week 1 - introduction to hwts

8/21/2019 Week 1 - Introduction to HWTS

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Introduction to the course

Introduction to Household Water Treatment and Safe Storage, Mo

Dr. Richard Johnston


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Course outline Quizzes and homewor

Course forum

Introduction


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Week 1

Background

Disease

Contamination

Week 2

Water Safety

Sedimentation

Filtration

Week 3

Disinfection

Safe storage

Week 4

Implementation

Strategies

Vulnerable groups

Outline


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In-video quizzes End of week quizzes

Peer-reviewed assignm

Final exam

Quizzes and Homework


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General discussion

Study groups

Lectures

Exercises

Course material errors

Technical issues

Online forums


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End of module

End of week

Summary


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Global Burden of Disease




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Diseases caused by u

and sanitation Water-borne

Water-washed

Water-based

Water-related

Global burden of disea Mortality

Morbidity

Introduction


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8.4 deaths/1,000 55 million people per year

19.9 births/1,000 135 million people per year

About 1.1% increase p Doubling every 60 years

Birth, taxes, and death


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Bradley Classification

Water-borne

Water-washed

Water-based

Water-related

Disease Classification System


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Water-borne diseases

Caused by ingestion

Diarrheal diseases Rotavirus

Cholera, Shigella

Cryptosporidiosis

Hepatitis A and EPolio

Improve water quality


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Water-washed diseases

Caused by poor hyg

lack of water

Most water-borne dise

Trachoma

Acute respiratory infec

Increase water quanti


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Water-based diseases

Caused by parasites

part of their life cycl

Schistosomiasis (bilha

Dracunculiasis (Guine

Target aquatic organis

Protect surface water


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Water-related diseases

Caused by insects w

in water

Malaria

Dengue fever

Remove habitat


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Many diseases are rel

water, sanitation, and h Water-borne diseases

by ingestion of contam

drinking-water

HWTS can reduce bur

borne diseases Not water-washed, water-ba

related diseases

Summary


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Mini-Quiz

Arrange the following five diseases in order of the number of dea

Tuberculosis

Diarrheal dis

Lower respiratory

infections

(e.g. pneumonia)

Mala

Measles


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Mini-Quiz

Source: WHO in 2013 published figures for 2011. Data files

Tuberculosis

Diarrheal disease

Lower respiratoryinfections

(e.g. pneumonia)

Malaria

Measles

976,000

1,894,000

3,203,000

589,000

167,000
http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.htmlhttp://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html


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1.9 million diarrheal de Most important water-borne

3.5% of all deaths 9.3% of under 5 child deaths

Second only to respira

among infectious disea

88% of diarrheal death

by inadequate water, shygiene 2011: Data not yet disag

2004: 1.9 million WASH

2.2 million diarrhea

Diarrheal disease


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Disability Adjusted

Life Years (DALYs)

DALY = YLL + YLD

YLL = Years of Life Lost

Number of deathsStandard

life expectancy at age of death in

years

YLD = Years Lived with Disability

Number of incident cases

Disability weightAverage

duration of the case (years)


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Diarrhea causes 52.5 3.1% of global total

9% of child disease burden

India 13.6 M

China 3.9 M

Nigeria 3.9 M

Pakistan 3.3 M DRC 3.3 M 10% of all DALYs

Diarrheal morbidity

Source:

G 20 0 S


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Global Burden of Disease 2010 Study (IHME)

GDB 2010 S d


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Similar approach to W

Not endorsed by WHO Methods not fully transparen

Lacked full access to results

Some key differences

numbers Revised disability weights

No hygiene risk factor

No disease burden from imp

sanitation

GDB 2010 Study


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http://www.healthmetricsandevaluation.org/g

GDB 2010 St d
http://www.healthmetricsandevaluation.org/gbdhttp://www.healthmetricsandevaluation.org/gbd


