1. Introduction to WASH-related diseases in Emergencies
Module 1 – Session 2
Health

2. What is health? World Health Organization defines health as:
“ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
WHO constitution also mentions:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”

3. Health in Emergency
“Public Health in Emergency”, is a natural disaster that poses a high probability of a large number of deaths or harm to a population.
-Health in Emergencies (deals with health in disasters)
-Health Emergencies (epidemics)

4. Consequences of Disasters
Severe injuries, deaths
Loss/damage to shelters
Loss of properties
Disease outbreaks
Food Shortages
Large population displacement
Load on health infrastructure
Load on water sanitation
Load on nutrition

5. Health Impact of different disasters
Injuries
Disease epidemics (water-borne, food-borne, vector-borne)–Diarrhea, Cholera, Typhoid Fever, Malaria, Tuberculosis…
Population specific health issues in emergencies
< 5 y/o children; elderly; physically challenged
ARI, Measles, Vit.A deficiency, malnutrition, reproductive health, HIV/AIDS
Psychological stress
Others-snake-bites, dog bites, skin diseases

6. Factors contributing to Disaster Severity
Human vulnerability due to poverty and social inequality
Environmental degradation
Rapid population growth especially among the poor
Increasing population density
Increased settlement in high-risks areas
Increased technological hazards and dependency

7. Factors that can increases to Diseases
Poor water
-Limited quantity of water for hygiene purposes
-Poor quality water
Poor sanitation
-Lack/absence of sufficient or appropriate and well-maintained excreta disposal facilities
-Lack of refuse collection, blocked drainage, standing water
-Inadequate control of vectors (e.g. mosquitoes, flies, fleas, insects & rodents

8. Factors that can increases to Diseases
Poor Housing and Drainage
-Poor, over-crowded housing
-Inadequate drainage systems
Poor knowledge and practice
-Poor level of hygiene understanding
-Poor hygiene practice (food contamination from soiled hands)

9. Water-borne diseases-
transmitted through drinking water which contains pathogen
e.g. cholera, typhoid, diarrheas, dysenteries and infectious hepatitis

10. Water-washed diseases
caused by pathogens whose transmission can be prevented by improving personal hygiene-water quantity rather than water quality
Types :-
diseases associated with the faecal-oral route-infections of the skin or eyes-infections caused by some vectors

11. Water-based diseases
pathogen spends parts of its lifecycle in the water
usually in a snail or other aquatic animal. -all caused by parasitic worms-pathogens usually enter the water from faeces and
urine of infected persons

12. Food-borne illnesses
result when disease-causing agents enter the body through food;

13. Vector Borne
diseases carried by insects that breed in or near dirty water-transmitted through vectors (e.g. mosquito, fly, lice)

14. Exercise 1: Disease transmission routes
The pathogen: the organism causing the infection
The host: the infected person or animal carrying the pathogen
The exit: the method the pathogen uses to leave in the body of the host
Transmission: how the pathogen is transferred from host to susceptible person or animal
The environment: the environment in which the transmission of the pathogen takes place
The entry: the method the pathogen uses to enter the body of the susceptible person or animal
The susceptible person or animal: the potential future host who is receptive to the pathogen

15. Diarrhea It is usually a symptom of gastrointestinal infection.
Severe diarrhea leads to fluid loss, and may be life-threatening, particularly in young children and people who are malnourished or have impaired immunity.
1.Infection:a host of bacterial, viral and parasitic organisms, most of which are spread by feces-contaminated water. Infection is more common when there is a shortage of clean water for drinking, cooking and cleaning.
Rotavirus and Escherichia coli-two most common causes of diarrhea in developing countries.
2. Malnutrition:Children who die from diarrhea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhea.

16. Diarrhea Mode of transmission
•Ingestion of contaminated food and water, or from person to person as a result of poor hygiene.
Signs and symptoms
•Passage of loose or liquid stools at least 3x a day, or more frequently than is normal for the individual.
•Excessive thirst
•Sunken fontanels

17. Diarrhea Immediate Treatment
Give Oral Rehydration Solution (ORESOL), rice soup (am) to replace lost body fluid
Continue feeding
Consult a health worker for signs of dehydration
Prevention and control
Improve access to safe drinking water
Improve sanitary conditions
Good personal and food hygiene
Health Education on how infections spread

18. Reduction in diarrhoea morbidity (%)
There is often much contention about these results. They do not refer to emergency situations and in different contexts different aspects may gain priority. However, they do underline the importance of the ‘software’ side and interventions such as hand washing. They also show that such interventions can make a difference. The line indicates the range of reduction in diarrhoeal incidence. 2

19. Cholera Causativeagent Bacteria(VibrioCholera) Modeoftransmission
Eatingoffoodordrinkingwatercontaminatedbyfeacalwastes
Signsandsymptoms
Suddenonsetoffrequentpainlesswaterystoolatleast3xaday
Vomiting
Rapiddehydration(sunkeneyeballs,wrinkleddryskin)

20. Cholera Immediate Treatment: Prevention and control-
Replace lost body fluid by giving Oral Rehydration Solution (ORESOL)
If symptoms persist, bring the patient to a nearest health facility
Prevention and control-
Improve access to safe drinking water. Practice boiling of water if unsure of the source and handling
Do water chlorination
Practice food safety by covering left over foods for future consumption
Wash and cook food properly
Sanitary disposal of human wastes
-Use toilet properly
Keep surroundings free from rubbish to prevent flies and other insects and rodents from breeding
Practice Hand-Washing

21. Typhoid fever Causative Agent Bacteria (Salmonella Typhi)
Mode of transmission
Ingesting contaminated food and/or water
Signs and symptoms
Sustained high fever
Headache
Malaise
Anorexia
Diarrhea or constipation and abdominal discomfort

22. Typhoid Prevention and Control
Improve access to safe drinking water. Practice boiling of water if unsure of the source and handling
Do water chlorination
Practice food safety by covering left over foods for future consumption
Wash and cook food properly

23. Leptospirosis Causative Agent -Bacteria (Leptospira interogans)
Mode of transmission
-Contact with water contaminated with bacteria-infected urine
Signs and symptoms
Early Stages
-Severe headache
-High Fever
-Redness in the eyes
-Muscle Pains (calf and back muscles)
-Fatigue
-Nausea
-Abdominal pain
-Jaundice

24. Leptospirosis Management and treatment
Wide range of antibiotic e.g. doxycycline, penicillin or streptomycin duly prescribed by a physician
Early recognition and treatment within last 2 days of illness to prevent complications of leptospirosis
Prevention and Control
Avoidance to direct and indirect contact with animal urine (e.g. wading in flood water)
Use of rubber boots and gloves
•In cases of cuts and abrasions on lower extremities, antiseptic ointment or betadine should be applied before and after exposure
•Drain potentially contaminated water
•Control of rodents
•Maintain cleanliness of surroundings