water, sanitation and health & health risk management 1 naomi radke, seecon international gmbh

Water, Sanitation and Health & Health Risk Management

Water, Sanitation and Health&

Health Risk Management

1

Naomi Radke, seecon international GmbH


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Contents

Water, Sanitation and Health1. Water-Borne Diseases2. Effects of Water-Borne Diseases3. Conclusion

Health Risk Management1. A Multi-Barrier Approach2. Transmission Routes3. Critical Questions 4. Mitigating Health Risks

References

3


Water, Sanitation and Health



Sources of Diseases

• Pathogenic microorganisms in contaminated water

• Lack of access to adequate (safe) water sources or water point-of-use water treatments

• But also lack of sanitation and poor hygiene are responsible for the transmission of diseases

• Water often contaminated due to inadequate sanitation and waste water treatment: faeces of an infected person enters the water untreated

• Some estimated 884 million people worldwide lack access to improved water supply and 2.6 billion people lack access to improved sanitation (WHO/UNICEF 2010)

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1. Water-Borne Diseases

Poor sanitation leads to discharge of sewage directly into the environment.Source: WaterAid (2013)



Diseases

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1. Water-Borne Diseases

Dirty water causes more deaths per year than armed conflicts.

Source: WSSCC (2007)

Diarrhoea (multiple liquid bowl movements per day; this loss of fluid can lead to death)

Cholera (infection in the small intestine leading to diarrhoea and vomiting and thus to dehydration)

Typhoid (fever, headache, pain and diarrhoea)

And several other parasitic infections (e.g. schistosomiasis, guinea worm, ...)

Most significant is the persistence and wide distribution of diarrhoea throughout the developing world – an effect of inadequate water supply and sanitation.



School Absence

Absence of 443 Mio school days each year (BORKOWSKY 2006) due to water-borne diseases

• Strong negative impact on nutrition, health and learning capacities especially of children

• Hurts prospects for future earnings and makes continuing poverty more likely

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2. Effects of Water-Borne Diseases

Adequate sanitation can reduce water-borne diseases of children.

Source: WHO (2012)



Severe Sickness and Death

• Parasitic helminthes infections: severe consequences e.g. cognitive impairment, massive dysentery, anaemia and death of around 9400 people every year

• In Sub-Saharan Africa, schistosomiasis kills more than 200,000 people every year

• Acute diarrhoea, as occurs in cholera, if left untreated can cause death within a day or less

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Breaking Economic Development

• Large-scale death and poor health also act as a brake on economic development

• Unsafe water and inadequate sanitation especially impacts the poor (About 2/3 of people without access to a protected water source live on less than US$2 a day )

• Adequate water supplies and sanitation are often key step out of poverty

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Clean Water and Sanitation are intertwined with more than health!

Due to the interconnectedness between water, sanitation, health and poverty, lack of safe water supply and proper sanitation has not only an impact on health, but consequently on education, ability to work and thus economic development.

Thus both adequate drinking water and sanitation are crucial for the health of human and thus their physical and economical development (school visits and escaping the poverty trap).

An approach to reduce health risk due to water/sanitation-borne diseases can be found in the following section:


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3. Conclusion



What is a barrier?

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… A part of the treatment or handling chain of a sanitation system that substantially reduces the number of pathogens present in excreta and thus the risk of infection.

Example of barrier: proper management of excreta acts as the primary barrier to the prevention of pathogen-spread.

1. A Multi-Barrier Approach



What is a multi-barrier approach? (1/2)

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… Pathogen reduction by various measures as opposed to only one measure (e.g. proper excreta management) along the treatment/handling chain.




What is a multi-barrier approach? (2/2)

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Source: STENSTROEM ET AL. (2011)



Exposure Points

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The origin of diarrhoea is faeces!

Transmission of faeces-related pathogens can take place at various points. These have to be controlled.

2. Transmission Routes

Source: STENSTROEM ET AL. (2011)



Transmission Routes (1/2)

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Primary: direct exposure

•Person-to-person contact

•Short-distance airborne transmission

Secondary: exposure through external route

•Vehicle-borne: contamination of food, water, etc.

•Vector-borne: created breeding sites of vectors




Transmission Routes (2/2)

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Spread of pathogens from excreta of an infected individual to a healthy individual.Source: STENSTROEM ET AL. (2011)



Questions to identify severity of health risk

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3. Critical Questions

WHO is exposed to pathogens from contaminated water and excreta?

