Environmental Health for public Health.ppt

Faculty of Health Sciences, Unity
Faculty of Health Sciences, Unity
University
University
05/16/25 1
Environmental health
Environmental health
I. Introduction
I. Introduction to Environmental Health

the total sum of the condition of the surroundings
within which an organism, or group, or an object
an organism, or group, or an object
exists.
Definitions : What is
Definitions : What is environment
environment?
?
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Atmosphere
Sea
Abiotic Environment
Biotic
Biotic Environment
Environment
Definitions: What is
Definitions: What is environment
environment?
?
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Definitions:
Definitions: What is the
What is the environment
environment?
?
 “Environment” is
 all that which is external to the individual
human host (Last 1995).
 the sum of all
all external
external influences and conditions
influences and conditions
which affect health, life, and growth. This
includes the physical, biological, and Psycho-
social environment” (WHO);
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Definitions: What is
Definitions: What is health
health?
?
 Health:
◦ The condition of being sound in body,
mind, or spirit.
◦ A state of complete physical, mental,
and social well-being and not merely the
absence of disease or infirmity ( WHO,1948).
Sanitation – Latin word “Santias”
 Equivalent to health
 Sanitation indicates the establishment of
environmental conditions favorable for health
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6
What makes an individual is becoming
healthy?
Stable global
environment
Safe and peaceful
settlements
Safe & sufficient
water
Clean air
Safe and
adequate food
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Source: Yassiet al. (2001). UNEP.
A Healthy Environment: Basic Requirements?????

Definitions: Environmental Health?
 In layman's terms, it is the health impact of
◦ the air we breathe,
◦ the water we drink,
◦ the homes we live in,
◦ the soil growing the food we eat, and
◦ the many other environmental exposures in our
lives.
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 It refers to the theory and practice of assessing,
correcting, controlling, and preventing those
factors in the environment that can potentially affect the
health of present and future generations (WHO).
 EH is “Is the prevention of disease and promotion of
health by elimination (controlling) the environmental
factors that form links in chain of disease transmission”
(WHO).
 Example: Quality of air, water, food, soil Vs quality of
Example: Quality of air, water, food, soil Vs quality of
life???
life???
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9
A hazard is anything in the environment that can hurt people
or make people sick.
Bacteria &
viruses
Harmful
chemicals
Loud noises
Tobacco
smoke
Stress
Hazards
“It is a branch of public health that protects against the
effects of environmental hazards that can
adversely effect health or the ecology of balances essential to
human health and environmental quality “ [Agency for Toxic
Substances, USA, 1998]
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 Environmental health is
◦ Similar with: “Environmental sanitation” or
“ Environmental hygiene”
 Synonyms: Sanitation, Environmental
sanitation, Environmental hygiene,
Environmental Health, now WASH
◦ Which one has broader concept? Hygiene;
Hygiene;
sanitation ; Environmental Health
sanitation ; Environmental Health
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The global disease burden, classified by risk factors,
reveals that 21%
21% are associated to environmental
environmental
health
health.
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Why we concern on environment?
Why we concern on environment?
(WHO, 2002 in Cairncross et al., 2003)
13 million deaths could be prevented every year
by making our environment healthier( WHO
2008b and 2008g)

Why we Concern
Why we Concern of
of environmental?
environmental?
 The three of the world‘s biggest child killers
three of the world‘s biggest child killers
diseases
diseases are related with environment management
environment management
 An improved environmental management could prevent
 40 % of deaths from malaria,
 41 % of deaths
41 % of deaths from lower respiratory infections and
 94 % of deaths
94 % of deaths from diarrhoeal diseases.
 Environmental factors influence 85 out of the
85 out of the
102
102 categories of diseases and injuries listed in The
world health report .
 Source: www> ( WHO, 2008b and 2008g, 2010)
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Environmental risk factors
Environmental risk factors
Environmental risk factors Related diseases and conditions
Contaminated water, lack of latrines,
poor hand washing, inappropriate solid
waste management, open defecation,
vector infestation
Indoor air pollution
Outdoor/ambient air pollution
General environmental hazards (climate,
mosquitoes, nutrition)
Environmental hazards in workplaces
(excess noise, heat, dust, chemicals)
Diarrhoeal diseases, trachoma,
schistosomiasis, ascariasis, trichuriasis,
hookworm, typhoid fever, relapsing
Fever
Chronic obstructive pulmonary disease,
lower respiratory infections, lung cancer
Respiratory infections, cardiovascular
diseases, lung cancer
Diarrhoeal diseases, malnutrition,
malaria and other vector-borne diseases;
heat exhaustion,
Injuries, hearing loss, cancer, asthma,
back pain, chronic obstructive
pulmonary disease
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Role of environmental health
Role of environmental health
 For the disease to occur in an individual three
conditions must exist simultaneously:
◦ There must be an etiologic agent
◦ There must be an a victim ( man) sensitive or
susceptible to that disease
◦ There must be a made of transmission through which
the etiologic agent gets in to the man (the path of the
agent the env’t).
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Therefore, to stop the spread of communicable
disease the chain can be broken by:-
Attacking the agent
Changing the environment
Protecting the host
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Direct contact
Vector
Vehicle
Susceptible host
Agent
Reservoir
Air borne
Droplet

Improving Human Health and Environment:
Improving Human Health and Environment:
3 Models
3 Models
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Scopes of Environmental Health
Scopes of Environmental Health
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 Food hygiene
 Healthful housing
 Institutional hygiene
 Occupational hygiene
 Human waste disposal
 Water supply
 Solid waste management
 Vector control
 Environmental pollution
 Hygiene education

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Any Questions?
Any Questions?
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End of presentation
End of presentation
Thanks

 Nature Vs Environment
 Nature :
◦ the whole of the physical world; it is also what
exists outside of any human action.
 Environment:
◦ the surroundings and the living conditions of man
and society, as they are or as they are
perceived’.
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Man-environment Interaction

Definition of terms
Definition of terms
 Built environment:
◦ refers to constructed surroundings that provide the
setting for human activity, ranging from the large-scale
civic surroundings to the personal places.
 Social environment:
◦ refers to the culture that an individual lives in, and the
people and institutions with whom they interact.
 Environmental Racism:
◦ refers to when vulnerable groups
vulnerable groups are more affected by
environmental health problems
environmental health problems. Eg. Women, children,
and the poor disproportionately affected by pollution
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Atmosphere:
Space occupied by air
Hydrosphere:
Space occupied by
water
Lithosphere/Pedosphere
: Space occupied by solid/soil
Biosphere: Space
occupied by life
Components of environment
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Component of Environment
Component of Environment
Environment Biological
Environment
Cultural
Environment
Physical
Environment
Atmosphere
Hydrosphere
Lithosphere
Plant
Animal
Microbial
Society
Economy
Politics 23
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Man environment relation ship
 How do you explain man vs EN r/ship?
 Two schools of thought
 A. Environmental Determinism:
◦ beliefs that environment impacts on human
behaviour.
◦ humans are solely the product of their environment.
◦ Processes of determinism are:
 Climate – major determinant of the state of
health and mind.

