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

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”

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)

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

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

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

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

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)

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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