Linkages between Water, Sanitation and Hygiene with Food Safety and Nutrition Prof. Indira...

Linkages between Water, Sanitation and Hygiene with Food

Safety and Nutrition

Prof. Indira Chakravarty, PhD, DSCChief Advisor

Public Health Engineering Department, Govt. of West BengalMember

National Drinking Water and Sanitation Council, MDWS, Govt. of India

Board MemberUnited Nations University - IIGH

Ex-MemberFood Safety and Standards Authority of India,

Ministry of Health and Family Welfare, Govt. of IndiaFormer Regional Director, South Asia

MI, IDRC, CanadaFormer Addl. DGHS, Director and Dean

All India Institute of Hygiene and Public Health, Ministry of Health and Family Welfare, Govt. of IndiaFormer Director

Chittaranjan National Cancer Institute, Ministry of Health and Family Welfare, Govt. of IndiaFormer Regional Advisor Nutrition(Act)

WHO, SEARO

Water and Sanitation Coverage – Indian Scenario Water and Sanitation Coverage – Indian Scenario (NFHS – 3 Survey of 2005- 2006)(NFHS – 3 Survey of 2005- 2006)

2

SANITATION PERCENTAGE OF SANITATION COVERAGE

RURAL 26%

URBAN 83.2%

All India Average 44.6%

(only 8.9% increase from 1998-99 NFHS-2)

WATER PERCENTAGE ACCESSTO SAFE DRINKING WATER

RURAL (2007) 74.39%

URBAN 91%

Projected by 2012 100%

Indira Chakravarty

Water and Sanitation Coverage Water and Sanitation Coverage (Census - 2011)(Census - 2011)

TOILET CONNECTIVITY DRINKING WATER SUPPLY

WITHIN PREMISES

TOTAL

WITHIN PREMISES NEAR PREMISES ELSEWHERE

INDIA (MEAN) 46.9 46.6 35.8 17.6

GUJARAT (MEAN) 57.4 64.0 23.5 12.4

Source: Census 2011

Sanitation Coverage – Mean stateDrinking Water Coverage – Mean state

3Indira Chakravarty

Data on wasting (Children) Stunting (Children) Data on wasting (Children) Stunting (Children) and Anemia (Children and Woman)and Anemia (Children and Woman)

UNDER WEIGHT WASTED STUNTED ANEMIA

India Gujarat India Gujarat India Gujarat

WOMEN CHILDREN

MARRIED WOMEN

PREGNANT WOMEN

India GujaratIndia Gujarat India Gujarat

NFHS-1 51.1 42.7 17.5 23.9 52.0 50.1 na na na na na na

NFHS-2 42.7 41.6 19.7 20.3 51.0 52.0 51.8 46.3 49.7 47.4 74.2 74.5

NFHS-3 40.4 41.1 22.9 19.7 44.9 49.2 56.2 55.5 57.9 60.8 78.9 79.8

Source- NFHS Survey

Indira Chakravarty 4

STATEDRINKING

WATER (TOTAL)

SANITATION (TOTAL)

WATER BORNE

DISEASES %

WOMENS LITERACY %

UNDER WEIGHT WASTED STUNTED ANEMIA

INDIA (MEAN)

87.9 44.6 10.0 65.46 40.4 22.9 44.9

PREGNANT WOMEN CHILDREN

58.7 69.5

GUJARAT 89.8 54.6 12.6 66.77 41.4 19.7 49.2 60.8 69.7

Source: Census 2011, NFHS-3

Comparative Assessment of WES, Water borne disease, Comparative Assessment of WES, Water borne disease, Women Literacy and Nutrition Women Literacy and Nutrition

5Indira Chakravarty

National Pilot Programme In Control Of Micronutrient National Pilot Programme In Control Of Micronutrient MalnutritionMalnutrition

States– Assam

– Bihar

– Jharkhand

– Orissa

– West Bengal

– Tripura

– Gujarat

6

STUDY CONDUCTED IN FOLLOWING STATES

Indira Chakravarty

Prevalence of Anemia in women over life – Prevalence of Anemia in women over life – Compiled data from 7 statesCompiled data from 7 states

(The National Pilot Programme on Control of Micronutrient Malnutrition, AIIH&PH, 1995-2008)

7

AGE GROUP

ANEMIA IN FEMALES

MILD & MODERATE SEVERE

RANGE (%) MEAN (%) RANGE (%) MEAN (%)

6 m – 6 y 49.2 - 86.5 68.2 1.2 - 4.5 2.8

6 – 12 y 61.9 - 87.1 81.3 0.6 - 11.0 6.0

12 – 19 y 79.5 - 89.3 82.7 3.2 - 9.1 6.4

19 – 45 y 70.8 - 90.4 82.7 3.6 - 9.3 6.4

45 – 60 y 68.0 - 88.0 79.1 3.0 - 9.4 5.9

60 y AND ABOVE 64.8 - 88.2 78.0 2.2 - 4.5 3.3

PREGNANT WOMAN

68.0 - 89.0 79.7 3.3 - 15.0 11.2

Indira Chakravarty

12.8

7.3

55.5

9.8

51

21.5 20.5

0.4

32.8

19.8

39.8

0.3

4.7

28.8

60.9

2.8

20.5

3.3

51.5

21.1

11.1

0.2

30.7

24.3

0

10

20

30

40

50

60

70

Pe

rce

nta

ge

Kumrup (A) Gumla (J) Jajpur (O) Bankura (W.B.) West Dist. (T) Sabarkantha(G)