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 B. Environment Possibilism:
◦ Beliefs that man is in the first place.
◦ Nature is an advisor.
◦ There are no necessities but everywhere
possibilities and man as the master of these
possibilities is the judge of their use.
 The processes of possibilism are:
◦ Technological advancement
◦ Human skills
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Man-environment interaction
Man-environment interaction
 The likely interactions are three types:
◦ Environment affecting humans
Environment affecting humans: natural
natural
disasters
disasters
◦ Man affecting the environment:
Deforestation
◦ Friendly co-existence
Friendly co-existence (Sustaining both)
 Environmental sustainability is a global issue
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 Fast population build up
Fast population build up
 Transition from agriculture to industrial
Transition from agriculture to industrial
society
society
 Development thrust:- more goods and
Development thrust:- more goods and
services per person are required.
services per person are required.
Factors that drives human and environmental
interaction severe
The World’s changing scenario
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Global issues of man-environment interaction
Global issues of man-environment interaction
◦ Hazardous waste
◦ Air pollution
◦ Trans-boundary
waste movement
◦ Global warming
◦ Ozone depletion
◦ Bio-terrorism
• New global problems on the environment
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Present
 Inadequate sanitation 2.0 Billion people
 Unsafe water 780 million people
 Air pollution 1.3 Billion people
 Indoor air pollution 0.7 Billion people
 Depletion of forest One football field every
second
Factors that drives human and environmental
interaction
Affected
The World’s changing scenario: present
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Tips
Tips
“The Earth provides enough
for every man’s need, but not
enough for every man’s
greed.”
•Mahatma Gandhi
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II. Provision of Safe and Adequate
Water Supply

III. Provision of Safe and Adequate Water
III. Provision of Safe and Adequate Water
Supply
Supply
 Definition of terms
 Importance of water
 Occurrence of water
 Impurities of water
 Major sources of water
 Treatment of water
 Water quality surveillance
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Introduction
Introduction
 Water is essential for life.
 About 70% of human’s body weight is water.
 It is the medium in which all living processes occur.
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 The provision of safe and
adequate water supply in
a community is therefore of
the greatest importance in
public health service.
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Introduction con’t
Introduction con’t
 water also plays a key role in
the prevention of disease.
 Drinking eight glasses of
water daily can decrease the
risk of
 colon cancer by 45%,
 bladder cancer by 50%

Definition of terms
Definition of terms
Raw-water: natural untreated water
natural untreated water from
different sources eg. Rivers, Lakes or from unprotected
wells or springs.
Potable water (drinking water): water which is free
from harmful substances, pathogenic organisms.
Palatable water: water which is pleasant to drink.
This is not necessary potable it may actually
contaminate.
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Occurrences of water
Occurrences of water
The tiny usable portion is about 0.8% of the total 2.53%,
which is neither evenly distributed nor properly used.
the distribution
distribution, quality
quality, quantity
quantity and mode of
mode of
occurrence
occurrence are highly variable from one locality to another.
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Which
countries are
under water
scarce and
stress in
1990? 2025?
Water stress
refers to unmet
water needs for
economic,
social, or
environmental
problems

Hydrologic cycle of water
Hydrologic cycle of water
What are the process occurring during Hydrologic
cycle?
What is its implication on quality of water?
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Importance of water
Importance of water
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 Physiological needs: drinking/ cleaning/washing
 Social use: swimming, recreational
 Cultural/ Spiritual values: “Tebel”,
“Timket”
 Economical: agriculture, transportation, power
 production, industrial use, etc,
 Q? Ethiopian case Vs disease
transmission ???

Public health importance of water
Public health importance of water
 How many are at risk?
 Over 780 million
Over 780 million people lack access to an “improved
improved”
drinking water supply; many more drink
drink water that is
grossly contaminated. (JMP 2012 report)
 How many are getting sick?
 4 billion cases of diarrhoea occur annually, of which
> 85% is attributable to unsafe water, and inadequate
sanitation and hygiene.
 How many are dying?
 1.8 million
1.8 million people die every year from diarrhoeal
diarrhoeal
diseases, the majority are children under 5.
(Source: WHO 2008a &b)
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Sources of water
Sources of water
Groundwater: Available at point of need with little cost
Surface water: Usually requires extensive purification
Rain water: relatively safe
Ocean water: Costly to desalinate
????? Health implication Vs source of water
 In Ethiopia which source of water is abundant?
 Overall: 54% improved sources. DHS 2011
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Impurities of water
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Class exercise
Class exercise
 How much “diarrhea diseases” could be
reduced if you will have 100% water
coverage in village “X”. Assume the
prevalence of diarrhea among under-five
children in this village is 45%.
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 Diseases associated with water can be broadly
classified in to 5 epidemiological
5 epidemiological groups:-
i. Water borne disease
ii. Water washed disease
iii. Water related disease
iv. Water based /impounding disease
v. Excess/shortage of minerals constituents
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Diseases associated with water

Water
Water
associated
associated
diseases
diseases
Diseases
Diseases
(Example)
(Example)
Prevention strategy
Prevention strategy
Water-borne Diarrhoea,
Typhoid
Hepatitis A
Improve water quality
Prevent casual use of unimproved
sources
Water-scarce
(water-washed)
Roundworm
(Ascariasis).
Trachoma,
Typhus
Improve water quantity
Improve water accessibility
Improve hygiene
Water-based Bilharzia
(Schistosomiasis)
Guinea worm
Decrease need for water contact
- control snail populations
- improve water quality
Water-related
insect vector
Malaria,
River blindness,
Sleeping
sickness
Improve surface water
management
- destroy breeding sites of insects
- decrease need to visit breeding
sites and improve design of storage
vessels
Water associated diseases and preventive strategies
Source: Cairncross et al (1981)
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Excess or shortage of minerals constituents
 Eg. Fluoride: Shortage  dental caries (tooth decaying)
 Excess dental fluorosis (mottled teeth), skeleton
fluorosis. Crippling fluorosis
 Measure: Regulating chemicals
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Diseases associated with water con’t
Dental fluorosis

