sanitation, water and waste

8/9/2019 Sanitation, Water and Waste

1/58

Sanitation,WaterandW

aste

MalinUdn-MasterinPublicHe

alth

Presenta

tionforDisasterM

edicine,MDH-17

September2009


2/58

Today

9:1510:15

Overviewofsanitation,waterandwaste

Whatdowemean?

Why

isitimportant?

Wherearetheconnections?

Discussionoftheway

sofspreading

pathogens

10:1510:4

5

Coffee

10:4512:0

0

Continuedov

erview

Factorsforim

provement

Examplesof

disastersCholerainZimbabwe


3/58

Premises

fortoday

spresentation

Masterthes

isinpublichealthaboutsan

itationinrural

Mozambiqu

ealowincomecountryin

southeastAfrica

Personalinterest:equitya

ndthefactthatsanitationis

oftencastin

theshadowo

fmoreglamo

rouspotable

water

Todaysma

infocus

Thelinkbetweenwaterandsanitation

Anoverviewofsocieties,

individualsandnatures

connectiontosanitationa

ndwater


4/58

Strictlysanita

tionmeansthat,tostayhealthypeopleneedto

be

separat

edfromh

uman

andanimalfec

es

separatedfromh

uman

andanimalfec

es(whileurineis

practicallyste

rile)

Waterissimp

lyH2

O.

Today

wewillt

ouchupon

Blackand

greywaterfe

ces,urine,clea

ning,washing

Usablewa

terforcleanin

g,washing

Potablewater,drinkingwater,highqualitywater

lowsalt

freeofd

iseasepathogens

lowleve

lsofharmfulch

emicalsandothercompounds

Buttouseve

rydaypeoplew

aterandsanitationisactually

morethenthat!

Sanitation,waterand

wasteA

novervie

w


5/58

Sanitation,waterand

wastea

noverview

Waste,sanitationandwatermanagementareallinextricablylinked.

Wastefrom

homes,nature,

fac

tories,communitys

ervicesandfarming

Sanitationmainlyhuman,also

fromanimals.

(Potable)Wa

tercomesfromnature

Partofthesam

esystem,

butmu

stbekeptsepara

te.

Linksare

Watercanbecomecontaminatedbybothwasteand

lackofsanitation

Sanitationca

nnotbeachievedw

ithoutwater

Manageddifferentlyoverthewo

rld,

fromsewagesystems,waterpiping

andrecyclingtoopendefecation

,groundwaterwe

llsandburyingan

d

burningwaste.

Inrichercountriesanelaboratesystemmanagedsothatuserscan

forgetaboutitonaneverydaybasis.

Meaningwe

donothavetowo

rry

aboutcholeraandmalariabut

uselargeamountsofenergy

Inlowincomecountriessimples

ystems,

lessdem

andingonnature

but

morediseases

andmorefragile


6/58


7/58

MDGs

Whereareweat?

Target7:E

nsureEnvironmentalSustainability

Target7

.C:Halve,by2015,

theproportionof

peoplew

ithoutsusta

inableaccesstosafe

drinking

waterandb

asicsanitation

Measures

7.8

Prop

ortionofpopulationusin

ganimprov

ed

drinking

watersource

7.9

Prop

ortionofpopulationusin

ganimprov

ed

sanitatio

nfacility


8/58

MDGs

Whereareweat?

Aboutwater

Halftheworldsp

opulationfacea

scarcityofwater

butthetargetw

illb

emet!

Notinsub-S

aharanAfrica

Notinruralareas.

In200696%

ofthe

urbanpopulationhadimproved

drinking

sources,

butonly78%oftheruralpopulations.

40%livenearinsecurefresh-w

atersources(Africa,

WesternAsia,

India,

China)

enviro

nmentaldegrada

tion,sporadicdroughtsand

competitionforwater.

10%haseconomicwaterscarcity:enoughfreshwater,but

inaccessibled

uetopolitical/financialreasons(s

ub-SaharanAfric

a).


9/58

Aboutsanitation

1.1

billionmorepeopleuseimprovedfacilitiestodaythen

1990.

Buttargetwilln

ot(?)bemet.

Ifso,weinthenext7years

wemustincrea

sethenumber

with1.6

billio

n

2.5

billionpe

oplelivewithou

timprovedsanitation.

Proportionallylargestinsub-Sa

haranAfrica

Largestnum

bersinAsia.

Mostproblemsinruralareas.5

0%liveinthere,b

uttheyrepresent7

0%

ofthoselackingsanitation

Massiveeco

nomicdifferences:In21countriesinsub-SaharanAfrica

,

only16%ofthepoorestquintileofthepopulation

haveaccessto

improvedsa

nitation,

79%ofth

epopulationinthe

richestquintile.