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1.5 million diarrheal de

89.5 million DALYs India 27 M

DRC 6.4 M

Nigeria 6.2 M

Pakistan 5.5 M

China 1.3 M

Only 25% diarrheal de

poor water and sanitat Water and sanitation: 0.9% o

Hygiene not included

GDB 2010 Study


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WHO calculations

2011: data and maps

1.9 million diarrheal deaths

52.5 million DALYs from diarrhea Disaggregated by disease and age

2004: data and maps


Disaggregated by disease, age, country, regio

IHME calculations

2010: data and maps


89.5 million DALYs from diarrhea

Burden of Disease

Summary

Conclusion


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Burden of disease from

is high

Diarrheal disease is a

of mortality and morbid

Different online resour

Next: Microbial Water

Conclusion


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Water-borne pathogens



Introduction


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Different classes of pa

Helminths

Protozoa

Bacteria

Viruses

Introduction

Protozoa


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Protozoa

Bacteria


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E. coli Toxic forms

Shigella Vibrio cholera

Bacteria

Viruses


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Rotavirus

Hepatitis A and E

Polio

Viruses

Guinea worm


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Guinea worm

Credit: The Carter Center

Guinea worm


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Guinea worm

Credit: The Carter Center / L. Gubb

Guinea worm


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Guinea worm

Credit: The Carter Center / L. Gubb

Guinea worm


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Guinea worm

Credit: The Carter Center / E. Staub

Summary


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Summary

Helminths

Dracunuculiasis(Guinea worm)

Larvae in insect host

~1000 m

Protozoa

Cryptosporidium, Entamoeba, G

Can form resistant cysts

~10 m

Bacteria

E. coli, Shigella, Vibrio cholera

~1 m

Viruses

Rotavirus, Hepatitis A and E, po

~0.1 m


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How does Drinking Water become unsafe?



Introduction


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Microbial safety Diarrheal disease

Faecal pathogens

Indicators of faecal con

F-diagram

Chemical safety

Introduction

The ideal faecal indicator should


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be universally present in faeces of human

in large numbers

be present in higher numbers than faecal

not be pathogenic

be readily detected by simple, inexpensive

persist in water in a similar manner to faec

not multiply in natural waters

respond to treatment in a similar fashion to

The ideal faecal indicator should

Common faecal indicators


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Total coliforms (TC)


Total Coliform



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Total coliforms (TC) Ferment lactose, producing acid and gas at 35 oC

Citrobacter, Klebsiella, Hafnia

Enterobacter

E. coli, Salmonella, Shigella, Yersinia

Not useful as faecal indicator Many non-faecal sources

Operational monitoring Effectiveness of treatment

Cleanliness and integrity of distribution system


Total Coliform



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Thermotolerant coliforms (TTC)

Total Coliform

Thermotoleran

Coliforms



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Thermotolerant coliforms (TTC) Ferment lactose within 48 h at 44 oC

Previously: Faecal coliforms

106-109cells per gram faeces

Some indication of non-faecal TTC Klebsiella, some Enterobacter spp.

May grow or die off at ambient temperatureTotal Coliform

Thermotoleran

Coliforms



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Escherichia coli (EC)

Total Coliform

Thermotoleran

Coliforms

E. coli



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Escherichia coli (EC) Generally considered most suitable indicator

Some possibility of growth in environment Only moderately persistent, resistant

Total Coliform

Thermotoleran

Coliforms

E. coli

Relative risk


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Indicator count

per 100 mL

1000

Relative risk matrix


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0 1 2 3 4 5

E

D

C

B

A

No

Action

Low

Risk

Intermed

Risk

Sanitary Inspection

E.coli

level

Other faecal indicators


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Coliphage viruses Require bacteria for hosts

Faecal streptococci Lower numbers than colifo

More persistent, resistant

Bacterial spores Similar to protozoa

Highly persistent, resistant

Clostridium perfringens

Bacillus spp.

