RADKE%202013%20Water%20Sanitation%20and%20Health_Health%20Risk%20Management_130827.pptx

Water, Sanitation and Health & Health Risk Management
Water, Sanitation and Health
&
Health Risk Management
1
Naomi Radke, seecon international GmbH

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Contents
1. Water-Borne Diseases
2. Effects of Water-Borne Diseases
3. Conclusion
1. A Multi-Barrier Approach
2. Transmission Routes
3. Critical Questions
4. Mitigating Health Risks
References
3

Sources of Diseases
• Pathogenic microorganisms in contaminated water
• Lack of access to adequate (safe) water sources or
water point-of-use water treatments
• But also lack of sanitation and poor hygiene are
responsible for the transmission of diseases
• Water often contaminated due to inadequate
sanitation and waste water treatment: faeces of an
infected person enters the water untreated
• Some estimated 884 million people worldwide lack
access to improved water supply and 2.6 billion
people lack access to improved sanitation
(WHO/UNICEF 2010)
5
Poor sanitation leads
to discharge of
sewage directly into
the environment.
Source: WaterAid (2013)

Diseases
6
Dirty water causes more deaths per
year than armed conflicts.
Source: WSSCC (2007)
Diarrhoea (multiple liquid bowl movements
per day; this loss of fluid can lead to death)
Cholera (infection in the small intestine
leading to diarrhoea and vomiting and thus
to dehydration)
Typhoid (fever, headache, pain and
diarrhoea)
And several other parasitic infections
(e.g. schistosomiasis, guinea worm, ...)
Most significant is the persistence and wide
distribution of diarrhoea throughout the
developing world – an effect of inadequate
water supply and sanitation.

School Absence
Absence of 443 Mio school days each year (BORKOWSKY 2006) due to
water-borne diseases
• Strong negative impact on nutrition, health and learning capacities
especially of children
• Hurts prospects for future earnings and makes continuing poverty
more likely
7
Adequate sanitation can reduce
water-borne diseases of children.
Source: WHO (2012)

Severe Sickness and Death
• Parasitic helminthes infections: severe consequences e.g. cognitive
impairment, massive dysentery, anaemia and death of around 9400
people every year
• In Sub-Saharan Africa, schistosomiasis kills more than 200,000 people
every year
• Acute diarrhoea, as occurs in cholera, if left untreated can cause
death within a day or less
8

Breaking Economic Development
• Large-scale death and poor health also act as a brake on economic
development
• Unsafe water and inadequate sanitation especially impacts the poor
(About 2/3 of people without access to a protected water source live
on less than US$2 a day )
• Adequate water supplies and sanitation are often key step out of
poverty
9

Clean Water and Sanitation are intertwined with more than health!
Due to the interconnectedness between water, sanitation,
health and poverty, lack of safe water supply and proper
sanitation has not only an impact on health, but
consequently on education, ability to work and thus
economic development.
Thus both adequate drinking water and sanitation are
crucial for the health of human and thus their physical and
economical development (school visits and escaping the
poverty trap).
An approach to reduce health risk due to water/sanitation-
borne diseases can be found in the following section:
10
3. Conclusion

What is a barrier?
12
… A part of the treatment or handling chain of a sanitation
system that substantially reduces the number
of pathogens present in excreta and thus the risk of infection.
Example of barrier: proper management of excreta acts as the
primary barrier to the prevention of pathogen-spread.

What is a multi-barrier approach? (1/2)
13
… Pathogen reduction by various measures as opposed to only one
measure (e.g. proper excreta management) along the
treatment/handling chain.

What is a multi-barrier approach? (2/2)
14
Source: STENSTROEM ET AL. (2011)

Exposure Points
15
The origin of diarrhoea is faeces!
Transmission of faeces-related pathogens can take place at various
points. These have to be controlled.

Transmission Routes (1/2)
16
Primary: direct exposure
• Person-to-person contact
• Short-distance airborne transmission
Secondary: exposure through external route
• Vehicle-borne: contamination of food, water, etc.
• Vector-borne: created breeding sites of vectors

Transmission Routes (2/2)
17
Spread of pathogens from
excreta of an infected
individual to a healthy
individual.

Questions to identify severity of health risk
18
WHO is exposed to pathogens from contaminated water and
excreta?
HOW MANY people (individuals) are likely to be exposed
directly or indirectly?
WHERE does the exposure occur within the sanitation system?
WHICH routes should we consider?
HOW frequently does exposure occur?
WHAT dose of exposure occurs?

WHO is exposed?
19
Groups affected can be:
• User – uses the technology (e.g. poor hygiene when using toilet,
drinking contaminated water)
• Worker – maintains/cleans/operates/empties the sanitation
technologies
• Farmer – uses generated sanitation products (wastewater,
sewage sludge etc.)
• Community – passively affected by living near
sanitation technologies or contaminated farming sites
Worker – a toilet emptier.
Source: SuSanA on Flickr (2010)

Technical components
20
The selected technology within each of the functional groups of a
sanitation system will govern the overall reduction efficiency and
the likelihood of disease transmission.
Each is linked to critical points where pathogens may be
transmitted or controlled.
Functional groups of a
sanitation system.
Source:
http://akvopedia.org/wiki/Sanitation_Portal

Non-technical components (1/2)
21
Extent of human health protection by the sanitation
system relates to socio-cultural aspects linked to specific features
of the system:
taboos
traditions
believes predominant
hygiene
practices

Non-technical components (2/2)
22
These taboos/believes/traditions/practices may reduce or elevate
pathogen exposure
Example: Reduction
Koranic edict: excreta are
regarded as impure (najassa)
and its use only permitted when
the najassa is removed.
Example: Elevation
In some cultures child faeces is
regarded as harmless.

Hygiene promotion
23
In order to mitigate health risks from inadequate sanitation and
unclean water it is important to:
• Promote good practices around the home (for sanitation,
cooking, drinking, etc.)
• Teach about risks and consequences of lack of hygiene
• Find out what practices are common in your target area and
adapt your promotion to it

Hygiene promotion – Most important practices to reduce risk
24
• Safe disposal of faeces (the primary source of diarrhoea) – use
toilets/latrines and if not possible bury faeces and cover with soil
• Hand washing – most importantly after touching faeces, before
eating, preparing food and feeding children
• Keep water clean – faecal material should not get into water
supplies. Additionally boil and filter water and cover water jars
• Fly control (transmitter of faeces-related diseases)– e.G. Cover
latrines or use fly traps
Source: UNICEF (1999)

ROMA, E.; PUGH, I, (2012): Toilets for health. London: London School of Hygiene & Tropical Medicine. URL:
http://www.lshtm.ac.uk/newsevents/features/2012/toilets_for_health:_flushed_with_success_.html [Accessed: 06.08.2013]
WSSCC (Editor) (2007): Hurry up! 2.6 billion people lack access to adequate sanitation. Geneva: Water Supply and Sanitation
Collaborative Council (WSSCC). URL: not available.
WHO (2012): UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS). The Challenge of Extending and
Sustaining Services. Geneva: World Health Organization (WHO). URL: http://www.who.int/water_sanitation_health/glaas/en/
[Accessed: 06.08.2013]
WATERAID (2013): Sanitation’s Impact on Health. New York: Water Aid America. URL:
http://www.wateraidamerica.org/what_we_do/the_need/sanitation.aspx [Accessed: 06.08.2013]
STENSTROEM, A.; SEIDU, R.; EKANE, M.; ZURBRUEGG, C. (2011): Microbial Exposure and Health Assessments in Sanitation
Technologies and Systems. Stockholm: Stockholm Environment Institute (SEI). URL: http://www.susana.org/lang-
en/library?view=ccbktypeitem&type=2&id=1236 [Accessed: 06.08.2013]
BORKOWSKI, L. (2006): UNDP on the World's Water Challenge. Brooklyn, New York: ScienceBlogs, LLC. URL:
http://scienceblogs.com/thepumphandle/2006/11/18/undp-on-the-worlds-water-challenge/ [Accessed: 06.08.2013]
UNICEF (1999): A Manual on Hygiene Promotion. New York, London: United Nations Children Fund (UNICEF), London School of
Hygiene and Tropical Medicine (LSHTM). URL: http://www.susana.org/lang-en/library/library?view=ccbktypeitem&type=2&id=424
[Accessed: 20.08.2013]
25
References

Water, Sanitation and Health & Health Risk Management 26
“Linking up Sustainable Sanitation,
Water Management & Agriculture”
SSWM is an
initiative
supported by:
Created
by:

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