1. Water, Sanitation and Health & Health Risk Management 1 Naomi Radke, seecon international GmbH

2. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Copy it, adapt it, use it – but acknowledge the source! Copyright Included in the SSWM Toolbox are materials from various organisations and sources. Those materials are open source. Following the open- source concept for capacity building and non-profit use, copying and adapting is allowed provided proper acknowledgement of the source is made (see below). The publication of these materials in the SSWM Toolbox does not alter any existing copyrights. Material published in the SSWM Toolbox for the first time follows the same open-source concept, with all rights remaining with the original authors or producing organisations. To view an official copy of the the Creative Commons Attribution Works 3.0 Unported License we build upon, visit http://creativecommons.org/licenses/by/3.0. This agreement officially states that: http://creativecommons.org/licenses/by/3.0 You are free to: Share - to copy, distribute and transmit this document Remix - to adapt this document. We would appreciate receiving a copy of any changes that you have made to improve this document. Under the following conditions: Attribution: You must always give the original authors or publishing agencies credit for the document or picture you are using. Disclaimer The contents of the SSWM Toolbox reflect the opinions of the respective authors and not necessarily the official opinion of the funding or supporting partner organisations. Depending on the initial situations and respective local circumstances, there is no guarantee that single measures described in the toolbox will make the local water and sanitation system more sustainable. The main aim of the SSWM Toolbox is to be a reference tool to provide ideas for improving the local water and sanitation situation in a sustainable manner. Results depend largely on the respective situation and the implementation and combination of the measures described. An in-depth analysis of respective advantages and disadvantages and the suitability of the measure is necessary in every single case. We do not assume any responsibility for and make no warranty with respect to the results that may be obtained from the use of the information provided. Copyright & Disclaimer

3. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Contents Water, Sanitation and Health 1.Water-Borne Diseases 2.Effects of Water-Borne Diseases 3.Conclusion Health Risk Management 1.A Multi-Barrier Approach 2.Transmission Routes 3.Critical Questions 4.Mitigating Health Risks References 3

4. Water, Sanitation and Health & Health Risk Management Water, Sanitation and Health

5. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Sources of Diseases Pathogenic microorganisms in contaminated water Lack of access to adequate (safe) water sources or water point-of-use water treatments But also lack of sanitation and poor hygiene are responsible for the transmission of diseases Water often contaminated due to inadequate sanitation and waste water treatment: faeces of an infected person enters the water untreated Some estimated 884 million people worldwide lack access to improved water supply and 2.6 billion people lack access to improved sanitation (WHO/UNICEF 2010) 5 1. Water-Borne Diseases Poor sanitation leads to discharge of sewage directly into the environment. Source: WaterAid (2013)

6. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Diseases 6 1. Water-Borne Diseases Dirty water causes more deaths per year than armed conflicts. Source: WSSCC (2007) Diarrhoea (multiple liquid bowl movements per day; this loss of fluid can lead to death) Cholera (infection in the small intestine leading to diarrhoea and vomiting and thus to dehydration) Typhoid (fever, headache, pain and diarrhoea) And several other parasitic infections (e.g. schistosomiasis, guinea worm,...) Most significant is the persistence and wide distribution of diarrhoea throughout the developing world – an effect of inadequate water supply and sanitation.

7. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info School Absence Absence of 443 Mio school days each year (BORKOWSKY 2006) due to water-borne diseases Strong negative impact on nutrition, health and learning capacities especially of children Hurts prospects for future earnings and makes continuing poverty more likely 7 2. Effects of Water-Borne Diseases Adequate sanitation can reduce water-borne diseases of children. Source: WHO (2012)

8. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Severe Sickness and Death Parasitic helminthes infections: severe consequences e.g. cognitive impairment, massive dysentery, anaemia and death of around 9400 people every year In Sub-Saharan Africa, schistosomiasis kills more than 200,000 people every year Acute diarrhoea, as occurs in cholera, if left untreated can cause death within a day or less 8 2. Effects of Water-Borne Diseases

9. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Breaking Economic Development Large-scale death and poor health also act as a brake on economic development Unsafe water and inadequate sanitation especially impacts the poor (About 2/3 of people without access to a protected water source live on less than US$2 a day ) Adequate water supplies and sanitation are often key step out of poverty 9 2. Effects of Water-Borne Diseases

10. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Clean Water and Sanitation are intertwined with more than health! Due to the interconnectedness between water, sanitation, health and poverty, lack of safe water supply and proper sanitation has not only an impact on health, but consequently on education, ability to work and thus economic development. Thus both adequate drinking water and sanitation are crucial for the health of human and thus their physical and economical development (school visits and escaping the poverty trap). An approach to reduce health risk due to water/sanitation- borne diseases can be found in the following section: Health Risk Management 10 3. Conclusion

11. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Health Risk Management

12. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info What is a barrier? 12 … A part of the treatment or handling chain of a sanitation system that substantially reduces the number of pathogens present in excreta and thus the risk of infection. Example of barrier: proper management of excreta acts as the primary barrier to the prevention of pathogen-spread. 1. A Multi-Barrier Approach

13. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info What is a multi-barrier approach? (1/2) 13 … Pathogen reduction by various measures as opposed to only one measure (e.g. proper excreta management) along the treatment/handling chain. 1. A Multi-Barrier Approach

14. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info What is a multi-barrier approach? (2/2) 14 1. A Multi-Barrier Approach Source: STENSTROEM ET AL. (2011)

15. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Exposure Points 15 The origin of diarrhoea is faeces! Transmission of faeces-related pathogens can take place at various points. These have to be controlled. 2. Transmission Routes Source: STENSTROEM ET AL. (2011)

16. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Transmission Routes (1/2) 16 Primary: direct exposure Person-to-person contact Short-distance airborne transmission Secondary:exposure through external route Vehicle-borne: contamination of food, water, etc. Vector-borne: created breeding sites of vectors 2. Transmission Routes

17. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Transmission Routes (2/2) 17 2. Transmission Routes Spread of pathogens from excreta of an infected individual to a healthy individual. Source: STENSTROEM ET AL. (2011)

18. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Questions to identify severity of health risk 18 3. Critical Questions WHO is exposed to pathogens from contaminated water and excreta? HOW MANY people (individuals) are likely to be exposed directly or indirectly? WHERE does the exposure occur within the sanitation system? WHICH routes should we consider? HOW frequently does exposure occur? WHAT dose of exposure occurs?

19. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info WHO is exposed? 19 3. Critical Questions Groups affected can be: User – uses the technology (e.g. poor hygiene when using toilet, drinking contaminated water) Worker – maintains/cleans/operates/empties the sanitation technologies Farmer – uses generated sanitation products (wastewater, sewage sludge etc.) Community – passively affected by living near sanitation technologies or contaminated farming sites Worker – a toilet emptier. Source: SuSanA on Flickr (2010)

20. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Technical components 20 4. Mitigating Health Risks The selected technology within each of the functional groups of a sanitation system will govern the overall reduction efficiency and the likelihood of disease transmission. Each is linked to critical points where pathogens may be transmitted or controlled. Functional groups of a sanitation system. Source: http://akvopedia.org/wiki/Sanitation_Portal http://akvopedia.org/wiki/Sanitation_Portal

21. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Non-technical components (1/2) 21 4. Mitigating Health Risks Extent of human health protection by the sanitation system relates to socio-cultural aspects linked to specific features of the system: taboos traditions believes predominant hygiene practices

22. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Non-technical components (2/2) 22 4. Mitigating Health Risks These taboos/believes/traditions/practices may reduce or elevate pathogen exposure Example: Reduction Koranic edict: excreta are regarded as impure (najassa) and its use only permitted when the najassa is removed. Example: Elevation In some cultures child faeces is regarded as harmless.

23. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Hygiene promotion 23 4. Mitigating Health Risks In order to mitigate health risks from inadequate sanitation and unclean water it is important to: Promote good practices around the home (for sanitation, cooking, drinking, etc.) Teach about risks and consequences of lack of hygiene Find out what practices are common in your target area and adapt your promotion to it

24. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info Hygiene promotion – Most important practices to reduce risk 24 4. Mitigating Health Risks Safe disposal of faeces (the primary source of diarrhoea) – use toilets/latrines and if not possible bury faeces and cover with soil Hand washing – most importantly after touching faeces, before eating, preparing food and feeding children Keep water clean – faecal material should not get into water supplies. Additionally boil and filter water and cover water jars Fly control (transmitter of faeces-related diseases)– e.G. Cover latrines or use fly traps Source: UNICEF (1999)

25. Water, Sanitation and Health & Health Risk Management Find this presentation and more on www.sswm.infowww.sswm.info ROMA, E.; PUGH, I, (2012): Toilets for health. London: London School of Hygiene & Tropical Medicine. URL: http://www.lshtm.ac.uk/newsevents/features/2012/toilets_for_health:_flushed_with_success_.html [Accessed: 06.08.2013]Toilets for health http://www.lshtm.ac.uk/newsevents/features/2012/toilets_for_health:_flushed_with_success_.html WSSCC (Editor) (2007): Hurry up! 2.6 billion people lack access to adequate sanitation. Geneva: Water Supply and Sanitation Collaborative Council (WSSCC). URL: not available. WHO (2012): UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS). The Challenge of Extending and Sustaining Services. Geneva: World Health Organization (WHO). URL: http://www.who.int/water_sanitation_health/glaas/en/ [Accessed: 06.08.2013]http://www.who.int/water_sanitation_health/glaas/en/ WATERAID (2013): Sanitation’s Impact on Health. New York: Water Aid America. URL: http://www.wateraidamerica.org/what_we_do/the_need/sanitation.aspx [Accessed: 06.08.2013] http://www.wateraidamerica.org/what_we_do/the_need/sanitation.aspx STENSTROEM, A.; SEIDU, R.; EKANE, M.; ZURBRUEGG, C. (2011): Microbial Exposure and Health Assessments in Sanitation Technologies and Systems. Stockholm: Stockholm Environment Institute (SEI). URL: http://www.susana.org/lang- en/library?view=ccbktypeitem&type=2&id=1236 [Accessed: 06.08.2013]http://www.susana.org/lang- en/library?view=ccbktypeitem&type=2&id=1236 BORKOWSKI, L. (2006): UNDP on the World's Water Challenge. Brooklyn, New York: ScienceBlogs, LLC. URL: http://scienceblogs.com/thepumphandle/2006/11/18/undp-on-the-worlds-water-challenge/ [Accessed: 06.08.2013]UNDP on the World's Water Challenge http://scienceblogs.com/thepumphandle/2006/11/18/undp-on-the-worlds-water-challenge/ UNICEF (1999): A Manual on Hygiene Promotion. New York, London: United Nations Children Fund (UNICEF), London School of Hygiene and Tropical Medicine (LSHTM). URL: http://www.susana.org/lang-en/library/library?view=ccbktypeitem&type=2&id=424 [Accessed: 20.08.2013]http://www.susana.org/lang-en/library/library?view=ccbktypeitem&type=2&id=424 25 References

26. Water, Sanitation and Health & Health Risk Management 26 “Linking up Sustainable Sanitation, Water Management & Agriculture” SSWM is an initiative supported by: Created by: