc-tions and sterilised by autoclaving [36] The MacConkeyagar was cooled dispensed in Petri dishes and incubatedovernight to test for sterilityThe samplewas diluted and withthe aid of a sterile tip of 100120583l of the sample a homogenatefrom the serial dilution was transferred to the surface of theMacConkey agar and inoculated by surface spreading usingsterile spreaders and then incubated at 37∘C for 18 hours Allpink colonies were counted as coliforms and E coli colonieswere identified as pink flat dry surfaces with small-to-medium-sized colonies Biochemical tests were conducted toconfirm the presence of E coli using indole for the formationof a pink ring on sides of the tube at the top of inoculatedpeptone water [37 38]

243 Isolation of Salmonella Water samples were inoculatedin buffered peptone water and incubated overnight at 37∘Cas the preenrichment stageThen 1ml of the enriched samplewas transferred to 9ml of selenite (Merck Germany) brothand incubated at 42∘C overnight Thereafter it was mixedcarefully and cultured on prepared Xylose Lysine Deoxy-cholate (Oxoid UK) by surface spreading using sterilespreaders and incubated for 24 hours at 37∘C Salmonella

colonies were identified as pink medium-sized colonies withblack centres due to the production of hydrogen sulphide gasConfirmation of Salmonella was done through the TripleSugar Iron test for yellow butt and red slant with hydrogensulphide gas production It was also nonmotile citrate andurease-negative

244 Data Management and Analysis The results were re-corded in a laboratory book and later entered into MicrosoftExcel The data was then double entered in Excel for qualitycontrol purposes Tables were drawn for total plate counts(TPC) E coli coliform and Salmonella counts A bar graphof averaged TPC for each swimming pool was drawn to showthe trends of the contamination

3 Results

31 Total Aerobic Load of Pool Water The results of the lab-oratory analysis are presented in Table 1 and Figure 1 Watersample F2T from pool F2 had the highest TPC with 635 times105 cfuml Water sample MH from pool M had the lowestTPC count with 3 times 101 cfuml Similarly pool F2 had thehighest average TPC (619 times 105 cfuml) and pool J the lowest(507 times 103 cfuml) (Figure 1) Six water samples K2T K2HM2H M2T G2H and G2T from swimming pools K2 M2

4 New Journal of Science

Table 2 Summary of positive and negative samples and pools

Number Positive NegativeSwimming pools (119899 = 13) 9 (692) 4 (308)Samples (119899 = 26) 18 (692) 8 (38)

0

100000

200000

300000

400000

500000

600000

700000

F F2 R T M K K2 M2 J J2 G R2 G2

Aver

age t

otal

pla

te co

unt (

cfu

ml)

Swimming pools

Figure 1 Average bacterial counts for 13 swimming pools

G and G2 exhibited no growth on the media that is fourswimming pools (308) were free from microbial contam-ination whereas 9 (622) had contamination (Table 2)Eighteen swimming pool samples (692) had TPC aboveacceptable limits of the UgandaNationalWater and SewerageCooperation standards of recreational water quality for bothportable treated water (0 cfu100mls) and untreated water(10 cfu100mls) Eight samples (308) out of the twenty-sixwater samples analysed had TPC within the acceptable limit(le5 times 102 cfuml) (Table 1)

32 Total Coliform and E coli Count of the Pool Water Afterseparate repeat runs of these tests using peptone water andMacConkey agar there was a failure to demonstrate coliformand E coli in the water samples analysed Dilutions of watersamples were analysed (ie 10minus2 and 10minus4) as well as theundiluted ones but none of them had growth in the media

33 Isolation of Salmonella Following all the appropriateprocedures and ample length of incubation periods using buff-ered peptone water for enrichment stage selenite broth andXylose Lysine Deoxycholate agar for incubation Salmonellagrowth did not occur

4 Discussion

The total coliform and E coli tests yielded no positiveresults an indication that faecal contamination of these poolswas unlikely since E coli a quite potent indicator of faecal

contamination was not detected The total aerobic platecount (TPC)which is a nonspecific test for everything includ-ing coliforms (if they are present) yielded positive resultsTPC does not give an indication of the types of organismspresent or their probable sources but indicates the culturableorganisms present which could be low or high total bacteriapresent [39]

