1. Key responses – Water Water supply priorities in cholera / AWD response Session 3.1 WASH Cholera / AWD EP&R training

2. WASH cholera / AWD EP&R training 2 Learning objectives By the end of the session the participants will be able to explain cholera / AWD transmission risks associated with most common water sources and possible ways to intervene if sources are identified as contaminated describe priorities for provision of water in cholera / AWD response list most common field tests used for water quality analysis compare appropriateness of most common HHWT methods in cholera / AWD response 2

3. WASH cholera / AWD EP&R training 3 Water sources Consider that water might be contaminated with vibrio cholerae where there is contact with: People who have cholera (remember they may be asymptomatic) Contaminated articles such as buckets, cups and clothes e.g. washing of patients beddings and clothes Faecal material e.g. when latrines are close to wells

4. WASH cholera / AWD EP&R training 4 Surface water Water sourceRisk of faecal contamination RiversHigh to very high LakeHigh to very high RainfallLow to high

5. WASH cholera / AWD EP&R training 5 Groundwater Water sourceRisk of faecal contamination Protected springNil or very low Closed dug wellLow Open dug WellMedium to high BoreholeNil or very low

6. WASH cholera / AWD EP&R training 6 Other ways of accessing water Vendors Water trucking Standpipe

7. WASH cholera / AWD EP&R training 7 Water trucking Provides immediate supply Water source and quality can be controlled Considerations: Number of trucks to ensure adequate water supply Cost very high Requires close monitoring Offloading to storage facility

8. WASH cholera / AWD EP&R training 8 Importance of proper assessment Have the different sources of contaminated water been identified? Can and have these sources been disinfected? If not; are there any measures taken to ensure safe water at household level, or have other water sources been provided? If wells are chlorinated is monitoring of residual chlorine levels taking place? Is there any system to provide safe water to high risk areas during an outbreak? Does population receive at least 15l of water /person /day? If chlorine tablets are provided at HH level does the population know how to use them properly?

9. WASH cholera / AWD EP&R training 9 Water Quality vs. Quantity You see a card in 3 corners of this room Walk around and decide which would be your priority for water in cholera / AWD response

10. WASH cholera / AWD EP&R training 10 Blocking of transmission of cholera by water interventions Cholera (Faeces and vomit) Fluids (water sources) Soil Hands Food New Host Sanitation Hand washing Water Quantity Water Quality

11. WASH cholera / AWD EP&R training 11 Transmission routes and prevention strategies Transmission route InfectionPrevention strategies Water-borne Diarrhoeas and dysenteries, including cholera Hepatitis A Improve quality of drinking water used Prevent casual use of unprotected sources Improve sanitation Improve hygiene Water- washed Infectious skin and eye diseases Louse-borne typhus Increased quantity of water used Improved accessibility & reliability of supply Improve hygiene Water-based Schistosomiasis Guinea worm Reduce need for contact with infected water Control snail populations Reduce contamination of surface waters Water-related insect vector Filariasis Malaria River blindness Yellow fever Improve surface water management Destroy breeding sites of insects Reduce need to visit breeding sites Use mosquito netting Source Cairncross & Feacham (1999, 2 nd edn) Environmental Health Engineering in the Tropics

12. WASH cholera / AWD EP&R training 12 Water quantity Source The Sphere Project (2004 )

13. WASH cholera / AWD EP&R training 13 Water Quality Physical E.g. turbidity, colour Chemical E.g. iron, arsenic Microbiological and biological E.g. bacteria, protozoa

14. WASH cholera / AWD EP&R training 14 During a cholera outbreak the most significant parameter to follow up are the bacteriological parameter

15. WASH cholera / AWD EP&R training 15 Sphere key indictors for water quality Turbidity (cloudiness index) - less than 5 NTU Faecal coliform - 0 FC/ 100 ml Residual chlorine (if water is disinfected) – 0.5 mg/l (for piped systems and during outbreaks)

16. WASH cholera / AWD EP&R training 16 Turbidity Refers to clarity of water i.e. the greater the amount of total suspended solids the higher the turbidity Affects disinfection: high turbidity protects micro-organisms from the action of disinfectants

17. WASH cholera / AWD EP&R training 17 How to test turbidity ? Turbidity tube (most common field method) Secchi disk Electronic devises

18. WASH cholera / AWD EP&R training 18 Microbiological and Biological Water Quality E-coli is used as an indicator for faecal contamination Testing for E-coli is not always required if the water is going to be treated anyway SPHERE key indicator Faecal coliform - 0 FC/ 100 ml Recommendation is to treat (chlorinate) all drinking water and water used for cooking during a cholera outbreak

19. WASH cholera / AWD EP&R training 19 How to test microbiological quality in the field DelAqua kit Wagtech H2S No field tests to detect V.C from water source

20. WASH cholera / AWD EP&R training 20 Use of DelAgua 4 – 6 hours 16hrs incubation ON source Medair Madagascar

21. WASH cholera / AWD EP&R training 21 An on-site testing method for microbial quality of drinking water Faeces contain a high concentration of hydrogen sulphide (H2S) producing bacteria so water contaminated with faeces will react Hydrogen Sulphide (H 2 S) tests Result: Yes / no (presence/ absence) Turns black when it comes in contact with hydrogen sulphide Eric Fewster, BushProof

22. WASH cholera / AWD EP&R training Common Household Water Treatment Methods Chemical e.g. Chlorination UV disinfection Boiling Filtration 22

23. WASH cholera / AWD EP&R training Data leads to some controversy, partly of the difficulty of splitting impacts of interventions. For example: * Hand-washing is not possible without a water supply, so ‘hand-washing’ is in fact ‘water supply and hand-washing’ ** Water quality at household will also have involved some hygiene promotion when setting up the household water treatment processes 23

24. WASH cholera / AWD EP&R training Let’s think of appropriateness of different HHWT methods in a cholera / AWD outbreak response Filtering Boiling UV disinfection Chemical 24

25. WASH cholera / AWD EP&R training Water storage 25

26. WASH cholera / AWD EP&R training Water storage 26

27. WASH cholera / AWD EP&R training 27 Learning objectives By the end of the session the participants will be able to explain cholera / AWD transmission risks associated with most common water sources and possible ways to intervene if sources are identified as contaminated describe priorities for provision of water in cholera / AWD response list most common field tests used for water quality analysis compare appropriateness of most common HHWT methods in cholera / AWD response 27