MDGs

Whereareweat?


10/58

Overview

ofsanitationandwa

terissues

Whyshouldwecareaboutit?

Infections/Physicalwellb

eing

Mentalwe

llbeing

Effectson

opportunities

Ourenviro

nment

Whatelsedecidesthec

ircumstances?

Technicalf

actors

Economics

Socialper

ceptions

Politics

Religion


11/58

Watersomecheckp

oints

Covers71%

oftheworldssurface!Sowhatstheissue?

1,6

%isgroundwater

0,6

%inrivers,pondsa

ndlakes(Gre

atLakesinUS

andLake

Baikalswallowsmost)

And:agricultureuses70%ofourfreshwater

Canadditionallybecomepollutedby

Nature(B

angladesh)

Pollution

(70%ofChineseriversfrom

factories,

3%

ofSwedishlakesacid)

Salt(Sea

water)

Lackofsanitation(John

Snow)


12/58

Whydowenee

dwater

and

sanitation?

Infectionsand

physicalwellbeing


13/58

Theimporta

nceofsanitation

wasdiscove

redin19thce

ntury

London.

Thebirthof

modern

epidemiolog

y

Peoplethou

ghtthatdisea

ses

spreadbya

irhygienew

as

terrible

JohnSnow

mappedchole

ra

casesandfoundthemallc

lose

toawell.

Removedth

ehandleand

the

epidemicstopped!

Probablyapitlatrineinthe

proximityof

thewell.

INFECTION


14/58

Groundrule

:weallnee

dtodefecate

Groundrule

:weallnee

dtodefecate

andurinate

severaltimesaday

andurinate

severaltimesaday

Fecesmayholdbacteria,virus

andparasites

Diseasesliketyphoidfever,cholera,

trachomaand

intestinalworm

sallcause:diarrhea

diarrhea

mightbefollowedbyanemia

,dehydrationand

malnourishmen

t

Especiallyrisky

forpregnantwomen,

illa

dultsa

nd

children

Maycausephy

sicalandmenta

ldisabilitiesifno

t

treatedoroften

repeated

INFECTION


15/58


16/58

INFECTIONS(Weneedtos

tayclearofour

ownfeces)


17/58

Physicalwellbeing

Weshouldbe

abletoperform

ourneedsatalltimes,otherwis

e

werisk

Urinarytractinfections

Dehydration

Constipation

Importantadjustmentsforind

ividuals

Disabilitya

djusted

Sit-orsqua

t?

Differentviewsonwhatism

ostimportant:sh

elter,lackofsme

ll,

comfortableandsoon(notthesameashealthprofessionals

views!)

Carryingwaterhardonsma

ll(andlarge)bod

ies.

Cancause

Chronicbackpain

Misscariges

Uterinep

rolapseworsene

dbyconstipation


18/58

Physicalw

ellbeein

g

Safeconstructions

Accidents

inthedark

Accidents

bydeteriorated

buildings

Snakesandinsects

Assaults

Womensneeds

Possibilitiestowashones

elfandclothsd

uringsanitation

Forownpeaceofmind

Toavoidinfections

Pre-andp

ostnatalperiods


19/58

Whydo

weneedimproved

waterandsanita

tion?

Me

ntalwellbeing


20/58

Mentalwellbeing

Pride

Relaxedmomentofprivacy

Feelingofcleanliness

Stressreduction


21/58

Discussionon

waterand

sanitationatho

useholdlevel


22/58

Asimplea

ndpedago

gicpictureofthe

waysofsp

readingpa

thogens


23/58

HOUSEHOLD

DISCUSSION

Identifyingrisks

Wherem

ightthesewaysofspread

ingpathogen

s

become

importantinyourwork?

Isthereanyarrowtha

tdoesisnot

important?

Shouldw

eadotherw

ays?

How(wh

y)dotheyap

pear?Think

ofboth

practical,economicandsocialreasons!


24/58

Whydowenee

dimpro

ved

waterandsanit

ation?

Effectsonwom

ensopportunities


25/58

Africanwomensemp

owermentisclosely

linkedtos

anitation

Viewson

womensbo

diesandth

eirproducts

is

aloadedfactor

Weareexpectedto

bemoreprivate.

Which

in

partsof

theworldleadstoeffectssuchas:

Forcedtowaittoeatanddrink

Leave

school(The

sameforfetc

hingwater!)