In the present study the results of the investigationaccording toTPC indicated an overall highmicrobial count inthe swimming pool water Seventeen (68) of the swimmingpool samples collected hadTPC above the acceptable limits ofNational Water and Sewerage Corporation (NWSC) andWorld Health Organisation (gt5 times 102 cfuml) There is nomaximum acceptable concentration (MAC) specified forTPC microbes in water supplied by public or semipublicwater systems but an increase in TPC concentrations abovebaseline levels (gt5times 102 cfuml) iswhat is considered undesir-able or unsafe [39] A number of reasons could be attributedto this level of contamination Kampala City swimming poolowners have little adherence to the national swimming poolor portable water standards because of poor enforcement oflaws ignorance and negligenceThis has resulted in all kindsof uncouth practices in the pool water There is always veryhigh bather density and often the water appears dirty Thiscoupled with the probability of soil contamination fromrainfall runoff and bacterial biofilm formation along thepipelines or other organic matters could be responsible forthe contamination Swimming pool contamination as a resultof high bather density and organic matter contamination iscommon especially in poorly maintained pools [40 41] Ifswimming pools adhered to theNationalWater and SewerageCooperation guidelines there would be minimal microbialcontamination Studies by previous researchers have shownthat swimming pools in major hotels and cities in developednations have lowmicrobial contamination ranging from 0 to25 (38ndash43) However the results from the swimming poolsin Kampala indicate absolutely very high microbial contam-ination with heterotrophic bacteria Our results concur withfinding elsewhere in developing countries where total platecounts exceeded the WHO limit (gt5 times 102 cfuml) [4 5 42]

The results of this study asserted that a high number ofswimming pools in Kampala City did not conform to inter-nationally and nationally acceptable standards as is in mostother developing countries Lack of appropriate maintenanceequipment and lack of well-trained human resources are thecommonest reasons for increased contamination of swim-ming pools in Kampala According to CDC [13 43ndash45] lackof proper pool hygiene could lead to building up of path-ogenic organisms

The commonly isolated swimming pool organisms suchas coliforms or E coli and Salmonella species were absent inall the samples analysed in this survey in spite of following allthe procedures and giving ample length for incubation Thiscould be attributed to consistent chlorine and iodine use indisinfecting the pools which may have low-to-moderate ef-fectiveness in killing other microbes According to CDC [4344] and Craun et al [46] E coli coliforms and Salmonellashould be absent in 100ndash500ml sample following appropriate

New Journal of Science 5

disinfection of swimming pools The disinfection may noteliminate certain highly resistant organisms and often differ-ent disinfectants have to be used at varying doses It is possiblethat the TPC represented the presence of water-dwellingorganisms such as Acinetobacter Aeromonas Chryseobac-terium (Flavobacterium)KlebsiellaMoraxella SerratiaPseu-domonas and Xanthomonas Bacillus Mycobacterium tuber-culosis Mycobacterium avium Pseudomonas aeruginosa andLegionella pneumophila that are emerging and reemergingpathogens capable of causing severe opportunistic infectionsespecially in immunocompromised individuals [8 39 47]

In developed nations swimming pools with efficient cir-culation systems have strainer baskets which continuouslyfilter off solid materials to prevent contamination [48]Unfortunately most pools in Uganda do not have an efficientwater circulation systemWater is changed when it is deemedas dirty by the pool attendants and this is based on mereobservation instead of having a standard testing system torely onThe pool attendants believe that once a disinfectant isused the pool is automatically safe They do not look at thisin terms of quantity of the disinfectants and the time lagMuch as a number of the swimming pool owners and users(bathers) are aware that contaminated pools are a source ofserious infections there has beenminimal change in their usein ways that are likely to be safe It is a big puzzle to explainthis but probably these individuals still require more sensiti-sation about swimming pools and diseases cycles Increasedawareness and sensitisation in terms of risk factors leadingto disease acquisition is a good pathway towards efficientcontrol and preventive mechanisms

5 Conclusions

The study established that most popular swimming pools(68) around Kampala City were contaminated Neverthe-less 32 yielded growth within the acceptable limitsThe tar-geted organisms coliforms E coli and Salmonella were notpresent in the pools however this did not guarantee the safetyof the pools since there was a high total aerobic plate countthat consisted of othermicrobes capable of causing infectionsin humans

Additional Points

To be able to protect swimming pool users from the risk ofacquiring a number of pathogens it is high time the govern-ment of Uganda enforced the adoption of existing nationalstandards for recreational waters The government shouldbe tasked to build more effective portable water managementand sanitation policies There should be a commitment fromthe government to supply clean potable water to the commu-nities and this initiative must be of high priority Communityprograms must be initiated to educate people on water safetymeasures personal hygiene and water treatment processesAccess to improved water sources should be corroboratedwith access to improved sanitation and hygiene (personalhygiene regular cleaning of vessels proper storage andtreatment)

