1. Diseases related to water, sanitation and hygiene (WASH)

2. WATSAN M15 ERU 2 Contents 1.Public Health in Emergencies: Indicators 2.Relevance of water, sanitation and hygiene to health 3.Diseases related to water and excreta, and transmission mechanisms.

3. 1. Health indicators in emergencies

4. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 4

5. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 5 Causes of Death in Emergencies (Worldwide) Diarrhoeal Diseases Trauma (Injury) Measles Malnutrition Malaria Acute Respiratory Infections (ARI)

6. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 6  Daily Crude Mortality Rate (CMR) Definition: The rate of death in the entire population, including both sexes and all ages. Formula most commonly used during disaster: Total number of deaths during time period x 10.000 persons Total population No.days in time period = deaths/10.000 persons/day  Under 5 Mortality Rate (U5MR) Definition : The rate of death among children below 5 years of age in population. Formula most commonly used during disaster: Total number of deaths in children <5 years during time period x 10.000 persons Total number of children < 5 years No.days in time period = deaths/10.000 children/day Health Indicators in Emergencies

7. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 7 Fuente: UNICEF State of the World’s Children 2003 Mortality Rates in Emergencies Baseline Reference Mortality Data by Region RegionCDR/CMR deaths/10,000/ day CDR/CMR emergency threshold U5DR/MR deaths/10,000 U5/day U5DR/MR emergency threshold Sub- Saharan Africa 0.440.91.142.3 South Asia0.250.50.591.2 Middle East and North Africa 0.160.30.360.7 East Asia and Pacific 0.190.40.240.5 Latin America and Caribbean 0.160.30.190.4

8. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 8 Benchmark for CMR and U5MR (worldwide) Benchmark for CMR (world): Baseline 0.5 Serious 1.0-2.0 Crisis >2.0 Benchmark for U5MR (world): Baseline 0.8-1.2 Serious >2.0-4.0 For a specific area, when baseline is unknown agencies should aim to maintain the CMR at below 1/10.000/ day.

9. 2. Relevance of water, sanitation and hygiene to health

10. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 10 The most important aim of a water and sanitation programme…...To minimise health risks of the population

11. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 11 The main objective of water supply, sanitation and hygiene programmes in disasters is to reduce the transmission of faecal-oral diseases and exposure to disease- bearing vectors that transmit diseases with epidemic potential, allowing people living with good health, dignity, comfort and security.

12. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 12 WATER / SANITATION / HYGIENE HEALTH

13. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 13 The crucial aims of water and sanitation programmes are….. To supply sufficient safe water To supply the means for an adequate excreta disposal and other types of waste To implement hygiene measures To train people regarding hygiene and the proper use of water

14. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 14 Fewtrell L et al. (2004) Lancet Infect Dis 5(1): 42-52.

15. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 15 Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST Most common routes for the transmission of Diarrhoea germs Sanitation DIAGRAM F Hygiene Water Water quantity Water quality

16. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 16 Faecal-oral transmission: 1.- Water 2.- Food 3.- Objects HEALTH CARE LATRINE SPRING SAFE WATER DOMESTIC AND PERSONAL HYGIENE

17. 3. Diseases associated with water and excreta, and spreading mechanisms

19. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 19 THE MOST IMPORTANTS DIARRHOEA FAECAL-ORAL route TRANSMITTED by VECTORS

20. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 20 Entomoeba Giardia Cryptosporidium 10.000/g Shigella V. cholera E. coli 10.000.000/g 10.000/g 10.000.000/g Rotavirus Poliovirus Virus de Hepatitis BACTERIA VIRUS PROTOZOAN

21. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 21 Water-borne or water-washed diseases Cholera, shigellosis, diarrhoea, salmonellosis. Typhoid, paratyphoid, etc. Amoebic dysentery, giardiasis Hepatitis A, poliomyelitis, rotavirus diarrhoea Transmission mechanisms FAECAL-ORAL Water contamination Poor sanitation Poor personal hygiene Crop contamination

22. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 22 DIARRHOEA DISEASES According to Curtis and Cairncross (2003), hand washing with soap and water after contact with faecal material can reduce diarrhoeal diseases by 42% or more. Curtis, V. and Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infectious Diseases 3: 275-281.

23. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 23 DIARRHOEA DISEASES Acute watery diarrhoea: Watery stools without visible blood, vomit and fever. Dehydration CholeraCholera Bacillary Dysentery (shigellosis): Acute bloody diarrhoea with fever, abdominal cramps and rectal pain. Complications include sepsis, rectal prolapse, haemolytic uraemic syndrome and seizures. Giardiasis: Watery stools, flatulence, greasy stools, stomach cramps, nausea, weight loss and dehydration. Amebiasis or Amebic Dysentery: Bloody stools or loose stools, stomach pain, stomach cramping and fever.

24. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 24 CHOLERA Caused by the Vibrio Cholerae (bacteria) Endemic or with epidemic potential (Africa,South America,Asia...) Watery diarrhoea classically rice-water stools, with or without vomiting, dehydration, shock IMPORTANT!! faecal-oral route -Faecal material and vomit mist be properly disinfected and disposed of -Adequate water supply -Clean water whenever food is being handled -Hand washing promotion Cause outbreaks with case-fatality rates

25. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 25 TYPHOID FEVER Caused by Salmonella Typhi (bacteria) Low grade fever, malaise and dry cough, abdominal discomfort, diarrhoea or constipation, altered mental status and multiples complications. FAECAL-ORAL - Waste water with human and animal faeces - Faeces contaminated food PREVENTION - Health education - Safe food and water, proper food handling - Safe food and water, proper food handling - Adequate excreta disposal - Adequate excreta disposal - Personal hygiene - Personal hygiene - Safe water collection points - Safe water collection points

26. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 26 KEY FACTORS FOR PREVENTING DIARRHOEA DISEASES Safe drinking water (Extraction, transport and storage) Controlled excreta disposal Safe food and proper food handling Hand washing with soap Breastfeeding Education

27. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 27 HEPATITIS Virus A and E.(exist B,C,Δ) Clinical: fever, tiredness, nauseas, digestive problems and later jaudince (yellow skin and mucous) with dark urine and whitish stools. Usually complete cure. No chronic, no carrier. Attention the A and E transmission FAECAL-ORAL route Risk factors Food and water contaminated Poor sanitation infrastructure Crowding Waste water with human and animal faeces

28. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 28 POLIOMYELITIS Virus polio virus (serotypes 1,2,3) In endemics areas epidemics usually affect children < 5 years of age. In non endemic areas where vaccination coverage is low, young adults are most commonly affected 90% a symptomatic 10% disease Non paralytic form: fever, muscle pain,tiredness, headache, intestinal problems (nausea,vomits,diarrhoea), backache, non neurological involvement Paralytic form: after the non specific signs,the patient develops rapid onset acute flaccid paralysis flaccid and meningeal symptoms. There is no cure. Prevention vaccination FAECAL-ORAL Point of contagious:Food and water contaminated by infected faeces, nose and mouth infected secretion.

29. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 29 Adapted from Winblad U & Dudley E, 1997. Source: WHO PHAST Most common routes for the transmission of Diarrhoea germs Sanitation DIAGRAM F Hygiene Water Water quantity Water quality

30. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 30 Water washed or water scarce diseases Skin and eye infections. Louse borne typhus or louse-borne relapsing fever. Inadequate water Poor personal hygiene Transmission mechanisms

31. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 31 Scabies:Scabies: Sarcoptes scabiei hominis (parasite) Larvae dig tunnels in the external skin layers. - Rash, scab skin. - Wrinkles, between fingers, elbows, writs, penis, nipples. Impetigo:Impetigo: Streptococcus and staphylococcus Contagious superficial skin infection. - Blisters with pus-scab - Face, nasal cavity, mouth, neck, groin. SKIN DISEASES

32. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 32 Conjunctivitis:Conjunctivitis: Acute inflammation of the conjunctiva due to bacterial or viral infection. * Irritation, teardrop, secretion. * Contagious : contact with infected conjunctivitis secretions,hands and clothes contaminated,fly…. Trachoma:Trachoma: Keratoconjunctivitis due to Chlamydia trachomatisKeratoconjunctivitis due to Chlamydia trachomatis * Progressive conjunctivitis andmost common cause of blindness in endemic areas. * Contagious : contact with infected conjunctivitis secretions,hands and clothes contaminated,fly…. EYE DISEASES

33. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 33  TYPHUS Caused of the genus Rickettsia pathogen R.prowasekii (bacteria) Clinical: Sudden onset of fever (temp of over 39 Cº), headache, myalgias. Exanthema maculopapular TRANSMISSION: Body louse due to lack of personal hygiene, crowding.  RELAPSING FEVER Caused of the genus Borrelia pathogen B.recurrentis, B.hispanica, B.persica.... (spirochetes) Clinical: High fever, artralgia, shivering, jaundice, bleeding. A febrile interval TRANSMISSION: Body louse and tick due to lack of personal hygiene, crowding..

34. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 34 KEY FACTORS FOR PREVENTING WATER-WASHED AND WATER-SCARCE DISEASES Non contaminated water for hygiene Hand washing with soap Laundry with soap Fly vector control Louse vector control No crowding

35. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 35 Excreta-related helminths (Parasite worms in human intestine) Roundworm, hookworm, whipworm Soil transmitted Helminths Open defecation Ground contamination Transmission mechanisms

36. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 36 ASCARIDIASIS Nematodiasis due to Ascaris lumbricoides (Parasite) Clinical Phase of larva migration: pulmonary and allergic signs (non productive cough, mild fever) Established infection: non specifics digestive signs nausea, vomits, diarrhoea, intestinal irritation, TRANSMISSION: Faecal -Oral

37. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 37 KEY FACTORS FOR PREVENTING HELMINTHS Controlled excreta disposal Hand washing with soap Non contaminated food

38. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 38 Schistosomiasis, Guinea worm (Dracunculosis), clonorchiasis. Long stay in infected waters Water contamination Water-based diseases Transmission mechanisms

39. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 39 SHISTOSOMIASES Infections by Schistosoma haematobium, S. mansoni are frequently, by S. japonicum y S. intercalatum lowness.(Parásitos) Clinical: Each species give rise to specific clinical form,it depends the parasite load Shistosomiases urinary S. haematobium signs : haematuria, frequent and painful micturation evolution to fibrosis urethral. Shistosomiases intestinal: S. mansoni signs : bloody diarrhoea, abdominal pain, nauseas, vomit and it evolution liver fibrosis TRANSMISSION: By contact with the parasite when bathing or swimming in contaminated water.

40. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 40 KEY FACTORS FOR PREVENTING WATER-BASED DISEASES Safe drinking water supply Adequate drainage of stagnant waters

41. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 41 Malaria, dengue, sleeping sickness, filariasis, yellow fever. Diarrhoea and dysentery Bitting by mosquitoes, flies. Transmited by flies, cockroaches Bite near water Breed in water Dirty environment Water-related insect vectors Excreta-related insect vectors Transmission mechanisms

42. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 42 VECTORS RELATED TO DISEASES Mosquitoes Flies Louse (Typhus, Relapsing Fever) Fleas (Plague) Ticks

43. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 43 MALARIA Pathogen: Plasmodium falciparum, vivax and ovale (Parasite) Vector: Mosquito Anopheles female Clinical: Painful muscles and joints,high fever with chills, headache, possybly diarrhoea and vomiting Stagnant waters are the breeding place.

44. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 44 DENGUE Pathogen: Virus (Flaviviridiae) Vector: Aedes aegypti Clinical: High fever, headaches, pain in muscles and joints, red spots on skin. Classic dengue, hemorrhagic dengue. Larva growth in water containers (tyres, vases, barrels) or other natural places (lagoons, pools). Epidemic dengue (red)

45. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 45 YELLOW FEVER Pathogen: Virus (Flaviviridiae) Vector: Aedes aegypti Clinical: Fever, headache, myalgia, nausea, red eyes, jaundice. Stagnant waters. Only bites during daylight. Vector Control

46. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 46 KEY FACTORS FOR PREVENTING WATER-RELATED INSECT VECTOR AND EXCRETA-RELATED INSECT VECTOR DISEASES Adequate drainage of stagnant water Disposal of waste water Excreta controlled disposal Safe storage of drinking water Vector control

47. Diseases related to water, sanitation and hygiene (WASH) WATSAN M15 ERU 47 Thank you……….