5.1.2 incidence of water borne diseases in states of...

Quality of Water and Water Related Diseases in Urban Areas

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5.1.2 Incidence of water borne diseases in states of India

The water borne diseases in India are occurring over the years despite various water

quality management plans by the Government of India. Regardless of the initial

water quality, unhygienic practices during collection, storage and consumption led to

diarrhea causing germs and other water related diseases (Montogomery A and

Elimlech M, 2007).

Incidence of water borne diseases in some selected states of India is presented

in table 5.2. There is a wide range of water borne diseases like diarrhea, cholera,

malaria, Japanese encephalitis, hepatitis, dengue, enteric fever etc. But here due to

some constraints, comparative data of some water related diseases was not available.

Diarrhea is one of the most occurring diseases in most of the states of India.

There were 8,501 thousand diarrhea incidences in various states in 1998 which

decreased to 8,414 thousand in 2006 with a fall of 1.02 percent change. Main states

affected due to diarrhea were Andhra Pradesh, Delhi, Gujarat, Haryana, Karnataka,

Kerala, Madhya Pradesh, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Uttar

Pradesh and West Bengal.

Malaria had 1668 thousand incidents in 2001 which decreased in 2005 to

1537 thousand. The states affected with malaria were Andhra Pradesh, Assam, Bihar,

Delhi, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Madhya Pradesh,

Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, West Bengal

and Uttarakhand. The water quality policies were successful in bringing down the

malaria incidences by 7.8 percent.

Hepatitis is also one of the water related disease. It was reported that there

were 140 thousand incidences of hepatitis in 2000-01, which fell to 129 thousand in

2006. The states affected by this particular disease were Andhra Pradesh, Gujarat,

Haryana, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Punjab,

Rajasthan, Tamil Nadu, Uttar Pradesh and West Bengal. Governments of various

states were successful enough in bringing down hepatitis incidences as there was a

fall of 7.8 percent in hepatitis incidences in the country collectively.

Table 5.2 was a collective presentation of incidences of various diseases in

different years in different states. Table 5.3 presents incidence of water borne

diseases in particular states in different years.


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Table 5.2: Trends in the incidence of water borne diseases in selected states of

India

Disease Incidence

(in thousands)

Percentage

change

States affected

1. Diarrhea 8501

(1998)

8414

(2006)

-1.02 Andhra Pradesh, Delhi, Gujarat,

Haryana, Karnataka, Kerala, Madhya

Pradesh, Maharashtra, Orissa,

Punjab, Rajasthan, Tamil Nadu,

Uttar Pradesh, West Bengal

2. Malaria 1668

(2001)

1537

(2005)

-7.85 Andhra Pradesh, Assam, Bihar,

Delhi, Gujarat, Haryana, Jharkhand,

Karnataka, Kerala, Madhya Pradesh,

Maharashtra, Orissa, Punjab,

Rajasthan, Tamil Nadu, Uttar

Pradesh, Uttarakhand, West Bengal

3. Hepatitis 140

(2000-

01)

129

(2006)

-7.85 Andhra Pradesh, Gujarat, Haryana,

Karnataka, Kerala, Madhya Pradesh,

Maharashtra, Orissa, Punjab,

Rajasthan, Tamil Nadu, Uttar

Pradesh, West Bengal

Note: Figures in brackets shows the years of study.

Source: 1. MoHFW, GOI, 2006

2. National Health Profile 2006, CBHI, DGHS – MoHFW 3. MoHFW, GOI, Annual Report, 2002-03

Andhra Pradesh had 18, 52, 642 incidences of diarrhea in 1998 which fell to

12, 15,659 in 2006. Malaria cases were 57,735 in 2001 which dropped to 39,099 in

2005 and hepatitis cases too bowl down to 17,846 in 2006 from 27,595 in 2000-01.

This shows that although there were a large number of various water related diseases

in Andhra Pradesh, but the government had been successful enough in bringing down

the incidences over the years.

Diarrhea cases had fallen in 2006 in comparison to 1998 in Andhra Pradesh,

Delhi, Haryana, Kerala, MP, Maharashtra, Orissa, Punjab and Uttar Pradesh while

the incidences had increased in Gujarat, Karnataka, Rajasthan, Tamil Nadu and West

Bengal. West Bengal had a different case as there were 7, 20,352 diarrhea incidences

in 1998 which increased to an astonishing figure of 26, 22,968 incidences in 2006.