Conflicts of Interest

The authors declare that they have no conflicts of interest

References

[1] A L Smith Principles of Microbiology CVMosby London 5thedition 1977

[2] V Chongsuvivatwong and L Mo-suwan ldquoEvaluation of villagepiped water a case study in southern Thailandrdquo The SoutheastAsian Journal of Tropical Medicine And Public Health vol 24no 4 pp 631ndash635 1993

[3] S C Cairncross D G Curtis R L Feahem and G H BradleyEvaluation for village water supply planning Chichester JohnWiley and Sons 2000

[4] C Papadopoulou V Economou H Sakkas et al ldquoMicrobi-ological quality of indoor and outdoor swimming pools inGreece investigation of the antibiotic resistance of the bacterialisolatesrdquo International Journal of Hygiene and EnvironmentalHealth vol 211 no 3-4 pp 385ndash397 2008

[5] G Masoud A Abbass A Abaza andW Hazzah ldquoBacteriolog-ical quality of some swimming pools in Alexandria with specialreference to Staphylococcus aureusrdquo Environmental Monitoringand Assessment vol 188 no 7 article no 412 2016

[6] T Kumar S Onichandran Y A L Lim et al ldquoComparativestudy on waterborne parasites between Malaysia andThailanda new insightrdquo The American Journal of Tropical Medicine andHygiene vol 90 no 4 pp 682ndash689 2014

[7] S Onichandran T Kumar C C Salibay et al ldquoWaterborneparasites a current status from the Philippinesrdquo Parasites ampVectors vol 7 no 1 article 244 2014

[8] WHO Guidelines for Safe Recreational Water EnvironmentCoastal And FreshWaters World Health Organization GenevaSwitzerland 2003

[9] C Sente J Erume I Naigaga et al ldquoXenic cultivation andgenotyping of pathogenic free-living amoeba from public watersupply sources in Ugandardquo New Journal of Science vol 2016Article ID 6358315 9 pages 2016

[10] C Sente J Erume I Naigaga et al ldquoOccurrence and geneticcharacterisation ofAcanthamoeba spp from environmental anddomestic water sources in Queen Elizabeth Protected AreaUgandardquo Parasites amp Vectors vol 9 article 127 2016

[11] R Cruickshank J P Duguid B P Marmion and R H ASwain Medical Microbiology A Guide to Laboratory DiagnosisAnd Control of Infections Churchhill Livingstone EdinburghScotland 12th edition 1975

[12] MM A El-Salam ldquoAssessment of water quality of some swim-ming pools A case study in Alexandria Egyptrdquo EnvironmentalMonitoring andAssessment vol 184 no 12 pp 7395ndash7406 2012

[13] CDC ldquoDomestic water sanitation and hygiene epidemiologyUSA center for disease control united states of Americardquohttpwwwcdcgovnceziddfwedwaterbornedomestichtml2015

[14] CDC ldquoNeglected parasitic infections (NPIs) in the UnitedStates [internet] centers for disease control and preventionrdquohttpwwwcdcgovparasitesnpi 2014

[15] CDC Parasites - Fascioliasis (Fasciola Infection) Center forDisease Control and Prevention 2013

4 New Journal of Science

Table 2 Summary of positive and negative samples and pools

Number Positive NegativeSwimming pools (119899 = 13) 9 (692) 4 (308)Samples (119899 = 26) 18 (692) 8 (38)

0

100000

200000

300000

400000

500000

600000

700000

F F2 R T M K K2 M2 J J2 G R2 G2

Aver

age t

otal

pla

te co

unt (

cfu

ml)

Swimming pools

Figure 1 Average bacterial counts for 13 swimming pools

G and G2 exhibited no growth on the media that is fourswimming pools (308) were free from microbial contam-ination whereas 9 (622) had contamination (Table 2)Eighteen swimming pool samples (692) had TPC aboveacceptable limits of the UgandaNationalWater and SewerageCooperation standards of recreational water quality for bothportable treated water (0 cfu100mls) and untreated water(10 cfu100mls) Eight samples (308) out of the twenty-sixwater samples analysed had TPC within the acceptable limit(le5 times 102 cfuml) (Table 1)

32 Total Coliform and E coli Count of the Pool Water Afterseparate repeat runs of these tests using peptone water andMacConkey agar there was a failure to demonstrate coliformand E coli in the water samples analysed Dilutions of watersamples were analysed (ie 10minus2 and 10minus4) as well as theundiluted ones but none of them had growth in the media

33 Isolation of Salmonella Following all the appropriateprocedures and ample length of incubation periods using buff-ered peptone water for enrichment stage selenite broth andXylose Lysine Deoxycholate agar for incubation Salmonellagrowth did not occur

4 Discussion

The total coliform and E coli tests yielded no positiveresults an indication that faecal contamination of these poolswas unlikely since E coli a quite potent indicator of faecal

contamination was not detected The total aerobic platecount (TPC)which is a nonspecific test for everything includ-ing coliforms (if they are present) yielded positive resultsTPC does not give an indication of the types of organismspresent or their probable sources but indicates the culturableorganisms present which could be low or high total bacteriapresent [39]

In the present study the results of the investigationaccording toTPC indicated an overall highmicrobial count inthe swimming pool water Seventeen (68) of the swimmingpool samples collected hadTPC above the acceptable limits ofNational Water and Sewerage Corporation (NWSC) andWorld Health Organisation (gt5 times 102 cfuml) There is nomaximum acceptable concentration (MAC) specified forTPC microbes in water supplied by public or semipublicwater systems but an increase in TPC concentrations abovebaseline levels (gt5times 102 cfuml) iswhat is considered undesir-able or unsafe [39] A number of reasons could be attributedto this level of contamination Kampala City swimming poolowners have little adherence to the national swimming poolor portable water standards because of poor enforcement oflaws ignorance and negligenceThis has resulted in all kindsof uncouth practices in the pool water There is always veryhigh bather density and often the water appears dirty Thiscoupled with the probability of soil contamination fromrainfall runoff and bacterial biofilm formation along thepipelines or other organic matters could be responsible forthe contamination Swimming pool contamination as a resultof high bather density and organic matter contamination iscommon especially in poorly maintained pools [40 41] Ifswimming pools adhered to theNationalWater and SewerageCooperation guidelines there would be minimal microbialcontamination Studies by previous researchers have shownthat swimming pools in major hotels and cities in developednations have lowmicrobial contamination ranging from 0 to25 (38ndash43) However the results from the swimming poolsin Kampala indicate absolutely very high microbial contam-ination with heterotrophic bacteria Our results concur withfinding elsewhere in developing countries where total platecounts exceeded the WHO limit (gt5 times 102 cfuml) [4 5 42]

The results of this study asserted that a high number ofswimming pools in Kampala City did not conform to inter-nationally and nationally acceptable standards as is in mostother developing countries Lack of appropriate maintenanceequipment and lack of well-trained human resources are thecommonest reasons for increased contamination of swim-ming pools in Kampala According to CDC [13 43ndash45] lackof proper pool hygiene could lead to building up of path-ogenic organisms

The commonly isolated swimming pool organisms suchas coliforms or E coli and Salmonella species were absent inall the samples analysed in this survey in spite of following allthe procedures and giving ample length for incubation Thiscould be attributed to consistent chlorine and iodine use indisinfecting the pools which may have low-to-moderate ef-fectiveness in killing other microbes According to CDC [4344] and Craun et al [46] E coli coliforms and Salmonellashould be absent in 100ndash500ml sample following appropriate

New Journal of Science 5

disinfection of swimming pools The disinfection may noteliminate certain highly resistant organisms and often differ-ent disinfectants have to be used at varying doses It is possiblethat the TPC represented the presence of water-dwellingorganisms such as Acinetobacter Aeromonas Chryseobac-terium (Flavobacterium)KlebsiellaMoraxella SerratiaPseu-domonas and Xanthomonas Bacillus Mycobacterium tuber-culosis Mycobacterium avium Pseudomonas aeruginosa andLegionella pneumophila that are emerging and reemergingpathogens capable of causing severe opportunistic infectionsespecially in immunocompromised individuals [8 39 47]

In developed nations swimming pools with efficient cir-culation systems have strainer baskets which continuouslyfilter off solid materials to prevent contamination [48]Unfortunately most pools in Uganda do not have an efficientwater circulation systemWater is changed when it is deemedas dirty by the pool attendants and this is based on mereobservation instead of having a standard testing system torely onThe pool attendants believe that once a disinfectant isused the pool is automatically safe They do not look at thisin terms of quantity of the disinfectants and the time lagMuch as a number of the swimming pool owners and users(bathers) are aware that contaminated pools are a source ofserious infections there has beenminimal change in their usein ways that are likely to be safe It is a big puzzle to explainthis but probably these individuals still require more sensiti-sation about swimming pools and diseases cycles Increasedawareness and sensitisation in terms of risk factors leadingto disease acquisition is a good pathway towards efficientcontrol and preventive mechanisms

