Abstract
Background: The COVID-19 pandemic highlighted the vulnerability of public health systems, exposing unfavourable environmental conditions that exacerbate health inequities in sub-Saharan Africa’s deprived populations. The lack of proper hygiene and sanitation has been identified as the leading cause of preventable diseases such as diarrhoeal illnesses, malnourishment, and neglected tropical diseases. The growing rate of urban migration has compounded challenges in addressing social determinants of health (SDOH) and health inequities in sub-Saharan Africa, as evident in the Khayelitsha Township.
Aim: The study aimed to investigate the occurrence of untreated sewage spillage-related incidences relating to the specified study period before and during the COVID-19 pandemic in the Khayelitsha Township, City of Cape Town.
Methodology: The research employed a descriptive cross-sectional design, utilizing secondary data records of sewerage spillage incidents for 2019-2021, encompassing all 13 wards within the demarcated boundaries of the Khayelitsha health sub-district. The data was sourced from the City of Cape Town’s Water and Sanitation Department. Data analyses were performed using the Statistical Packages for Social Sciences (SPSS 26). Bivariate and multivariate logistic regression models were used to analyse the data, with a p-value of <0.05 considered statistically significant. Pearson's chi-square test was employed to compare sewerage spillage incidences and maintenance response times over two years.
Results: A total of 547 sewage spillage incidents were recorded between 2019 and 2021, with 72.9% occurring between 2020 and 2021. Sewer blockages and overflows accounted for 96% of cases, with the highest concentrations reported in Kuyasa (98.5%), Makhaza (95%), and Harare (90.8%). Response times varied significantly, with 48.4% of incidents taking more than 30 days to resolve, while only 27% were addressed within seven days. Seasonal trends showed a peak in incidents during the third quarter (July–September). Logistic regression analysis confirmed a significant increase in blockage-related cases during the COVID-19 pandemic, with response delays influenced by factors beyond incident
iv
type. However, no statistically significant correlation was found between response times and sewer blockages.
Conclusion: The analysis confirmed a significant rise in sewer blockages and overflows during the COVID-19 pandemic, peaking in 2020 before slightly declining in 2021. Blockages were strongly associated with variables such as response times, foul smells, stolen covers, reinstatements, and broken pipes. However, response delays were not statistically linked to incident type, suggesting other contributing factors. Socio-demographic factors, including ward and suburb designations, showed no significant influence on incident patterns or sewer infrastructure conditions. These findings underscore the urgent need for improved sanitation infrastructure and more responsive maintenance strategies to mitigate sewage-related health risks in vulnerable communities.