Water Borne Diseases, Causes, Prevention and Control
Chapter One
Objectives of study
- To assess the quality of stored household drinking water
- To establish the extent to which sanitation behavior is affected by household socio-cultural demographic factors like age and education level of the head
- To investigate the occurrence of diarrhea among young children (0-59 months old) in households and
- To identify and recommend good intervention methods to eliminate or reduce the outbreak of diseases and improve sanitation
CHAPTER TWO
CLASSIFICATION OF WATERBORNE DISEASES
Waterborne or water related diseases encompass illnesses resulting from both direct and indirect exposure to water, whether by consumption or by skin exposure during bathing or recreational water use. It includes disease due to water-associated pathogens and toxic substances. A broader definition includes illness related to water shortage or water contamination during adverse climate events, such as floods and droughts, and diseases related to vectors with part of their life cycle in water habitats [34]. Basically, waterborne diseases can be transmitted through four main routes: Water- borne route, Water-washed route, Water-based route and Insect vector route or water related route.
WATER-BORNE DISEASES
Waterborne diseases are those diseases that are transmitted through the direct drinking of water contaminated with pathogenic microorganisms. Contaminated drinking water when used in the preparation of food can be the source of food borne disease through consumption of the same microorganisms. Most waterborne diseases are characterized by diarrhoea, which involves excessive stooling, often resulting to dehydration and possibly death. According to the World Health Organization, diarrheal disease accounts for an estimated 4.1% of the total daily global burden of disease and is responsible for the deaths of 1.8 million people every year. Further estimates suggest that 88% of that burden is attributable to unsafe water supply, sanitation and hygiene and is mostly concentrated on children in developing countries [13,35,36]. Most waterborne diseases are often transmitted via the fecal-oral route, and this occurs when human faecal material is ingested through drinking contaminated water or eating contaminated food which mainly arises from poor sewage management and improper sanitation. Faecal pollution of drinking-water may be sporadic and the degree of faecal contamination maybe low or fluctuate widely. In communities where contamination levels are low, supplies may not carry life-threatening risks and the population may have used the same source for time immemorial. However, where contamination levels are high, consumers (especially the visitors, the very young, the old and those suffering from immunodeficiency-related diseases) may be at a significant risk of infection. In rural African regions, faecal contamination of water arises from runoffs from nearby bushes and forest which serve as defecation sites for rural dwellers. Waterborne disease can be caused by protozoa, viruses, bacteria, and intestinal parasites. Some of the organisms remarkable for their role in the outbreak of waterborne disease include Cholera, Amoebic dysentery, Bacillary dysentery (shigellosis), Cryptosporidiosis, Typhoid, Giardiasis, Paratyphoid, Balantidiasis, Salmonellosis, Campylobacter enteritis, Rotavirus diarrhoea, E. coli diarrhea, Hepatitis A, Leptospirosis and Poliomyelitis [37].
WATER-WASHED DISEASES
Water washed or water scarce diseases are those diseases which thrive in conditions with freshwater scarcity and poor sanitation. Control of water-washed diseases depends more on the quantity of water than the quality [38]. Examples of water washed diseases includes; Scabies, Typhus, Yaws, Relapsing fever, Impetigo, Trachoma, Conjunctivitis and Skin ulcers. Four types of water-washed diseases are considered here: soil-transmitted helminthes, acute respiratory infections (ARI), skin and eye diseases, and diseases caused by fleas, lice, mites or ticks. For all of these, washing and improved personal hygiene play an important role in preventing disease transmission [38].
SOIL-TRANSMITTED HELMINTHS
Helminths are intestinal worms (nematodes) that are transmitted primarily through contact with contaminated soil. The most prevalent helminths are ascaris (Ascaris lumbricoides), hookworm (Ancylostoma duodenale and Necator americanus) and whipworm (Trichuris trichiura). Together, these ‘geohelminths’ currently infect about one-quarter to one-third of the world’s population [38]. Over 130 million children suffer from high intensity geohelminthic infections; helminths cause about 12,000 deaths each year [39]. These diseases can be considered water washed. Improved hygiene and sanitation can reduce their incidence. Mass deworming of children is also recognized as an effective control measure [38].