5 Conclusions

The study established that most popular swimming pools(68) around Kampala City were contaminated Neverthe-less 32 yielded growth within the acceptable limitsThe tar-geted organisms coliforms E coli and Salmonella were notpresent in the pools however this did not guarantee the safetyof the pools since there was a high total aerobic plate countthat consisted of othermicrobes capable of causing infectionsin humans

Additional Points

To be able to protect swimming pool users from the risk ofacquiring a number of pathogens it is high time the govern-ment of Uganda enforced the adoption of existing nationalstandards for recreational waters The government shouldbe tasked to build more effective portable water managementand sanitation policies There should be a commitment fromthe government to supply clean potable water to the commu-nities and this initiative must be of high priority Communityprograms must be initiated to educate people on water safetymeasures personal hygiene and water treatment processesAccess to improved water sources should be corroboratedwith access to improved sanitation and hygiene (personalhygiene regular cleaning of vessels proper storage andtreatment)

Conflicts of Interest

The authors declare that they have no conflicts of interest

References

[1] A L Smith Principles of Microbiology CVMosby London 5thedition 1977

[2] V Chongsuvivatwong and L Mo-suwan ldquoEvaluation of villagepiped water a case study in southern Thailandrdquo The SoutheastAsian Journal of Tropical Medicine And Public Health vol 24no 4 pp 631ndash635 1993

[3] S C Cairncross D G Curtis R L Feahem and G H BradleyEvaluation for village water supply planning Chichester JohnWiley and Sons 2000

[4] C Papadopoulou V Economou H Sakkas et al ldquoMicrobi-ological quality of indoor and outdoor swimming pools inGreece investigation of the antibiotic resistance of the bacterialisolatesrdquo International Journal of Hygiene and EnvironmentalHealth vol 211 no 3-4 pp 385ndash397 2008

[5] G Masoud A Abbass A Abaza andW Hazzah ldquoBacteriolog-ical quality of some swimming pools in Alexandria with specialreference to Staphylococcus aureusrdquo Environmental Monitoringand Assessment vol 188 no 7 article no 412 2016

[6] T Kumar S Onichandran Y A L Lim et al ldquoComparativestudy on waterborne parasites between Malaysia andThailanda new insightrdquo The American Journal of Tropical Medicine andHygiene vol 90 no 4 pp 682ndash689 2014

[7] S Onichandran T Kumar C C Salibay et al ldquoWaterborneparasites a current status from the Philippinesrdquo Parasites ampVectors vol 7 no 1 article 244 2014

[8] WHO Guidelines for Safe Recreational Water EnvironmentCoastal And FreshWaters World Health Organization GenevaSwitzerland 2003

[9] C Sente J Erume I Naigaga et al ldquoXenic cultivation andgenotyping of pathogenic free-living amoeba from public watersupply sources in Ugandardquo New Journal of Science vol 2016Article ID 6358315 9 pages 2016

[10] C Sente J Erume I Naigaga et al ldquoOccurrence and geneticcharacterisation ofAcanthamoeba spp from environmental anddomestic water sources in Queen Elizabeth Protected AreaUgandardquo Parasites amp Vectors vol 9 article 127 2016

[11] R Cruickshank J P Duguid B P Marmion and R H ASwain Medical Microbiology A Guide to Laboratory DiagnosisAnd Control of Infections Churchhill Livingstone EdinburghScotland 12th edition 1975

[12] MM A El-Salam ldquoAssessment of water quality of some swim-ming pools A case study in Alexandria Egyptrdquo EnvironmentalMonitoring andAssessment vol 184 no 12 pp 7395ndash7406 2012

[13] CDC ldquoDomestic water sanitation and hygiene epidemiologyUSA center for disease control united states of Americardquohttpwwwcdcgovnceziddfwedwaterbornedomestichtml2015

[14] CDC ldquoNeglected parasitic infections (NPIs) in the UnitedStates [internet] centers for disease control and preventionrdquohttpwwwcdcgovparasitesnpi 2014

[15] CDC Parasites - Fascioliasis (Fasciola Infection) Center forDisease Control and Prevention 2013

New Journal of Science 5

disinfection of swimming pools The disinfection may noteliminate certain highly resistant organisms and often differ-ent disinfectants have to be used at varying doses It is possiblethat the TPC represented the presence of water-dwellingorganisms such as Acinetobacter Aeromonas Chryseobac-terium (Flavobacterium)KlebsiellaMoraxella SerratiaPseu-domonas and Xanthomonas Bacillus Mycobacterium tuber-culosis Mycobacterium avium Pseudomonas aeruginosa andLegionella pneumophila that are emerging and reemergingpathogens capable of causing severe opportunistic infectionsespecially in immunocompromised individuals [8 39 47]

In developed nations swimming pools with efficient cir-culation systems have strainer baskets which continuouslyfilter off solid materials to prevent contamination [48]Unfortunately most pools in Uganda do not have an efficientwater circulation systemWater is changed when it is deemedas dirty by the pool attendants and this is based on mereobservation instead of having a standard testing system torely onThe pool attendants believe that once a disinfectant isused the pool is automatically safe They do not look at thisin terms of quantity of the disinfectants and the time lagMuch as a number of the swimming pool owners and users(bathers) are aware that contaminated pools are a source ofserious infections there has beenminimal change in their usein ways that are likely to be safe It is a big puzzle to explainthis but probably these individuals still require more sensiti-sation about swimming pools and diseases cycles Increasedawareness and sensitisation in terms of risk factors leadingto disease acquisition is a good pathway towards efficientcontrol and preventive mechanisms

5 Conclusions

The study established that most popular swimming pools(68) around Kampala City were contaminated Neverthe-less 32 yielded growth within the acceptable limitsThe tar-geted organisms coliforms E coli and Salmonella were notpresent in the pools however this did not guarantee the safetyof the pools since there was a high total aerobic plate countthat consisted of othermicrobes capable of causing infectionsin humans

Additional Points

To be able to protect swimming pool users from the risk ofacquiring a number of pathogens it is high time the govern-ment of Uganda enforced the adoption of existing nationalstandards for recreational waters The government shouldbe tasked to build more effective portable water managementand sanitation policies There should be a commitment fromthe government to supply clean potable water to the commu-nities and this initiative must be of high priority Communityprograms must be initiated to educate people on water safetymeasures personal hygiene and water treatment processesAccess to improved water sources should be corroboratedwith access to improved sanitation and hygiene (personalhygiene regular cleaning of vessels proper storage andtreatment)

Conflicts of Interest

The authors declare that they have no conflicts of interest

References

[1] A L Smith Principles of Microbiology CVMosby London 5thedition 1977

[2] V Chongsuvivatwong and L Mo-suwan ldquoEvaluation of villagepiped water a case study in southern Thailandrdquo The SoutheastAsian Journal of Tropical Medicine And Public Health vol 24no 4 pp 631ndash635 1993

[3] S C Cairncross D G Curtis R L Feahem and G H BradleyEvaluation for village water supply planning Chichester JohnWiley and Sons 2000

[4] C Papadopoulou V Economou H Sakkas et al ldquoMicrobi-ological quality of indoor and outdoor swimming pools inGreece investigation of the antibiotic resistance of the bacterialisolatesrdquo International Journal of Hygiene and EnvironmentalHealth vol 211 no 3-4 pp 385ndash397 2008

[5] G Masoud A Abbass A Abaza andW Hazzah ldquoBacteriolog-ical quality of some swimming pools in Alexandria with specialreference to Staphylococcus aureusrdquo Environmental Monitoringand Assessment vol 188 no 7 article no 412 2016

[6] T Kumar S Onichandran Y A L Lim et al ldquoComparativestudy on waterborne parasites between Malaysia andThailanda new insightrdquo The American Journal of Tropical Medicine andHygiene vol 90 no 4 pp 682ndash689 2014

[7] S Onichandran T Kumar C C Salibay et al ldquoWaterborneparasites a current status from the Philippinesrdquo Parasites ampVectors vol 7 no 1 article 244 2014

[8] WHO Guidelines for Safe Recreational Water EnvironmentCoastal And FreshWaters World Health Organization GenevaSwitzerland 2003

[9] C Sente J Erume I Naigaga et al ldquoXenic cultivation andgenotyping of pathogenic free-living amoeba from public watersupply sources in Ugandardquo New Journal of Science vol 2016Article ID 6358315 9 pages 2016

[10] C Sente J Erume I Naigaga et al ldquoOccurrence and geneticcharacterisation ofAcanthamoeba spp from environmental anddomestic water sources in Queen Elizabeth Protected AreaUgandardquo Parasites amp Vectors vol 9 article 127 2016

[11] R Cruickshank J P Duguid B P Marmion and R H ASwain Medical Microbiology A Guide to Laboratory DiagnosisAnd Control of Infections Churchhill Livingstone EdinburghScotland 12th edition 1975

