2. INTRODUCTION
• WATER HAS A PROFUND INFLUENCE ON HUMAN HEALTH.
• THE FIRST PRIORITY MUST BE TO PROVIDE ACCESS FOR
THE WHOLE POPULATION TO SOME FORM OF IMPROVED
WATER SUPPLY.
• MICROBIOLOGICAL QUALITY OF WATER IS IMPORTANT IN
PREVENTING ILL-HEALTH IN PUBLIC.
• CHEMICAL WATER QUALITY IS GENERALLY OF LOWER
IMPORTANCE AS THE IMPACT ON HEALTH TEND TO BE
CHRONIC LONG-TERM EFFECTS AND TIME IS AVAILABLE
TO TAKE REMEDIAL ACTION.

4. EPIDEMIOLOGY
• WATER RELATED DISEASE PLACES AN EXCESSIVE
BURDEN ON POPULATION AND HEALTH SERVICES OF
MANY COUNTRIES WORLDWIDE AND IN PARTICULAR
THOSE IN DEVELOPING COUNTRIES.
• IN INDIA, SEVERAL HUNDRED DEATHS HAV BEEN
REPORTED IN LAST THREE YEARS DUE TO
CONSUMPTION OF UNSAFE AND CONTAMINATED
WATER
• A TOTAL OF 257 DEATH HAVE BEEN REPORTED DUE
TO THESE DISEASES IN THE KARNATAKA DURING
2009, 2010, 2011 AMONG THE 21,12,308 CASES
DETECTED.

5. EPIDEMIOLOGY
• AMONG THESE, 3 PEOPLE DIED OF CHOLERA OUT OF
610 CASES DETECTED. ANDRA PRADESH SAW 4
DEATHS OUT OF 715 CASES, WHILE 2 DIED IN
TAMIL NADU OUT OF 1,308 CASES, KERALA SAW 3
DEATHS OUT OF THE 81 CASES DETECTED.
• SIMILARLY, ACUTE DIARRHEAL DISEASE TOOK 192
LIVES IN KARNATAKA WITH 19,62,271 CASES
DETECTED, WHILE ANDRA PRADESH, TAMIL NADU
AND KERALA SAW 4,24,976 AND 6 PEOPLE DIED
RESPECTIVELY DUE TO THE DISEASE.

6. THE TABLE SHOWS ESTIMATES OF THE MORTALITY
AND MORBIDITY RATES OF SOME MAJOR WATER-
RELATED DISEASES WORLDWIDE (AFTER WHO, 2005)
DISEASE CASES PER YEAR DEATHS PER YEAR
(THOUSANDS) (THOUSANDS)
CHOLERA 384 11
THYPHOID 500 25
GIARDIASIS 500 LOW
DIARRHOEAL DISEASES 1,500,000 4,000
ASCARIASIS 1,000 20
TRICHURIASIS 100 LOW
ANCYLOSTOMA 1,500 60
DRACUNCULIASIS > 5,000 -
SCHISTOSOMIASIS 200,000 800
TRACHOMA 360,000 9,000

7. Diseases Related to
Water
Water-borne
Diseases
Water-washed
Diseases
Water-based
Diseases
Water-related
Diseases

9. WATER - BORNE DISEASES
• Diseases caused by ingestion of water
contaminated by human or animal excrement,
which contain pathogenic microorganisms.
• Include cholera, typhoid, amoebic and bacillary
dysentery and other diarrheal diseases as
• Giardiasis (Protozoan)
• Cryptosporidiosis (Bacteria)
• Campylobacteriosis (Bacteria)
• Shigellosis (Bacteria)
• Viral Gastroenteritis (Virus)
• Cyclosporiasis (Parasite)

10. WATER - BORNE
DISEASES
• In addition, water-borne disease can be
caused by the pollution of water with
chemicals that have an adverse effect on
health
• Arsenic
• Flouride
• Nitrates from fertilizers
• Carcinogenic pesticides (DDT)
• Lead (from pipes)
• Heavy Metals

12. WATER - WASHED
DISEASES
• Diseases caused by poor personal
hygiene and skin and eye contact
with contaminated water.
• These include scabies, trachoma,
typhus, and other flea, lice and
tick-borne diseases.

14. WATER-BASED DISEASES
• Diseases caused by parasites found
in intermediate organisms living in
contaminated water
• These include schistosomiasis and
dracunculiasis

16. WATER-RELATED
DISEASES
• Water-related diseases are caused by insect
vectors, especially mosquitoes, that breed or
feed near contaminated water
• They are not typically associated with lack of
access to clean drinking water or sanitation
services
• These include dengue, malaria, filariasis,
onchocerciasis, trypanosomiasis and yellow fever

17. The Problem
• ~80% of infectious
diseases
• > 5 million people
die each year
• > 2 million die from
water-related diarrhea
alone
• Most of those dying
are small children

18. Other Consequences
• Lost work days
• Missed educational
opportunities
• Official and
unofficial healthcare
costs
• Draining of family
resources

