Hope says two million people die due to water born diseases annually

Sunil C. Perera in Colombo
Chairman of the Hopes International Charity Indra Deva Adithya says 1.1 billion people lack access to clean drinking water, and nearly 2 million people die each year due to waterborne-related disease (90% of which are children under the age of 5.) By providing a source of clean, safe drinking water to those in need, we are preventing waterborne disease and circumventing the need to treat it. For those without access to doctors and antibiotics, this prevention is literally life saving.She explained these details according to their recent survey on water born diseases and said the second biggest killer of children in the world is neither malaria, nor tuberculosis, nor AIDS - its diarrhoea.
In the past 10 years diarrhoea has killed more children than all the people lost to armed conflict since World War II.
In 1998, 308,000 people died from war in Africa, but more than two million (six times as many) died of diarrhoeal diseases.
In China, India and Indonesia twice as many people are dying from diarrhoeal diseases as from HIV/AIDS
The World Health Organization (WHO) estimates that diarrhoea and respiratory infections are responsible for two thirds of child deaths.
UNICEF estimates that diarrhoea alone kills one child every 30 seconds.

Millennium Development Goals
4. Reduce child mortality
6. Combat HIV/AIDS, malaria and other diseases
Causes of Diarrhoea
The prevention of microbiological contamination in water is the measure likely to have the greatest impact. Microbiological contamination in water means contamination by disease-causing organisms (pathogens).

Preventative measures

There are many high cost methods being used to prevent diarrhoeal diseases: the promotion of breastfeeding, adequate complementary feeding, measles immunization, safe water supply, and safe faeces disposal.
Improved water quality reduces childhood diarrhoea by 15-20% and better hygiene through hand washing and safe food handling reduces it by 35% Hand washing .
A recent study in 2003 suggests that hand washing with soap, particularly after contact with faeces reduces diarrhoeal incidence by 42-47 percent, while other ongoing work suggests a 30 percent reduction in respiratory infections is possible through hand washing.
In developing countries most households have soap but only 15-20% of people routinely use it to wash their hands at appropriate times. The cause of low hand washing rates is rarely a lack of soap. Soap is present in the vast majority of households worldwide, but it is commonly used for bathing and laundry, not hand washing. Lack of water is usually not a problem either, as hands can be effectively washed with little, or recycled, water. In studies around the world, the main reason given why rates of hand washing with soap are so low is that it is simply not a habit.
Approximately one sixth of the world population - a total of 1.1 billion people - remain without access to a clean water supply, however studies have shown that hand-cleansing with soap improves hand cleanliness even when contaminated water is used or hands are dried on clothing.
When hygiene promotion is combined with access to improved water supply and sanitation, the estimated cost is only US$ 3 per household per year for each averted case of diarrhoea in children under five. When no water and sanitation facilities are provided, the cost of promoting good hygiene is obviously higher. However, it costs only US$ 6 per household per year to keep a child free from diarrhoea when hygiene is improved without the costs of hardware.
Due to the fact that hand washing can prevent the transmission of a variety of pathogens, it may be more effective than any single vaccine. Promoted on a wide-enough scale, hand washing with soap could be thought of as a ‘do-it-yourself’ vaccine.

Public-Private Partnerships

Because both the public and private sectors have an interest in promoting hand washing, country programs usually take the form of a public-private partnership (PPP). While the public sector can be wary of working with industry and the private sector sceptical that working with government would produce significant results, both sectors stand to gain from cooperation.
(Used in Guatemala effectively - Following the introduction of the Guatemalan Handwashing Initiative in 1998, there were 322,000 fewer cases of diarrhoea each year amongst the 1.5 million children under 5 nationwide in the country's lowest income groups)
SODIS, Solar Water Disinfection
An estimated 1.1 billion people rely on unsafe drinking-water sources. Even more are likely to be using microbiologically contaminated water if one takes into account re-contamination during water collection and transport, the use of unsafe storage vessels and poor hygiene.
The following technologies are regarded as ‘improved water supply’: household connection, public standpipe, borehole, protected dug well, protected spring, rainwater collection. The water quality in improved water supply systems often is affected from unreliable operation and lack of maintenance, or the water is subject to secondary contamination during collection, transport and storage. So while the countries in the world that are now classified as having improved water supply do have access to water, more efforts are required to make that water safe for drinking.
SODIS, Solar Water Disinfection, improves the microbiological quality of drinking water, using solar UV-A radiation and temperature to inactivate pathogens causing diarrhoea
The Method
The Solar Water Disinfection (SODIS) process is a simple technology used to improve the microbiological quality of drinking water. SODIS uses solar radiation to destroy pathogenic micro-organisms which cause water borne diseases. SODIS is ideal to treat small quantities of water. Contaminated water is filled into transparent plastic bottles and exposed to full sunlight for six hours.
Sunlight is treating the contaminated water through two synergetic mechanisms: Radiation in the spectrum of UV-A (wavelength 320-400nm) and increased water temperature. If the water temperatures raises above 50°C, the disinfection process is three times faster.
Benefits
Uses solar radiation to clean biologically infected drinking water. Uses cheap, readily available containers such as clear glass or plastic bottles or bags. No or extremely low costs. Ideal for household quantities. Traditional and tested historical method. Saves on electricity bills as it is used a substitute for boiling water to remove bacteria. Needs clear water, turbid water must be filtered to remove particles. Needs daylight from clear or cloudy sky. Needs organized exposure of containers. Exposure time varies depending on latitude and strength of daylight. A survey assessing the socio-cultural acceptance of SODIS revealed that users appreciate the sustainable and simple water treatment method. An average of 84% of the users stated that they will certainly continue to use SODIS after the conclusion of the demonstration projects. About 13% of the users consider to maybe use it in the future, while only 3% refuse to use SODIS as their health is not affected by the present water quality
Promotion of SODIS

