Diseases related to water, sanitation and hygiene (WASH)

Diseases related to water, sanitation and

hygiene (WASH)

Diseases related to water, sanitation and hygiene (WASH)WATSAN M15 ERUWATSAN M15 ERU 2

Contents

1.1. Public Health in Emergencies: IndicatorsPublic Health in Emergencies: Indicators

2.2. Relevance of water, sanitation and hygiene to health Relevance of water, sanitation and hygiene to health

3.3. Diseases related to water and excreta, and Diseases related to water and excreta, and

transmission mechanisms.transmission mechanisms.

1. Health indicators in emergencies



Causes of Death in Emergencies (Worldwide)

Diarrhoeal Diseases

Trauma (Injury)

Measles

Malnutrition

Malaria

Acute Respiratory Infections (ARI)


Daily Crude Mortality Rate (CMR)

• Definition: The rate of death in the entire population, including both sexes and all ages.• Formula most commonly used during disaster:

Total number of deaths during time period x 10.000 persons

Total population No.days in time period = deaths/10.000 persons/day

Under 5 Mortality Rate (U5MR)

• Definition : The rate of death among children below 5 years of age in population.• Formula most commonly used during disaster:

Total number of deaths in children <5 years during time period x 10.000 persons

Total number of children < 5 years No.days in time period = deaths/10.000 children/day

Health Indicators in Emergencies


Fuente: UNICEF State of the World’s Children 2003

Mortality Rates in Emergencies

Baseline Reference Mortality Data by Region

Region CDR/CMR deaths/10,000/day

CDR/CMR emergency threshold

U5DR/MR deaths/10,000 U5/day

U5DR/MR emergency threshold

Sub- Saharan Africa

0.44 0.9 1.14 2.3

South Asia 0.25 0.5 0.59 1.2

Middle East and North Africa

0.16 0.3 0.36 0.7

East Asia and Pacific

0.19 0.4 0.24 0.5

Latin America and Caribbean

0.16 0.3 0.19 0.4


Benchmark for CMR and U5MR (worldwide)

Benchmark for CMR (world):

•Baseline 0.5 •Serious 1.0-2.0 •Crisis >2.0

Benchmark for U5MR (world):

•Baseline 0.8-1.2 •Serious >2.0-4.0

For a specific area, when baseline is unknown agencies should aim to maintain the CMR at below 1/10.000/ day.

2. Relevance of water, sanitation and hygiene to health


The most important aim of a water and sanitation programme…

...To minimise health risks of the population


The main objective of water supply, sanitation and hygiene programmes in disasters is to reduce the transmission of faecal-oral diseases and exposure to disease-bearing vectors that transmit diseases with epidemic potential, allowing people living with good health, dignity, comfort and security.


WATER / SANITATION / HYGIENE

HEALTH


The crucial aims of water and sanitation programmes are…..

• To supply sufficient safe water • To supply the means for an adequate excreta

disposal and other types of waste • To implement hygiene measures • To train people regarding hygiene and the proper use

of water


Fewtrell L et al. (2004) Lancet Infect Dis 5(1): 42-52.


Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST

Most common routes for the transmission of Diarrhoea germs

Sanitation

DIAGRAM F

Hygiene

Water

Water quantity

Water quality


Faecal-oral transmission:

1.- Water2.- Food

3.- Objects

HEALTH CARE LATRINE

SPRING SAFE WATER

DOMESTIC AND PERSONAL HYGIENE

3. Diseases associated with water and excreta, and spreading mechanisms


THE MOST IMPORTANTS

DIARRHOEA

FAECAL-ORAL route TRANSMITTED by VECTORS


EntomoebaGiardia

Cryptosporidium

10.000/g

10.000/g10.000/g

Shigella

V. cholera

E. coli

10.000.000/g

10.000/g

10.000.000/g

Rotavirus

PoliovirusVirus de Hepatitis

BACTERIA

VIRUS

PROTOZOAN


Water-borne or water-washed diseases

Cholera, shigellosis, diarrhoea, salmonellosis.

Typhoid, paratyphoid, etc.

Amoebic dysentery, giardiasis

Hepatitis A, poliomyelitis, rotavirus diarrhoea

Transmission mechanisms

FAECAL-ORALFAECAL-ORAL

• Water contamination

• Poor sanitation

• Poor personal hygiene

• Crop contamination


DIARRHOEA DISEASES

According to Curtis and Cairncross (2003), hand washing with soap and water after contact with faecal material can reduce diarrhoeal diseases by 42% or more.

