Ramogobedi Lebogang: optometrist and public health researcher at USAWA, a civil society organisation focused on health equity; and Haseena Majid, director of public health programmes at USAWA, and Global Atlantic Fellow for health equity and social justice.

A conjunctivitis or “pink eye” outbreak in KwaZulu-Natal was first reported on the  26^th of February 2024. Since then, at least 13,593 cases have been confirmed – 13,500 of these are in eThekwini. 

There has been extensive media coverage about the province’s water crisis and its impact on residents since 2022. Water tankers are insufficient, and there is no safe and sustainable solution in place to ensure the needs of all people including the elderly and people living with disability. 

On 26 Jan 2024, the Department of Water and Sanitation released a statement to explain the water supply disruptions in eThekwini and to inform the public of interventions to address these interruptions. 

The root causes of the challenge as expressed in their statement includes the heightened demand for water that exceeds the current supply capacity, damaged infrastructure due to the floods, and loadshedding. While the department shared a list of expensive projects underway, no tangible relief is in sight and health risks continue to rise. Among these being infectious disease, including the outbreak of conjunctivitis.

Water-related diseases 

Many ocular diseases can be attributed to contaminated water and we use the term “water-related ocular diseases” (WRODs) to denote this spectrum of diseases. 

WRODs are directly related to human interaction with contaminated water and can occur through toxic, allergic, inflammatory or infective mechanisms. Although the condition is mild and self- limiting in most cases, in circumstances such as immunocompromise or advanced age, WRODs can be devastating and blinding. 

We assert that the recent outbreak of “pink eye” could likely be attached to the lack of access to clean, safe water. Beyond “pink eye”, additional risks present for ocular disease linked to acanthamoeba and pseudomonas, both of which require extensive public health awareness and urgent preventive measures from authorities. 

”Pink eye” is an umbrella term used to describe conjunctivitis. There are several types of conjunctivitis with viral conjunctivitis being the most contagious. The Department of Health needs to inform us about the type of conjunctivitis being diagnosed, because it is necessary in the determination of the management approach, and the procurement and distribution of correct medication. Additionally it will enable more accurate public health interventions to  curb the spread of the infection.

Practising good hygiene

We urge the public to present to their local eye clinics for examination, diagnosis, and suitable management. We request optometrists, ophthalmologists and other health service providers in the public and private sectors to document and report their findings with a focus on the areas people live and work in to establish causal links and support context-specific responses. This is yet another instance of the dangers of a polarised health system, where the private sector exists in isolation with no reporting system toward the provincial and national health. 

While the Department has advised the public to exercise good hygiene as a preventive measure, we wish to highlight that good hygiene is unavoidably attached to the access of safe and clean water, a right enshrined in our constitution. 

We call upon provincial and district departments responsible for health, environmental health, and water and sanitation to act swiftly.  Reaching a point of infectious outbreak of ocular disease is alarming and has far reaching impacts for individuals and communities.