4.1.

Physicochemical and bacteriological characterisation of the septic tank

effluents
The pH of the samples studied during the different campaigns fluctuated between
7.43 and 7.86, underscoring the existence of a slightly alkaline environment. The
variation noted in the pH measurements of hospital effluents is less than 1 unit pH.
The results of the physicochemical characterisation of the septic tank effluents
studied are summarised in Table 1.
The results obtained for electric conductivity [297–324 μm/cm] indicate the
presence of mineral substances in moderate concentrations. Values for chlorides
vary from 172 to 191 mg/L. These concentrations are higher than the values [30–
100 mg/L] usually found in domestic wastewater (Metcalf and Eddy,1991). On the
other hand they are lower than the values [63–359 mg/L] obtained by Emmanuel et
al. (2004a) for the effluents of a tropical disease unit of a hospital in a large city in
southeast France.
The concentrations obtained for metals are mostly lower than the threshold values
set by international regulations on discharges of wastewater containing these
pollutants (European Commission, 1998a). The lead, nickel and chrome contents
of the wastewaters studied are far higher than the concentrations measured for the
hospital effluents by Emmanuel et al. (2005a). In the samples of effluents from the
septic tank, COD concentrations vary from 425 to 618, much higher than the
threshold value of 125 mg/L recommended by Directive 98/15/EC for industrial
wastewaters.

The information available in the literature highlights the very low concentration of
bacterial flora present in the effluents (Bernet and Fines, 2000). In this study, the
maximum value obtained for bacterial flora was 119×104 NPP/100 ml. This
number is lower than the 1×108 NPP/100 ml generally found in urban wastewater
(Metcalf and Eddy, 1991), and higher than the flora 2.4×103 NPP/100 ml counted
in the hospital effluents by Emmanuel et al. (2005a). The low concentration of
bacterial flora and the ecotoxicity of hospital effluents have been attributed by some
authors to the presence of drugs and disinfectants in them (Deloffre-Bonnamour,
1995).
During the sampling campaign of 2002, 5 samples were collected at the inlet and
outlet of the septic tank in the framework of this study. The results obtained from
this campaign permit appreciating the capacity of the septic tank to retain certain
pollutants contained in the effluents studied. The efficiency of the septic tank for
the primary treatment of hospital effluents was assessed by using Eq. (6),

Where Cxe in the concentration of parameter “x” at the inlet of the septic tank
(input), and Cxs is the concentration of the same parameter at its outlet (effluent).
Table 2 supplies the first results on the efficiency of the septic tank in retaining
certain substances and organic material in particular.

The efficiency of the septic tank in treating hospital effluents is poor. Indeed,
regarding the retention of biodegradable substances their efficiency is in the region
of 35% (Gschlössl et al.,1999). Only 17% of COD concentration is retained.
Likewise for NO3, it is 39% for TSM (Total suspended matters) and Pb, 45% for
Ni. For chromium, it has been observed that the concentration in the influent is
lower than the concentration in the effluent of the septic tank. The results obtained
for Pb and Ni are probably due to the distance separating the inlet pipe from the
bottom of the tank. No efficiency was detected for total chrome. Considering the
volume used by the hospitals, this distance can also influence the settling of solids
and biochemical reaction cycles.

4.2. Results of physicochemical and bacteriological analyses of groundwater

The results of the physicochemical and bacteriological analyses of groundwater are
summarised in Table 3. The pH of the samples studied during the campaigns varied
from 6.74 to 8.01. Although higher than 1 unit of pH, this variation lies within the
limits proposed by (OMS, 1994) for drinking water.
COD, a non conventional pollutant, is sometimes used to characterise the global
concentration of organic pollutants (Rodier, 1996). COD can be used to provide
data on the existence of organic substances that can only be oxidised by aerobic
biological processes (USEPA, 1993). High concentrations of COD were measured
[59–112 mg/L] in the groundwater. Although this parameterwas not considered
directly as a risk tracer, it should nonetheless be emphasised that its minimal
concentration was far higher than the threshold value of 5 mg/L prescribed by the
Belgian standard (DGRNE, 1998) for water intended for human consumption,
probably expressing the presence of high concentrations of organic substances in
the groundwater of the site studied.
A maximal concentration of 0.09 mgAOX/L was measured in the hospital well
water. Concentrations of bromochloromethane and dichloromethane were both b1
μg/L. As for the other organohalogenic solvents studied, the following maximal
concentrations were obtained: chloroform [1.2 μg/L], dichlorobromomethane [2.6
μg/L], dibromochloromethane [5.2 μg/L] and bromoform [4.6 μg/L].
Metals Pb [10–40 μg/L], Ni [15–250 μg/L] and Cr [18–470 μg/L] were detected in
the hospital well water. Maximal concentrations of metals measured in this water
were higher than those obtained for the same parameters in the septic tank (Table
1).