Curtis, V. and Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infectious Diseases 3: 275-281.


DIARRHOEA DISEASES• Acute watery diarrhoea:

Watery stools without visible blood, vomit and fever. Dehydration

• CholeraCholera

• Bacillary Dysentery (shigellosis):

Acute bloody diarrhoea with fever, abdominal cramps and rectal pain. Complications include sepsis, rectal prolapse, haemolytic uraemic syndrome and seizures.

• Giardiasis:

Watery stools, flatulence, greasy stools, stomach cramps, nausea, weight loss and dehydration.

• Amebiasis or Amebic Dysentery:

Bloody stools or loose stools, stomach pain, stomach cramping and fever.


CHOLERA

• Caused by the Vibrio Cholerae (bacteria)

• Endemic or with epidemic potential (Africa,South America,Asia...)

• Watery diarrhoea classically rice-water stools, with or without vomiting, dehydration, shock

• IMPORTANT!! faecal-oral route

-Faecal material and vomit mist be properly disinfected and disposed of

-Adequate water supply

-Clean water whenever food is being handled

-Hand washing promotion

• Cause outbreaks with case-fatality rates


TYPHOID FEVER• Caused by Salmonella Typhi (bacteria)• Low grade fever, malaise and dry cough, abdominal discomfort, diarrhoea

or constipation, altered mental status and multiples complications.•FAECAL-ORAL - Waste water with human and animal faeces - Faeces contaminated food•PREVENTION

- - Health educationHealth education - Safe food and water, proper food handling- Safe food and water, proper food handling - Adequate excreta disposal - Adequate excreta disposal - Personal hygiene - Personal hygiene - Safe water collection points- Safe water collection points


KEY FACTORS FOR PREVENTING DIARRHOEA DISEASES

• Safe drinking water (Extraction, transport and storage)

• Controlled excreta disposal

• Safe food and proper food handling

• Hand washing with soap

• Breastfeeding

• Education


HEPATITIS

• Virus A and E.(exist B ,C,Δ)

• Clinical: fever, tiredness, nauseas, digestive problems and later jaudince (yellow skin and mucous) with dark urine and whitish stools.

• Usually complete cure. No chronic, no carrier.

• Attention the A and E transmission FAECAL-ORAL route

• Risk factors

• Food and water contaminated• Poor sanitation infrastructure• Crowding• Waste water with human and animal faeces


POLIOMYELITIS• Virus polio virus (serotypes 1,2,3)• In endemics areas epidemics usually affect children < 5 years of age. In non endemic areas where vaccination coverage is low, young adults are most commonly affected• 90% a symptomatic

• 10% disease • Non paralytic form: fever, muscle pain,tiredness, headache, intestinal problems (nausea ,vomits ,diarrhoea), backache, non neurological involvement•Paralytic form: after the non specific signs,the patient develops rapid onset acute flaccid paralysis flaccid and meningeal symptoms .

• There is no cure. Prevention vaccination

• FAECAL-ORAL•Point of contagious:Food and water contaminated by infected faeces,

nose and mouth infected secretion.


Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST

Most common routes for the transmission of Diarrhoea germs

Sanitation

DIAGRAM F

Hygiene

Water

Water quantity

Water quality


Water washed or water scarce

diseases

Skin and eye infections.

Louse borne typhus or louse-borne relapsing fever.

• Inadequate water

• Poor personal hygiene



• Scabies:Scabies:• Sarcoptes scabiei hominis (parasite)• Larvae dig tunnels in the external skin

layers. - Rash, scab skin.- Wrinkles, between fingers, elbows,

writs, penis, nipples.

• Impetigo:Impetigo:• Streptococcus and staphylococcus

Contagious superficial skin infection. - Blisters with pus-scab- Face, nasal cavity, mouth, neck,

groin.

SKIN DISEASES


• Conjunctivitis:Conjunctivitis: • Acute inflammation of the conjunctiva due to

bacterial or viral infection.* Irritation, teardrop, secretion.* Contagious : contact with infected conjunctivitis secretions,hands and clothes contaminated,fly….