Malaria incidences too had increased in West Bengal. Other states in which

malaria incidences had increased from 2001 to 2005 were Gujarat, Haryana,

Jharkhand, Kerala, Punjab, Tamil Nadu, Uttar Pradesh, and Uttarakhand. While the

states of Andhra Pradesh, Assam, Bihar, Delhi, Karnataka, Madhya Pradesh,

Maharashtra, Orissa and Rajasthan had reportedly less incidences of Malaria in 2005

as compared to 2001.


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Table 5.3: Incidence of water borne diseases in major states of India

States Diarrhea Malaria Hepatitis

1998 2008 Percentage

change

2001 2005 Percentage

change

2000-01 2006 Percentage

change

Andhra Pradesh 1,852,642 1,215,659 -34.38 57,735 39,099 -32.27 27,595 17,846 -35.32

Assam 596,176 - - 95,142 67,885 -28.64 - - -

Bihar N.R. - - 4,108 2,733 -33.47 - - -

Delhi 133,089 94,398 -29.07 1,484 1,133 -23.65 4,007 4,080 1.82

Gujarat 207,027 382,056 84.54 81,347 179,023 120.07 3,982 9,396 135.96

Haryana 375,113 285,342 -23.93 1,202 33,262 2667.22 1,086 3,983 266.76

Jharkhand - 14,752 130,784 193,144 47.68 - 51

Karnataka 674,805 939,221 39.18 197,625 83,181 -57.90 24,571 14,980 -39.03

Kerala 550,768 475,510 -13.67 2,289 2,554 11.57 5,521 7,018 27.11

Madhya Pradesh 479,073 318,935 -33.42 183,118 104,317 -43.03 6,620 2,499 -62.25

Maharashtra 1,098,750 695,723 -36.67 56,043 47,608 -15.05 40,962 43,215 5.5

Orissa 793,442 373,748 -52.89 454,541 396,573 -12.75 14,011 2,687 -80.82

Punjab 196,398 182,451 -7.10 604 1,883 211.75 1,796 3,829 113.19

Rajasthan 211,710 318,169 50.28 129,233 52,286 -59.54 1,601 3,869 141.66

Tamil Nadu 47,367 116,062 145.02 31,551 39,678 25.75 1,740 4,523 159.94

Uttar Pradesh 564,587 284,709 -49.57 94,524 105,303 11.40 988 3,716 276.11

Uttarakhand - 94,746 - 1,196 1,242 3.84 - 3,381 -

West Bengal 720,352 2,622,968 264.12 145,053 185,964 28.20 5,831 7,433 27.47 NR: Not reported

Source: 1.Ministry of Health and Family Welfare, GOI, 2006

2. National Health Profile 2006, CBHI, DGHS-MoHFW 3. MoHFW, GOI, Annual Report 2002-03


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Hepatitis cases too had a downfall from 2000-01 to 2006 in the states of

Andhra Pradesh, Karnataka, Madhya Pradesh and Orissa, while in most of the states

the incidence of hepatitis had increased in 2006 as compared to 2000-01.

Apart from these diseases, the incidences of cancer deaths in Punjab are much

higher than the accepted national and international averages. World Health

Organization (WHO) reference regarding incidences of cancer was 80 affected

persons from the population of one lakh while Punjab‘s survey revealed this figure as

90 affected persons from the population of one lakh (The Indian Express,

Chandigarh, Tuesday, Jan. 29, 2013, 2:03 hrs.). A survey was conducted by Punjab

Government in 2012 wherein it was revealed that 33,318 cancer deaths have occurred

during last 5 years, out of which 14,682 were in Malwa region alone. As many as

4,000 of these deaths happened in Ludhiana.

5.1.3 Perception of households about the quality of water in various cities

The perception of households about the quality of water being supplied by municipal

corporations in different cities is shown in Table 5.4. Collectively taken, all 7 cities,

approximately 3 percent households reported that water is ‗not safe at all‘, 5 percent

opined that water was ‗not so safe‘, 21.3 and 28.4 percent respondents, respectively

reported that water was ‗somewhat safe‘ and ‗quite safe‘. Only around 26.0 percent

households have the idea that water supplied by municipal taps was ‗very safe‘.