1. Point source pollution:
 the discharge of pollutants arise from specific
locations
 It includes factories, power plants, sewage
treatment plants, & latrines that are directly
connected to water bodies etc
2. Non-point source pollution:
 It is scattered or diffuse, having no specific location
where they discharge into a particular body of water.
 Sources include runoff from farm fields and feedlots,
roads, and parking lots, etc
 Q which one is easy for controlling pollution & Rx?
Sources of water pollution
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Water treatment/disinfection
Water treatment/disinfection
 Process of removing all those substances whether
biological, chemical or physical impurities
biological, chemical or physical impurities which are
potentially dangerous or undesirable in water supplies for
human and domestic use.
 Water treatment processes can be:
 Physical treatment
Physical treatment process??????
 Chemical treatment
Chemical treatment process???????
 What is the important factor to selection proper water
Rx process?
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Main objectives of water treatment
Main objectives of water treatment
 To remove pathogenic organisms
 To remove substances which impart color, taste or
color, taste or
odor
odor to the water.
 To remove excess/undesirable chemicals or
minerals.
 To regulate essential elements or chemicals (e.g.
fluoride.
 To remove excess or undesirable dissolved gases.
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Types of water treatment
Types of water treatment
B. Homemade water
(small scale) treatment
Boiling
sand filter
Candle filter
chlorination
Storage ??????????????
SODIS (solar
disinfection)
A. Municipality (large
scale water) treatment
1. Ground water:
Aeration
Disinfection
2. Surface water:
 Screening
 Coagulation
 Sedimentation
 Filtration
 Chlorination (Pre vs Post)
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…
…Small-scale water
Small-scale water
1. Household sand ﬁlter
2. Cloth ﬁltration
3. Solar disinfection
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…
…Small-scale water
Small-scale water
4. Chemical disinfection methods
4.1. Chlorine solution
4.2. Aquatabs
4.3. PUR
4.4. Wuha Agar
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Water Disinfection
Water Disinfection
 Water disinfection is the destruction, or at least the
complete inactivation of harmful micro-organisms
present in the water.
 Pre-treatments of water can not assure the water is
bacteriological safe, i.e. final disinfection (post-chlorination)
will be needed.
◦ purpose: controlling algae, taste, and odor and kill
kill
pathogens.
pathogens. it may produce disinfection by-products
disinfection by-products
(DBPs)
(DBPs) If it reacts with some organic materials
post-chlorination: It is normally performed at the end of
the treatment after the filtration stage
filtration stage.
 Purpose : for residual effect to protects cross
contamination
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Chlorine and its compounds
Why they preferred ? They are:
comparatively in-expensive.
relatively easy to handle
and transport
readily available almost
everywhere.
Effective
simple to apply
relatively easy to detect in
water.
The most popular
substances in the
chlorine family are:-
Chlorine (Cl2): 100%
High-concentration
hypochlorite(Ca(OCl)2):
70%
Sodium hypochlorite
(NaOCl): 2.5% to 17% 05/16/25 54

Relation between dose/demand/residual
Relation between dose/demand/residual
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Why the right residual chlorine amount is required?
Why the right residual chlorine amount is required?

Residual chlorine : 0.2- 0.5mg/L
 Contact time : > 30 minutes
 PH: 6.5- 8.5
 Turbidity: 5 NTU
WHO recommends the following conditions for a proper
disinfection:
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Surveillance of Water
Surveillance of Water
 Surveillance
Surveillance is an investigative activity to identify and
evaluate factors associated with drinking water which could
pose a risk to health
pose a risk to health.
 Surveillance is also both:
 Preventive actions: detecting risks so that action may be
taken before public health problems
before public health problems occur and
 Remedial actions: identifying the source of Out-breaks
of water borne disease so that corrective action
corrective action may be
taken properly.
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Water
Water Surveillance con’t
Surveillance con’t
 What its objective?
 Is to collect and collate information for protection of public
health by providing full information
full information about water supply respect to:
Quality,
Quantity,
Coverage
Cost
Continuity
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Water
 Methods used in water surveillance:
 1. Sanitary surveillance: system integrity to identify
source of contamination
source of contamination; sanitary check list is used a
tool. There are 10 questions related to contamination
 Contamination risk score
 9-10; very high risk
 6-8; high risk
 3-5: Intermediate risk
 0-2: low risk
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Water
 Methods used in water surveillance:
 2. Laboratory surveillance:
 Membrane filtered method
Membrane filtered method or most probable
most probable
number
number are used to assess the quality of water
 Escherichia coli or thermotolerant coliform bacteria
can be used as an indicator of water quality.
 Bacteriophages and/or bacterial spores, should be
considered if there are resistant bacteria to
disinfection such as Enteric viruses and protozoa.
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Rural Water Supply in the pastoralist
Rural Water Supply in the pastoralist
area is worse
area is worse
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Water Sample,
Gashemo Wereda