• Trachoma:Trachoma:• Keratoconjunctivitis due to Keratoconjunctivitis due to Chlamydia Chlamydia

trachomatistrachomatis* Progressive conjunctivitis and most

common cause of blindness in endemic areas.

* Contagious : contact with infected conjunctivitis secretions,hands and clothes contaminated,fly….

EYE DISEASES


TYPHUS• Caused of the genus Rickettsia pathogen R.prowasekii (bacteria)• Clinical:

Sudden onset of fever (temp of over 39 Cº), headache, myalgias.Exanthema maculopapular

• TRANSMISSION: Body louse due to lack of personal hygiene, crowding.

RELAPSING FEVER• Caused of the genus Borrelia pathogen B.recurrentis, B.hispanica, B.persica.... (spirochetes)• Clinical:

High fever, artralgia, shivering, jaundice, bleeding. A febrile interval

• TRANSMISSION: Body louse and tick due to lack of personal hygiene, crowding..


KEY FACTORS FOR PREVENTING WATER-WASHED AND WATER-SCARCE DISEASES

• Non contaminated water for hygiene


• Laundry with soap

• Fly vector control

• Louse vector control

• No crowding


Excreta-related helminths(Parasite worms in human

intestine)

Roundworm, hookworm, whipworm

Soil transmitted Helminths

• Open defecation

• Ground contamination



ASCARIDIASIS• Nematodiasis due to Ascaris lumbricoides (Parasite)

• ClinicalPhase of larva migration: pulmonary and allergic signs (non productive cough, mild fever)Established infection: non specifics digestive signs nausea, vomits,

diarrhoea, intestinal irritation, • TRANSMISSION: Faecal -Oral


KEY FACTORS FOR PREVENTING HELMINTHS

• Controlled excreta disposal


• Non contaminated food


Schistosomiasis, Guinea worm (Dracunculosis), clonorchiasis .

Long stay in infected waters

• Water contamination

Water-based diseases



SHISTOSOMIASES

• Infections by Schistosoma haematobium, S. mansoni are frequently, by S. japonicum y S. intercalatum lowness.(Parásitos)

• Clinical:• Each species give rise to specific clinical form,it depends the parasite loadShistosomiases urinary S. haematobium signs : haematuria, frequent and painful micturation evolution to fibrosis urethral.Shistosomiases intestinal: S. mansoni signs : bloody diarrhoea ,

abdominal pain, nauseas, vomit and it evolution liver fibrosis• TRANSMISSION: By contact with the parasite when bathing or swimming in contaminated water.


KEY FACTORS FOR PREVENTING WATER-BASED DISEASES

• Safe drinking water supply

• Adequate drainage of stagnant waters


Malaria, dengue, sleeping sickness, filariasis, yellow fever.

Diarrhoea and dysentery

Bitting by mosquitoes, flies. Transmited by flies, cockroaches

• Bite near water

• Breed in water

• Dirty environment

Water-related insect vectors

Excreta-related insect vectors



VECTORS RELATED TO DISEASES

• Mosquitoes

• Flies

• Louse (Typhus, Relapsing Fever)

• Fleas (Plague)

• Ticks


MALARIA• Pathogen: Plasmodium falciparum, vivax and ovale (Parasite)• Vector: Mosquito Anopheles female • Clinical:

Painful muscles and joints,high fever with chills, headache, possybly diarrhoea and vomiting

• Stagnant waters are the breeding place.


DENGUE• Pathogen: Virus (Flaviviridiae)• Vector: Aedes aegypti• Clinical:

High fever, headaches, pain in muscles and joints, red spots on skin. Classic dengue, hemorrhagic dengue .

• Larva growth in water containers (tyres, vases, barrels) or other natural places (lagoons, pools).

Epidemic dengue (red)


YELLOW FEVER• Pathogen: Virus (Flaviviridiae)• Vector: Aedes aegypti• Clinical:

Fever, headache, myalgia, nausea, red eyes, jaundice. • Stagnant waters. Only bites during daylight.• Vector Control


KEY FACTORS FOR PREVENTING WATER-RELATED INSECT VECTOR AND EXCRETA-RELATED INSECT

VECTOR DISEASES

• Adequate drainage of stagnant water

• Disposal of waste water

• Excreta controlled disposal

• Safe storage of drinking water

• Vector control


Thank youThank you……….……….

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Diseases related to water, sanitation and hygiene (WASH)