>5 million die by unsafe drinking water, lack of sanitation, and insufficient water for hygiene. At any given time, almost half of the people in developing countries suffer from water-related diseases. Collectively, they are more lethal than AIDS, according to WHO.
Diseases related to water- Ashwin
INTRODUCTION• WATER HAS A PROFUND INFLUENCE ON HUMAN HEALTH.• THE FIRST PRIORITY MUST BE TO PROVIDE ACCESS FORTHE WHOLE POPULATION TO SOME FORM OF IMPROVEDWATER SUPPLY.• MICROBIOLOGICAL QUALITY OF WATER IS IMPORTANT INPREVENTING ILL-HEALTH IN PUBLIC.• CHEMICAL WATER QUALITY IS GENERALLY OF LOWERIMPORTANCE AS THE IMPACT ON HEALTH TEND TO BECHRONIC LONG-TERM EFFECTS AND TIME IS AVAILABLETO TAKE REMEDIAL ACTION.
EPIDEMIOLOGY• WATER RELATED DISEASE PLACES AN EXCESSIVEBURDEN ON POPULATION AND HEALTH SERVICES OFMANY COUNTRIES WORLDWIDE AND IN PARTICULARTHOSE IN DEVELOPING COUNTRIES.• IN INDIA, SEVERAL HUNDRED DEATHS HAV BEENREPORTED IN LAST THREE YEARS DUE TOCONSUMPTION OF UNSAFE AND CONTAMINATEDWATER• A TOTAL OF 257 DEATH HAVE BEEN REPORTED DUETO THESE DISEASES IN THE KARNATAKA DURING2009, 2010, 2011 AMONG THE 21,12,308 CASESDETECTED.
EPIDEMIOLOGY• AMONG THESE, 3 PEOPLE DIED OF CHOLERA OUT OF610 CASES DETECTED. ANDRA PRADESH SAW 4DEATHS OUT OF 715 CASES, WHILE 2 DIED INTAMIL NADU OUT OF 1,308 CASES, KERALA SAW 3DEATHS OUT OF THE 81 CASES DETECTED.• SIMILARLY, ACUTE DIARRHEAL DISEASE TOOK 192LIVES IN KARNATAKA WITH 19,62,271 CASESDETECTED, WHILE ANDRA PRADESH, TAMIL NADUAND KERALA SAW 4,24,976 AND 6 PEOPLE DIEDRESPECTIVELY DUE TO THE DISEASE.
THE TABLE SHOWS ESTIMATES OF THE MORTALITYAND MORBIDITY RATES OF SOME MAJOR WATER-RELATED DISEASES WORLDWIDE (AFTER WHO, 2005)DISEASE CASES PER YEAR DEATHS PER YEAR(THOUSANDS) (THOUSANDS)CHOLERA 384 11THYPHOID 500 25GIARDIASIS 500 LOWDIARRHOEAL DISEASES 1,500,000 4,000ASCARIASIS 1,000 20TRICHURIASIS 100 LOWANCYLOSTOMA 1,500 60DRACUNCULIASIS > 5,000 -SCHISTOSOMIASIS 200,000 800TRACHOMA 360,000 9,000
Diseases Related toWaterWater-borneDiseasesWater-washedDiseasesWater-basedDiseasesWater-relatedDiseases
WATER - BORNE DISEASES• Diseases caused by ingestion of watercontaminated by human or animal excrement,which contain pathogenic microorganisms.• Include cholera, typhoid, amoebic and bacillarydysentery and other diarrheal diseases as• Giardiasis (Protozoan)• Cryptosporidiosis (Bacteria)• Campylobacteriosis (Bacteria)• Shigellosis (Bacteria)• Viral Gastroenteritis (Virus)• Cyclosporiasis (Parasite)
WATER - BORNEDISEASES• In addition, water-borne disease can becaused by the pollution of water withchemicals that have an adverse effect onhealth• Arsenic• Flouride• Nitrates from fertilizers• Carcinogenic pesticides (DDT)• Lead (from pipes)• Heavy Metals
WATER - WASHEDDISEASES• Diseases caused by poor personalhygiene and skin and eye contactwith contaminated water.• These include scabies, trachoma,typhus, and other flea, lice andtick-borne diseases.
WATER-BASED DISEASES• Diseases caused by parasites foundin intermediate organisms living incontaminated water• These include schistosomiasis anddracunculiasis
WATER-RELATEDDISEASES• Water-related diseases are caused by insectvectors, especially mosquitoes, that breed orfeed near contaminated water• They are not typically associated with lack ofaccess to clean drinking water or sanitationservices• These include dengue, malaria, filariasis,onchocerciasis, trypanosomiasis and yellow fever
The Problem• ~80% of infectiousdiseases• > 5 million peopledie each year• > 2 million die fromwater-related diarrheaalone• Most of those dyingare small children
Other Consequences• Lost work days• Missed educationalopportunities• Official andunofficial healthcarecosts• Draining of familyresources
REPORTS FROM WORLDHEALTH ORGANISAION• Has Reported That Water Born Diseases Kill more people thanany other disease in the World• 1.1 billion people globally lack basic access to drinking waterresources• Some 3.4 million people, many of them young children, dieeach year from water-borne diseases, such as intestinaldiarrhea (cholera, typhoid fever and dysentery), caused bymicrobially-contaminated water supplies that are linked todeficient or non-existent sanitation and sewage disposalfacilities.• Globally, water-borne diseases are the second leading cause ofdeath in children below the age of five years, while childhoodmortality rates from acute respiratory infections ranks first.• While 2.4 billion people have inadequate sanitation facilities,which accounts for many water related acute and chronicdiseases
LIST OF WATER AND SANITATION RELATEDDISEASES ACCORDING TO WHO• Anemia• Arsenicosis• Ascariasis• Campylobacteriosis.• Cholera.• Cyanobacterial Toxins• Dengue and Dengue Haemorrhagic Fever.• Diarrhea .• Drowning• Fluorosis• Guinea-Worm Disease (Dracunculiasis).• Hepatitis.
