Global Issues in Water, Sanitation, and Health Workshop Summary (2009) / Chapter Skim
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1 Global Problems, Local Solutions
1 Global Problems, Local Solutions
Pages 50-95
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From page 50... ...
Focusing on China, the Middle East, Africa, India, and the United States, Running Dry presents compelling arguments for international cooperation on water issues and highlights some promising grassroots programs to improve access to safe water. Grassroots efforts to improve water access, sanitation, and health are also featured in the chapter's second contribution, by Donald R
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From page 51... ...
Water gathered in this way is vulnerable to contamination between its source and its point of use, and thus requires the most local of interventions in order to ensure its safety: household water treatment and storage interventions (also known as "point-of-use" strategies)
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From page 52... ...
Julius Nyerere The Carter Center's motto is "Waging Peace, Fighting Disease, Building Hope." Our divisional motto in the Health Programs of The Carter Center is "Fighting Disease and Building Hope at the Grassroots." It is in the spirit of that motto that I shall review aspects of two programs we are assisting: illustrating the interaction of water and health in the fight against dracunculiasis (Guinea worm disease) in Ghana, and the interaction of sanitation and health in the fight to control trachoma in Ethiopia.
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From page 53... ...
. In partnership with national and regional health authorities and local Lions Club members, and with support of the Lions Club International Foundation, Pfizer Inc.
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SOURCE: Courtesy of The Carter Center/L. Rotondo.
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From page 55... ...
The resulting pain incapacitates victims for periods averaging two to three months and severely constrains agricultural productivity and school attendance. People are infected by drinking water that contains tiny water fleas that have ingested immature forms of the parasite that have been spewed into stagnant ponds from emerging adult worms.
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From page 56... ...
SOURCE: Courtesy of The Carter Center.
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From page 57... ...
Ghana's poor, arid, and long-neglected Northern Region, which includes one-third of the land mass of the country and the lowest rates of literacy, school attendance, and access to safe drinking water and medical care, was found to contain 56 percent of all cases. With early external support from The Carter Center, the U.S.
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From page 58... ...
But advocacy by health workers in this eradication campaign for consideration to be given to distribution of disease in establishing priorities for providing and rehabilitating sources of drinking water has at least helped affirm that important principle for future decision makers. Meanwhile, the global Dracunculiasis Eradication Program has reduced cases of the disease from the estimated 3.5 million cases in 20 countries in 1986 to a projected total of less than 5,000 cases in 6 countries in 2008, with the overwhelming majority (98 percent)
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From page 59... ...
. SOURCE: Courtesy of The Carter Center.
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From page 60... ...
Bradley London School of Hygiene and Tropical Medicine Introduction This paper seeks to do three things, all related to functional classification, or taxonomy, of water-related diseases. The first is to revisit the taxonomies of diseases related to water and to sanitation that I put forward more than 30 years Ross Professor of Tropical Hygiene Emeritus.
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From page 61... ...
The broad spectrum of water-related diseases was therefore reduced to a subset and the term waterborne diseases was inappropriately used for the whole lot, with the consequent narrow focus on microbiological water quality that has limited the range of interventions as well as implying a single transmission route, which is far from true. Our introduction of a broader approach -- of dividing water-related communicable disease transmission into four functional categories -- seemed to meet the need for a way of communicating across disciplines and has become widely accepted (White et al., 1972)
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From page 62... ...
Lest these endeavors appear too abstract, the final section applies these concepts to a very rapidly changing area of Uganda and explores their relevance in the real world. The Functional Classification of Water-Related Disease Transmission Revisited The original classification of water-related disease transmission was developed for a study of domestic water use in East Africa.
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From page 63... ...
and water-related insect vectors -- both drew attention to further hazards of undeveloped or poorly managed surface water sources and also brought together two previously disparate literatures and areas of study: domestic water supply and diseases of water resource development (such as reservoir construction and irrigation projects) , to their mutual benefit (Bradley, 1977a,b; Ensink et al., 2002; Moriarty et al., 2004)
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From page 64... ...
There is a further way in which water affects disease transmission. In semiarid areas, sources of surface water may be both few and small in size, and in great demand not only by people and their livestock but also by wildlife in the area.
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From page 65... ...
is most effective in the first two categories of disease transmission, the sanitary infrastructure affects categories II-IV the most, and the last two categories are most dependent on rather specific measures unless the general sanitary standard is relatively high. Thus, the classification gives a sense of the most important means of control for particular diseases: whether personal hygiene behavior, domestic water s upply, provision of toilets and how they are maintained, eventual treatment of the excreta, or very specific methods of attack are most cost-effective.
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From page 66... ...
66 TABLE 1-2 Excreta-Related Transmission Routes of entry Type Latency Persistence Multiplication Biology, predominantly: Examples and egress* I No Short No Viruses, Protozoa, Helminths Enterobius vermicularis, or, pa Rotavirus or, fe II No Longer Yes Bacteria Salmonella typhi, or, ur/fe Leptospira interrogans pc, ur III Yes Long No Helminths Ascaris lumbricoides, or, fe Necator americanus pc, fe IV Yes [Long]
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From page 67... ...
There is a sense in which the waterrelated transmission categories point to appropriate behavior: boiling or filtering water for waterborne diseases, hand washing with soap for the water-washed transmission, avoiding water bodies with water-based disease transmission, and so on. But could there be a wider and more informative approach?
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From page 68... ...
WATER-RELATED INSECT VECTORS VI Spread by excreta-related insects Some mosquitoes FIGURE 1-7 Relation of water- and excreta-related transmission categories. Some waterborne and some water-washed diseases are also related to excreta, in both categories I and II; the water-aerosol diseases are not excreta-related, nor are the excreta-related disease categories III and IV primarily water-related diseases.
