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Introduction to household water treatment and safe storage, module 1 by Dr. Richard johnston. Disease caused by unsafe water and sanitation. Deaths / 1,000 55 million people per year; births / 1,000 135 million per year About 1.1% increase per year Doubling every 60 years Birth, taxes, and death.
Introduction to household water treatment and safe storage, module 1 by Dr. Richard johnston. Disease caused by unsafe water and sanitation. Deaths / 1,000 55 million people per year; births / 1,000 135 million per year About 1.1% increase per year Doubling every 60 years Birth, taxes, and death.
Introduction to household water treatment and safe storage, module 1 by Dr. Richard johnston. Disease caused by unsafe water and sanitation. Deaths / 1,000 55 million people per year; births / 1,000 135 million per year About 1.1% increase per year Doubling every 60 years Birth, taxes, and death.
Introduction to Household Water Treatment and Safe Storage, Module 1.1
Dr. Richard Johnston
Course outline Quizzes and homework Course forum
Introduction
Introduction to HWTS| 2 Week 1 Background Disease Contamination Week 2 Water Safety Sedimentation Filtration Week 3 Disinfection Safe storage Week 4 Implementation Strategies Vulnerable groups Week 5 Validating technologies Monitoring and evaluation Health Impacts Outline Introduction to HWTS| 3
In-video quizzes End of week quizzes Peer-reviewed assignment Final exam Quizzes and Homework Introduction to HWTS| 4 General discussion
Study groups Lectures Exercises
Course material errors Technical issues Online forums Introduction to HWTS| 5 End of module
End of week
Summary Introduction to HWTS| 6 Global Burden of Disease Introduction to Household Water Treatment and Safe Storage, Module 1.2 Dr. Richard Johnston Introduction to HWTS | 2 Diseases caused by unsafe water and sanitation Water-borne Water-washed Water-based Water-related
Global burden of disease Mortality Morbidity Introduction
Introduction to HWTS | 3 8.4 deaths/1,000 55 million people per year
19.9 births/1,000 135 million people per year
About 1.1% increase per year Doubling every 60 years
Birth, taxes, and death Introduction to HWTS | 4 Bradley Classification
Target aquatic organism host Protect surface water bodies
Introduction to HWTS | 8 Water-related diseases Caused by insects which breed in water
Malaria Dengue fever
Remove habitat
Introduction to HWTS | 9 Many diseases are related to poor water, sanitation, and hygiene Water-borne diseases are caused by ingestion of contaminated drinking-water HWTS can reduce burden of water- borne diseases Not water-washed, water-based, or water- related diseases Summary
Introduction to HWTS | 10 Mini-Quiz Arrange the following five diseases in order of the number of deaths per year Tuberculosis Diarrheal disease Lower respiratory infections (e.g. pneumonia) Malaria Measles Introduction to HWTS | 11 Mini-Quiz Source: WHO in 2013 published figures for 2011. Data files Tuberculosis Diarrheal disease Lower respiratory infections (e.g. pneumonia) Malaria Measles 976,000 1,894,000 3,203,000 589,000 167,000 Introduction to HWTS | 12 1.9 million diarrheal deaths per year Most important water-borne disease 3.5% of all deaths 9.3% of under 5 child deaths Second only to respiratory infection among infectious diseases 88% of diarrheal deaths are caused by inadequate water, sanitation and hygiene 2011: Data not yet disaggregated 2004: 1.9 million WASH deaths out of 2.2 million diarrheal deaths Diarrheal disease
Introduction to HWTS | 13 Disability Adjusted Life Years (DALYs)
DALY = YLL + YLD
YLL = Years of Life Lost Number of deaths Standard life expectancy at age of death in years
YLD = Years Lived with Disability Number of incident cases Disability weight Average duration of the case (years)