Most of the heavy metals present in water occur in ionic forms. Heavy metal ions
are acknowledged to be highly toxic and can accumulate in water and soils (Siegel,
2002; Bradl, 2004; Qin et al., 2006; Bhattacharyya and Gupta, 2007). Since the
values obtained for lead, nickel and chromium in this study are very high;
consumers of this water are exposed to major health problems. Despite the relative
abundance of clay in the soils of Port-au-Prince, several other factors may explain
the high concentrations of heavy metals in the groundwater studied. Indeed, clay
minerals in soils act as natural scavengers by removing and accumulating the
contaminants in the water that passes through the soil, through ion exchange and
adsorption (Bhattacharyya and Gupta, 2007). However, inorganic colloids, metal
speciation, metal concentration, pH, solid, solution mass ratio and contact time are
also very important in controlling the adsorption of heavy metals and their
distribution between soil and water (Bradl, 2004).
The information reported in the literature on the individual behavior of selected
heavy metals states that pH plays an important role in the adsorption and
precipitation behavior of chromium, lead and nickel in soils. Cr(III) adsorption
increases with increasing pH and soil organicmatter content whereas there is a
decrease of competing cations and dissolved organic ligands in the solution. The
increased adsorption of Cr(III) with increasing pH is caused by the cation exchange
reactions of hydrolyzed substances (Bradl, 2004). The adsorption of Cr (VI) onto
various adsorbents is a function of pH. Adsorption increaseswith decreasing pH due
to the protonation of hydroxyl groups (Rai et al., 1989). Bhattacharyya andGupta
(2007) showthat is not possible to carry out adsorption experimentswith Pb(II) at
pHN6.0, or for Ni(II) at pHN8.0, due to precipitation of themetals as hydroxides,
thereby introducing uncertainty into the interpretation of the results. Since thepHof
the septic tank effluents ranged from 7.43 to 7.86, it appears necessary in the future
to carry out experimental studies on soil pH and pursue research into the geological
and chemical characteristics of the selected site in order to understand the different
mechanisms governing the transfer of heavy metals to the groundwater.

Nitrate contamination is generally observed in low yielding wells and in close

proximity to potential point waste sources but may also arise from diffuse sources.
Most nitrates found in naturalwaters is of anthropogenic origin, originating from
organic and inorganic sources, the former including wastewater, waste discharges
and the latter comprising mainly artificial fertilizers. Nitrate is present naturally in
groundwater in low concentrations, typically in the range 5–9 mg/L NO3 (OMS,
1996).
The nitrate concentrations measured [100 to 148 mg/L] were much higher than
those usually detected in natural waters, as well as the threshold value of 50 mg/L
for drinking water (OMS, 1996; European Commission, 1998b). Degradation of
groundwater quality by nitrates and its consequences on human health have been
the subject of many studies (Fraser and Chilvers, 1981; Laftouhi et al., 2003; Saadi
and Maslouhi, 2003; Ibnoussina et al., 2006). Experimental studies have shown that
the presence of high concentrations of nitrates in groundwater is linked to the nature
of the soil on the one hand and, on the other, to the effect of continuous discharges
of wastewater and successive irrigations (Ibnoussina et al., 2006). Poss and
Saragoni (1992) described a leaching phenomenon, using experimental tests in a
column, that highlights the effect of the quantity of water on nitrate transport,
resulting in an appreciable loss in the upper soil layers and accumulation in the
deeper ones, where the nitrates finally enter drainagewater. Ibnoussina et al. (2006)
showed that the aquifers of sandy soil with low clay and organic contents are
particularly sensitive to nitrate contamination. Since the clay content of the soil of
the site studied is high, there should be no sign of nitrates being released into the
groundwater. Therefore it appears that preferential paths exist in the non saturated
area of the site studied (Fig. 1) leading, during heavy rainfalls, to rapid leaching of
the nitrates stored in the soil into the groundwater.

In addition, excess consumption of nitrates in the human diet can lead to health risks
that include methamoglobinaemia in infants (blue baby syndrome) and possible
carcinogenic hazards. The toxicity of nitrates to humans is thought to result solely
from its reduction to nitrites. Nitrites are involved in the oxidation of normal
haemoglobin into methaemoglobin which is unable to transport oxygen to the
body's tissues (OMS, 1996).
According to international regulations E. coli must be non detectable in a sample of
100ml (OMS,1996; European Commission,1998b). A number of faecal coliforms
(E. coli) varying from 300 to 989 NPP/100 were counted in the hospital wellwater.
In addition to this high bacterial contamination, the literature reports considerable
circulation of Cryptosporidium sp. oocystes identified in the surface water and in
the water supply intended for human consumption in several districts of Port-au-
rince (Brasseur et al., 2002). The strong presence of E. coli in the wellwater
highlights the existence of amajor source of faecal contamination. The effluents
from septic tanks, agricultural organic waste and dumps are the sources most
usually considered as the potential causes of groundwater contamination.
Soils can be effective in removing microorganisms by predation, filtration and
asorption (Dussart-Baptista et al., 2003). Also, soils contribute to the adsorption of
nitrates contained in wastewater and the effluents of irrigation (Ibnoussina et al.,
2006). They are also one of the factors controlling the adsorption of heavy metal
ions (Kerndorf and Schnitzer, 1980). However, natural, unprotected areas, such
aswith karstic, sandy and gravely terrains and extremely vulnerable fractured
aquifers, allowthe rapidmovement of contaminants into the groundwater
withminimal attenuation, leading to the possibility of high risk situations. Although
the presence of clayey soils, tillage and peat will, in many instances, retard the
verticalmigration of microbes, preferential secondary flowpaths such as cracks in
clay materials can bypass the filtering effect of such soils.
The values measured in the hospital well water emphasise substantial
contamination of the groundwater resources of the study area and lead to the
assumption of a high health risk for the consumers of water from this water table.
Given the importance of this aquifer to the water supply of PPUC (Emmanuel et
al., 2004b), it will be necessary in future to identify the different sources of
pollution, extend the physicochemical characterisation of these waters and identify
the mechanisms governing the transfer of pollutants from the surface to the
groundwater.