19. REPORTS FROM WORLD
HEALTH ORGANISAION
• Has Reported That Water Born Diseases Kill more people than
any other disease in the World
• 1.1 billion people globally lack basic access to drinking water
resources
• Some 3.4 million people, many of them young children, die
each year from water-borne diseases, such as intestinal
diarrhea (cholera, typhoid fever and dysentery), caused by
microbially-contaminated water supplies that are linked to
deficient or non-existent sanitation and sewage disposal
facilities.
• Globally, water-borne diseases are the second leading cause of
death in children below the age of five years, while childhood
mortality rates from acute respiratory infections ranks first.
• While 2.4 billion people have inadequate sanitation facilities,
which accounts for many water related acute and chronic
diseases

20. LIST OF WATER AND SANITATION RELATED
DISEASES ACCORDING TO WHO
• Anemia
• Arsenicosis
• Ascariasis
• Campylobacteriosis.
• Cholera.
• Cyanobacterial Toxins
• Dengue and Dengue Haemorrhagic Fever.
• Diarrhea .
• Drowning
• Fluorosis
• Guinea-Worm Disease (Dracunculiasis).
• Hepatitis.

21. LIST OF WATER AND SANITATION RELATED
DISEASES 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.

22. ASCARIASIS
• Ascariasis is found worldwide. Infection occurs with
greatest frequency in tropical and subtropical
regions,and in any areas with inadequate sanitation.
• Ascariasis is an infection of the small intestine caused
by Ascaris lumbricoides, a large roundworm. The eggs of
the worm are found in soil contaminated by human
faeces or in uncooked food contaminated by soil
containing eggs of the worm.
• Eating uncooked food grown in contaminated soil or
irrigated with inadequately treated wastewater is
another frequent avenue of infection.
• Ascariasis is one of the most common human parasitic
infections.
• Worldwide, severe Ascaris infections cause
approximately 60,000 deaths.

23. SCABIES
• Scabies is a contagious skin infection that
spreads rapidly in crowded conditions and is
found worldwide.
• Personal hygiene is an important preventive
measure and access to adequate water supply is
important in control.
• Epidemics have been linked to poverty, poor
water supply, sanitation and overcrowding.
• There are about 300 million cases of scabies in
the world each year.

24. MALARIA
• Malaria, the world's most important parasitic
infectious disease, is transmitted by mosquitoes
which breed in fresh or occasionally brackish
water.
• Malaria is among the five leading causes of
death in under-5-year-old children in Africa.
• WHO estimates 300-500 million cases of
malaria, with over one million deaths each year.

25. 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 and
E) can be transmitted through water and food; hygiene is
therefore important in their control
• Hepatitis A and E viruses, while unrelated to one
another, are both transmitted via the faecal-oral route,
Most often through contaminated water
From person to person.
Via food contaminated by infected
foodhandlers,uncooked foods, or foods handledafter
cooking”

26. TYPHOID
• Typhoid fever is the result of systemic
infection mainly by salmonella typhi.
• It occurs in all parts of the world where water
supplies and sanitation are sub-standard.
• The disease is characterised by a typical
continuous fever for 3 to 4 weeks, relative
bradycardia with involvement of lymphoid
tissues
• It is endemic in India. Reported data for the
year 2011 shows 1.06 million cases and 346
deaths. The prevalance rate in India is 88
cases/lac population and death rate is 0.029/lac
population.

27. CHOLERA
• Cholera is an acute diarrhoeal disease caused
by vibrio cholera O1 (Classical or El Tor)
• Cholera transmission is linked to inadequate
environmental management. Typical at-risk
areas include peri-urban slums and in areas
where as a consequence of disaster, disruption
of water and sanitation system takes place.
• It remains a global threat to public health and
key indicator of lack of social development.
• Reported cases for 2011 alone, a total of
589,854 cases were notified from 58 countries,
including 7,816 deaths.

28. CASE MANAGEMENT
• The key management of a patient who has a water
borne infection is identifying the specific
organism and instituting specific therapy
appropriate for the organism.
• Supportive therapy includes:
1 Monitoring the patient’s response to
therapy.
2 Ensuring hydration and fluid balance
3 Continually observing for complications and
providing information to both the patient and
family.

29. CASE MANAGEMENT
• 􀂾 Nursing intervention: The goals of nursing management
are to give supportive care and to monitor for
complications.
1 ) Encourage high fluid intake.
2 ) During the period of anorexia, the patient should
receive frequent small feedings, supplemented, if
necessary 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 specific
disease and therapeutic regimens. She or he is
instructed about personal hygiene and the maintenance of
the home environment to prevent the spread of infection
to other family member.

30. CASE MANAGEMENT
6 ) Inform the family about the disease problem and how
they 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 its
severest form. The patient requires special support during this
period. Patient safety must be maintained with the use of side
rails and other restraints.
9 ) Tepid water sponges are administered for temperature
over 400
C.
10 ) Observe for bladder distension.
11 ) Monitoring for complications: for example, in typhoid
fever a dangerous complication is intestinal hemorrhage and
perforation of the bowel with resultant peritonitis.
12 ) Additionally, hepatitis A will rarely progress to fulminate
hepatitis terminating in cirrhosis or death.

31. References
• park’s text book of preventive and
social medicine.
• water borne diseases by yenisel
cruz.
• water borne diseases outbreak-
case studies at small water system
by rob rin and megan marsel.
• water, sanitation and hygiene:
interventions and diarrhoea- review
by lora fewtrell and jack colford
• water borne diseases- ethiopian
health centre team, haramaya
university