Introduction to HWTS | 14 Diarrhea causes 52.5 M DALYs/year 3.1% of global total 9% of child disease burden
India 13.6 M China 3.9 M Nigeria 3.9 M Pakistan 3.3 M DRC 3.3 M 10% of all DALYs
Diarrheal morbidity
Source: WHO, 2008 Introduction to HWTS | 15 Global Burden of Disease 2010 Study (IHME)
Introduction to HWTS | 16 Similar approach to WHO methods
Not endorsed by WHO Methods not fully transparent Lacked full access to results for evaluation
Some key differences with WHO numbers Revised disability weights No hygiene risk factor No disease burden from improved water and sanitation GDB 2010 Study
Introduction to HWTS | 17 http://www.healthmetricsandevaluation.org/gbd Introduction to HWTS | 18 1.5 million diarrheal deaths
89.5 million DALYs India 27 M DRC 6.4 M Nigeria 6.2 M Pakistan 5.5 M China 1.3 M
Only 25% diarrheal deaths due to poor water and sanitation Water and sanitation: 0.9% of DALYs Hygiene not included GDB 2010 Study
Introduction to HWTS | 19 WHO calculations 2011: data and maps 1.9 million diarrheal deaths 52.5 million DALYs from diarrhea Disaggregated by disease and age 2004: data and maps 2.2 million diarrheal deaths Disaggregated by disease, age, country, region, risk factor
IHME calculations 2010: data and maps 1.5 million diarrheal deaths 89.5 million DALYs from diarrhea
Burden of Disease Summary
Introduction to HWTS | 20 Burden of disease from poor WASH is high
Diarrheal disease is a leading cause of mortality and morbidity
Different online resources
Next: Microbial Water Quality Conclusion
Water-borne pathogens Introduction to Household Water Treatment and Safe Storage, Module 1.3 Dr. Richard Johnston Different classes of pathogens Helminths Protozoa Bacteria Viruses
Introduction
Protozoa E. coli Toxic forms Shigella Vibrio cholera
Bacteria Rotavirus Hepatitis A and E Polio
Viruses
Guinea worm
Credit: The Carter Center
Guinea worm
Credit: The Carter Center / L. Gubb
Guinea worm
Credit: The Carter Center / L. Gubb
Guinea worm
Credit: The Carter Center / E. Staub Summary Helminths Dracunuculiasis (Guinea worm) Larvae in insect host ~1000 m Protozoa Cryptosporidium, Entamoeba, Giardia Can form resistant cysts ~10 m Bacteria E. coli, Shigella, Vibrio cholera ~1 m Viruses Rotavirus, Hepatitis A and E, poliovirus ~0.1 m
How does Drinking Water become unsafe? Introduction to Household Water Treatment and Safe Storage, Module 1.4 Dr. Richard Johnston Introduction to HWTS | 2 Microbial safety Diarrheal disease Faecal pathogens
Indicators of faecal contamination
F-diagram
Chemical safety Introduction
Introduction to HWTS | 3 be universally present in faeces of humans and animals in large numbers be present in higher numbers than faecal pathogens not be pathogenic be readily detected by simple, inexpensive methods persist in water in a similar manner to faecal pathogens not multiply in natural waters respond to treatment in a similar fashion to faecal pathogens The ideal faecal indicator should
Introduction to HWTS | 4
Total coliforms (TC)
Common faecal indicators Total Coliforms Introduction to HWTS | 5
Total coliforms (TC) Ferment lactose, producing acid and gas at 35 o C Citrobacter, Klebsiella, Hafnia Enterobacter E. coli, Salmonella, Shigella, Yersinia
Not useful as faecal indicator Many non-faecal sources
Operational monitoring Effectiveness of treatment Cleanliness and integrity of distribution system
Common faecal indicators Total Coliforms Introduction to HWTS | 6
Total coliforms (TC)
Thermotolerant coliforms (TTC)
Common faecal indicators Total Coliforms Thermotolerant Coliforms Introduction to HWTS | 7
Total coliforms (TC)
Thermotolerant coliforms (TTC) Ferment lactose within 48 h at 44 o C Previously: Faecal coliforms 10 6 -10 9 cells per gram faeces
Some indication of non-faecal TTC Klebsiella, some Enterobacter spp.