LIST OF WATER AND SANITATION RELATEDDISEASES ACCODIND TO WHO• Japanese Encephalitis.• Lead Poisoning.• Leptospirosis• Malaria .• Malnutrition .• Methaemoglobinemia• Onchocerciasis (River Blindness).• Ringworm (Tinea)• Scabies• Schistosomiasis.• Spinal Injury• Trachoma.• Typhoid and Paratyphoid Enteric Fevers.
ASCARIASIS• Ascariasis is found worldwide. Infection occurs withgreatest frequency in tropical and subtropicalregions,and in any areas with inadequate sanitation.• Ascariasis is an infection of the small intestine causedby Ascaris lumbricoides, a large roundworm. The eggs ofthe worm are found in soil contaminated by humanfaeces or in uncooked food contaminated by soilcontaining eggs of the worm.• Eating uncooked food grown in contaminated soil orirrigated with inadequately treated wastewater isanother frequent avenue of infection.• Ascariasis is one of the most common human parasiticinfections.• Worldwide, severe Ascaris infections causeapproximately 60,000 deaths.
SCABIES• Scabies is a contagious skin infection thatspreads rapidly in crowded conditions and isfound worldwide.• Personal hygiene is an important preventivemeasure and access to adequate water supply isimportant in control.• Epidemics have been linked to poverty, poorwater supply, sanitation and overcrowding.• There are about 300 million cases of scabies inthe world each year.
MALARIA• Malaria, the worlds most important parasiticinfectious disease, is transmitted by mosquitoeswhich breed in fresh or occasionally brackishwater.• Malaria is among the five leading causes ofdeath in under-5-year-old children in Africa.• WHO estimates 300-500 million cases ofmalaria, with over one million deaths each year.
HEPATITIS• Hepatitis, a broad term for inflammation of the liver,has a number of infectious and non-infectious causes.• Two of the viruses that cause hepatitis (hepatitis A andE) can be transmitted through water and food; hygiene istherefore important in their control• Hepatitis A and E viruses, while unrelated to oneanother, are both transmitted via the faecal-oral route,Most often through contaminated waterFrom person to person.Via food contaminated by infectedfoodhandlers,uncooked foods, or foods handledaftercooking”
TYPHOID• Typhoid fever is the result of systemicinfection mainly by salmonella typhi.• It occurs in all parts of the world where watersupplies and sanitation are sub-standard.• The disease is characterised by a typicalcontinuous fever for 3 to 4 weeks, relativebradycardia with involvement of lymphoidtissues• It is endemic in India. Reported data for theyear 2011 shows 1.06 million cases and 346deaths. The prevalance rate in India is 88cases/lac population and death rate is 0.029/lacpopulation.
CHOLERA• Cholera is an acute diarrhoeal disease causedby vibrio cholera O1 (Classical or El Tor)• Cholera transmission is linked to inadequateenvironmental management. Typical at-riskareas include peri-urban slums and in areaswhere as a consequence of disaster, disruptionof water and sanitation system takes place.• It remains a global threat to public health andkey indicator of lack of social development.• Reported cases for 2011 alone, a total of589,854 cases were notified from 58 countries,including 7,816 deaths.
CASE MANAGEMENT• The key management of a patient who has a waterborne infection is identifying the specificorganism and instituting specific therapyappropriate for the organism.• Supportive therapy includes:1 Monitoring the patient’s response totherapy.2 Ensuring hydration and fluid balance3 Continually observing for complications andproviding information to both the patient andfamily.
CASE MANAGEMENT• Nursing intervention: The goals of nursing managementare to give supportive care and to monitor forcomplications.1 ) Encourage high fluid intake.2 ) During the period of anorexia, the patient shouldreceive frequent small feedings, supplemented, ifnecessary by IV infusion of glucose containing fluids.3 ) Encourage the patient to express fears / worries.4 ) Skin care (perineal care).5 ) Teach the patient about his or her specificdisease and therapeutic regimens. She or he isinstructed about personal hygiene and the maintenance ofthe home environment to prevent the spread of infectionto other family member.
CASE MANAGEMENT6 ) Inform the family about the disease problem and howthey can seek additional health care.7 ) Patient and family need specific guidelines about diet,rest and follow up.8 ) In case of typhoid fever, delirium is common in itsseverest form. The patient requires special support during thisperiod. Patient safety must be maintained with the use of siderails and other restraints.9 ) Tepid water sponges are administered for temperatureover 400C.10 ) Observe for bladder distension.11 ) Monitoring for complications: for example, in typhoidfever a dangerous complication is intestinal hemorrhage andperforation of the bowel with resultant peritonitis.12 ) Additionally, hepatitis A will rarely progress to fulminatehepatitis terminating in cirrhosis or death.
References• park’s text book of preventive andsocial medicine.• water borne diseases by yeniselcruz.• water borne diseases outbreak-case studies at small water systemby rob rin and megan marsel.• water, sanitation and hygiene:interventions and diarrhoea- reviewby lora fewtrell and jack colford• water borne diseases- ethiopianhealth centre team, haramayauniversity