Water-related diseases

Ghaiath HusseinMBBS, MHSc. (Bioethics)

overview• Introduction• Health risks related to water• Examples of more significant diseases• Figures from the KSA

Access to water supply as of 2002

• In 2002, 1.1 billion people lacked access to improved water sources, which represented 17% of the global population.

• Over half of the world’s population has access to improved water through household connections or yard tap.

• Of the 1.1 billion without improved water sources, nearly two thirds live in Asia.

• In sub-Saharan Africa, 42% of the population is still without improved water.

• In order to meet the water supply MDG target, an additional 260,000 people per day up to 2015 should gain access to improved water sources.

• Between 2002 and 2015, the world’s population is expected to increase every year by 74.8 million people.

Access to sanitation as of 2002

• In 2002, 2.6 billion people lacked access to improved sanitation, which represented 42% of the world’s population.

• Over half of those without improved sanitation – nearly 1.5 billion people – live in China and India.

• In sub-Saharan Africa sanitation coverage is a mere 36%.

• Only 31% of the rural inhabitants in developing countries have access to improved sanitation, as opposed 73% of urban dwellers.

• In order to meet the sanitation MDG target, and additional 370 000 people per day up to 2015 should gain access to improved sanitation.

Emergencies and disasters• Almost two billion people were affected by natural

disasters in the last decade of the 20th century, 86% of them by floods and droughts.

• Flooding increases the ever-present health threat from contamination of drinking-water systems from inadequate sanitation, with industrial waste and by refuse dumps.

• Droughts cause the most ill-health and death because they often trigger and exacerbate malnutrition and famine, and deny access to adequate water supplies.

• Disaster management requires a continuous chain of activities that includes prevention, preparedness, emergency response, relief and recovery.

THE GLOBAL RESPONSE• Millennium Development Goals (MDGs)• By including water supply, sanitation and hygiene in the MDGs, the world

community has acknowledged the importance of their promotion as development interventions and has set a series of goals and targets.

• Goal 7: Ensure environmental sustainability• Target 9: Integrate the principles of sustainable development into country

policies and program and reverse the loss of environmental resources.• Target 10:

o Halve by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.

o Integrate sanitation into water resources management strategies.• Target 11: Have achieved by 2020, a significant improvement in the lives of at

least 100 million slum dwellers.• Goal 4: Reduce child mortality• Target 5: Reduce by two-thirds, between 1990 and 2015, the U5MR• Goal 6: Combat HIV/AIDS, malaria, and other diseases• Target 8: Have halted by 2015 and begun to reverse the incidence of malaria

and other major diseases.

What causes water-related health problems?The great majority of evident are the result of:• microbial (bacteriological, viral, protozoan or other

biological) contamination. • Serious health concerns may occur as a result of

the chemical contamination of drinking-water.• many of the waterborne diseases may also be

transmitted by other routes, including person-to-person contact, droplets and aerosols and food intake.

Waterborne pathogens and their significance in water supplies

Public Health IssuesPathogenic bacteria, viruses and protozoa in water and wastewater represent potential risks to public health.

(Giardia) (Cryptosporidium)

Viruses(Hepatitis, Polio)

Bacteria(E.coli)

Protozoa

Most significant WRIs• Diarrhoea • Arsenicosis• Ascariasis • Campylobacteriosis. • Cholera. • Dengue

and Dengue Haemorrhagic Fever.

• Fluorosis• Guinea-Worm Disease (Drac

unculiasis).

• Hepatitis. • Typhoid and Paratyphoid Ent

eric Fevers

• Japanese Encephalitis. • Lead Poisoning. • Leptospirosis • Malaria . • Onchocerciasis (River Blindn

ess).

• Ringworm (Tinea)• Scabies • Schistosomiasis.

Modes of transmission• Faecal contamination. • Some organisms grow in piped water distribution systems (e.g.,

Legionella), whereas others occur in source waters (guinea worm Dracunculus medinensis) and may cause outbreaks and individual cases.

• inhalation of water droplets (aerosols) in which the causative organisms have multiplied because of warm temperatures and the presence of nutrients.

• These include legionellosis and Legionnaires’ disease, caused by Legionella spp., and those caused by the amoebae Naegleria fowleri (primary amoebic meningoencephalitis [PAM]) and Acanthamoeba spp. (amoebic meningitis, pulmonary infections).

• Schistosomiasis (bilharziasis) is a major parasitic disease of tropical and subtropical is primarily spread by contact with water.

Factors affecting WRI• Increases in human and animal populations, • Escalating use of wastewater, • changes in lifestyles and medical interventions,

population movement and travel and • selective pressures for new pathogens and mutants

or recombinations of existing pathogens. • The immunity of individuals also varies

considerably, whether acquired by contact with a pathogen or influenced by such factors as age, sex, state of health and living conditions.

