Diseases related to water sanitation and hygiene WASH

Diseases related to water, sanitation and hygiene (WASH)

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Contents 1. Public Health in Emergencies: Indicators 2. Relevance of water, sanitation and hygiene to health 3. Diseases related to water and excreta, and transmission mechanisms. 2

1. Health indicators in emergencies

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 4

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Causes of Death in Emergencies (Worldwide) üDiarrhoeal Diseases üTrauma (Injury) üMeasles üMalnutrition üMalaria üAcute Respiratory Infections (ARI) 5

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Health Indicators in Emergencies Ø 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 Total population = deaths/10. 000 persons/day 10. 000 persons No. days in time period Ø Under 5 Mortality Rate (U 5 MR) • • 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 Total number of children < 5 years = deaths/10. 000 children/day x 10. 000 persons No. days in time period 6

Diseases related to water, sanitation and hygiene (WASH) WATSAN M 15 ERU Mortality Rates in Emergencies Baseline Reference Mortality Data by Region CDR/CMR deaths/10, 000/ day CDR/CMR emergency threshold U 5 DR/MR deaths/10, 000 U 5/day U 5 DR/MR emergency threshold Sub- Saharan Africa 0. 44 0. 9 1. 14 2. 3 South Asia 0. 25 0. 59 1. 2 Middle East and North Africa 0. 16 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 Fuente: UNICEF State of the World’s Children 2003 7

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Benchmark for CMR and U 5 MR (worldwide) Benchmark for CMR (world): • Baseline 0. 5 • Serious 1. 0 -2. 0 • Crisis >2. 0 Benchmark for U 5 MR (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. 8

2. Relevance of water, sanitation and hygiene to health

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) The most important aim of a water and sanitation programme… . . . To minimise health risks of the population 10

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) The main objective of water supply, sanitation and hygiene programmes in disasters is to reduce the transmission of faecal-oral diseases and exposure to diseasebearing vectors that transmit diseases with epidemic potential, allowing people living with good health, dignity, comfort and security. 11

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) WATER / SANITATION / HYGIENE HEALTH 12

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 13

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Fewtrell L et al. (2004) Lancet Infect Dis 5(1): 42 -52. 14

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 15 Most common routes for the transmission of Diarrhoea germs Hygiene DIAGRAM F Water quantity Sanitation Water quality Water Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) HEALTH CARE LATRINE Faecal-oral transmission: 1. - Water 2. - Food 3. - Objects SPRING SAFE WATER DOMESTIC AND PERSONAL HYGIENE 16

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

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) THE MOST IMPORTANTS DIARRHOEA FAECAL-ORAL route TRANSMITTED by VECTORS 19

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) E. coli BACTERIA 10. 000/g V. cholera 10. 000/g VIRUS Shigella Poliovirus Virus de Hepatitis Rotavirus Giardia Entomoeba PROTOZOAN 10. 000/g Cryptosporidium 20

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Water-borne or water-washed diseases Transmission mechanisms Cholera, shigellosis, diarrhoea, salmonellosis. FAECAL-ORAL • Water contamination Typhoid, paratyphoid, etc. • Poor sanitation Amoebic dysentery, giardiasis • Poor personal hygiene Hepatitis A, poliomyelitis, rotavirus diarrhoea • Crop contamination 21

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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. 22

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) DIARRHOEA DISEASES • Acute watery diarrhoea: Watery stools without visible blood, vomit and fever. Dehydration • Cholera • 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. 23

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 24

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 education - Safe food and water, proper food handling - Adequate excreta disposal - Personal hygiene - Safe water collection points 25

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 26

Diseases related to water, sanitation and hygiene (WASH) WATSAN M 15 ERU 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 27

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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. 28

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 29 Most common routes for the transmission of Diarrhoea germs Hygiene DIAGRAM F Water quantity Sanitation Water quality Water Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST

WATSAN M 15 ERU Water washed or water scarce diseases Diseases related to water, sanitation and hygiene (WASH) Transmission mechanisms Skin and eye infections. • Inadequate water Louse borne typhus or louse-borne relapsing fever. • Poor personal hygiene 30