Water
Methods used in water surveillance:
3. Epidemiological survey: association of disease
with drinking water: cross sectional data,
secondary data are used.
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Indicators of a drinking-water supply
Indicators of a drinking-water supply
What are the parameters used for assessing improved
water supply?
 Quality
 Quantity(in service level)
 Accessibility
 Affordability: tariff paid by domestic consumers
 Continuity: yearly round plus 24 hrs
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Quality
Quality
 It is water that does not contain harmful chemical
harmful chemical
substances, or microorganisms
substances, or microorganisms in concentration
that could cause illness in any form (WHO).
 Criteria for assessing quality of water
◦ Clear, tasteless and colorless
◦ Pathogen free
◦ Low in concentrations of toxic compounds
(according to WHO drinking water
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Quality
Quality
 Does every country has the same quality parameters? Why
 Quality assessment parameters are:
◦ Physical parameter: Qualitative method :taste, smell:
quantitative method: turbidity, color
◦ Biological parameter: Quantitative method; total
coliform (10/100ml) and faecal coliform (0/100 ml)
◦ Chemical parameter
Chemical parameter:
: Quantitative method
 different chemicals has their own cut off point: see
WHO criteria for developing countries.
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Water quality parameter Measure as Highest desirable
level
Maximum permissible
level
TDS(total dissolved solids) mg/l 500 2000
Turbidity NTU 5 25
Colour mg pt/l 5 50
Iron mg Fe2+
/l 0.1 1.0
Manganese mg Mn2+
/l 0.05 0.5
Nitrate mg No-
3/l 50 100
Nitrate mg N/l 1 2
Sulphate mg SO42-
/l 200 400
Fluoride mg F-
/l 1.0 2.0
Sodium mg Nat
/l 120 400
Lead mg Pb/l 0.05 0.1
Mercury mg Hg/l 0.001 0.005
6+/
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Water quality parameters con’t

Critical quality Parameters
Critical quality Parameters
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These parameters must be performed daily in
water treatment. why?

 Accessibility: time/distance (<30 minutes for round trip
and if the source of water found with in 1 km radius
(WHO), 1.5 km (Ethiopia).
 Coverage is the percentage
percentage of the population that has
reasonable access to an improved drinking water supply
program.
 Improved
Improved water
water supply
supply includes: House hold connection,
House hold connection,
public standpipes, protected underground water sources
public standpipes, protected underground water sources
and protected springs.
and protected springs.
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Accessibility and Coverage

 How Much Do We Need per day?
 Adequateness: availability/quantity (a minimum amount of
water required for domestic and drinking purpose.)
◦ Minimum amount of water needed to prevent
prevent
dehydration
dehydration 2 to 4.5 litres
2 to 4.5 litres person per day is required
◦ Minimum amount of water required for domestic use
(drinking, personal hygiene, cooking, laundry and cleaning)
20 litres per person per day is required
20 litres per person per day is required
◦ Access to safe water (69.0%): based on 20 lit/c/d for
urban Vs 15 l/cl/d for rural at 0.5 km radius (data taken
from MOWR)
Quantity of water
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Table. Service level and quantity of water collected:
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Improved water supply
◦ Household connection
◦ Public standpipe
◦ Borehole
◦ Protected dug-well
◦ Protected spring
◦ Rain water collection
These joint monitoring program
joint monitoring program have been also defined in
terms of providing “reasonable access” as summarized below:
 Unimproved water
supply
◦ Unprotected well
◦ Unprotected spring
◦ Tanker-truck provision
of water
◦ Bottled
water??????????????
Accessibility and Coverage
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Source of drinking water in Ethiopia
Source of drinking water in Ethiopia
 Improved source
◦ Piped into dwelling 0.9
◦ Piped to yard/plot 7.6
◦ Public tap/standpipe 22.5
◦ Borehole 3.5
◦ Protected well 6.9
◦ Protected spring 9.3
◦ Rainwater 0.2
◦ Bottled water ???? 0.0
 Non-improved source
 Unprotected well 4.0
 Unprotected spring 26.9
 Tanker truck/cart with small
tank 0.7
 Surface water (river/lake/pond)
17.3
 Other source 0.3
 Improved Water coverage was 73%???? according to
ministry of water and energy report in 2012. In 2013 (61%)
 54 %
54 % (95% in urban, 42% in rural): DHS in 2011 report
 61.5%: DHS 2005 report
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Coverage of water supply
Coverage ? Are countries in line with MDG goals?
Proportion of households getting improved water source
Goal 1. Eradicate extreme poverty and hunger
Goal 2. Achieve universal primary education
Goal 3. Promote gender equality and empower women
Goal 4. Reduce child mortality
Goal 5. Improve maternal health
Goal 6. Combat HIV/AIDS, malaria and other diseases
Goal 7. Ensure environmental sustainability
Target 10. Reduce by half the proportion
half the proportion of
people without sustainable access to safe drinking
water
Goal 8. Develop a global partnership for development
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What is the role of Public health manager
What is the role of Public health manager
in drinking water supply?
in drinking water supply?
 Initiating drinking water development
(Small and large scale)
 M & E: Source quality assurance
 Water supply-line quality assurance
 Epidemic investigation Vs Water?
 Developing small scale water supply
development
 Enhancing community participation:
planning, implementation, use, M & E)
 Hygiene Education
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Outline
Outline
 Definition and concept of food hygiene
 Public Health importance
 Food safety interventions
 Tools to monitor and evaluate food hygiene
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 Food
Food: is any solid or liquid, when
eaten and absorbed by the body,
produce energy, promote the growth
and repair of tissue; promotes
resistance against diseases or
maintains and regulates these
processes (WHO)

Definitions
Definitions
 It does not include substances used as a
drug or medicine (WHO definition).
 Or
 Food is the one which is physically, chemically,
physically, chemically,
and biologically safe
and biologically safe for human consumption.
05/16/25
Definitions
Definitions
78

 Food means
◦ ‘
‘Any raw, semi-processed or processed substance
Any raw, semi-processed or processed substance for
commercial purpose or to be served for the public in any
way intended for human consumption that includes water
and other drinks, chewing gum, supplementary food and
chewing gum, supplementary food and
any substance
any substance which has been used in the manufacture,
preparation or treatment of food, but does not include
tobacco and substances used only as medicines’.
(FMHACA : Proclamation No. 661/2009)
05/16/25
Definitions
Definitions
79

“Food hygiene means all conditions and measures
necessary for ensuring the safety, wholesomeness,
safety, wholesomeness,
and fitness
and fitness for consumption of food at all its stages
from its production, processing, storage, distribution,
preservation, handling, and service.(WHO/FAO);
Food safety is:
◦ All measures to ensure that food will not cause
harm to the consumer when it is prepared and/or
eaten according to its intended use(WHO).
 Food spoilage Vs food adulteration
 Misbranded ?? Safe temperature??
05/16/25
Definitions
Definitions
80

• Total Burden of Food-Borne diseases
– Each day millions of people become ill and
thousands die from a preventable food-borne
illness
– WHO estimate:
 Food-borne illness are increasing worldwide
 Worldwide 5 – 10% of the population suffer
from food-borne illnesses annually
05/16/25
Public health importance of food
81