Districts

Percentage distribution of families according to drinking water sources (others sources such as pond, river, any other have not been shown)

Well Kuchha

Well Pucca

Tubewell

Municipal supply

8Indira Chakravarty

Op

en f

ield

Lat

rin

es (

pri

vate

)

Lat

rin

es (

com

mu

nit

y)

An

y o

ther

Ku

mru

p (

A)

Gu

mla

(J

)

Ja

jpu

r (O

)

Ba

nk

ura

(W

.B.)

We

st

Dis

t. (

T)

Sa

ba

rka

nth

a(G

)

77.7

21.7

0.6 0.1

1222.3

0.7

65.6

90.9

8.70.3 0.2

85.6

13.9

0 0.6

94.4

4.70.3 0.6

47.344.1

5.82.80

10

20

30

40

50

60

70

80

90

100

Pe

rce

nta

ge

Human excreta disposal practice

Districts

Percentage distribution of families according to practices of human excreta disposal

9Indira Chakravarty

92.6

7.5

86.5

13.5

51.648.6

71.3

28.7

85.8

14.2

81.2

18.8

83.3

16.7

90.9

9.1

84.4

15.6

84.5

15.5

86.8

13.2

87.7

12.3

0

10

20

30

40

50

60

70

80

90

100

(%)

of

Mo

the

rs

Kamrup (A) Gumla (J) Jajpur (O) Bankura/Purulia(W.B.)

West Dist. (T) Sabarkantha (G)

Districts

Percentage distribution of pregnant mothers who consumed Folifer tablets

Consumed

Not consumed

Full quota

Partial quota

10Indira Chakravarty

0

100

200

300

400

500

600

700

800

900

Vita

min

A (u

g)

Kamrup(A) Gumla(J ) J ajpur(O) Bankura/P urulia(W.B) West.Dist.(T) Sabarkantha (G) RDA

Districts

Mean dietary Vitamin A (ug/acu/day) intake from Diet Survey

Vitamin A


10.8

3.5

30

12

20.9

7.7 8.1

2.8

17.87

4.9

0

5

10

15

20

25

30

Pe

rce

nta

ge


Sabarkantha (G)

Districts

Percentage distribution of families with dietary intake of Vitamin A at different deficiency levels

Sev. def.% RDA

Ver. Sev. % RDA

Note - Sev. def. <50% of RDA Ver. Sev. def. <25% of RDA


0

10

20

30

40

50

60

70

80

Pe

rce

nta

ge

Kamrup (A) Gumla (J) Jajpur (O) Bankura/Purulia (WB) Sabarkantha (G)

Districts

Percentage distribution of families with dietary intake of Iron at different deficiency levels

Sev. def.% RDA

Ver. Sev. % RDA

Note - Sev. def. < 50% of RDA Ver. Sev. def. < 25% of RDA


8.19

7.5

9.38.6

15

0

2

4

6

8

10

12

14

16

Zin

c (

mg

)


Sabarkantha (G) RDA

Districts

Average Consumption (mg/acu/day) of dietary Zinc intake


Impact of Water, Impact of Water, Sanitation and Hygiene Sanitation and Hygiene on Nutritional status.on Nutritional status.


1. Unsafe water as well as unsafe food results in infections like diarrhea which causes loss of valuable nutrients from the body. This eventually leads to under-nutrition.

2. Reduced sanitary facilities and open defecation results in worm infestation which leads to micronutrient deficiencies (Hidden Hunger) viz anemia and under-nutrition.

Impact of Unsafe Water and Lack Of Impact of Unsafe Water and Lack Of Hygiene & Sanitation On Nutrition– Hygiene & Sanitation On Nutrition–

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3. Unavailability of water near habitats results in long walks (particularly for women) carrying heavy loads of water. This leads to expenditure of valuable nutritional energy (calories) from the body and loss of time. Hence, inaccessibility to water leads to loss of both calorific energy as well as time. Leads to overall malnutrition and ill health.

4. Pollutants in water like Arsenic, Fluoride etc. lead to a direct toxic impact on health and nutrition. Arsenic in particular also enter the food chain at several points.

Impact of Unsafe Water and Lack Of Hygiene Impact of Unsafe Water and Lack Of Hygiene & Sanitation On Nutrition–& Sanitation On Nutrition–

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1. Under-nutrition in the entire community, especially in children.

2. Anemia, especially in children and women. This may lead to Low Birth Weight (LBW) Babies, higher Maternal Mortality Rate (MMR), low work capacity, tiredness etc.