Maycausedehy

dration,cons

tipationand

urinarytractinfects

Effectson

womenso

pportunities


26/58

Responsibilitiesforhealth,sa

nitationandwaterareoften,

but

not

always,women's

Workdivisionmeanswomen

inside,cleaningtoilet,cooking,

washingclo

thes(babiesnappies)andgatheringwater

Womenm

oreexposedtob

acteriawhencaringforthehousehold

Arealsoexposedinthework

situationatthefie

ldifopendefecation

isused

Thussecurity,

dignity,comfortandprivacyareo

ftenespecially

importantforwoman

But

Viewstheviewonwome

nscapabilitiesfortechnicalsolutions

isoftenpoor.Menconstruct,controlthebudget

andthemain

decision-making(athome,atw

orkandatgover

nmentaloffices)

Effectson

womenso

pportunities


27/58

Whydowehavethesediffere

nces,

forexamp

leinconstructio

n?

Aremenstronger?(ButmakeacomparisonwithSweden!)

Isitculturalvalues?

Ontheotherhandwomen'sresponsibilitiesofthehousehold

means

Thattheyh

avemorevested

interest

Thattheyk

nowalotaboutw

hatworks,what

doesnotworkand

howitcanbeimproved

Severalstu

diesshowthatw

omensinvolvem

entmakesformore

sustainable

solutionsonwaterandsanitation

Effectson

womenso

pportunities


28/58

Whydowenee

dimpro

ved

waterandsanit

ation?

En

vironmental

factors


29/58

Ecosan?


30/58

EcosanEcolo

gicalsanitaiton


31/58

Whate

lsedecid

esthe

circum

stances?

Te

chnicalfacto

rs


32/58

Wecannotexpe

cteverythingto

goasplanned.Peoplecannot

upholdperfec

thygienewiththeirsanitaitonandwateratall

times.

Thereforepeopleneed

topreparehom

esandcitiesfor

Animals

Runsin

thefood,

dishes

Spreadstheirfeceswith

theirfeet

Children,shouldideallynot

beabletogetto

water,wasteand

food

Techincal


33/58

Instructura

lterms

Livingru

ral

Mostd

ifficultthusmos

texpensivetoconstructpiped

watera

ndsewage.Pe

rcs:

Alotofspaceforburryingwaste

Possib

ilitytohaveone

latrineperfam

ily

Inthe(p

oor)city

Mores

anitationandw

atercovarege

Crowdingmakesiteasiertospreadd

iseases

Itismore

difficultforyou

tostayclearof

diharroeal

diseasesasforexample

acaringMozam

biquan,

thena

sloppySw

ede

Techincalfactors


34/58

Aboutdefecationoptions

Aboutdefecationoptions

Thesimple

latrine

Thesimple

latrine

Deteriorat

ingwalls

Smell

Riskofsn

akes,

insectsandrats

Difficultto

clean

Hardand

unhygienicworkto

movethem

Lacksrunningwaterforh

ygiene

Collapses

duringrainsea

son

Mayriskinfectingwater

shouldbe

keptfarfromw

ells

Technicalfac

tors


35/58


36/58

Waterhandling

Gathered

fromwellsand

highgroundwater

Oftennotcoveredairtight

Shouldbe

boiled

butboilingrequireswo

od

Food

Foodcan

becomeexposedbyanimalsa

ndinsects

Mustbecleanedinwater

andthenheate

dabove72oC

Butwomen

caringforth

eirfamiliesh

ealthare

exposedhighlevelsofa

irpollutionfr

omcombustion

Technical


37/58

Intimatehygiene

Mostwish

forimproved

showers(ba

thtubsandrunningwater)

Wallskeep

seyes,snakesa

nd

eyesaway

Canalizatio

nneededtokee

p

mosquitoesaway

Wastewater

fromkeepinghy

giene

Washingnappies(ideas!)

Intimateh

ygiene

Washingthelatrine

Techincal


38/58

Whate

lsedecid

esthe

circum

stances?

Ec

onomics


39/58

Sanitationanddrinkingw

atercanbecrea

tedalmost

a

nywhereaslong

assomeonecan

pay


40/58


41/58


42/58

Whate

lsedecid

esthe

circum

stances?

So

cialcircums

tances


43/58

Socialc

irc

umstances

Weviewfe

cesdifferently

Someare

tooafraid,causingavoidance

ofcleaning

Itismuchlessglamorousandprestigious

thenproviding

freshwater

Lackof

sanitationismoredeadlythenlac

koffreshwater

Governmentsoftenfailtoacknowledgeth

isproblem

Ontheotherhandembarrassmentcanbe

positive:itforce

s

ustoclean.

Butwedonotwanttocarem

oreabouthow

thingslookstheniftheyareareclean

Someembraceitanduse

sfecesasfertilizer

Mostofus

endupinbetw

eenthoseoptions


44/58


45/58

Factorsforim

provem

ent

(Othertheneconomicimprovement)


46/58

Thecond

itions

Sanitation

andwaterisasystem,

itdoesnotknowhuman

perception

sofboundaries

Waterand

sanitationarem

ostlya

household

issueinpractica

lterms

inlowinco

mecountries

But

itis

acommunityissue

whenitcomestoknowledg

e,

practicalh

elpandwhenit

comestospreadingdiseases!