HOW MANY people (individuals) are likely to be exposed directly or indirectly?

WHERE does the exposure occur within the sanitation system?

WHICH routes should we consider?

HOW frequently does exposure occur?

WHAT dose of exposure occurs?



WHO is exposed?

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3. Critical Questions

Groups affected can be:

• User – uses the technology (e.g. poor hygiene when using toilet, drinking contaminated water)

• Worker – maintains/cleans/operates/empties the sanitation technologies

• Farmer – uses generated sanitation products (wastewater, sewage sludge etc.)

• Community – passively affected by living nearsanitation technologies or contaminated farming sites

Worker – a toilet emptier.Source: SuSanA on Flickr (2010)



Technical components

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4. Mitigating Health Risks

The selected technology within each of the functional groups of a sanitation system will govern the overall reduction efficiency and the likelihood of disease transmission.

Each is linked to critical points where pathogens may be transmitted or controlled.

Functional groups of a sanitation system.

Source: http://akvopedia.org/wiki/Sanitation_Portal



Non-technical components (1/2)

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Extent of human health protection by the sanitation system relates to socio-cultural aspects linked to specific features of the system:

taboostaboos

traditionstraditions

believesbelieves predominant hygiene practices

predominant hygiene practices



Non-technical components (2/2)

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These taboos/believes/traditions/practices may reduce or elevate pathogen exposure

Example: Reduction

Koranic edict: excreta are regarded as impure (najassa) and its use only permitted when the najassa is removed.

Example: Elevation

In some cultures child faeces is regarded as harmless.



Hygiene promotion

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In order to mitigate health risks from inadequate sanitation and unclean water it is important to:

• Promote good practices around the home (for sanitation, cooking, drinking, etc.)

• Teach about risks and consequences of lack of hygiene

• Find out what practices are common in your target area and adapt your promotion to it



Hygiene promotion – Most important practices to reduce risk

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• Safe disposal of faeces (the primary source of diarrhoea) – use toilets/latrines and if not possible bury faeces and cover with soil

• Hand washing – most importantly after touching faeces, before eating, preparing food and feeding children

• Keep water clean – faecal material should not get into water supplies. Additionally boil and filter water and cover water jars

• Fly control (transmitter of faeces-related diseases)– e.G. Cover latrines or use fly traps

Source: UNICEF (1999)



ROMA, E.; PUGH, I, (2012): Toilets for health. London: London School of Hygiene & Tropical Medicine. URL: http://www.lshtm.ac.uk/newsevents/features/2012/toilets_for_health:_flushed_with_success_.html [Accessed: 06.08.2013]

WSSCC (Editor) (2007): Hurry up! 2.6 billion people lack access to adequate sanitation. Geneva: Water Supply and Sanitation Collaborative Council (WSSCC). URL: not available.

WHO (2012): UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS). The Challenge of Extending and Sustaining Services. Geneva: World Health Organization (WHO). URL: http://www.who.int/water_sanitation_health/glaas/en/ [Accessed: 06.08.2013]

WATERAID (2013): Sanitation’s Impact on Health. New York: Water Aid America. URL: http://www.wateraidamerica.org/what_we_do/the_need/sanitation.aspx [Accessed: 06.08.2013]

STENSTROEM, A.; SEIDU, R.; EKANE, M.; ZURBRUEGG, C. (2011): Microbial Exposure and Health Assessments in Sanitation Technologies and Systems. Stockholm: Stockholm Environment Institute (SEI). URL: http://www.susana.org/lang-en/library?view=ccbktypeitem&type=2&id=1236 [Accessed: 06.08.2013]

BORKOWSKI, L. (2006): UNDP on the World's Water Challenge. Brooklyn, New York: ScienceBlogs, LLC. URL: http://scienceblogs.com/thepumphandle/2006/11/18/undp-on-the-worlds-water-challenge/ [Accessed: 06.08.2013]

UNICEF (1999): A Manual on Hygiene Promotion. New York, London: United Nations Children Fund (UNICEF), London School of Hygiene and Tropical Medicine (LSHTM). URL: http://www.susana.org/lang-en/library/library?view=ccbktypeitem&type=2&id=424 [Accessed: 20.08.2013]

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References

Water, Sanitation and Health & Health Risk Management 26

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