3. Disability – Both under-nutrition as well as unsafe environment are the causes of disability in many cases, specially in children.

The most significant impact of poor The most significant impact of poor WES On NutritionWES On Nutrition


Impact of Water, Sanitation and Hygiene Impact of Water, Sanitation and Hygiene on Anemiaon Anemia

20

Economic LossEconomic Loss

Poor HealthPoor HealthInfectious and other DiseasesInfectious and other Diseases

Loss of Nutrients from body Poor absorbing capacity etc Loss of Nutrients from body Poor absorbing capacity etc

Under NutritionUnder Nutrition

Worm Infestation

Worm Infestation

Toxic effectsToxic effects

Under NutritionUnder Nutrition

• Arsenicosis• Fluorosis• Pesticide toxicity

etc.

• Arsenicosis• Fluorosis• Pesticide toxicity

etc.

Poor HealthPoor Health

?

Indira Chakravarty

21

CASECASE

STUDIESSTUDIESIndira Chakravarty

IMPACT OFIMPACT OF SANITATION SANITATION && CLEAN CLEAN

WATER SUPPLYWATER SUPPLYANDAND HEALTH EDUCATION HEALTH EDUCATION

ONONNUTRITIONAL STATUSNUTRITIONAL STATUS

(A WHO supported study)(A WHO supported study)


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STUDY AREASTUDY AREA

Village : Daharpur

District : Midnapore

State : West Bengal

Period : 3 years

Indira Chakravarty

INCIDENCE OF DIARRHOEAL DISEASES AND WORM INCIDENCE OF DIARRHOEAL DISEASES AND WORM INFESTATION IN CHILDREN INFESTATION IN CHILDREN

(INCIDENCE RATE %)(INCIDENCE RATE %)

24

Incidence rate reduced

PARAMETERS BASE-LINE POST INTERVENTION

Diarrhoeal Diseases 27.27 21.06

Worm Infestation 85.00 75.35

Indira Chakravarty

25

CHANGE IN NUTRITIONAL STATUS OF CHILDREN CHANGE IN NUTRITIONAL STATUS OF CHILDREN AFTER PROVISION OF WES AFTER PROVISION OF WES

[Weight for Age ][Weight for Age ]

Significant improvement

NUTRITIONAL STATUS BASE LINE POST INTERVENTION (%)

NORMAL5.27 13.46

GRADE – I 26.31 38.46

GRADE – II 57.89 38.46

GRADE – III 10.83 9.62

Indira Chakravarty

26

• Significant Reduction in diarrheal and and worm

infestation rate.

• Significant improvement in weight for age

(nutritional status).

After provision of WES for 3 years

CONCLUSIONCONCLUSION

*-Based on values of Normal.

Indira Chakravarty

Easy Access To Easy Access To Water Saves Time Water Saves Time

And EnergyAnd Energy

(An UNICEF supported study)(An UNICEF supported study)


28

Districts covered in Districts covered in NepalNepal

Zones Districts • Central • Kavre • Mid West • Surkhet • Far West • Dadeldura

Indira Chakravarty

29

THE STUDY COVERED FOLLOWING ASPECTS THE STUDY COVERED FOLLOWING ASPECTS

• Epidemiological information.• Nutritional status.• Dietary intake.• Health parameters.• Water collection, usage, quality, etc.• Time spent for water collection.• Energy spent for water collection.• Adverse effects of carrying water in hilly and mountainous zones.• Housing / sanitation, etc.• Socio-economic status.• Utilization of saved time - Social, Economic, Child Care, etc.

Indira Chakravarty

30

AVERAGE TIME AND ENERGY SAVEDAVERAGE TIME AND ENERGY SAVED

Cross Sectional : Water already provided (compared with other villages without provision of water supply)

Longitudinal : After provision of water to control villages.

DESCRIPTIONSAVED

CROSS-SECTIONAL LONGITUDINAL MEAN

Energy (K. Cal) 588(20.50%)

510(18.08%)

549(19.29%)

Time (Hrs.) 4.50 3.00 3.75

Indira Chakravarty

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IMPROVEMENT IN NUTRITIONAL STATUS OF IMPROVEMENT IN NUTRITIONAL STATUS OF CHILDREN* CHILDREN*

(WEIGHT FOR AGE)

* 0-5 YEARS

Pooled = Central, Mid-west, Far-west.

Significant improvement of nutritional status

Sl ZONE STATUS NUTRITIONAL STATUS OF CHILDREN (%)

NORMAL GRADE-I GRADE-II GRADE-III

1. POOLED CONTROL 20.4 32.7 26.6 20.4

EXPERIMENTAL 26.3 34.2 26.3 13.2

Indira Chakravarty

Increased access to water leads to a Increased access to water leads to a significantsignificant

• Amount of time being saved for fruitful activities.

• Improvement in nutritional status of children.


Coverage of Safe water, Coverage of Safe water,

Sanitation and Hygiene along Sanitation and Hygiene along

with balanced nutrition is with balanced nutrition is

essential for proper Growth essential for proper Growth

and Development of Childrenand Development of Children


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