Who are the promoters?
The promoters are the contact persons between the local population and the institution that wishes to disseminate SODIS. The promoters transmit the knowledge on SODIS and they are the ones to verify the correct application of the method.
What do the promoters do?
The promoters teach the correct application of Solar Water Disinfection. By regularly making home visits, the promoters check the application of SODIS and correct possible mistakes made by the users.
What kind of knowledge must the promoters have?
As SODIS is a method to improve the quality of drinking water, it is important, that the promoters have good knowledge about all issues related with water and sanitation. They must be able to explain local communities the relation between the quality of drinking water, safe handling of water, contamination of water, disposal of excreta, and the effects on health. The promoters must have knowledge on water sources and water distribution systems and the problems connected with maintenance. They must understand different methods and possibilities to disinfect drinking water at central or household level and know the advantages and disadvantages of the different water treatment methods.

What kinds of qualifications are required from a promoter?
As the promoters are the ones who are in direct contact with the population, they must have a very good and clear understanding of SODIS and general hygiene practices. They must be able to transmit their knowledge to people with little or no school education. Therefore it is important that the promoters are familiar with the local community and have a good relation with the people. They must be able to speak the local language, have good communication skills and an active personality. The promoters have to be able to start and guide group discussions.
Practical examples
In the 1990s Conroy conducted health impact studies with Maasai communities in Kenya and found a 16% reduction of diarrhoeal illnesses among children under 5 and a 24% reduction of severe diarrhoea among children of families that used SODIS treated water
A study in Bolivia in 2003 showed that the consumption of SODIS treated water has a significant impact on health: children of families regularly using SODIS, had 35% less diarrhoea
Health centres of the local government in East Lombok, Indonesia introduced SODIS in more than 60 villages during 20 months (2003-2004). Two thirds of the population, 80,000 people, now use SODIS for the treatment of their drinking water. Water quality tests have shown that the average contamination with E.coli of 164 CFU/ 100ml has been reduced to an average contamination of 4 CFU/ 100 ml. The data on diarrhoea incidence gathered by the health centres showed that diarrhoea in the local population has been reduced by 73%.
The Nepalese NGO ENPHO disseminates SODIS since 2002 in the Kathmandu valley and the Terai flatland of Nepal. A diarrhoea reduction of about 50% among children below 5 years was achieved among the 5000 families trained in SODIS. A similar effect was observed during a health study among children below 5 years in Uzbekistan. Children of SODIS users had a reduction of diarrhoea incidence of 53%, whereas in the control group the occurrence of diarrhoea illnesses increased.
SODIS health impact study was implemented from February to August 2002 in the urban slum in Vellore, Tamil Nadu. The research team assessed diarrhoeal morbidity in children under 5 years. 100 children were assigned to drink SODIS treated water. The diarrhoea incidence of SODIS users was reduced by 40% as compared to the 100 children within the control group
Why use both?
Interventions simultaneously addressing different contamination routes such as water- or surface transmission as well as secondary contamination, are more effective. Furthermore, if general hygiene education is disseminated at the same time as the technology, other main transmission routes such as person-to-person and food borne transmission can be prevented. Multiple interventions can thus achieve a considerable effect on the population’s health.
Hygiene education messages should be positive and build on the local cultural knowledge, beliefs and values. Before people adopt a new hygiene practice, they will ask themselves how the new practice fits into their ideas and affects their lives. They will adopt a new practice, if they believe that the practice has net benefits for health or other benefits, and if they consider these benefits to be important.
Connection with preventing Acute Respiratory Infections (ARIs)

Cause nearly 4 million deaths each year yet approaches to preventing deaths have been curative as opposed to preventative. Need to focus on reduction in transmission of the infections not just in treatment.
The link between diarrhoeal diseases and ARIs is that the pathogens which cause diarrhoea can also cause respiratory symptoms. This is true particularly of the enteric viruses, such as those which cause ‘gastric flu’. The second connection is that both respiratory and enteric pathogens are often transmitted on surfaces and that the surface we most often use to inoculate ourselves with infection is the skin of our hands.
The link between hand washing and ARI is more than a hypothesis for speculation. A quick search of the literature found six studies, all showing that hand washing reduced the risk of ARIs to a significant degree. However, all were conducted in industrialized countries

Strategy
Promotion of appropriate hand hygiene is complex. Successful promotion in health-care settings requires system change, education and motivation of caregivers, leadership, administrative support, and, in some instances, empowerment of patients. Multimodal interventions have more chance of success than programmes focusing on a single element and have sustained effects, for example: intensive ongoing education and encouragement, distribution of free soap, and focused group discussion.
End