WASH Training

INTRODUCTION
 Safe Drinking
Water and
Sanitation
Water is essential for life. An adequate, safe
and accessible water supply must be
available to all people, and improving
access to safe drinking water can result in
tangible benefits to health.
Water is one of the factors which contribute
to the transmission of many diseases.
 The public health importance
of water
We begin this study session by describing the
public health significance of water.
A satisfactory water supply must be available
to all humans.
By ‘satisfactory’ we mean water must be
available in adequate quantity, be safe to drink
and be accessible.
Improving access to safe drinking water can
result in tangible benefits to health so every
effort should be made to achieve drinking
water quality that is as safe as is practicably
possible.
The great majority of water-related health
problems are the result of microbial
(bacteriological, viral, protozoan or other
biological) contamination.
Infectious waterborne diseases such as diarrhoea
typhoid and cholera are leading causes of death
and illness in the developing world.
There are many diseases associated with water,
which can be classified as waterborne,
waterwashed, water-based and water-related .
 Water sources
Water source simply means water in its
natural environment that is used by people
to meet their need for water.
Common water sources are groundwater,
surface water such as rivers and lakes,
spring water, and rainwater.
Water sources can be described as protected or
unprotected. Unprotected sources are those
where there is no barrier or other structure to
protect the water from contamination. Protected
sources, on the other hand, are covered by
stonework, cement or other material that prevents
the entry of any physical, chemical or biological
contaminant.
Water from a protected source is likely to be safe
to drink but water from unprotected sources
cannot be considered safe.
 The uses of safe water
13.2.1 For drinking
All individuals need water for drinking every
day. Inadequate consumption of water, either
by drinking or through food, can lead to
dehydration of the body and ultimately to
death.
The water requirement of individuals for
drinking and food preparation will vary
according to diet, climate and the type of work
they do.
Pregnant women and breastfeeding mothers
need more water than other people.
 The minimum amount of water needed for
survival ranges from about 2 litres per capita pe
day in temperate climates to about 4.5 litres for
people in hot climates who have to carry out
manual work.
For food preparation and cooking
Water is an ingredient of many foodstuffs and is
also needed for food hygiene to make certain that
food is safe to eat. Most people need at least 2
litres of safe water per day for food preparation.
 Introduction