05/16/25
 Only few case of food-
borne diseases is reported
due to lack of reporting
system or not know the
exact cause
•The illness we see are only the
tip of the iceberg…..or the eyes
of the hippo!
however, very few cases are reported annually. Why ????
however, very few cases are reported annually. Why ????
82

Kinds of food
Kinds of food
 1. Perishable foods:
Perishable foods: eggs, meat, fish, poultry, milk,
creamy cake, vegetables.
 2. Semi-perishable:
Semi-perishable: bread, fruits;
 3. Non perishable: dry foods; canned foods; food
oil
 Q? Which one is potential hazards foods?
05/16/25 83

Factors affecting the growth of
Factors affecting the growth of
microorganisms in foods
microorganisms in foods
Extrinsic factors
 Temperature
 Humidity
 Oxygen
Intrinsic factors
 Moisture content
 pH
 Nutrient content
 Structure of food items
05/16/25 84

Food hazards
Food hazards
 Types: biological , chemical Physical,
Types: biological , chemical Physical,
Hazard
Hazard
I. Biological hazard Vs health
effect
 Communicable diseases; Food
borne infection, intoxication
and the outcome will be mild to
sever, disability, death
05/16/25
THE DANGER ZONE
Pathogenic bacteria double in number every 20 minutes in the DANGER
ZONE.
The longer a potentially hazardous food remains in the DANGERZONE, the
greater the risk that particular food could cause food borne diseases.
85

Routes of microbial contamination
of food
of food
 Air and dust
 Soil, water and plants
 Animals
 Animal feeds
 Food handlers
 Cross-contamination
05/16/25 86

of food ..con’d
of food ..con’d
 Food utensils
 Unsafe temperature
 Poor personal hygiene
 Pests or insects
05/16/25 87

Hazards Vs health effects
Hazards Vs health effects
05/16/25
II. Chemical hazard Vs health effect
 Chronic disease due to low level exposure and
 Food poisoning and the out come may be acute/death.
Get
Get through
Crop production: chemical contaminants, natural
toxins
Production in industry: Food additives
88

Ways of chemical contamination of food
Ways of chemical contamination of food
 Contamination in the crop field
 From cooking
cooking metal
metal containers
 Unauthorized use of additives
additives
 Accidental poisoning: rodentcides or insecticides
 Use of un cleaned
un cleaned containers used for chemical
storage .
05/16/25 89

Chemical contamination of food
Chemical contamination of food
 Food can be contaminated through the misuse
or mistaken handling of chemicals, including
pesticides, bleach and other cleaning materials.
05/16/25 90

Who is food handler?
Who is food handler?
i. Food production
ii. Food Transportation
iii. Food Preparation
iv. Food Distribution
v. Handling of
equipments/utensils;
vi. Storage of food
vii. Food service
05/16/25 91

Unhygienic Practices by Food Handlers
Unhygienic Practices by Food Handlers
 Poor personal hygiene practice
 Unguarded coughing or sneezing
 Nose picking or ﬁngering the nose
 Working in street clothing
 Spitting in food-handling areas
 Uncovered hair
 Smoking in kitchens
 Wearing ornaments
05/16/25 92

Unhygienic….
Unhygienic….
 Ignoring hand washing before starting
work, after handling contaminated
materials, after breaks and after using toilet
facilities.
05/16/25 93

Tapeworms
Tapeworms
Tapeworms are one of the most common
causes of food borne parasitic diseases in
Ethiopia.
05/16/25 94

05/16/25
Dirty Hands Dirty Finger Nails
Dirty Hands Dirty Finger Nails
Dirty Uniforms
Dirty Uniforms
Smoking in Food
Smoking in Food
Open Cuts
Open Cuts
Being sick at
Being sick at
work
work
Food Handlers Hygiene
Food Handlers Hygiene
95

Preventing Food borne diseases
Preventing Food borne diseases
1. Practice of appropriate storage Temperature:
Temperature: Potentially
hazardous foods must be kept in safe temperature
( above 140 O
F, or below 40 O
F
2. Prevent Cross Contamination: Practice good personal
hygiene and regular medical check up of food handlers
3. Practice proper cleaning and Sanitizing of utensils
proper cleaning and Sanitizing of utensils
4. Regular inspection by concerned body: quality analysis
5. Setting standards by responsible body
5. Setting standards by responsible body
05/16/25 96

The WHO Golden Rules
The WHO Golden Rules
(for food preparation/ hygiene)
(for food preparation/ hygiene)
1. Choose foods processed for safety
2. Cook food thoroughly
3. Eat cooked foods immediately
4. Store cooked foods carefully
5. Reheat cooked foods thoroughly
6. Avoid contact between raw foods and cooked foods
7. Wash hands repeatedly
8. Keep all kitchen surfaces meticulously clean
9. Protect foods from insects, rodents, and other
animals.
10. Use pure water
05/16/25 97

05/16/25
V. Waste Management
98

Waste Management
Waste Management
 A. Human waste disposal
◦ Definition of terms
◦ Health importance of excreta
◦ Proper disposal methods of excreta
 B. Solid waste disposal
◦ Classification by source and characteristics
◦ Importance
◦ Processing of wastes
◦ Proper disposal methods
 C. Hazards and infectious waste
◦ Characteristics of hazards and infectious wastes
◦ Control of hazards and infectious wastes
05/16/25 99

A. Human waste disposal
A. Human waste disposal
05/16/25 100

Definitions
Definitions
 Sanitation refers to waste management,
particularly management of human waste (Solid and
human waste (Solid and
liquid)
liquid).
 Basic sanitation: refers to the management of
human faeces at the household level. It means
access to a toilet
toilet or latrine
latrine.
 Onsite sanitation Vs offsite sanitation???
 Q. which one is common in Ethiopia?
05/16/25 101

INTRODUCTION
INTRODUCTION
one gram of faces can contain (UNICEF).
 10,000 viruses
 1,000,000 bacteria
 1,000 parasitic cyst
 100 parasitic eggs
102
05/16/25

Barriers for prevention of faecal-oral disease
Primary Vs Secondary barriers
Which one is feasible and cost effective?
05/16/25 103

