Water Sanitation and Health Issues

8/13/2019 Water Sanitation and Health Issues

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Deaths caused by selected infectiousdiseases in the SEA Region, 2002(Figures in 000)

DiseaseMortality stratum

Total Low child,low adult

High child, highadult

Respiratory infections 1377 121 1256

Diarrhoeal diseases 802 44 758

Tuberculosis 701 160 541

HIV/AIDS 445 60 385

Measles 193 32 161

Malaria 95 9 86

Source: World Health Report 2002


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Burden of disease in DALYs caused byselected infectious diseases in the SEARegion, 2002 (Figures in 000)

DiseaseMortality stratum

Total Low child,low adult

High child, highadult

Respiratory infections 32904 2497 30407

Diarrhoeal diseases 22377 1128 21249

Tuberculosis 15968 3549 12149

HIV/AIDS 13608 1850 11758

Measles 6922 1151 5771

Malaria 3680 353 3327

Source: World Health Report 2002


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Government of India Agencies involvedin Water & Sanitation Programme

Planning Commission

Ministry of Urban Development/ CPHEEO

Ministry of Rural Development/ RGNDWMMinistry of Water Resources/ CWC & CGWB.

Ministry of Environment & Forests/ CPCB.

Ministry of Health & Family Welfare/ NICD.Ministry of Social Welfare.


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Water and Health: Background

About 21% communicable diseases are water borne50 million suffer from intestinal diseases, like diarrhoea, cholera,dysentery, typhoid etc.5 million people die, of which 1.5 million are children below 5.

Maximum morbidity and mortality occur due to diarrhoea.- Reported morbidity in 1998 was 9.6 million- Infant mortality is 0.5 million every year- In order to reduce morbidity/ infant mortality rate (IMR)/ B5 mortality, it is

necessary to reduce diarrhoea and jaundice, the main causes

- Common water borne microbiological disease include Cholera,Diarrhoea, Dysentery, Typhoid, Bacillary, Trachoma, Amoebiasis,Giardiasis, Worm infestation, Guineaworm, Viral Hepatitis, Philariasis,Poliomyelitis etc.


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Water Usage by Sector A Birds Eye View


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1947 5150 Cu.m

2000 2200 Cu.m2017 1600 Cu.m

(Water Stressed Condition)

Per Capita Availability of Water


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Urban demand1990 25 BCM

2025 52 BCM

Industrial Demand1990 34 BCM2025 191 BCM

Agricultural Demand 2025 770 BCM

Total 1013 BCM

Aggregate annual utilizable water in India 1100 BCM

Demand and Available Utilizable Waterin India


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The blocks in red areareas where, due toextraction ofgroundwater,especially for irrigation,the groundwater levelshave fallen by morethan 4 metres (@ > 20cm/year) during 1981-

2000

Source: CGWB

Groundwater Depletion in India


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Water Borne Diseases

Disease of Syndrome

Enteric DiseasesDiarrheas, Dysenteries,Gastoenteritis, etc.

Skin Diseases

Otitis Externa, Scabies, SkinSepsis and Ulcers, Tineas(Ringworm)

Lou se-Born e DiseasesLouse-borne Fever, Pediculosis,Relapsing Fever, Typhus Fever,Wolhynian Fever

TreponematosesEndemic Syphilis, Pinta, Yaws

Eye DiseasesConjunctivitis, Trachoma

Remarks

Prevalence of most fecal-oral diseases is less withadequate quantity of water

Prevented by personalhygiene, including frequentbathing and laundering withuse of soap

Prevented by personalhygiene, including bathingand laundering andchanging of clothing

Prevented by general publicand personal hygiene. Non-venereal.

Trachoma rare whereample water is available.


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Water Contact Diseases

Disease or Syndrome Remarks

Drowning

Enteric Disease Ingestion during bathing or swimming

Granulomal Skin Infections Mycobacteria in water. Swimming of occupationalexposure

Ichthyotoxism Poisonous coelenterates or fish

Hirudiniasis Aquatic leeches

Leptospirosis Zoonosis; contact of abarded skin or drinking ofwater contaminated by infective rat urine

Otitis Ear infection from immersion

Pharyngoconnunctival Fever Virus infection associated with swimming pools

Primary AmoebicMeningoencephalitis

Rare but fatal disease of swimmers and divers


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Water Habitat Vector Borne Diseases


Schistosomiasis Major tropical disease transmitted through directcontact and penetration of immersed skin byschistosome cercariae. 200 million people areinfected.