While 16.8 percent respondents have shown their inability to say anything about the

quality of water.

Contamination of municipal tap water has been a common problem in

majority of the cities of India. Only about 1 percent respondents of Kanpur, state that

water was very safe, while 57 percent respondents of Hyderabad city have the

perception that water was very safe.

Very small portion of the respondents of Mumbai reported that water was not

safe at all, while 3 percent each of Delhi, Kolkata and Hyderabad respondents were of

the same opinion. It seems that Kanpur respondents were more conscious for the

quality of water being supplied by municipal taps as 10 percent respondents say that

water was not safe at all for consumption and approximately 13 percent say that water

was not so safe and 46 percent respondents were unable to say anything about the

quality of municipal water.


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Table 5.4: Perception of households about the quality of water in various cities: 2007 (percentage of households)

Safety level All cities Delhi Mumbai Kolkata Hyderabad Kanpur Ahmadabad Madurai

Not safe at all 2.90 2.96 0.20 3.25 2.76 9.90 1.11 1.89

Not so safe 5.00 6.71 2.40 6.50 3.02 12.54 2.49 1.89

Somewhat safe 21.30 30.97 28.40 24.25 12.06 20.46 7.20 21.13

Quite safe 28.40 30.97 31.80 15.50 22.36 10.23 43.49 47.55

Very safe 25.60 20.51 33.60 24.25 57.04 0.99 9.14 26.04

Cannot say 16.80 7.88 3.60 26.25 2.76 45.88 36.57 1.50

Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Source: Shaban and Sharma, 2007


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Approximately, 48 percent respondents of Madurai reported that water was

quite safe while 43, 32, 31, 22, 15 and 10 percent respondents of Ahmadabad,

Mumbai, Delhi, Hyderabad, Kolkata and Kanpur, respectively have the perception

that water was quite safe for consumption.

Water quality standards prescribe the maximum allowable limit for various

pollutants in drinking water. Beyond that limit, water is not considered good for

consumption. Although, most of the respondents were not aware of these limits, these

perceptions and observations were general in nature.

5.1.4 Level of satisfaction with quality of water supply in different localities of

Delhi

The level of satisfaction with quality of water supply ranges from satisfied, fairly

satisfied and not satisfied. All the respondents of Ambedkar Nagar, a resettlement

colony were satisfied with the quality of water supply (Table 5.5) and all the

respondents were paying for water supply. So here it seems that there is a direct

association between quality of water and payment made.

Next to that, 70, 40, 20 and 5 percent respondents each of Bhagat Singh Park,

Bhalsawa, Rajeev Nagar and BD Patil Nagar, respectively were satisfied with the

quality of water supply, while none of the respondents of these colonies were paying

anything for water supply. None of the respondents of Sanjay Colony were satisfied

with the quality of water.

As opposed to that 90 and 60 percent respondents of Bhalsawa and Samaipur

Gaon made payment for water supply and their level of satisfaction was 30 and 15

percent, respectively.

Approximately 85 percent respondents of Sanjay Colony were dissatisfied

with the quality of water supplied by municipal taps. 80 percent respondents each of

BD Patil Nagar and Samaipur Gaon were dissatisfied and 55 percent respondents

each of Bhalsawa and Bhalaswa Gaon respectively were not satisfied with the quality

of water supply. While only 20 percent respondents of Bhagat Singh Park were not

satisfied with the quality of water being supplied by municipal taps.


