DEPARTMENT: WATER AFFAIRS & FORESTRY Cholera Outbreak Response in Limpopo and Mpumalanga Provinces
Key responses – Water Water supply priorities in cholera / AWD response
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Transcript of Key responses – Water Water supply priorities in cholera / AWD response
Key responses – Water
Water supply priorities in cholera / AWD response
Session 3.1 WASH Cholera / AWD EP&R training
WASH cholera / AWD EP&R training
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Learning objectivesBy the end of the session the participants will be able to• explain cholera / AWD transmission risks associated
with most common water sources and possible ways to intervene if sources are identified as contaminated
• describe priorities for provision of water in cholera / AWD response
• list most common field tests used for water quality analysis
• compare appropriateness of most common HHWT methods in cholera / AWD response
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WASH cholera / AWD EP&R training
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Water sourcesConsider that water might be contaminated withvibrio cholerae where there is contact with:
• People who have cholera (remember they may be asymptomatic)
• Contaminated articles such as buckets, cups and clothes e.g. washing of patients beddings and clothes
• Faecal material e.g. when latrines are close to wells
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Surface waterWater source Risk of faecal
contamination
Rivers High to very high
Lake High to very high
Rainfall Low to high
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GroundwaterWater source Risk of faecal
contaminationProtected spring Nil or very low
Closed dug well Low
Open dug Well Medium to high
Borehole Nil or very low
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Other ways of accessing water
• Vendors• Water trucking• Standpipe
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Water trucking• Provides immediate supply• Water source and quality can be controlled
Considerations:• Number of trucks to ensure adequate water supply • Cost very high • Requires close monitoring • Offloading to storage facility
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Importance of proper assessment • Have the different sources of contaminated water been
identified?• Can and have these sources been disinfected?• If not; are there any measures taken to ensure safe
water at household level, or have other water sources been provided?
• If wells are chlorinated is monitoring of residual chlorine levels taking place?
• Is there any system to provide safe water to high risk areas during an outbreak?
• Does population receive at least 15l of water /person /day?
• If chlorine tablets are provided at HH level does the population know how to use them properly?
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Water Quality vs. Quantity
You see a card in 3 corners of this room
Walk around and decide which would beyour priority for water in cholera / AWDresponse
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Blocking of transmission of cholera by water interventions
Cholera (Faeces
and vomit)
Fluids (water
sources)
Soil
Hands
Food New Host
Sanitation
Hand washing
Water Quantity
Water Quality
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Transmission routes and prevention strategies Transmission
routeInfection Prevention strategies
Water-borne Diarrhoeas and dysenteries, including choleraHepatitis A
Improve quality of drinking water usedPrevent casual use of unprotected sourcesImprove sanitation Improve hygiene
Water-washed
Infectious skin and eye diseasesLouse-borne typhus
Increased quantity of water usedImproved accessibility & reliability of supplyImprove hygiene
Water-based SchistosomiasisGuinea worm
Reduce need for contact with infected waterControl snail populationsReduce contamination of surface waters
Water-related insect vector
FilariasisMalariaRiver blindnessYellow fever
Improve surface water management Destroy breeding sites of insects Reduce need to visit breeding sites Use mosquito netting Source Cairncross & Feacham (1999, 2nd edn)
Environmental Health Engineering
in the Tropics
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Water quantity
Source The Sphere Project (2004)
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Water Quality
•Physical E.g. turbidity, colour•ChemicalE.g. iron, arsenic•Microbiological and biological
E.g. bacteria, protozoa
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During a cholera outbreak the most significant parameter to follow up are the bacteriological parameter
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Sphere key indictors for water quality
• Turbidity (cloudiness index) - less than 5 NTU
• Faecal coliform - 0 FC/ 100 ml
• Residual chlorine (if water is disinfected) – 0.5 mg/l (for piped systems and during outbreaks)
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Turbidity• Refers to clarity of water i.e. the
greater the amount of total suspended solids the higher the turbidity
• Affects disinfection: high turbidity protects micro-organisms from the action of disinfectants
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How to test turbidity ?
• Turbidity tube (most common field method)
• Secchi disk
• Electronic devises
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Microbiological and Biological Water Quality
• E-coli is used as an indicator for faecal contamination
• Testing for E-coli is not always required if the water is going to be treated anyway
• SPHERE key indicator Faecal coliform - 0 FC/ 100 mlRecommendation is to treat (chlorinate) alldrinking water and water used for cooking
during a cholera outbreak
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How to test microbiological quality in the field
• DelAqua kit• Wagtech
• H2S
• No field tests to detect V.C from water source
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Use of DelAgua
4 – 6 hours
16hrs incubationON
source Medair Madagascar
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• An on-site testing method for microbial quality of drinking water
• Faeces contain a high concentration of hydrogen sulphide (H2S) producing bacteria so water contaminated with faeces will react
Hydrogen Sulphide (H2S) tests
Result: Yes / no (presence/ absence)
Turns black when it comes incontact with hydrogensulphide
Eric Fewster, BushProof
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Common Household Water Treatment Methods
• Chemical e.g. Chlorination• UV disinfection• Boiling• Filtration
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WASH cholera / AWD EP&R training
0 10 20 30 40 50
% reduction in diarrhoea
Water Supply (quality& quantity)
Water Quality Source
Water QualityHousehold
Sanitation
Hand washing
Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis, Fewtrell et al
(2005)
Data leads to some controversy, partly of the difficulty of splitting impacts of interventions. For example:
* Hand-washing is not possible without a water supply, so ‘hand-washing’ is in fact ‘water supply and hand-washing’
** Water quality at household will also have involved some hygiene promotion when setting up the household water treatment processes
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WASH cholera / AWD EP&R training
Let’s think of appropriateness of different HHWT methods in a cholera / AWD outbreak response
Filtering Boiling
UV disinfection
Chemical
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Water storage
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Water storage
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Learning objectivesBy the end of the session the participants will beable to• explain cholera / AWD transmission risks associated
with most common water sources and possible ways to intervene if sources are identified as contaminated
• describe priorities for provision of water in cholera / AWD response
• list most common field tests used for water quality analysis
• compare appropriateness of most common HHWT methods in cholera / AWD response
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