Clonorchiasis (Asiatic liver fluke) Human infection by eating raw or partly cookedinfective fish.

Opisthorchiasis (Cat liver fluke) Human infection by eating raw or partly cookedinfective fish.

Fascioliasis (Liver fluke) Human infection by eating raw, infective aquatic

plants, especially watercress.Fasciologsiasis (intestinal fluke) Human infection by eating raw, infective aquatic

plants, especially water chestnut and water caltrop


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Water Habitat Vector Borne Diseases


Arboviruses Many different viral diseases including yellow feverand dengue.

Filariasis Bancroftian form increasing in populous areas dueto propensity of Culex fatigans for breeding in

polluted waters. 250 million people are infected.Malaria Classical tropical disease with high death toll.

Loaiasis (Loa Loa) Mangrove fly of genus Chrysops breeds in water inWest and Central Africa

Onchocerciasis Simulium spp. Breeds in flowing water in Africa and

Central America. Blindness common in W. Africa.


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Emerging diseases

Emerging Disease of Infectious origin AIDS (Acquired Immune Deficiency Syndrome)EbolaSevere Acute Respiratory Syndrome

Water borne emerging diseasesCryptosporidiumLegionellaEscherichia coli O157 (E. coli O157)

Rotavirus, Hepatitis E virus, NorovirusHelicobacter pylori (H. pylori)


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Water Quality Problems

Quality Problem Remarks

Fluoride The population at risk is estimated to be around 66million

Arsenic Arsenic contamination ground water exceeding thepermissible limit of .05 mg per litre in part of West

Bengal has been found as a major quality problemand health hazard affecting rural population of 4000habitations.

Iron A total of 1,38,670 habitations spread over 16 statesin the country are found to be affected with ironcontamination.

Nitrate Nitrate is emerging as a major problem in the Statesof Tamil Nadu, Rajasthan, Gujarat, Karnataka,Maharashtra, and Uttar Pradesh

Brackishness 29 projects were sanctioned for Andhra Pradesh,Karnatka, Kerala, Orissa, Punjab, Rajasthan, TamilNadu and Madhra Pradesh


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Increased Pollution of Surface and Ground Water.

Improper Water Resource Management

Shortcomings in the Design.

Lack of implementation of legislation and regulations.

Increase in Population.

Undue aspiration of the rich

Fresh Water Crisis


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Industrialization

Urbanization

Agricultural Modernization

Rapid Growth without taking into account environmental issues

Environmental Problems


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21% of all communicable diseases are waterrelated

200 million mandays lost annually

30.3 million DALYs are lost

Rs. 36.6 billion total annual loss

Loss due to water related diseases


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Rural

unsafe drinking water

Inadequate excreta disposal

Agricultural run-off containing chemicals andpesticides

Urban

Lack of infrastructure to meet rapid population riseUncontrolled industrialization

Lack of waste management

Water Related EnvironmentalHealth Hazard


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Excessive extraction of groundwater.

Chemical and bacteriological contaminants in drinkingwater.

Ingress of seawater into coastal aquifers.Pollution of ground and surface water from agrochemicalsand industrial waste.

Pollution of ground and surface water due to urban bodiesnot resorting to adequate waste management.

Shortage of water due to


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Polluted water sources create fresh water crisis calls for additionalinvestment and long distance water systems.

Inequitable distribution of drinkable water leading to wastage.

All these lead to low availability of drinking water and ofquestionable quality.

Lack of storage and handling of drinking water at HH level.

Household Water Security


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Inadequate municipal waste water treatment facilities add to75% of water pollution. Surface water sources get polluted dueto municipal and industrial waste and agricultural runoff

Quality of ground water deteriorates due to over exploitation,

leaching of chemical fertilizers and or land disposal ofmunicipal and industrial waste

Lack of HH toilet facilities in the vulnerable areas

Inadequate solid waste management and landfill dumping

Lack of hygiene education and adaptation of poor personalhygiene practices.