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From page 69... ...
Space The other aspect of epidemiology that has developed dramatically over recent years concerns spatial processes. In rural and peri-urban sites, especially under the conditions of rapid environmental change that prevail in many developing countries, the factors related to disease transmission are spatially variable and complex.
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As for many health interventions, "one size does not fit all." If one has a very small number of people using a water source that is polluted only by themselves, is the risk of disease much reduced compared to larger common sources? What are the extra hazards when surface water sources are shared among livestock and people?
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From page 71... ...
New nucleated settlements have increased point-source pollution; charcoal burning has removed tree cover from large areas. The water source of last resort in drought, Lake Mburo, is in a National Park, and cattle, buffalo, and zebra can be seen drinking its water beside each other.
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The Hima traditionally live on a largely milk diet (Jelliffe and Blackman, 1962) , so that they are not used to drinking water on a large scale.
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Leader, Diarrheal Diseases Team, Enteric Disease Epidemiology Branch, DFBMD, NCZVED, CDC.
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From page 74... ...
. For example, in Pittsburgh, Pennsylvania, the overall death rate from typhoid fever dropped from 130 per 100,000 in 1907, just before the water treatment plant opened, to just 24 in 1909, when 75 percent of the population was supplied with treated water (Rosenau, 1928)
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From page 75... ...
If expanded, these and similar interventions can contribute to reaching the Millennium Development Goals by decreasing childhood morbidity and mortality and by increasing access to safe drinking water at the point of use. These interim solutions also represent a down payment on long-term solutions.
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From page 76... ...
Both groups then store their drinking water in the home, where further contamination can occur. Indeed, in many parts of the world, municipal systems provide "economic water," usable for laundry and flushing latrines or toilets and other household purposes, but that requires further treatment in order to make it potable (Moe and Rheingans, 2006)
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From page 77... ...
. Four different approaches to point-of-use water treatment have demonstrated effectiveness at improving water quality and reducing diarrheal diseases: chlorination, combined chlorination-flocculation, filtration, and solar disinfection.
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From page 78... ...
. A growing number of randomized controlled intervention trials conducted in a variety of developing world settings demonstrate that point-of-use water treatment and safe storage strategies are generally effective in reducing the incidence of diarrheal disease and are more effective than interventions focused on improving the quality of water at the source.
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From page 79... ...
However, hand washing can be effectively co-promoted with safe water programs and integrated with other public health interventions. Integrating Safe Water and Hand Washing Promotion in the Clinical Setting Integration of combined safe water and hand hygiene interventions into health facilities has proven to be feasible and effective.
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From page 80... ...
Exit interviews with 220 clinic clients found that 85 percent of mothers had received education about water treatment, 80 percent on hand washing with soap, and 76 percent on both topics. Two weeks after the exit interviews, home visits were conducted with a random sample of 98 clinic clients and confirmed that 68 percent were using WaterGuard ® (by measuring chlorine residuals in stored water)
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From page 81... ...
The curriculum used to train nurses in these programs has been adapted for use in at least five other countries in sub-Saharan Africa and Asia. In 2007, a project was launched in antenatal clinics in Malawi to provide free hygiene kits consisting of safe water storage containers, WaterGuard ® solution, soap, two sachets of oral rehydration salts, and education to pregnant mothers attending the clinics (Figure 1-9; Sheth et al., 2008)
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From page 82... ...
. In this program, drinking water stations and hand washing stations were provided to the school; teachers were trained about water treatment and hand washing and taught their pupils about these two topics; and safe water clubs were formed so pupils could engage in water and hygiene learning projects.
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the clay pot with treated water for drinking. SOURCE: Figure courtesy of Dr.
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Anna Bowen, CDC. safe water storage containers, soap, insecticide-treated bed nets, micronutrient S prinkles (Heinz Co., Toronto, Canada)
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From page 85... ...
It is possible that some of the general reduction in diarrheal illness observed when household water disinfection is practiced is the result of safer foods and safer drinking water. An intervention study remains to be done that evaluates the microbial quality of weaning foods prepared in homes with and without pointof-use water disinfection.
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From page 86... ...
Though no assessment of health impact was attempted, the intervention trial showed that making clean water and soap available at the street vendors' point of use resulted in a less contaminated product. This intervention can be easily adopted as a public health policy and incorporated into ongoing efforts to educate and license street vendors.
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From page 87... ...
In each location, illness was linked to eating green onions, which were traced back through the supply chain to likely source farms in northern Mexico. In rural Mexico, hepatitis A is a common infection in young children, acquired as a result of poor sanitation and unsafe drinking water, and usually causes relatively mild diarrhea.
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From page 88... ...
They provide broad health benefits including fewer diarrheal illnesses and respiratory and skin infections, in both children and adults, and they decrease school absenteeism in students and teachers. Hand washing promotion can be easily added to a program that provides safe water at the point of use.
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From page 89... ...
Beyond the clinic, water treatment strategies can be promoted by pharmacists, traditional healers, and birth attendants. Progress in reaching the benchmarks of the Millennium Development Goals will also be faster if safe drinking water at point of use and handwashing are recognized and promoted as useful strategies.
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From page 90... ...
American Journal of Tropical Medicine and Hygiene 79(4)
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From page 91... ...
2002. Linkages between irrigation and drinking water in Pakistan.
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From page 92... ...
2005. Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster r andomised controlled trial.
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1995. Safe water treatment and storage in the home: a practical new strategy to prevent waterborne disease.
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From page 94... ...
2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowl edge in rural Kenyan households following a clinic-based intervention.
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2004. Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use.
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