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Table 5.5: Level of satisfaction with quality of water supply: 2005 (Percentage of households)

Level of

satisfaction

BD Patil

Nagar

(JJ Cluster)

Rajeev Nagar

(Unauthorized

Colony)

Bhalsawa

(Resettlement)

Bhalsawa

Gaon (Urban

Village)

Sanjay

Colony

(JJ Cluster)

Bhagat Park

(Unauthorized

Colony)

Ambedkar

Nagar

(Resettlement)

Samaipur

Gaon

(urban)

Satisfied 5.00 20.00 40.00 30.00 0.00 70.00 100.00 15.00

Fairly

satisfied

15.00 10.00 5.00 15.00 15.00 10.00 0.00 5.00

Not

satisfied

80.00 70.00 55.00 55.00 85.00 20.00 0.00 80.00

Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Source: Singh and Shukla, 2005


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Source: Singh and Shukla, 2005

0

20

40

60

80

100

BD Patil Nagar (JJ

Cluster)

Rajeev Nagar

(Unauthorised

Colony)

Bhalsaswa

(Resettlement)

Bhalsaswa Gaon

(Urban Village)

Sanjay Colony (JJ

Cluster)

Bhagat Park

(Unauthorised

Colony)

Ambedkar Nagar(

Resettlement)

Samaipur Gaon

(urban)

Per

cen

tag

e o

f h

ou

seh

old

s

Colonies

Fig. 5.1: Level of satisfaction with quality of water supply: 2005 (Percentage of households)

Satisfied Fairly satisfied Not satisfied


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5.1.5 Water quality status: Results of sample surveys

A sample study in selected cities was carried out for 6,430 households. Seven

hundred and eighty seven representative water samples were collected from the

selected cities to know the quality of water. The selected samples were analyzed for

the fifteen* drinking water parameters (Raju et al, 2007).

In Hubli, 250 water samples were analyzed, out of which 98 i.e.

approximately 39 percent samples were non-potable and 17 wards of Hubli were

affected from various contaminants. Further, in Dharward 200 water samples were

analyzed, from which 16 wards were supplied contaminated water as 45 percent

samples were not fit for consumption.

Table 5.6: Water quality status: 2007 (Results of sample study in selected cities)

Cities Number of

samples analyzed

Number of non-

potable samples

Total number of

wards affected

Hubli 250 98 (39.2) 17

Dharwad 200 90 (45.0) 16

Belgaum 200 41 (20.5) 17

Kolar 137 133 (97.08) 31 (all wards)

Source: Raju et al., 2007

Figures in brackets are percentages

Kolar was having a very depressive story as out of total 137 water samples,

133 i.e. approximately 97 percent water samples were contaminated with excess

fluoride and all wards of Kolar were affected from pollutants. Belgaum wards were

too affected with excess fluoride. Out of total water samples analysis, 20.5 percent

samples were found to be non-potable.

5.1.6 Quality of potable water in Ludhiana city

Potable water of Ludhiana city was tested for quality and the testing report was

carried out on July 21st, 2006. It was found that actual pH level in water was 7.05

whereas 6.5 to 8.5 was the desirable limit. The presence of total solids per milligram

(mg) in one liter of water was 380 wherein the desirable limit was 500 mg/l and

permissible limit was 2000 mg/l. Alkalinity levels in per mg per liter of water was

332, the desirable and permissible limits were 200 and 600 mg respectively (Table

5.7).

* Turbidity, colour pH, electricity conductivity, total dissolved solids, chloride, sulphate, fluoride, nitrate, calcium, magnesium,

sodium, iron and alkalinity and bacteriological parameters Most Portable Number(MNP)


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Total hardness in water was also below than the desirable and permissible

limits prescribed by the Bureau of Indian Standards- 10500: 1991. The presence of

chloride was much less than the desirable and permissible limits i.e. there was only

30 mg/ l of chloride present in drinking water while desirable and permissible limits

were 250 and 1000 mg/l respectively.

Table 5.7: Quality of potable water as per testing report conducted in

Ludhiana: 2006

Parameter Actual Value Desirable Limit Permissible

Limit

pH 7.05 6.5 to 8.5 No relations

Total Solids (mg/l) 380 500 2000

Alkalinity (mg/l) 332 200 600

Total Hardness (mg/l) 210 300 600

Chlorides (mg/l) 30 250 1000

Sulphate (mg/l) 20 200 400

Nitrate (mg/l) 7.0 50 No relation

Fluoride (mg/l) 0.6 1 1.5

Faecal Coli (MNP/100

ml)

Nil _ _

Source: City Development Plan, Ludhiana, 2006

Sulphate was found to be only 20 mg/l in the drinking water, while the

desirable and permissible limits for the same were much higher as of 200 and 400

mg/ l respectively. The desirable limit for nitrate was 50 mg/ l while actually the

presence of nitrate in the drinking water was 7.0 mg/l. Fluoride concentration was

there in the potable water of 0.6 mg/l while the desirable and permissible limits for

fluoride presence were 1.0 and 1.5 mg/l respectively. Faecal coli was found to be

absent in the water quality testing report of drinking water in Ludhiana.