May grow or die off at ambient temperature
Common faecal indicators Total Coliforms Thermotolerant Coliforms Introduction to HWTS | 8
Total coliforms (TC)
Thermotolerant coliforms (TTC)
Escherichia coli (EC)
Common faecal indicators Total Coliforms Thermotolerant Coliforms E. coli Introduction to HWTS | 9
Total coliforms (TC)
Thermotolerant coliforms (TTC)
Escherichia coli (EC) Generally considered most suitable indicator Some possibility of growth in environment Only moderately persistent, resistant
Common faecal indicators Total Coliforms Thermotolerant Coliforms E. coli Introduction to HWTS | 10 Indicator count per 100 mL Risk level <0 A Conformity 1-10 B Low 11-100 C Intermediate 101-1000 D High >1000 E Very high
Relative risk Introduction to HWTS | 11
Relative risk matrix 0 1 2 3 4 5 6 7 8 9 E D C B A No Action Low Risk Intermediate Risk Very high Risk Sanitary Inspection Score E .
c o l i
l e v e l
Introduction to HWTS | 12
Other faecal indicators
Coliphage viruses Require bacteria for hosts
Faecal streptococci Lower numbers than coliforms More persistent, resistant
Bacterial spores Similar to protozoa Highly persistent, resistant Clostridium perfringens Bacillus spp.
Introduction to HWTS | 13 The F-Diagram Introduction to HWTS | 14 Opportunities for contamination 1 Water Resource 2 Delivery system 3 Collection and Transport 4 Household storage 5 Consumption Introduction to HWTS | 15 E. coli is the preferred indicator bacteria for faecal contamination
The F-Diagram shows how faecal pathogens can be distributed in the environment, and be ingested by a new host
Drinking water can become contaminated in a variety of ways along the water chain.
Summary
What is HWTS? Introduction to Household Water Treatment and Safe Storage, Module 1.5 Dr. Richard Johnston Household Water Treatment Sedimentation Filtration Disinfection
Safe Storage
Introduction
Removal of suspended solids, turbidity
Gravity Settling
Coagulation Plant-based Aluminium and iron salts
Sedimentation Water is passed through porous material Ceramic filters Synthetic membranes Biological filters
Gravity or external pressure
Particles removed
Challenge of fouling, clogging Filtration
Disinfection: heat
Disinfection: ultraviolet radiation
Disinfection: chlorine To prevent recontamination
Small opening Possible to clean
Tap to dispense water hygienically
Safe storage Introduction to future processes
Detailed explanations will consider Efficiency against different classes of pathogens Advantages Challenges
No one process is the best
Summary
HWTS and the MDGs Introduction to Household Water Treatment and Safe Storage, Module 1.6 Dr. Richard Johnston What are the Millennium Development Goals?
How does HWTS fit into them?
Introduction
Introduction to HWTS| 2 The Millennium Development Goals
1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development
Introduction to HWTS| 3 The Millennium Development Goals
1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development
Target 7C: To halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Introduction to HWTS| 3 HWTS can contribute to sustainable access to safe water Short- or medium-term measure MDG 7 needs quantity and access HWTS contributes to other MDGs MDG 4: reduce child mortality MDG 6: combat HIV/AIDS, malaria, and other diseases MDG 1: links with malnutrition MDG 2: links with education
Sustainable access to safe water
Introduction to HWTS| 4 HWTS contributes to the MDG target for safe water And other targets
Not an indicator in its own right Doesnt equal sustainable access to safe water
Summary
Introduction to HWTS| 5 International Network on Household Water Treatment and Safe Storage (The Network) A platform for researchers, practitioners and policy makers in HWTS Michael Forson, (co-host of the Network) WASH Specialist (Water Supply and quality) UNICEF, New York The HWTS Network | 2 The issue What triggered the network Why a network? The Network strategy Network mission Network objectives Network Targets Hosting and implementation arrangements Membership and Benefits of participation Key Achievements Challenges what worked (is working) and what did not Way forward Participation and benefits Outline
The HWTS Network | 3 A large part of the worlds population is without access to drinking-water from improved sources (768 million; 2011); several billion more, without access to SAFE drinking-water. Millions, often in urban areas, served by unreliable piped systems are force to store drinking-water with significant risks of contamination. Millions are affected by emergency situations where water, sanitation and health services may have broken down partially or completely, posing risk to the safety of the drinking water. Diarrhoeal death major cause of child mortality; safe drinking-water important prevention intervention The Issue . What triggered the Network? Stanford University/AmyPickering The HWTS Network | 4 Why a Network? WHO convened a multi-stakeholder meeting in Feb 2003 to identify a platform that will cover all stakeholders to address the issues identified, and a network was deemed the best forum to be used in this case