Poor drainage facilities leading to silage / rain water collection

Environmental Sanitation


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About 1.6 Million deaths a year worldwide are attributed to unsafewater, sanitation and hygiene, mainly through infectious diarrhoea.Nine out of ten such deaths are in children, and virtually all thedeaths are in developing countries.

In India, the lack to access safe water and proper sanitation facilitiesis a major cause for diarrhoeal infections, and kills 600,000 peopleannually.

Unsafe water and sanitation


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History of the WHO Guidelines forDrinking Water

1958, 1963, 1971: International Standards

1984: First edition of Guidelines: basis for formulating standards,but standard setting is a national prerogative

1993: Second edition with increase in number of chemicals covered2004: Third edition introducing systematic water safety approach


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WHO Water Guidelines

AIMProtection of human health

Advisory in NatureFacilitate national standard-setting

Features Socio-Economic and environmental contextRisk benefit philosophy local adaptation for health gainsBest available evidence- science and practiceScientific expert consensus

ApproachExploit global information and experience


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Why we need to review our approach

In all countries waterborne illness still occursOutbreaks show us that we cannot solely rely on water treatmentindicatorsEnd-point testing is too-little-too-late


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Interrelation of the chapters of the Guidelines for Drinkingwater Quality in ensuring drinking water safety

Introduction (Chapter 1)

The guidelinerequirements (Chapter 2)

Health-based targets (Chapter 3)

Public health contextand health outcome

Water Safety Plans(Chapter 4)

Systemassessment

Monitoring Management andcommunication

Surveillance(Chapter 5)

FRAMEWORK FOR SAFE DRINKING WATER SUPPORTINGINFORMATION

Microbial aspects

(Chapters 7 and 11)Chemical aspects (Chapters 8 and 12)

Radiologicalaspects

(Chapter 9)

Acceptabilityaspects (Chapter 10)

Application of the Guidelines in specific circumstances(Chapter 6)

Large buildings, Emergencies and disasters, Travellers, Desalination systems,Packaged drinking water, Food production, Planes and ships


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Framework for Water Safety in 3rdEdition WHO GDWQ

Health Based TargetsWater Safety Plans

1. System Assessment2. Monitoring of control measures3. Management Plans

Independent Surveillance


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Water Safety Plan

A WSP comprises, as a minimum, the threeessential actions that are the responsibility ofthe drinking water supplier in order to ensure

that drinking water is safe. These are: a system assessment; effective operational monitoring; and

management


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WHOs Response

Moving away from reliance on output monitoring- i.e. measuringpara-metres in final waterMore input monitoring- i.e. measuring para-metres showing that thesystem is working

Priority focus on microbial hazardsShort- term chemical changes and exposuresCatchment-to- consumer (farm -to- fork) Multiple barrier approach HACCP Reality check on todays water supply situations


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Independent Surveillance

Systematic independent surveillance that verifies that the WSPsare operating properly

Audit of Water supply planShows WSP is being adhered to

VerificationEnd-product final check


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Start Up Activities

Initial meetings/workshops with Ministry of Urban Development,CPHEEO, BWS&SB, HMWS&SB and other partners in 2004 :

jointly by USEPA and WHO.

September 2004: Workshop for strengthening Drinking WaterQuality Surveillance programme involving five Ministries, tenresearch agencies and ten selected water boards/ PHEDs.

March 2005: Workshop to introduce the concept of WSP,Development of Directory of DWQ Labs., Development of Manualsfor Lab. Practitioners.


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Development of Support Documents forDWQ Laboratories

1. Directory of Drinking WaterQuality Test Laboratories.

2. Guidance Manual for DrinkingWater Quality Monitoring and Assessment.


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What made Water Safety PlanAcceptable?

Since WSPs are a risk management toolto prevent the contamination of drinkingwater before it occurs, WS Managersaccepted the concept. Some basicquestions to build a WSP:

1. What are the hazards to safe drinkingwater?

2. How will these hazards be controlled?

3. How will the control for the hazard bemonitored?

4. What actions must be taken to restorecontrol?

5. How can the effectiveness of the systembe verified?


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Activities initiated under WSP

WSPs in Hyderabad Metropolitan Areas.

- Training of Laboratory personnel to make use of thedeveloped Manual.

