D3 1

WASH Cluster – Emergency Training

D

WASH related diseases

Session 3Categorisation and

Transmission

D3 2

WASH Cluster – Emergency Training

D

2

Session Aim

• To understand some key issues with respect to Environment/WASH related diseases

D3 3

WASH Cluster – Emergency Training

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Session Name here 3

Session Objectives

• To list the key environment/WASH related diseases in emergencies

• To describe how such diseases are often categorised

• To explain how such diseases are transmitted and the key pathogens

D3 4

WASH Cluster – Emergency Training

D

Session Name here 4

Session Objectives

• To design a control & prevention strategy for Hepatitis E

• To discuss the importance of hand washing in preventing diarrhoea

D3 5

WASH Cluster – Emergency Training

D

WASH related diseases

• Question to group

• What are the WASH/Environment related diseases you generally associate with emergency settings?

• How might you categorise them?

D3 6

WASH Cluster – Emergency Training

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Diseases affecting displaced persons in disasters

• Group to receive a handout Pages 170 and 171 from “Environmental Health in Emergencies and Disasters, Edited by B. Wisner and J.Adams, WHO, 2003

• Table 11.1 Diseases affecting displaced populations in disasters

D3 7

WASH Cluster – Emergency Training

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Broad Categories of WASH related Diseases

1. Water-borne infections

2. Water-washed infections

3. Vector borne infections

4. Food-borne infections

Source: Controlling and Preventing disease

D3 8

WASH Cluster – Emergency Training

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Other categorisationsSome might refer to:

• Waterborne diseases• Sanitation and Hygiene-Related

Diseases• Vector or Insect-borne diseases

associated with water• Neglected Tropical DiseasesSource: Centers for Disease Control and Prevention

D3 9

WASH Cluster – Emergency Training

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Other categorisations

– Water-borne diseases(microbial contamination of drinking water)

– Water-washed diseases(sufficient water quantities )

– Water-based diseases(infection through contact with water)

– Water-associated vector-bornediseases (ecosystems conducive to vector breeding)

Source: WHO

D3 10

WASH Cluster – Emergency Training

D

Categorisations

• We will classify into three broad categories

1. Water-borne 2. Sanitation and Hygiene related3. Insect or Vector borne

D3 11

WASH Cluster – Emergency Training

D

Waterborne Diseases

• Waterborne diseases are caused by pathogens that can be directly spread through contaminated water. Most cause diarrhoeal illness spread through the faecal-oral route

Examples include:• Amoebiasis, Cholera, Cryptosporidiosis,

Guinea Worm, Giardiasis, Rotavirus, Schistosomiasis (Bilharzia), Shigellosis and Typhoid Fever.

D3 12

WASH Cluster – Emergency Training

D

Faecal-oral route

Source: WEDC

D3 13

WASH Cluster – Emergency Training

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Sanitation and Hygiene Related Diseases

Examples include• Lice• Scabies• Soil transmitted helminthiasis

(Ascaris, Whipworm, Hookworm)• Trachoma

D3 14

WASH Cluster – Emergency Training

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Insect or Vector Borne

Examples include

• Dengue/Dengue Haemorrhagic Fever• Malaria• Yellow Fever• Rift Valley Fever• Plague

D3 15

WASH Cluster – Emergency Training

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http://www.lboro.ac.uk/well/resources/technical-briefs/51-water-sanitation-and-hygiene-understanding.pdf

D3 16

WASH Cluster – Emergency Training

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Key Pathogens• Question to group

• What are the key pathogens to be aware of in disaster situations?

D3 17

WASH Cluster – Emergency Training

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Key Pathogens

• Bacteria (e.g. Vibrio cholerae responsible for Cholera, Shigella spp responsible for Shigellosis)

• Viruses (e.g. Hepatitis A, B, C and E responsible for Hepatitis (viral), Flaviviridae serotypes 1, 2, 3 and 4 responsible for Dengue)

• Parasites (e.g. Plasmodium falciparum responsible for Malaria, Sarcoptes scabiei responsible for Scabies)

• Helminths (worms) (e.g. Dracunculus medinensis responsbile for Guinea worm disease)

• Protozoa (e.g. Leishmania spp responsible for Leishmanisasis)

• Rickettsia (e.g. Rickettsia mooseri responsible for flea-borne typhus)

D3 18

WASH Cluster – Emergency Training

D

Group Work - Hepatitis E

• Divide into groups

• Each group to receive four one page handouts summarising the problem of Hepatitis E in Darfur and Chad

• 20 mins plus 20 mins for plenary feedback

D3 19

WASH Cluster – Emergency Training

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Group Work -Hepatitis E

• How would you categorise Hepatitis E?

• What key control and prevention strategies would you employ?

D3 20

WASH Cluster – Emergency Training

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Voting Exercise• In terms of preventing diarrhoea please

vote on the following in order of importance:

• Water Quantity• Water Quality at Source• Water Quality Household• Sanitation (Latrines)• Handwashing

D3 21

WASH Cluster – Emergency Training

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0 10 20

30

40

50

% reduction in diarrhoea

Water Quantity

Water Quality Household

Hand washing

Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis, Fewtrell

et al (2005)

Taken from Hygiene Promotion Briefing Paper prepared for the WASH cluster meeting in February 2008

Sanitation

Water Quality Source

D3 22

WASH Cluster – Emergency Training

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Handwashing with Soap

• A recently conducted randomised control trial in Karachi, Pakistan, further confirmed the findings of the two most recent reviews by finding an average reduction of 45% in diarrhoea incidence when handwashing with soap was practised (19). (WELL Factsheet, Health Impact of handwashing with soap)