WASH

TRAINING

Continue Part 2
For hygiene
Providing safe water and encouraging people to
practise good hygiene will achieve massive healt
benefits.
For example, the Shigella bacterium causes
dysentery or bloody diarrhoea and it is a major
contributor to the millions of water-related death
each year.
However, the simple step of washing hands
with soap and water will significantly
reduce shigellosis and other diarrhoeal
diseases.
Moreover, providing clean water for washing
can prevent trachoma, which is the leading
cause of preventable blindness.
Sufficient quantity
According to international and national
guidelines, the quantity of water available in each
household should be 50–100 litres per person per
day, or an absolute minimum of 20 litres. In
practice, the amount of water collected every day
by households is considerably less than this and
is largely determined by the distance of the
source of water from the home. If the water
source is outside the home, but within around 1
kilometre (or 30 minutes total collection time),
about 20 litres per person per day will typically
be collected.
Where water is supplied through a single tap
within the confines of the household’s living
area, the water used is typically about 50 litres
per person per day.
At this level it is much easier to ensure good
hygiene.
For example, households may use 30 times
more water for child hygiene compared with
those who have to collect water from a
communal source..
• Households that do not have to travel to collect
water have more time for economic activity, food
preparation, child care and education. Having
access to a greater volume of water potentially
encourages hand washing, general physical
cleanliness and improved living conditions
 Safe and acceptable
Safe and acceptable
Water must be safe for drinking and other
household uses.
Drinking water must be free from microbes
and parasites, and free from chemical and
physical contaminants that constitute a danger
to a person’s health. It must also be acceptable
in terms of colour and odour.
Animals come to the river to drink at the same place as the women collect the
water.
Future impacts on provision of
water
• Rapid population growth puts increasing
pressure on our limited resources. The
percentage of young children is increasing
within the Somalian population.
This means an increase in the proportion of
the total population at highest risk from
infectious waterborne diseases
(gastrointestinal illnesses disproportionately
affect the health of the very young and very
old).
 The general increase in population means that
more and more land is brought into use to
support the growing number of people. This
can have a serious impact on the environment
and also on water resources. There is a close
relationship between land use, and water
quality and quantity.
If land is cleared of natural vegetation, water
will run off the surface more quickly and will
not soak into the soil.
This not only reduces the amount of soil
water available for plant growth it also
reduces replenishment of groundwater
reservoirs.
The water flows off into rivers before it has
penetrated into the ground.
The increased runoff resulting from loss of vegetation
also causes soil erosion, especially in the rainy
season, because the soil is washed away into the
rivers.
Erosion is especially likely on slopes and where the
ground is ploughed, which loosens the surface layers
The eroded soil particles run off into the rivers and
make the water very turbid (muddy).
The loss of natural vegetation, especially forest, also
means a loss of biodiversity, i.e. a reduction in the
number of different types of living organisms of all
types that exist in an area.
Poverty
Poverty is a major cause of public health
problems in Somalia. Although we hope this will
change, in reality it is likely that poverty will be
problem in the future as well.
Poverty makes it difficult for people to access
safe water and find solutions for the sanitation
problems in the country.
Lack of resources, lack of education and limited
political, social and economic influence all have
a significant impact on the provision of safe
water.
 Climate change
Climate change is the name given to the
longterm change in global weather patterns
caused by human activities.
It is a global problem and its effects may
not be easy to see at a local level.
However, it may have an increasingly
important impact on the future provision of
safe water and therefore on human health
and safety.
The effects of climate change could include more
frequent and intense rainfall events that can
mobilise disease-causing organisms and other
contaminants. It could also mean increased
frequency and magnitude of flood events which
would affect the availability of clean water.
On the other hand, it could also mean reduced
rainfall. Climate change could have profound
impacts on the burden of illness associated with
waterborne diseases
Increasing water shortage will lead to an
increase in sickness and death amongst the
populations of developing countries. In Somalia,
although it is difficult to make exact estimates of
the impacts of climate change, declining rainfall
could lead to reduced water sources and
depleted groundwater, climate sensitive disease
could increase, and food insecurity could
become an increasing problem.
Globalisation
Today’s world is becoming a big village in
which people are increasingly mobile and goods
and materials are transported further and faster.
Globalisation has both advantages and
disadvantages.
Infectious and vector-borne diseases associated
with water are moving from place to place in a
shorter time, and pathogens and vectors can also
travel around the globe.
 WASH TRAINING