Hygiene & Sanitation performance Indicators
Hygiene & Sanitation performance Indicators
 Safe disposal of Human excreta
 Hand hygiene (Hand washing at the critical times) 3A’s & 3B’s
◦ Before eating
◦ Before feeding a child
◦ Before food preparation
◦ After defecation
◦ After cleaning child bottom
◦ After cleaning house/animal dung
 Safe water storage (SWS)
◦ Narrow necked storage container
◦ Covered container
◦ Placed off floor
◦ Cleanly kept
05/16/25 104

12 countries account for almost three-quarters of
12 countries account for almost three-quarters of
the people who practice open defecation:
the people who practice open defecation:
1. India (626 million)
2. Indonesia (63 million)
3. Pakistan (40 million)
4. Ethiopia (38 million)
5. Nigeria (34 million)
6. Sudan (19 million)
7. − Nepal (15 million)
8. − China (14 million)
9. − Niger (12 million)
10. − Burkina Faso (9.7
million)
11. − Mozambique (9.5
million)
12. − Cambodia (8.6 million).
The WHO/UNICEF (JMP) 2012
05/16/25 105

Sanitation in Ethiopia
Sanitation in Ethiopia
 According DHS 2011.
◦ A HH is classified as having an improved toilet if
it is used only by members of one HH (that is, it
it
is not shared
is not shared) (WHO and UNICEF, 2010).
◦ 8.8 % ?????? (18 % in urban and 7 % in rural ) of
HHs use improved toilet facilities.
improved toilet facilities.
 82% of HH used
82% of HH used non-improved toilet facility such
as
◦ 44% used an open pit latrine or pit latrine without
slabs
◦ 38 % of households have no toilet facility
05/16/25 106

Facts about sanitation
Facts about sanitation
05/16/25 107

B. Solid waste management
B. Solid waste management
05/16/25 108

Definitions
Definitions
Solid wastes:
◦ All the wastes arising from human &
animal activities that are normally solid &
that are discarded as useless or unwanted.
◦ The term may be used like Refuse
(Garbage, Rubbish). Eg Plastics, bottles, cans,
papers, scrap iron, & other trash
05/16/25 109

Definitions
Definitions
Solid waste management
 A systematic administration of activities
that provide for the collection, source separation,
collection, source separation,
storage, transportation, transfer, processing,
storage, transportation, transfer, processing,
treatment and disposal of solid waste
treatment and disposal of solid waste.
 It is a discipline associated with the control of
generation, storage, transfer and transport processing
generation, storage, transfer and transport processing
and disposal of solid waste
and disposal of solid waste
05/16/25 110

Functional elements of MSWMS
Functional elements of MSWMS
05/16/25 111

Solid Waste management hierarchy
Solid Waste management hierarchy
 Prevent the production of waste, or reduce the amount
generated.
 Reduce the negative impacts of the waste that is
generated.
 Reuse in their current forms the materials recovered from
the waste stream.
 Recycle, compost, or recover materials for use as direct or
indirect inputs to new products.
 Recover energy by incineration, anaerobic digestion, or
similar processes.
 Reduce the volume of waste prior to disposal.
 Dispose of residual solid waste in an environmentally sound
manner, generally in landfills.
Source: UNEP, 2009
05/16/25 112

Main sources of solid waste
(waste generation)
1. Residential( domestic)
2. commercial
3. Institutional
4. Construction
Demolition
5. Municipal services
6. Treatment plant sites
7. Industrial
8. Agricultural
05/16/25
 Source Reduction,
Reuse, Recycling
1. Sanitary landfill
2. Incineration
3. Composting
4. Dumping in to sea
5. Discharge to sewers
6. Open dump
Disposal Methods
113

Solid waste collection in Addis Ababa
Solid waste collection in Addis Ababa
05/16/25
 What types of hazard are occurred during
handling of Solid wastes?
114

Solid waste disposal site in Addis Ababa
Solid waste disposal site in Addis Ababa
05/16/25
Aerial View of Reppi /Koshe Solid Waste Disposal Site,
Addis Ababa, Ethiopia
115

Solid waste disposal site in Addis
Ababa
Ababa
05/16/25
Reppi Solid Wste Disposal Site, Addis Ababa, Ethiopia
116

Ababa
Ababa
 Addis Ababa land fill, Ethiopia
05/16/25 117

C. Infectious wastes
C. Infectious wastes
 Wastes that require special handling due to
serious threat to human health and the env’t if
mismanaged
 Why Infectious Waste is Regulated?
 A. To minimize the spread of disease from a
medical setting to the general public
 B. To protect
protect the environment
05/16/25 118

The 10 categories of HCW
The 10 categories of HCW
 1. Infectious waste
 2. Pathological and anatomical waste
 3. Hazardous pharmaceutical waste
 4. Hazardous chemical waste
 5. Waste with a high content of
heavy metals
 6. Pressurized containers
 7. Sharps
 8. Highly infectious waste
 9. Genotoxic / cytotoxic waste
 10. Radioactive waste
05/16/25 119

Actors in the HCWM process
Actors in the HCWM process
 Who should involved in the
management of HCW?
◦ Health care facilities.
◦ Service providers who collect the
waste from the healthcare facilities and
transport it to the treatment facilities;
◦ Treatment facilities that process
the waste to make it safe for final
disposal.
05/16/25 120

Risks associated with HCW
 Who are at risk?
◦ Medical staff:
◦ In and out-patients
◦ Workers in support
services
◦ Workers in waste disposal
facilities,
◦ The general public and more
specifically the children.
05/16/25 121

Acquiring of diseases caused by Blood borne
Acquiring of diseases caused by Blood borne
Pathogens. Example;
Pathogens. Example;
 Hepatitis C
 Malaria
 Rabies
 Syphilis
 Viral Hemorrhagic Fevers
 HIV / AIDS
 Hepatitis B
Brucellosis
05/16/25 122

Con’t
Con’t
 Poor management of health-care waste exposes
◦ Health care workers Infections,
◦ waste handlers Toxic effects
◦ Patients Injuries
◦ the community
 Studies revealed that from HCW who had HBV
and HCV, of these :-
 33% of HBV Direct or indirect
 42% of HCV exposure to
infectious wastes
infectious wastes.
05/16/25 123

Strategies for avoiding risks associated
HCW
HCW
1. Changing behavior of HC workers,
patients & community.
2. Ensuring availability of equipment &
supplies
3. Safe and appropriate management of
HCW
HCW
HCW
05/16/25 124