[12] MM A El-Salam ldquoAssessment of water quality of some swim-ming pools A case study in Alexandria Egyptrdquo EnvironmentalMonitoring andAssessment vol 184 no 12 pp 7395ndash7406 2012

[13] CDC ldquoDomestic water sanitation and hygiene epidemiologyUSA center for disease control united states of Americardquohttpwwwcdcgovnceziddfwedwaterbornedomestichtml2015

[14] CDC ldquoNeglected parasitic infections (NPIs) in the UnitedStates [internet] centers for disease control and preventionrdquohttpwwwcdcgovparasitesnpi 2014

[15] CDC Parasites - Fascioliasis (Fasciola Infection) Center forDisease Control and Prevention 2013

6 New Journal of Science

[16] G Bwire M Malimbo B Maskery Y E Kim V Mogasale andA Levin ldquoThe Burden of Cholera in Ugandardquo PLoS NeglectedTropical Diseases vol 7 no 12 Article ID e2545 2013

[17] G BwireMMwesawina Y Baluku S S E Kanyanda andCGOrach ldquoCross-border cholera outbreaks in Sub-Saharan Africathe mystery behind the silent illness What needs to be donerdquoPLoS ONE vol 11 no 6 Article ID e0156674 2016

[18] S H Choy H M Al-Mekhlafi M A Mahdy et al ldquoPrevalenceand associated risk factors of Giardia infection among indige-nous communities in rural Malaysiardquo Scientific Reports vol 4article 6909 2014

[19] S H Choy M A K Mahdy H M Al-Mekhlafi V L Lowand J Surin ldquoPopulation expansion and gene flow in Giardiaduodenalis as revealed by triosephosphate isomerase generdquoParasites and Vectors vol 8 no 1 article 1084 2015

[20] T GebruM Taha andW Kassahun ldquoRisk factors of diarrhoealdisease in under-five children among health extension modeland non-model families in Sheko district rural communitySouthwest Ethiopia Comparative cross-sectional studyrdquo BMCPublic Health vol 14 no 1 article 395 2014

[21] G S Visvesvara H Moura and F L Schuster ldquoPathogenic andopportunistic free-living amoebae Acanthamoeba spp Bala-muthiamandrillaris Naegleria fowleri and Sappinia diploideardquoFEMS Immunology ampMedical Microbiology vol 50 no 1 pp 1ndash26 2007

[22] H B Nguendo Yongsi ldquoPathogenic microorganisms associatedwith childhood diarrhea in low-and-middle income countriescase study of Yaounde - Cameroonrdquo International Journal ofEnvironmental Research and Public Health vol 5 no 4 pp 213ndash229 2008

[23] H B N Yongsi ldquoSuffering for water suffering from wateraccess to drinking-water and associated health risks inCameroonrdquo Journal of Health Population and Nutrition vol 28no 5 pp 424ndash435 2010

[24] C Sente J Erume I Naigaga et al ldquoPrevalence of pathogenicfree-living amoeba and other protozoa in natural and com-munal piped tap water from Queen Elizabeth protected areaUgandardquo Infectious Diseases of Poverty vol 5 no 1 article 682016

[25] S Fuhrimann M S Winkler M Stalder et al ldquoDisease burdendue to gastrointestinal pathogens in a wastewater system inKampala Ugandardquo Microbial Risk Analysis vol 4 pp 16ndash282016

[26] Monitor ldquoUgandan Swimming Pools a Pleasure With Riskrdquohttpallafricacomstories201202150043html 2012

[27] D Byamukama F Kansiime R L Mach and A H FarnleitnerldquoDetermination of Escherichia coli contamination with chro-mocult coliform agar showed a high level of discriminationefficiency for differing fecal pollution levels in tropical watersof Kampala UgandardquoApplied and Environmental Microbiologyvol 66 no 2 pp 864ndash868 2000

[28] K D Beer J W Gargano V A Roberts et al ldquoOutbreaks Asso-ciated with Environmental and undeterminedWater Exposures- United StatesrdquoMorbidity andMortalityWeekly Report vol 64no 31 pp 849ndash851 2015

[29] M B Desilva S Schafer M K Scott et al ldquoCommunitywidecryptosporidiosis outbreak associated with a surface water-supplied municipal water system - Baker City Oregon 2013rdquoEpidemiology and Infection vol 144 no 2 pp 274ndash284 2016

[30] M C Hlavsa V A Roberts A M Kahler et al ldquoRecreationalwater-associated disease outbreaks in United StatesrdquoMorbidityand Mortality Weekly Report vol 63 no 1 p 10 2009