The F-Diagram


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Opportunities for contamination


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1Water Resource

2Delivery system

3Collection and Transpo

4 Household storage

5Consumption

Summary


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E. coli is the preferred

bacteria for faecal con

The F-Diagram shows

pathogens can be dist

environment, and be in

new host

Drinking water can bec

contaminated in a vari

along the water chain.


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What is HWTS?



Introduction


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Household Water Trea Sedimentation

Filtration Disinfection

Safe Storage

Sedimentation


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Removal of suspended

turbidity

Gravity Settling

Coagulation Plant-based

Aluminium and iron salts

Filtration


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Water is passed throug

material Ceramic filters Synthetic membranes

Biological filters

Gravity or external pre

Particles removed

Challenge of fouling, c

Disinfection: heat


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Disinfection: ultraviolet radiation


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Disinfection: chlorine


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Safe storage


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To prevent recontamin

Small opening Possible to clean

Tap to dispense water

Summary


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Introduction to future p

Detailed explanations Efficiency against different c

pathogens

Advantages

Challenges

No one process is the


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HWTS and the MDGs



Introduction


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What are the Millenniu

Development Goals?

How does HWTS fit int

The Millennium Development Goals


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1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower wome4. Reduce child mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

The Millennium Development Goals


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1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower wome4. Reduce child mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

Target 7C: To halve, by 2015, the proportion of

sustainable access to safe drinking water a

sanitation.

Sustainable access to safe water


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HWTS can contribute t

access to safe water

Short- or medium-term meas

MDG 7 needs quantity

HWTS contributes to o

MDG 4: reduce child mortali

MDG 6: combat HIV/AIDS, mdiseases

MDG 1: links with malnutritio

MDG 2: links with education

Summary


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HWTS contributes to t

target for safe water

And other targets

Not an indicator in its o

Doesnt equal sustainable a

water


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International Network on Household Water

Treatment and Safe Storage (The Network)

A platform for researchers, practitioners and policy makers in HWT

Michael Forson, (co-host of the Network)

WASH Specialist (Water Supply and quality)

UNICEF, New York

Th i Wh t t i d th

Outline


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The issueWhat triggered the ne

Why a network?

The Network strategy

Network mission Network objectives

Network Targets

Hosting and implementation arran

Membership and Benefits of parti

Key Achievements

Challengeswhat worked (is wodid not

Way forward

Participation and benefits

A large part of the worlds population is without access to drinking w

The Issue . What triggered the Network?


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A large part of the worlds population is without access to drinking-w

improved sources (768 million; 2011); several billion more, without a

drinking-water.

Millions, often in urban areas, served by unreliable piped systems ar

drinking-water with significant risks of contamination.

Millions are affected by emergency situations where water, sanitatio

services may have broken down partially or completely, posing risk t

the drinking water.

Diarrhoeal death major cause of child mortality; safe drinking-wate

prevention intervention

Stanford University/AmyPickering

Why a Network?


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WHO convened a multi-stakeholder meeting

in Feb 2003 to identify a platform that will

cover all stakeholders to address the issuesidentified, and a network was deemed the

best forum to be used in this case

Why a Network? The advantages


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A network is a forum, information

clearinghouse and vehicle to

promote collective, bilateral and

individual action on the part of its

stakeholders

A network encourages

communication, cooperation and

coordinated action while optimizing

flexibility, participation and

creativity.

As a network we canMonitor and map global effo

advocacy, implementation aRaise awareness about the

with one understanding and

governments in decision ma

Conduct agreed targeted an

research to increase effectiv

=> health gains (impacts)

Maximize collective gains in

on individual gains

How things evolved down the timeline .

East African


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Strategic

consultations

PHAPHASE 1

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

WHO conceived

the idea to

facilitated a forumfor promotion of

HWTS based on

health gains

Multi-

stakeholder

consultative

meeting in

Feb 2003

7-point strategy

for comprehensive

diarrhoea control

adopted by WHO

and UNICEF. HWTS

is mentioned as a

key intervention

Letters of exchange

to co-host the

Network was signed

between UNICEF and

WHO

HW

wo

Na

exbe

West

Regio

work

Accra

South African

Regional HWTS

Workshop Held

in Mozambique

East African

Regional

HWTS

Workshop

Held in

Uganda

Plenary Meeting

Nairobi, Kenya

June 2004.