Whentraditio

nalsewagesystemsaretoo

expensiveto

berealisticoptionsinrural

areas,

thebe

standonlysolutionisthe

locallyadjustedalternative.


47/58

Talkopenly

!

Walkaroun

dfacethefacts,

inspectunsanitary

places

Moreconst

ructionknowledge

Releasewo

mensideasandinterest

Thingsthatcancomein

thewayofspreading

knowledge

are:

Embarras

sment

Misunderstandingsbetw

eengeneration

s

Jealousy

Denialof

ownriskinone

shousehold

Genderdisparities

Importantfac

torsforchan

ge


48/58

Improvedcooper

ation

Improvedcooper

ation

Thereisoften

cooperationbetw

eenpeopleonc

ommongrounds

Whorealizesthatlackofwater

andsanitationis

everyone's

business?

Makecommonagreements

Abandonfielddefecation

Keepareasclosetowaters

ourcesfreeoffeces.

Importantfac

torsforchan

ge


49/58

SOCIALANDCULTURA

LISSUES

Whereca

nfearofsp

eaking/acknowledging

problems

withpersonalhygiene

becomean

obstacleinyourlineofwork?

Dohaveexamplesofnationaldifferences?


50/58

Examples

ofdisasterCholerain

Zimbabwe


51/58

Cholerain

Zimbabw

e

Background

In1980Rob

ertMugabwe

tookcontrollo

fthethen

Rhodesia,forcingthewhiteEuropeansoutofthe

country.

Thestatew

asontheupriseinearlyindependencebu

t

hassinceth

ensunkdeep

erintopoverty.

Lifeexpecancyfrom60yearsformento37formena

nd

34forwomen.

(Extrelylow

,rightatthebottomcompared

toothernations).

Moreorlessconstantfoodshortage

Hyperinflation


52/58

HIV

Prevalenc

e15%-mid90sitwasashig

has30%

Hitsmainlyhitsyoungpeopleandwome

n

Iseastima

tedtohavelow

eredthepopulationwithabout4

millionpeople

Mainreas

onforZimbabw

ehavingthehighestproportionof

orphansin

theworld.

Afterthe

2008elections

Newprevioslyunknowno

finflationrates

Politicalunstableness

Massmigration

CholerainZimbab

we


53/58

TheOutbreak

StartedAugust2008Ongoing

100000su

spectedcases.

4300con

firmeddeaths.

Spread

55of62d

istricts

8000casesreportedper

weekFebruary

.Casefatalityr

ate

6%

100cases

reportedperw

eekMay.

Case

fatalityrate1,5

%

Numbersp

ropablyunde

restimatedt

otounder

reporting.E

veninSwed

enitisnotunusalforitto

be

upto100timesasmanyinfectedas

firstguessed

.

CholerainZimbab

we


54/58

Collapseof

Urbanwate

rsupply

Sanitations

upply

Garbageco

llectionsystem

Plusrainse

ason

Cholerab

acteriawashe

dintowaters

ources

Opendrainswashedfece

sintolivingareas.

CholerainZimbab

we


55/58

Otherhelpe

rs

Shortage

ofpurification

chemicalsas

chlorine

Christmashollidays

Burialofinfectedcorpsesinruralareas

Collapse

ofpublichealthsystem.

Onlyone

offourmajorhosp

italsoperating.

Nomedicaleducation

Nooperationtheaters

Nostafformedicines(theh

yperinflation!)

CholerainZimbab

we


56/58

Politicalco

nsequences

Europea

ndtheUSblamesRobertMugabweandh

is

administr

ation.

which

madeAmericanandBritishleaderscall

Zimbabw

eafailedstat

e

Mugabwe

ontheother

handmeantth

atitwasthe

formerco

lonialpowers

fault.

Organizationsandna

tionswherestoppedfrom

enteringwithexpertise

Spreadin

toneighborin

gcountries

Contribut

edtoSouthAfricarestricting

migration

policiesforeveryone

CholerainZimbab

we


57/58

Medicalimplications

Cholera

cannotbecu

red

Vaccine

takentwicew

asimpossibletoadminister,

notrecommendedby

theWHO.

Tocos

tly

Increaseantimicrobialresistance

WHOrecommendations

Foodsafety

Personalhygiene

Oralrehydrationthera

py

CholerainZimbab

we


58/58

Thank

you!

Questio

ns?

sanitation, water and waste

Documents