4.3. Assessment of dangers for human health

This step, which was introduced in the general methodology of health risk
assessment (NRC, 1983), consists in comparing (Table 4) the concentrations
measured in the groundwater for the risk tracers selected to the guide values for
drinking water prescribed by international regulations.
With the exception of organohalogenic solvents and Cr(VI), all the other
physicochemical parameters were found at values higher than the threshold values
for water intended for human consumption. The ratio between the maximal number
of faecal coliforms present in the groundwater and the bacteriological quality
standard of water intended for human consumption was far greater then 1. These
results confirm the existence of a danger to the health of the population consuming
this groundwater and thus the need to pursue these studies.

4.4. Characterisation of risks for human health

4.4.1. Microbiological risks
The infectious risk calculated for the faecal coliforms measured in the groundwater
gave a resultof 10−5 infectionper year (1 personper 100000). This risk is lower than
that of 10−4 infection per year per person, considered in theUnited States as the
tolerable risk level linked to the consumption of drinkingwater (Hass,1996).
Furthermore, in a tropical country where temperature favours the development and
growth of pathogenic germs, 10−5 infection per year per person appears to be non
negligible risk.

The approach presented here leads to a quantitative assessment of infectious risks.

It should be improved regarding the risk linked to Cryptosporidium and to the
enteroccocus which are currently very efficient indicators for estimating faecal
pollution. Indeed, in certain districts of Port-au-Prince risk of infection by oocystes
of Cryptosporidium ranging from 1% to 5% and from 1% to 97% have been
calculated respectively for the immunocompetent population; and for the
immunodepressed population according to the load of oocystes contained in the
water consumed (Bras et al., 2007). It is therefore advisable, in the framework of
managing risk to human health related to the contamination of the fresh water
resources of Port-au-Prince by hospital effluents, to henceforth verify these initial
results by measuring other indicators of faecal pollution of water such as faecal
enteroccocus, Cryptosporidium sp., other parasites and the entero-viruses.

4.4.2. Chemical risks

Regarding lead and its inorganic derivatives, the USEPA (1989a,b) and ATSDR
(1999) do not propose any value for carcinogenic effects. Age, state of health,
ponderal load in lead, and length of exposure are all factors that influence lead
metabolism and complicate the establishment of these values (INERIS, 2002).
The USEPA (1998a,b) notes that there is insufficient information to determine the
carcinogenic effects of Cr(III) in water and in foods. As for nickel, little is known
as yet about human exposure by the oral path to water contaminated by this metal.
Thus risk calculations for metals were performed by using the method usually
employed for noncarcinogenic substances, i.e. substances acting with a threshold
effect. Table 5 shows the risk levels calculated for non-carcinogenic substances.
With the exception of chrome, which has a moderate risk for adults, all the other
metals have a high risk for both adults and children. In spite of the prevailing
uncertainty about whether or not substances such as Cr(III) and Ni(II) have
carcinogenic properties, the results obtained show that the population is exposed to
a considerable chemical risk.

The quality of a risk assessment depends on the validity of the different data used
to perform it: physicochemical, toxiclogical, epidemiological data, etc. as well as
the construction of realistic scenarios (Zmirou and Perrodin, 1999). However,
numerous uncertainties remain regarding the approach pursued. In the case of the
scenario studied, mention can bemade in particular of the choice of pollutants and
the toxicological data on the non or carcinogenic character of the pollutant minerals
in the drinking water. These uncertainties are almost always present in health risk
management.
Risk assessment remains a scientific activity that permits predicting the probable
effects of pollutants in human beings. Nonetheless, it is obvious that the results of
these assessments permit the adoption of policies designed to avert aworst-case
situation. The scenario presented here leads to a quantitative assessment of human
health risks.
In the case of the scenario studied, it should be noted that the degradation of
groundwater is due to human activities. The content measured for the mineral
pollutants is far higher than the values naturally present in thesewater resources. It
is necessary in the future to validate these initial results by further and more in-
depth assessments of risks to human health including, among other things, the
determination of other biological indicators of faecal pollution of water, especially
by Cryptosporidium spp., faecal enterococcus and the enteroviruses, coupled with
epidemiological studies.