5.1.7 Water quality in Ludhiana City: Results of sample analysis

The water sampling report of Ludhiana city for the period of January 2011 to May

2012 i.e. for approximately one and half year and was collected from Civil Surgeon

Office, Ludhiana (Table 5.8). During January to December 2011, total 809 water

samples were collected, out of which only 538 were found to be potable and 268


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failed while the result was awaited for 3 samples till date. During January to May

2012, 271 water samples were collected out of which 65 failed and 206 were potable.

Thus during this period, total 1080 samples were collected wherein 333 failed and

744 were potable. So this shows that the status of water quality is deteriorating with

each passing day.

Table 5.8: Water sampling report of Ludhiana city for the period January

2011 to May 2012

Period Water Samples

Collected

Potable Failed Result

Awaited

Jan. to Dec. 2011 809

(100.00)

538

(66.50)

268

(33.12)

03

(0.38)

Jan. to May 2012 271

(100.00)

206

(76.01)

65

(23.99)

00

(0.00)

Total 1080

(100.00)

744

(68.88)

333

(30.84)

03

(0.28)

Source: Civil Surgeon Office, Ludhiana, 2012

5.1.8 Water borne diseases in Ludhiana district

Water borne diseases are spreading at a very fast rate both in rural as well as in urban

areas. It is of great concern for the governments of different States/ UTs. An

Integrated Disease Surveillance Programme (IDSP) has been started by the

government and in Ludhiana district IDSP had collected the incidences of various

water borne diseases (Table 5.9).

Table 5.9: Water borne diseases in Ludhiana district for the period January

2011 to May 2012

Period Acute

Diarrhea

Cholera Hepatitis A

and E

Typhoid Total

Jan. to Dec. 2011 18258 07 607 6298 25170

Jan. to May 2012 9142 00 336 2491 11969

May 2012 2243 00 47 526 2816

Total 29643 07 990 9315 39955

Source: Integrated Disease Surveillance Programme Office, Ludhiana, 2012

Mostly diarrhea, cholera, typhoid and hepatitis A and E occur due to non-

potable water. In 2011, around 18258 diarrhea, 6298 typhoid, 607 hepatitis A and E

and 7 cases of cholera were reported. From January 2012 to May 2012, 9142


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diarrhea, 2491 typhoid, 336 hepatitis A and E were reported. Thus it made a total of

11969 cases of water borne disease in a period of 5 month. But if we analyze the

status of only one summer month i.e. May 2012, then it came to light that in just one

month total 2816 cases were reported which showed that the outbreak of water

related disease is high in summer season.

Source: Integrated Disease Surveillance Programme Office, Ludhiana, 2012

In brief, water quality problems are due to pollution of surface or

groundwater. The over- exploitation of groundwater leads to contamination of water

and serious health problems crop up. The unsafe water causes various water borne

diseases like diarrhea, malaria, cholera, skin infection, tuberculosis, etc. These

incidences have been increasing year by year thus putting great stress on the health of

the masses. Still many states suffer from the supply of contaminated water and this

has led to spread of water borne diseases. So to provide safe drinking water to people

various government institutions and departments are functioning so as to monitor the

quality of water. But still the investment in water supply and sanitation sector and

various pollution control boards does not coextensive with the health benefits. So

there is a need to pump in more resources in the supply of the drinking water in the

urban areas with special emphasis on the weaker sections of the society.

0

4000

8000

12000

16000

20000

Jan. to Dec. 2011 Jan. to May 2012 May-12

No

. o

f d

isea

ses

Time period

Fig. 5.2: Water borne diseases in Ludhiana district for the

period January 2011 to May 2012

Acute Diarrhea

Cholera

Hepatitis A and E

Typhoid

5.1.2 incidence of water borne diseases in states of...

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