Part Three

Treatment of Drinking Water at

Introduction
Water has always played a prominent role in human
civilisation.
Water was, and continues to be, needed for
drinking, preparing food, bathing, cleaning,
irrigating crops and a variety of other tasks.
Having ready access to water, therefore, has
always been important.
However, the water sources used for supplying
water were not always clean.
Treating drinking water to improve smell and
taste and to remove disease-causing organisms
has been necessary throughout human history.
Waterborne diseases
Diarrhoea, infectious hepatitis, typhoid and
paratyphoid enteric fever are all examples of
 waterborne diseases that are common
problems in our country. These are all caused
by microbial contamination. Lead poisoning
and fluorosis, caused by chemical
contamination, are also classified as
waterborne diseases
Causes of waterborne disease
outbreaks
There are a lot of possible causes for an
outbreak of waterborne disease.
The use of untreated spring water and surface
water, and inadequately or interrupted
disinfection of surface water, spring water and
well water may all be responsible.
These are all causes associated with the
source of water but other problems can arise at
points in the system after the source.
For example, cross-connections of pipework,
contamination of water in the household,
contamination during the construction of water
source protection, contamination of storage
facilities including private storage tanks are all
contributors.
Consumption of water that was not intended for
drinking, contaminated bottled water and
ingestion of water while swimming are also
possible causes.
Water treatment
The purpose of water treatment is to reduce or
remove all contaminants that are present in the
water and to improve water quality so that it is
completely safe to drink.
Water is unlikely to be completely free of
contaminants at the original source.
The types of water treatment processes depend
on the characteristics of the raw water
(untreated water direct from its source) and
required water quality standards.
Suspended solids, bacteria, algae, viruses, fungi,
minerals such as iron and manganese, and
fertilisers are among the substances that are
removed during water treatment. (Suspended
solids are tiny particles of solid material that are
carried along or suspended in the water.)
Effective treatment should ensure the removal of
all disease-causing agents and so reduce the
possibility of the outbreak of waterborne disease.
 Solar disinfection
Solar disinfection, also known as SODIS, relies
on energy from the sun to kill pathogenic
organisms, especially bacteria. Ultraviolet
light from the sun is an effective bactericide
for water. Turbidity is a measure of the
cloudiness of water. It is caused by very small
particles (suspended solids) that are
individually too small to see with the naked
eye.
This simple technique requires only a few plastic
bottles and sunlight. Firstly, collect several bottles
(0.3 to 2.0 litre) made of clear plastic, remove all
labels and wash them thoroughly.
Fill the bottles with water of low turbidity and
shake for about 20 seconds to aerate the water.
Expose the bottles to the sun by placing them on
a roof or rack for at least six hours (if sunny) or
two days (if cloudy) (see Figures 14.4 and 14.5).
The water is now ready to drink.
 Chemical disinfection methods
There are several commercially
available products designed for treating
water at household level.
Chlorine solution
Chlorine solution, also known as sodium
hypochlorite solution or bleach, is the most
affordable, easiest to produce, and most widely
available chemical for household water treatment.
It is supplied in bottles and has easily interpretable
instructions for use on the side of the bottle.
Typically, the procedure is to add a capful of chlorine
solution to a 25 litre water storage container, then
shake and wait for 30 minutes chlorine contact time
before drinking. Double dosing is advisable if the
water is visibly dirty.
 Aquatabs
Aquatabs are a specifically formulated and
branded solid form of sodium
dichloroisocyanurate (NaDCC) NaDCC is stable
in Aquatabs form as a solid which gives it a longer
shelf life and makes storage, handling and transport
much easier than with liquid bleach. One
Aquatab contains 67 mg of NaDCC and treats 20
litres of clear water. For visibly turbid water, two
tablets per 20 litres are needed. It is very important
to mix well and leave for 30 minutes contact time
before consumption.
Boiling
Boiling is also an optional water treatment at
household level. Boiling is a simple way of
killing any ova (eggs), cysts, bacteria and viruses
present in contaminated water. Water should be
heated until large bubbles are continuously
coming to the surface of the water.
The disadvantage of boiling as a treatment
method is that it requires large amounts of fuel,
so cost may prevent people from using this
method.
Also, boiling may give an unpleasant taste to
the water, which may be unacceptable, and very
hot water can cause accidents in the home.
Boiled water can become recontaminated once
it has cooled.
 Safe storage
Whatever type of treatment method is used, it
is essential that water is stored safely and
hygienically. Even if water has come from an
improved source, this will not guarantee that it
is safe because contamination can occur in the
household due to poor storage and handling
practices.
The principal health risk associated with
household water storage is the ease of
recontamination, particularly where the members
of a family or community do not all follow good
hygiene practice.
Safe storage is especially designed to eliminate
sources of recontamination by keeping objects,
including hands, out of the system.
 Chlorination
Chlorination, used at both household and large-
scale levels, is one of the most effective and
widely used methods for disinfecting water and
making it safe to drink.
Whatever the level, it is important that the
correct quantity of chlorine is added to remove
all impurities
Suppose you have a group of women in your area
who want to know about household water
treatment by chlorine solution, particularly Wuha
Agar. What are the key points you would explain
to them?
Answer
Wuha Agar is a type of chlorine solution that is
commonly available. To use it you add one capful
of Wuha Agar to a 20 litre jerrycan of water,
replace the lid and shake. After 30 minutes of
contact time you can use the water for drinking
and other domestic purposes. This will kill
bacteria and help to reduce diarrhoeal diseases.
A man comes to see you and explains that his
family obtains water from a protected water
source and that it has been treated with chlorine.
He asks you how he can find out whether the
chlorine still protects his family or not. How could
you find out if his water was still safe to drink?
 Answer
You should do the orthotolidine-arsenite test
(OTA) to measure the residual chlorine. The
residual chlorine helps to prevent
recontamination of pathogenic bacteria if it is
between 0.2–0.5 mg/l.