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) SKIN DISEASES • Scabies: • Sarcoptes scabiei hominis (parasite) • Larvae dig tunnels in the external skin layers. - Rash, scab skin. - Wrinkles, between fingers, elbows, writs, penis, nipples. • Impetigo: • Streptococcus and staphylococcus Contagious superficial skin infection. - Blisters with pus-scab - Face, nasal cavity, mouth, neck, groin. 31

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) EYE DISEASES • 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: • Keratoconjunctivitis due to Chlamydia trachomatis * Progressive conjunctivitis and most common cause of blindness in endemic areas. * Contagious : contact with infected conjunctivitis secretions, hands and clothes contaminated, fly…. 32

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) ØTYPHUS • Caused of the genus Rickettsia pathogen R. prowasekii (bacteria) • Clinical: üSudden onset of fever (temp of over 39 Cº), headache, myalgias. üExanthema maculopapular • TRANSMISSION: Body louse due to lack of personal hygiene, crowding. ØRELAPSING FEVER • Caused of the genus Borrelia pathogen B. recurrentis, B. hispanica, B. persica. . (spirochetes) • Clinical: üHigh fever, artralgia, shivering, jaundice, bleeding. üA febrile interval • TRANSMISSION: Body louse and tick due to lack of personal hygiene, crowding. . 33

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 34 KEY FACTORS FOR PREVENTING WATER-WASHED AND WATER-SCARCE DISEASES • • • Non contaminated water for hygiene Hand washing with soap Laundry with soap Fly vector control Louse vector control No crowding

WATSAN M 15 ERU Excreta-related helminths (Parasite worms in human intestine) Diseases related to water, sanitation and hygiene (WASH) Transmission mechanisms Soil transmitted Helminths Roundworm, hookworm, whipworm • Open defecation • Ground contamination 35

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) ASCARIDIASIS • Nematodiasis due to Ascaris lumbricoides (Parasite) • Clinical üPhase of larva migration: pulmonary and allergic signs (non productive cough, mild fever) üEstablished infection: non specifics digestive signs nausea, vomits, diarrhoea, intestinal irritation, • TRANSMISSION: Faecal -Oral 36

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) KEY FACTORS FOR PREVENTING HELMINTHS • Controlled excreta disposal • Hand washing with soap • Non contaminated food 37

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Water-based diseases Transmission mechanisms Long stay in infected waters Schistosomiasis, Guinea worm (Dracunculosis), clonorchiasis. • Water contamination 38

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 load üShistosomiases urinary S. haematobium signs : haematuria, frequent and painful micturation evolution to fibrosis urethral. üShistosomiases 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. 39

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) KEY FACTORS FOR PREVENTING WATER-BASED DISEASES • Safe drinking water supply • Adequate drainage of stagnant waters 40

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Water-related insect vectors Excreta-related insect vectors Malaria, dengue, sleeping sickness, filariasis, yellow fever. Diarrhoea and dysentery Transmission mechanisms Bitting by mosquitoes, flies. Transmited by flies, cockroaches • Bite near water • Breed in water • Dirty environment 41

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) VECTORS RELATED TO DISEASES • • • Mosquitoes Flies Louse (Typhus, Relapsing Fever) Fleas (Plague) Ticks 42

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) MALARIA • Pathogen: Plasmodium falciparum, vivax and ovale (Parasite) • Vector: Mosquito Anopheles female • Clinical: üPainful muscles and joints, high fever with chills, headache, possybly diarrhoea and vomiting • Stagnant waters are the breeding place. 43

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) DENGUE • Pathogen: Virus (Flaviviridiae) • Vector: Aedes aegypti • Clinical: üHigh 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) 44

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) YELLOW FEVER • Pathogen: Virus (Flaviviridiae) • Vector: Aedes aegypti • Clinical: üFever, headache, myalgia, nausea, red eyes, jaundice. • Stagnant waters. Only bites during daylight. • Vector Control 45

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) 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 46

WATSAN M 15 ERU Diseases related to water, sanitation and hygiene (WASH) Thank you………. 47