From a study by: Adnan J. Al-Saati (King Abdulaziz City for Science & Technology, Riyadh)

Rapid Urbanization and Population Growth

Urban and Rural Population Growth in Saudi Arabiafor the period 2000-2030 (Millions)

Source: ESCWA, 2001

Region 1421H(2000)

Riyadh 4,730,330

Makkah 5,448,773

Madinah 1,378870

Eastern 3,008,913

Qasim 979,858

Asir 1.637,464

Hail 519,984

Al-Baha 476,382

Tabuk 593,706

Jazan 1,083,022

Najran 385,588

Al-Jouf 354,450

Northern 249,544

Kingdom 20,846,884

Estimated Population of Saudi Arabia in the year 2000

Source: Ministry of Planning, 2002

Meeting the Growing Water Demand

1024633

376

295 233 187

• Limited service coverageo 75% of urban population covered by

drinking water distribution systemso One third of the urban population covered

by sewerage system

Water Supply, treatment

and reuse in 1995 (MCM)/d

ReuseDrinking water

WastewaterTreated

3.3

1.31

0.28

Urban Water and Sanitation Services

• Operational Difficultieso Water consumption averages 295 lpcd

and contributes to: low quality water intermittent supply Excessive wastewater

o Extraordinary subsidy: Average SR 230/customer/month

The Year 1995

Region M3/day lpcd

Riyadh 1,272,177 341

Mekkah 695,938 170

Madinah 163,707 194

Eastern 679,269 317

Qasim 221,504 432

Asir 94,418 188

Hail 6,913 32

Al-Baha na na

Tabuk 14,467 35

Jazan 17,715 100

Najran na na

Al-Jouf 12,698 64

Northern 10,006 54

Kingdom 3,188,818 240

Estimated urban water supply and Household use for the year 1996

Household Water Supply

The Year 1996

• A wide variability of water supply and per capita water use between regions

• Qasim has the highest per capita day and Hail has the lowest

• There are six regions with household use of less that 65 lpcd

• The average household (domestic) use is 240 lpcd.

Number of people receiving Household Water through alternative water sources for the Year 2000

Region Public Water Tank

Well Water Container Other Total

Riyadh 3,081,613 702,640 38,384 899,811 7,882 4,730,330

Mekkah 2,883,279 1,424,108 121,663 1,013,809 5,914 5,448,773

Madinah 786,529 411,485 9,693 167,094 4,069 1,378,870

Eastern 737,618 1,154,910 9,678 1,094,048 12,659 3,008,913

Qasim 661,371 297,388 9,505 9,804 1,790 979,858

Asir 389,500 975,606 204,363 64,492 3,503 1,637,464

Hail 98,051 381,319 23,303 9,139 8,172 519,984

Al-Baha 56,361 147,221 89,995 182,686 119 476,382

Tabuk 240,238 166,177 28,954 149,198 9,139 593,706

Jazan 605,183 331,657 66,406 4,774 75,002 1,083,022

Najran 58,411 245,408 73,136 8,211 422 385,588

Al-Jouf 228,734 103,914 17,075 4,727 - 354,450

Northern 74,841 173,329 1,374 - - 249,544

Kingdom 9,901,729 6,515,162 693,529 3,607,793 128,671 20,846,884

Sources of Household Water

Diarrhoeal cases by age and sex in 1421H (2000)

Age Group Male Female Total % of Total

0-4 Years 115,189 86,356 201,545 73

5 Years and More 42,389 32,124 74,513 23

Total 157,578 118,489 276,058 100

Age Group Male Female Total % of Total

0-4 Years 1,538,508 1,476,477 3,014,985 14.5

5 Years and More 9,776,458 8,055,441 17,831,699 85.5

Total 11,314,966 9,531,918 20,846,884 100

Age Group Male Female % of Total

0-4 Years 74.5 58.5 66.8

5 Years and More 4.3 4.0 4.2

Total 13.9 12.4 13.2

Population by age and sex in 1421H (2000)

Rate of diarrhoeal cases by age and sex in 1421H (2000)(cases per 1,000 of population)

Incidents of water-borne related diseases

Diarrhoeal Cases by result of treatment in 1421H (2000)

Result of Treatment Number of Cases %

Improved 251,923 91.3

Admitted to hospital 5,990 2.2

Death 1 0.0003

Unknown 18,144 6.6

Total 276,056 100


Reported Cases of Diarrhoeal Related Diseases in KSA for the year 2000

Year Diseases Cases Salmonellosis Shigellosis

1996 Reported cases 2349 925

Incidence rate per 100,000 12.80 5.04










Reported cases of diarrhoeal related diseases in KSA during the period (19996-2000)


Reported monthly cases of diarrhoeal related diseases in KSA during for the 2000


Reported cases of environmental health related diseases by region for 2000

Region Amoebic dysentery

Typhoid & Paratyphoid

Shigellosis salmonellosis Hepatitis A

Riyadh 96 52 78 320 164

Makkah 2058 60 72 106 656

Madinah 19 32 9 33 189

Eastern 246 73 120 1321 195

Qassim 94 17 25 39 98

Asir 419 76 1 35 254

Hail 29 40 1 0 10

Al-Baha 0 3 0 34 8

Tabuk 75 28 90 92 176

Jazan 98 22 1 2 100

Najran 80 2 74 143 202

Al-Jouf 30 3 29 1 78

Northern 0 12 1 1 20

Kingdom 3244 420 501 2045 2250


Key messages• Outbreaks of waterborne disease may affect large numbers of persons, and

the first priority in developing and applying controls on drinking-water quality should be the control of such outbreaks.

• failure to detect outbreaks is not a guarantee that they do not occur; nor does it suggest that drinking-water should necessarily be considered safe.

• Contaminated drinking-water lead to severe and sometimes life-threatening disease. Examples include typhoid, cholera, infectious hepatitis (caused by hepatitis A virus [HAV] or HEV) and disease caused by Shigella spp. and E. coli O157. Others are typically associated with less severe outcomes, such as self-limiting diarrhoeal disease (e.g., Norovirus, Cryptosporidium).

• sensitive subgroups (e.g., the young, the elderly, pregnant women and the immunocompromised) in the population may have a greater probability of illness or the illness may be more severe, including mortality.

• Not all infected individuals will develop symptomatic disease.

Water-related diseases

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