Health.water.sanitation

Diseases related to
water, sanitation and
hygiene (WASH)

Diseases related to water, sanitation and hygiene (WASH)WATSAN M15 ERU 2
Contents
1.1. Public Health in Emergencies: IndicatorsPublic Health in Emergencies: Indicators
2.2. Relevance of water, sanitation and hygiene to healthRelevance of water, sanitation and hygiene to health
3.3. Diseases related to water and excreta, andDiseases 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.- Water
2.- 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

Entomoeba
Giardia
Cryptosporidium
10.000/g
10.000/g
10.000/g
Shigella
V. cholera
E. coli
10.000.000/g
10.000/g
10.000.000/g
Rotavirus
Poliovirus
Virus de
Hepatitis
BACTERIA
VIRUS
PROTOZOA
N

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
Transmission
mechanisms

• 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 toKeratoconjunctivitis due to ChlamydiaChlamydia
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
Transmission
mechanisms

ASCARIDIASIS
• Nematodiasis due to Ascaris lumbricoides (Parasite)
• Clinical
Phase 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
Transmission
mechanisms

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
Shistosomiases 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
Transmission
mechanisms

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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