Healthcare wastes containers
Healthcare wastes containers
05/16/25 125

05/16/25
V I. Housing and
Institutional Health
126

VI. Housing and Institutional Health
VI. Housing and Institutional Health
 Good house keeping principles
 Institutions related to public health
05/16/25 127

Definition of terms
Definition of terms
 Housing
◦ It is a term that describes for a physical
a physical
structure
structure in which we live.
◦ It is as ‘flats and houses for people to live in
flats and houses for people to live in.’
The Oxford Dictionary.
◦ It is also considered as a
a dwelling or physical
dwelling or physical
shelter
shelter that is used for living purposes.
 Many of these definition focus on the nature of
the nature of
housing
housing as a physical structure or shelter
physical structure or shelter.
05/16/25 128

 The WHO uses the term ‘
‘Residential
Residential
environment
environment’
’, rather than ‘Housing
Housing’, which
define as:
 the physical structure
physical structure that man uses for shelter
and the environs of that
the environs of that struc
structure including all
necessary services, facilities, equipment, and
devices needed or desired for the physical, mental,
and social wellbeing of the family and individual.
Definition of terms
Definition of terms
05/16/25 129

130
Definitions
Standard Housing
 Is a house that is properly planned and constructed in
proper site, comfortable, safe to live in and fulfill the
basic housing necessities
◦ provided with safe and adequate water supply
safe and adequate water supply,
◦ safe and proper waste disposal ,
◦ adequate light, space
adequate light, space,
◦ well ventilated
well ventilated, etc.
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131
 Substandard Housing:-
 Is a house, which is poorly sited, planned and
poorly sited, planned and
constructed, inadequate floor space
constructed, inadequate floor space for the
family ( overcrowded), poorly maintained and
does not in general comply with the more
important sanitary facilities
important sanitary facilities.
Definitions
05/16/25

 Slum:-
◦ It is an area in which substandard housing predominates
and frequently accompanied with overcrowding.
◦ It is ‘‘a highly congested, usually urban, residential
area characterized by deteriorated unsanitary buildings,
deteriorated unsanitary buildings,
poverty, and social disorganization
poverty, and social disorganization’’ (Webster’s Third
International Dictionary, 1966).
 Blighted area:-
◦ an area, which is undesirable
undesirable for residential,
residential,
agricultural, commercial, industrial or recreational
agricultural, commercial, industrial or recreational
purpose
purpose.
◦ Examples:- Marshy and rocky areas, gorges and
mountainous areas, and plots.
Definitions
05/16/25 132

Basic requirements of healthful housing
Basic requirements of healthful housing
 WHO has adopted four basic requirements of
healthful housing :
◦ Satisfaction of physiological needs
Satisfaction of physiological needs
◦ protection against infection
protection against infection
◦ protection against accidents
protection against accidents
◦ protection against psychological and social
protection against psychological and social
stresses
stresses
◦ Protecting people at special risk
Protecting people at special risk
05/16/25 133

Factors affecting healthful housing
Factors affecting healthful housing
Housing condition or structure can be
affected by:-
◦ Poverty
◦ Education
◦ Climate
◦ culture and
◦ population mobility
05/16/25 134

Structure of housing in different areas
Structure of housing in different areas
of Ethiopia
of Ethiopia
05/16/25 135

1. School hygiene and sanitation
1. School hygiene and sanitation
05/16/25 136

 Public health importance of school environment
Public health importance of school environment
◦ School children spend about one third of their time.
◦ Schools provide an ideal opportunity to detect poor
poor
hygiene practice
hygiene practice by children.
◦ School
School dropouts
dropouts are related with water supply and
sanitation conditions of schools.
◦ upper respiratory
upper respiratory infections, skin infections, abdominal
infections, skin infections, abdominal
discomfort, eye infections, gastroenteritis
discomfort, eye infections, gastroenteritis (diarrhoea) and
(diarrhoea) and
tonsillitis
tonsillitis are the commonest ailments for school clinic visits
Institutions: School environment
Institutions: School environment
05/16/25 137

Institutions: School health programme
Institutions: School health programme
 School health programme includes:
School health programme includes:
◦ Health-related policies in schools
Health-related policies in schools
◦ Promotion of hygiene
Promotion of hygiene
◦ Provision of safe water supply
 Water availability should be about ﬁve liters
ﬁve liters
per day per student and water must be
available throughout the school day.
◦ Presences of sanitation facilities
 It should be proportional with number of
students
◦ Healthy school environment
Healthy school environment
05/16/25 138

139
Sanitary facilities in school
 If the sanitary facility is a water flush system
 In the use of latrines, the number of seat holes and
urinals as practically applied in most of developed
countries is:
a. 1 seat hole for every 15- 20 boys.
b. 1 urinal for every 30 to 45 boys.
c. 1 seat hole for every 10 to 20 girls.
05/16/25

Provision of drinking water
Provision of drinking water
 The Ministry of Health advises 1 water
tap for 50 students.
05/16/25 140

141
Hospital (Health Institutions) Sanitation
 less care, poor sanitation
less care, poor sanitation have become a
means of introducing contaminants and
infections to the hospital environment that
◦ delay recovery,
delay recovery,
◦ overburden the weakened patient
overburden the weakened patient.
 Hospitals have therefore, many potential
hazards that can pose a threat to
◦ employees,
employees,
◦ patients and
patients and
◦ visitors
visitors
05/16/25

142
Source of Nosocomial Infections
 Deficient infrastructures, rudimentary equipment and a poor
Deficient infrastructures, rudimentary equipment and a poor
quality of care contribute
quality of care contribute the occurrence of nosocomial
infections
 in developing countries incidences of nosocomial infections
which have been estimated to be between 2-6 times higher
than those in developed nations.
 Those who are working at
1. Laundry
2. Healthcare wastes
3. House keeping
4. Laboratory
5. Central supply
6. Maintenance of physical structure are at risk for biological
hazard
05/16/25

143
Prison Health
 Because, the prisoners usually live in an overcrowded
conditions and use a single room for living, sleeping,
reading, and etc.
 Moreover, some prisoners may have an infection
before they are sentenced.
sentenced.
 Communicable disease transmission is very rapid in
such crowded condition, which is apparent in
prison.
05/16/25