Composite planning for selected WTPs at Hyderabad, Puneand Delhi.

Drinking Water Quality Monitoring & Development ofSurveillance Mechanism to support Water Safety Plan

Pune WSPs


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WSP Demonstration Projects inHyderabad

Three Locations

* Adikmet area 24X7 water supply maintained by HMWS&SB.Comparatively new system.

* Serilingampally area- Bulk supply by HMWS&SB augmented byground water sources. Maintained by Local Body.

* Moin Bagh area Old city, narrow lanes, intermittent water

supply maintained by MHWS&SB. Old system.


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WSP Demonstration Projects in Hyderabad

Adikmet area

Health 5% of WaterBorne diseases casesreported from this area inFever Hospital -Mostlyreported from Slums

Socio- economicconditions LIG 30%

MIG - 40% HIG - 30%

SerilingampallyMunicipality

Health Data Notavailable

Socio- economic

conditions LIG 20% MIG- 40%

HIG - 40%

Moin Bagh Area

Socio- economicconditions

LIG 70%

MIG- 20%

HIG - 10%


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Health-Based Targets for DWSObjectives

The overall objective of the study is to conduct a riskassessment in each of the three project sites that wouldprovide baseline data for establishing health based targets toguide and evaluate the implementation of the WSPs in thesesites. Specifically, in each of the project areas, the study aims

to: Estimate incidence of acute gastroenteritisEstimate intra-household and distribution point prevalenceof drinking water contamination

Assess relative risk relationship between exposure factors(drinking water and hygiene practices and water quality)and health outcomes

Assess socioeconomic determinants influencing exposureto risks and disease burden


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Incidence of Acute Gastroenteritis

Area Slum Non Slum Total GE Cases (Last Seven Days)

Adikmet 5 5 10Moinbagh 45 32 77Serilingampally 27 23 50

Total 77 60 137Population Covered

Adikmet 896 1511 2407Moinbagh 1320 1343 2663Serilingampally 796 1493 2289

Total 3012 4347 7359Incidence Rate of GE Per 1000

Adikmet 5.58 3.31 4.15Moinbagh 34.09 23.83 28.91Serilingampally 33.92 15.41 21.84

Overall 25.56 13.80 18.62


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Findings

Incidence rates of gastroenteritis from survey is several fold higherthan that reported by the public health surveillance system

Incidence rate of Acute GE in slum areas almost double than thatin non slum areas

Contamination of source water a significant risk for GE in non slumareas.

Risk of Gastroenteritis is lower in households having Metrodomestic connections and significantly higher in households usingpit taps as a drinking water source

24x7 water supply significantly reduces risk for gastroenteritis


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Drinking Water Quality Monitoring &Development of SurveillanceMechanism to support Water SafetyPlan: Delhi pilot project.


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Category HIG MIG LIG Society Slum

Area 1 1 3 2 3

No. of households 3 3 12 8 12

No. of samples 42 42 168 112 168

No. of sampleswith+ve TotalColiforms

2 2 6 Nil 47

No. of samples

with+ve FaecalColiforms

Nil Nil Nil Nil 3

Number of households water samples collected from differentareas and their bacteriological characterization during Dec. 2006to June 2007


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Location Source Total Sample Positive Sample

WTP RAW 72 64

HIG

Source 16 0

Consumer Point 48 0

MIG

Source 16 0

Consumer Point 48 1

SOCIETY 1

Source 16 0

Consumer Point 64 0

SOCIETY 2 Consumer Point 64 0

Bacteriological characterization of water samples


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Location Source Total Sample Positive Sample

LIG 1

Source 16 0

Consumer Point 64 3

LIG 2

Source 16 0

Consumer Point 64 0

LIG 3

Source 20 1

Consumer Point 80 5

SLUM 1

Source 21 5

Consumer Point 84 25

SLUM 2

Source 21 1

Consumer Point 84 6

SLUM 3

Source 21 5

Consumer Point 84 19

Bacteriological characterization of water samples


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Conclusion

WSPs protect from contaminationfrom catchments to consumer

WSPs are comprehensivemanagement strategies to preventoutbreak of disease

WSPs assist water boards withmaking targeted investments formaximum benefit

*picture courtesy HMWS & SB