The HWTS Network | 5 A network is a forum, information clearinghouse and vehicle to promote collective, bilateral and individual action on the part of its stakeholders A network encourages communication, cooperation and coordinated action while optimizing flexibility, participation and creativity. As a network we can Monitor and map global efforts to inform advocacy, implementation and investment Raise awareness about the role of HWTS with one understanding and support governments in decision making Conduct agreed targeted and coordinated research to increase effective use of HWTS => health gains (impacts) Maximize collective gains in HWTS based on individual gains
Why a Network? The advantages The HWTS Network | 6
Strategic consultations
PHASE 2 PHASE 1 How things evolved down the timeline . 2 0 0 3
2 0 0 4
2 0 0 5
2 0 0 6
2 0 0 7
2 0 0 8
2 0 0 9
2 0 1 0
2 0 1 1
2 0 1 2
2 0 1 3
2 0 1 4
2 0 1 5
2 0 1 6
WHO conceived the idea to facilitated a forum for promotion of HWTS based on health gains Multi- stakeholder consultative meeting in Feb 2003 7-point strategy for comprehensive diarrhoea control adopted by WHO and UNICEF. HWTS is mentioned as a key intervention Letters of exchange to co-host the Network was signed between UNICEF and WHO HWTS/WSP workshop in Nagpur India to explore linkages between the 2 West African Regional HWTS workshop held in Accra, Ghana South African Regional HWTS Workshop Held in Mozambique East African Regional HWTS Workshop Held in Uganda Plenary Meeting Nairobi, Kenya June 2004. 1 st 5 year strategic plan (2003 2008) developed. Strategic consultation in Geneva proposing co-hosting with UNICEF We are now here The HWTS Network | 7 To contribute to a significant reduction in water-borne and water- related vector-borne diseases, especially among vulnerable populations, by promoting household water treatment and safe storage as a key component of community- targeted environmental health programmes. HWTS Network Global Strategy 2011 - 2016
Mission statement The HWTS Network | 8 Objectives HWTS evidence base of public health relevance significantly strengthened Tangible results in the scaling-up of household water treatment and safe storage achieved globally National policies and institutional frameworks developed (=> integration of environmental health interventions) Best practice in HWTS programmes evaluated and disseminated for advocacy purposes Targets By 2015, 30 countries have established policies on household water treatment and storage. By 2015, strengthened evidence to guide effective and replicable HWTS programmatic approaches to achieve long-term widespread use and public health impact. By 2020, 50 countries have achieved country-wide scale up of project-based HWTS.
HWTS Network Global Strategy 2011 - 2016 The HWTS Network | 9 Currently over 160 membership Connect with a global Network of HWTS experts, including senior officials, programme implementers, researchers, and on-the-ground practitioners Receive the latest news on HWTS projects, meetings, and events through the Network listserv and newsletter Find out who is active where and engage with those who have faced similar challenges Have your work disseminated and highlighted in Network communications material Have a voice in the annual network meeting and therefore to have input to the annual work plan Have access to an online, interactive webspace to share files and discuss matters of interest with Network participants
Participation and benefits The HWTS Network | 11 Responsibilities within the secretariat WHO Knowledge Advancement Research Knowledge Management Technology assessment Policy and Advocacy Global and National level advocacy Policy formulation and review UNICEF Capacity Development Training workshops dissemination of best practices, etc Monitoring Global progress in HWTS Mapping country level implementations UNC Maintain Regular and constant communication within the secretariat The HWTS Network | 14
Key Achievements Hosted over half-dozen regional workshops leading to the formation of over 20 national HWTS action plans Developed toolkit and harmonized indicators to strengthen monitoring and implementation Raised awareness for integration among key public health efforts (HIV/AIDS, maternal/child health, nutrition) on role of HWTS Supporting quality assurance through the HWTS evaluation scheme Global capacity building through strategic webinars
The HWTS Network | 15 What worked (is working) Co-hosting arrangement harnessed the strengths of both organizations Regional workshops (focused, controlled) Integration with other environmental health projects On-going challenges Working groups started well, but died off. Like a community of practice Ambitious budget Need clear alignment and harmonization between Water Safety Plans and HWTS Advisory group was working great, however faced with challenges of participation
More information and links Week 1 Summary Introduction to Household Water Treatment and Safe Storage, Module 1.8 Dr. Richard Johnston Global Burden of Disease Disease classification system Morbidity (DALYs) and mortality from diarrheal disease Estimates from WHO and IHME