[31] J E Painter J W Gargano S A Collier and J S Yoder ldquoGia-rdiasis surveillancemdashUnited States 2011-2012rdquo Morbidity andmortality weekly report Surveillance summaries (WashingtonDC 2002) vol 64 pp 15ndash25 2015

[32] J Barben G Hafen and J Schmid ldquoPseudomonas aeruginosain public swimming pools and bathroom water of patients withcystic fibrosisrdquo Journal of Cystic Fibrosis vol 4 no 4 pp 227ndash231 2005

[33] G Dalmau M Estela Martınez-Escala V Gazquez et alldquoSwimming pool contact dermatitis caused by 1-bromo-3-chloro-55-dimethyl hydantoinrdquo Journal of Contact Dermatitisvol 66 no 6 Article ID 3350339 pp 335ndash339 2012

[34] C Hang B Zhang T Gong and Q Xian ldquoOccurrence andhealth risk assessment of halogenated disinfection byproductsin indoor swimming pool waterrdquo Science of the Total Environ-ment vol 543 pp 425ndash431 2016

[35] K Kummerer ldquoDrugs diagnostic agents and disinfectants inwastewater and water a reviewrdquo Schriftenr Ver Wasser BodenLufthyg vol 2000 no 105 pp 59ndash71 2000

[36] APHA ldquoMicrobiological examination part 9000rdquo in StandardMethods for the Examination of Water and Wastewater L SClesceri A Greenberg and A D Eaton Eds vol 12 pp 308-309 American Public Health Association Washington DCUSA 20th edition 1998

[37] J S Cheesbrough B C Taxman S D R Green F I Mewa andA Numbi ldquoClinical definition for invasive Salmonella infectionin African childrenrdquo Pediatric Infectious Disease Journal vol 16no 3 pp 277ndash283 1997

[38] M CheesbroughDistrict Laboratory Practice in Tropical Coun-tries Cambridge University Press Cambridge UK 2nd edition2006

[39] WHO Heterotrophic Plate Counts and Drinking-water SafetyThe Significance of HPCs for Water Quality and Human HealthIWA Publishing London UK 1st edition 2003

[40] A Rabi Y Khader A Alkafajei and A A Aqoulah ldquoSanitaryconditions of public swimming pools in Amman JordanrdquoInternational Journal of Environmental Research and PublicHealth vol 5 no 3 pp 152ndash157 2008

[41] A Rabi Y Khader A Alkafajei and A A Aqoulah ldquoSanitaryconditions of public swimming pools in Amman Jordanrdquo Inter-national Journal of Environmental Research and Public Healthvol 4 no 4 pp 301ndash306 2007

[42] G Adjei G S K Sarpong E Laryea and E Tagoe ldquoBacterio-logical quality assessment of swimming pools in the osu-labadiarea Accrardquo Journal of Natural Sciences Research vol 19 pp126ndash129 2014

[43] CDC Prevention of parasites in faecal material from chlorin-ated swimming pools Centre for Disease Control 2008 httpswwwcdcgovparasitesabouthtml

[44] CDC ldquoSalmonella USA Centers for Disease Control and Pre-ventionrdquo Centers for Disease Control and Prevention httpswwwcdcgovsalmonella 2016

[45] CDC Naegleria fowleri-Primary Amebic Meningoencephalitis(PAM)- Amebic Encephalitis Pahogen and the environmentCenters for Disease Control and Prevention 2016 httpswwwcdcgovparasitesnaegleriastate-maphtml

New Journal of Science 7

[46] G F Craun R L Calderon andM F Craun ldquoOutbreaks associ-ated with recreational water in the United Statesrdquo InternationalJournal of Environmental Health Research vol 15 no 4 pp 243ndash262 2005

[47] WHO Joint Monitoring Programme for Water Supply andSanitation Meeting the MDG Drinking Water And SanitationTarget The Urban And Rural Challenge of The Decade WorldHealth Organization Geneva Switzerland 2006

[48] H TomM Dick and F CraneHow stuff works Virginia USA2015 httphomehowstuffworkscomswimming-poolhtm

Submit your manuscripts athttpswwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Anatomy Research International

PeptidesInternational Journal of

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International Journal of

Volume 201

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Molecular Biology International

GenomicsInternational Journal of

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The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioinformaticsAdvances in

Marine BiologyJournal of

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Signal TransductionJournal of

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Evolutionary BiologyInternational Journal of

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Biochemistry Research International

ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Microbiology