1st5 year strategic

plan (2003 2008)

developed.

Strategic

consultation in

Geneva proposingco-hosting with

UNICEF

HWTS Network Global Strategy 2011 - 2016


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To contribute to a signifi

reduction in water-borne

related vector-borne disespecially among vulner

populations, by promotin

water treatment and saf

a key component of com

targeted environmental

programmes.

Mission statement

Obj ti T t

HWTS Network Global Strategy 2011 - 2016


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Objectives HWTS evidence base of public health

relevance significantly strengthened

Tangible results in the scaling-up ofhousehold water treatment and safe

storage achieved globally

National policies and institutional

frameworks developed (=> integration of

environmental health interventions) Best practice in HWTS programmes

evaluated and disseminated for

advocacy purposes

Targets By 2015, 30 countries ha

policies on household w

and storage. By 2015, strengthened

guide effective and replic

programmatic approache

long-term widespread us

health impact. By 2020, 50 countries h

country-wide scale up of

HWTS.

Currently over 160 membership

Participation and benefits


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Currently over 160 membership

Connect with a global Network of HWTS ex

senior officials, programme implementers,

on-the-ground practitioners

Receive the latest news on HWTS projectsevents through the Network listserv and ne

Find out who is active where and engage w

have faced similar challenges

Have your work disseminated and highligh

communications material

Have a voice in the annual network meetinhave input to the annual work plan

Have access to an online, interactive webs

and discuss matters of interest with Netwo

Responsibilities within the secretariat


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WHO

Knowledge Advancement Research

Knowledge Management

Technology assessment

Policy and Advocacy

Global and National level

advocacy Policy formulation and review

UNICEF

Capacity Developme Training workshops

dissemination of best

etc

Monitoring

Global progress in HW

Mapping country levimplementations

UNC

Maintain Regular and

constant communication

within the secretariat

Key Achievements

Hosted over half dozen regional workshops


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Hosted over half-dozen regional workshops

leading to the formation of over 20 national HWTS

action plans

Developed toolkit and harmonized indicators tostrengthen monitoring and implementation

Raised awareness for integration among key

public health efforts (HIV/AIDS, maternal/child

health, nutrition) on role of HWTS

Supporting quality assurance through the HWTSevaluation scheme

Global capacity building through strategic webinars

What worked (is working)

What worked (is working) and on-going challenges


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What worked (is working) Co-hosting arrangement harnessed the strengths of

both organizations

Regional workshops (focused, controlled) Integration with other environmental health projects

On-going challenges Working groupsstarted well, but died off. Like a

community of practice

Ambitious budget

Need clear alignment and harmonization between WaterSafety Plans and HWTS

Advisory groupwas working great, however faced with

challenges of participation

HWTS Network webpage:

More information and links


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HWTS Network webpage:

http://www.who.int/household_water/network/en/

HWTS Network communications portal

http://waterinstitute.unc.edu/hwts
http://www.who.int/household_water/network/en/http://waterinstitute.unc.edu/hwtshttp://waterinstitute.unc.edu/hwtshttp://waterinstitute.unc.edu/hwtshttp://www.who.int/household_water/network/en/http://www.who.int/household_water/network/en/


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Week 1 Summary



Week 1 Summary


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Global Burden of Disea

Disease classification system

Morbidity (DALYs) and mortadisease

Estimates from WHO and IH

Water-borne pathogen

Helminths, protozoa, bacteri

Week 1 Summary


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Contamination pathwa

F-diagram

Faecal indicator bacteria

First glance at treatme

Sedimentation

Filtration

Disinfection (heat, ultraviolet

Safe storage

Week 1 Summary


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HWTS and the MDGs

The HWTS Network

week 1 - introduction to hwts

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