ACUTE RESPIRATORY INFECTIONS
Acute respiratory infections (ARI) including pneumonia are responsible for approximately 19% of total child deaths every year [38]. Evidence demonstrating that good hygiene practices, especially hand-washing with soap, can significantly reduce the transmission of ARI abounds. In view of the link between ARI and hygiene, it can now be considered a water- washed disease [40,41,42].
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Conclusion
It was evident from the study that household factors like family size, age of head, the educational attainment and the religion of the head of household had significant relation with the sanitation conditions of the household. Majority of caretakers of children were illiterate and yet did not attend child healthcare programmes.
Most houses in the study area are built with mud. Earth is the most used material for floor construction. Besides the use of straw, corrugated sheets are the most used material for roofing in the community. The use of low quality materials for walls, floors and roofs makes the houses easy for insect vector and pest attacks and thereby, increase the chances of sanitation related diseases occurring in these houses. There could also be huge building maintenance cost at least in terms of time, since birds and rodents create holes and make nest on the roofs and the floor if inferior materials are used which becomes a burden on the household. The supply of sanitation facilities like household toilets and rubbish dumps was inadequate and there was extensive use of the bush as place of convenience and indiscriminate disposal of rubbish. Sanitation conditions in the households of the sampled areas were generally poor since modes of disposal of household waste were not as safe to guarantee an improvement in the health of the people living in those communities.
The gender of the heads of household was predominantly male and the proportion of male heads of household was higher than the national average. Furthermore, it was observed in the sampled LGA that the women were always engaged in petty trading and subsistence farming when they were not doing anything at home. A physical observation of drinking water storage containers in the sampled households revealed that most of the respondents did not cover their water storage containers. Majority of the households dipped cups and bottles into the container to fetch water for use. From these ways of collecting water, foreign materials can be introduced easily into the containers anytime water is collected as these cups and jugs might not be clean enough. This attitude towards water usage makes the respondents much prone to water borne diseases since majority of the inhabitants use water from unprotected surface water sources.
Recommendations
The following actions are strongly recommended as the way forward for lessening the poor sanitation situation in the sampled communities so as to improve the health of the people and reduce the incidence of water borne diseases. It is suggested at the end of this study that a thorough investigation into the effects of sanitation conditions on water quality of households be undertaken in the sampled communities. Such study must be done using a larger sample size and with more sensitive laboratory techniques for determining bacteriological quality, for example the multiple tube fermentation method using 10 tubes or the 3M™ Petrifilm™ test. It is also suggested that a study comprising the determination of water quality at source, when in transit and in storage be undertaken to determine where exactly contamination occurs and factors responsible for the contamination. Furthermore, it is suggested that a detailed study of simple and cheaper water treatments methods, especially, the potential of using solar disinfection to treat water be undertaken.
Mass Health Education
The LGA Assembly and NGOs operating in the area must collaborate and give more attention to educating the people of the community regarding the need to keep their environment clean and cultivate good sanitation and hygiene practices. The messages should be planned based on the community’s characteristics and appreciation of health, sanitation and hygiene. As suggested by the PHAST (WHO, 1998), local health clubs and animations must be employed to promote good hygiene routine. Formal education must also be improved in the area to increase educational status so as to achieve improvement in health behaviour. The programme must aim at young heads of households, households with large family size and households whose heads are Christians and Moslems.
Sanitation Facilities
The LGA Assembly, Community Water and Sanitation Agencies and NGOs should all help the communities to build household toilet facilities and institute better mechanisms of refuse disposal systems at reduced subsidies. This will reduce the risk of contamination of water in the communities. When this is supported by education to change behaviour towards the proper and consistent use of these facilities the incidence of public health diseases may reduce.
Formal Education
Formal education must be promoted across the study area and all its surrounding villages. Some of the resources invested in water and sanitation facility provision must be channelled into formal education promotion. The study has shown that, formal education can positively influence the sanitation conditions of households since household sanitation improved with the educational attainment of the heads of the households. This is based on the fact that a literate person in the study is someone who has had at least six years formal education that is up to primary school in Nigeria’s education system.
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