144
Sources of Diseases in the Prison
 Infections may occur from two sources in the
prison:
1. Some prisoners may join the prison with apparent
or in apparent infection from outside & infect
healthy ones.
2. Infection that originate in the prison it self
because of poor environment
◦ (Poor housing, inadequate ventilation,
overcrowding, malnutrition, poor hygiene due to
lack of facilities, inadequate water supply, etc)
 Strict follow up and environmental sanitation
should be practice in prison
05/16/25

145
Aim of Prison Health Services
1. To solve the immediate physical and mental
physical and mental health
problems of the prisoners.
2. To teach prisoners the basic principles of healthy
healthy
living
living
3. To prevent the infections diseases
infections diseases specially the
chronic ones such as tuberculosis
4. To advise prison administration
prison administration on health and
environmental conditions of the prison.
05/16/25

 Single occupancy cells: these should be at least 7m2
in size,
‘with a minimum of 2m between walls, 2.5 meters between
floor and ceiling’.
 Multi-occupancy cells: In addition to the basic cell size of
7m2
, there should be an extra 4m2
for each additional prisoner.
Space required in prison
Space required in prison
05/16/25 146

Sanitation facilities in prison
Sanitation facilities in prison
 1 shower for15 inmates
 1 Water Close-set for eight prisoners
 1 lavatory for eight prisoners
05/16/25 147

05/16/25
VII. Safe Working Environment
VII. Safe Working Environment
148

Outline of the presentation
Outline of the presentation
 Components of occupational health
 Components of safe working environment
 The range of health hazards encountered in the
workplace
 Occupational hygiene management
05/16/25 149

Definitions:
Definitions:What is Occupational Hygiene?
What is Occupational Hygiene?
 Occupational Hygiene
◦'The discipline of anticipating, recognizing,
evaluating and controlling health hazards in the
working environment
working environment with the objective of
protecting worker
protecting worker health and well-being and
safeguarding the community at large
community at large.' according
International Occupational Hygiene Association (IOHA).
05/16/25 150

 Occupational Hygiene, also called Industrial
Hygiene, is both a profession and a science.
 It is defined as a science and an art devoted to the
ANTICIPATION, RECOGNITION, EVALUATION, and
CONTROL of those environmental factors or stresses
arising in or from the work place which may cause
SICKNESS, IMPAIRED HEALTH, and WELL-BEING or
significant Discomfort
Discomfort and Inefficiency
Inefficiency among workers
or among the citizens of the community.
Definition: What is Occupational Hygiene?
05/16/25 151

Exposure
Work Activity
Disease
Occupational
Hygiene
Occupational
Medicine
Occupational
Health
Safe working environment is similar with occupational hygiene
Safe working environment is similar with occupational hygiene.
05/16/25 152

 Anticipation
 this involves identifying potential hazards in the
workplace before
before they are introduced
introduced.
 How?
 Recognition
 this involves identifying the potential hazard that
a chemical
chemical,
, physical
physical or
or biological
biological agent
agent or
an adverse ergonomic situation poses to
health effect.
05/16/25 153

 EVALUATION
 the extent
extent of
of exposure
exposure to the chemical hazards, physical
or biological agents (or adverse ergonomic situation) in the
workplace should be evaluated
evaluated .
This often involves measurement of the personal
exposure of a worker to the hazard/agent in the workplace.
assessment of the data in terms of recommended
occupational exposure limits (OELs), where such criteria
exist.
05/16/25 154

Control
Control
 Control
CONTROL of the chemical, physical or biological
agent or adverse ergonomic situation, by procedural
procedural,
,
engineering
engineering or
or other
other means
means where the evaluation
indicates that this is necessary.
05/16/25 155

Hazard and Risk
Hazard and Risk
 A hazard
 is something that can cause harm if not
controlled.
 The outcome is the harm that results from
an uncontrolled hazard.
 A risk
◦ is a combination of the probability that a
particular
particular outcome will occur and the
severity
severity of the harm involved.
05/16/25 156

Hazards: Environmental factors or stresses
Hazards: Environmental factors or stresses
Chemical agents
Gases, vapours,
fibres, liquids,
dusts, mists, fumes, etc.
Physical agents
Noise and vibration
Heat and cold
Electromagnetic fields,
lighting etc.
Biological agents Bacteria, fungi, etc.
Psychosocial
factors
Stress, workload and
work organisation
05/16/25 157

Occupational Health Components
Occupational Health Components
 Occupation
Safety
◦ Accident
prevention
◦ Injury prevention
 Occupational
Medicine
◦ Diagnostics,
◦ medical surveillance
◦ Treatment
◦ Rehabilitation
Occupational/Industrial Hygiene
• Concern with environmental agents
and ergonomics hazard to prevention
of occupational disease
• Wide range of technical and
management to prevent the exposure
• skills needs
• Science and health
• Engineering and technology
• Management and communication
05/16/25 158

Public health importance of safe working
Public health importance of safe working
environment
environment
 The World Health Organisation/ ILO estimates
that globally there are:
◦ 2.3 million
2.3 million work-related deaths per year.
◦ Economic
Economic loss
loss of 4% global GDP
◦ 386,000 deaths
386,000 deaths each year from exposure to airborne
airborne
particulates.
particulates.
◦ 152,000 deaths
152,000 deaths per year from carcinogens
carcinogens in the
workplace.
◦ 37% of Lower Back Pain is attributed to occupation.
05/16/25 159

Occupational diseases form working environment
 Disease of
respiratory system
 Musculoskeletal
disease
 Skin disease
 Eye diseases
 Disease of the
nervous system
05/16/25
 Reproductive disorders
 Cardiovascular disease
 Hematological disorders
 Liver diseases (hepatic
disorders)
 Hearing loss
160

Prevention of occupational diseases
Prevention of occupational diseases
 Primary prevention: exposure reduction at
source, path, and worker level eg. Safety
practices, prevention of exposure
 Secondary prevention: early detection through
blood checking (lead concentration, level of
cholestarase, ..)
 Tertiary prevention: occupational medicine.eg
rehabilitation.
05/16/25 161

Types of prevention and Control Measures
Types of prevention and Control Measures
Elimination
Substitution
Isolation
Segragation
Engineering Controls Including LEV
Administrative Controls
Personal Protective Equipment
Increasing
preference
05/16/25 162

Environmental Health for public Health.ppt

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