Introdution To Env. Health

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Mekelle University

College of Health Sciences,


School of Public Health
Department of Environmental Health and Behavioral Sciences

Determinants of Health
Instructor: Tsegaluel Abay.(MSc. In Water and Public Health)
Week Two
Lecture Note
Ecology and Environmental health:
A. Introduction to environmental health
• Environmental health: definition, concept and history
• Components of environmental health
• Occupational health and safety
• Infection prevention
B. Introduction to Human ecology
• Human – environment interaction
• Ecology of health and disease
• Biosphere and pollution
objectives
At the end of the course the students will be able to:
• To make students familiar with the concept, terms and theories that
helps them to identify and intervene environmental and ecological
factors to human health.
• Identify and explain components of environmental health
• Realize the practical techniques in planning, development and
maintenance of safe water supplies and waste disposal facilities.
• Identify vectors of health importance and introduce appropriate control
measures.
• Know the basic requirements of healthful housing and institutions.
• Solve the health and safety problems encountered in industries, various
occupational and recreational areas.
Introduction to Environmental health
What is the environment?
• is the physical, chemical and biological entities, conditions and dynamics that surrounds us
• The complex of physical, chemical and biological factors that act upon an organism or an
ecological community and ultimately determine its form and surrounding.
• Environment is divided into four traditionally: Atmosphere, biosphere, lithosphere and
hydrosphere. Adding the anthrosphere: technologically effect
• Contributors to the “Environment/health”
• Chemical − Air pollutants, toxic wastes, pesticides, VOCs
• Biological − Disease organisms present in food and water
− Insect and animal allergens
• Physical − Noise, ionizing and non-ionizing radiation
• Socio-economic − Access to safe and sufficient health care
Public Health Definition of “The Environment”
• All that which is external to the individual host. It can be divided into physical, biological,
social, and cultural factors, any or all of which can influence health status in populations
Definitions and concepts of environment
 Ecology
• Is the study of the interaction of organisms and their environment and how organisms interact with
each other in which they live.
• Is the scientific study of the environmental factors that effect organisms and how organisms
interact with these factors and with each other.
 Environmental science
• Is the scientific study of human (organisms) interactions with the environment environmental
indicators).
• Is the study of the earth, air, water, and living environments, and the effects of technology thereon
(anthrosphere).
 Environmental studies
• Is the discipline dealing with the social, political, economical, philosophical and ethical issues
concerning man's interactions with the environment.
 Environmentalist
• A person working to solve environmental problems, such as air, water pollution and soil
contaminations, the exhaustion of natural resources, uncontrolled population growth, etc.
Definition: health
• The condition of being sound in body, mind, or spirit
• A flourishing condition or well-being—not just the absence of
disease
or
• A state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity
- WHO (1948)
Definition: Disease
• Trouble or a condition of the living animal or plant body or one of its parts
that impairs or damages the performance of a vital function
What is Environmental Health?

Environmental health is
• broader than hygiene and sanitation; it includes hygiene, sanitation and
many other aspects of the global environmental challenges such as global
warming, climate change, radiation, gene technology, flooding and
natural disasters.
• It also involves studying the environmental factors that affect health.

The World Health Organization’s definition is as follows:


• addresses all the physical, chemical, and biological factors external to a
person, and all the other related factors impacting behaviors (social and
psychological factors) in the environment.
• It encompasses the assessment and control of those environmental
factors that can potentially affect health (WHO).
What is Environmental Health?
• The Key phrases in this definition are environmental factors
and potentially affect health.

Environmental factors – what?


• Factors (“pollutants” or “toxicants”) in air, water, soil, or food
− Transferred to humans by inhalation, ingestion, or absorption
− Production of adverse health effects

• The World Health Organization (WHO) estimates that over 90–95% of all

cancers are “environmentally related”—diet, tobacco, and occupations are

all controllable aspects of our environment.


Facets of Environmental Health

Environmental epidemiology - Associations between
exposure to environmental agents and subsequent
development of disease

Environmental toxicology - Causal mechanisms between
exposure and subsequent development of disease

Environmental engineering - Factors that govern and reduce
exposure

Preventive medicine - Factors that govern and reduce
disease development

Law - Development of appropriate legislation to protect
public health
Components of environmental health
Components of environmental health
Role of environmental health in public health
• Environmental health is part of public health where the primary goal is
preventing disease and promoting people’s health.
• Environmental health is associated with recognizing, assessing,
understanding and controlling the impacts of people on their environment
and the impacts of the environment on the public.
Public health risk

Impact of People Impact of


Environment

Environmental pollution
Role of environmental health in public health

• The role of the environmental health in public health:


• Improving human health by protecting from environmental hazards.
• Acting independently to provide advice on environmental health matters;
designing and developing plans of action for environmental health.
• Initiating and implementing health/hygiene, sanitation and environmental
programs to promote understanding of environmental health principles.
• Enforcing environmental(health) legislation….. The health regulatory
• Monitoring and evaluating environmental health activities, programs and
projects.
Continued …….

Role of Environmental Health in community health:

• Three basic strategies: Promotion, Prevention and Control.

1. Promotion: targeted to behavioral changes mainly through IEC; housing


improvement, basic sanitary provisions.

2. Prevention: of communicable diseases before it happens: safe water, safe food,


latrine provisions, personal hygiene, proper solid waste management, vector control,
etc.

3. Control: Control of communicable diseases through various environmental


interventions.
Role of environmental health in public health

• The chain of disease transmission can be grouped in to three category: Agent,


Host and Environment.
• For a Person to get sick from infectious agent those three necessary factors must
exist.
Introduction to environmental
sanitation
Sanitation means the prevention of human contact with wastes, for
hygienic purposes.
It also means promoting health through the prevention of human
contact with the hazards associated with the lack of healthy food, clean
water and healthful housing, the control of vectors (living organisms
that transmit diseases), and a clean environment.
It mainly focuses on management of waste produced by human
activities.
Types of sanitation relating to particular situations
• Basic sanitation: refers to the management of human faeces at the household level. It
means access to a toilet or latrine.
• Onsite sanitation: the collection and treatment of waste at the place where it is deposited.
• Food sanitation: refers to the hygienic measures for ensuring food safety.
• Food hygiene is similar to food sanitation.
• Housing sanitation: refers to safeguarding the home environment (the dwelling or resident
and its immediate environment).
• Environmental sanitation: the control of environmental factors that form links in disease
transmission. This category includes solid waste management, water and wastewater
treatment, industrial waste treatment and noise and pollution control.
• Ecological sanitation: the concept of recycling the nutrients from human and animal
wastes to the environment.
Definitions and concepts of hygiene

Hygiene is generally:
• refers to the set of practices associated with the preservation of health and
healthy living.
• The focus is mainly on personal hygiene that looks at cleanliness of the hair,
body, hands, fingers, feet and clothing, and menstrual hygiene.

The aim of hygiene education and promotion is :


• transfer knowledge and understanding of hygiene and associated health risks in order
to help people change their behavior to use better hygiene practices.
CONT…
 Problem Solving Paradigm in EH
Seven steps
1. Define the problem Risk Assessment,
2. Measure its magnitude problem defining
3. Understand key determinants situational analysis

4. Develop intervention/Prevention Strategies


5. Set policy / Priorities Risk management
6. Implement (Problem mg’t)
7. M & E
CONT…

The scientific basis for the practice of environmental health

• CO2 emissions have increased 30% since the industrial revolution.

• 25% of world’s population and 60% population in developing countries lack basic housing
sanitation.

• Lack of safe water due to contamination

• 80% of health problems in developing countries is due to lack of safe water and basic
sanitation.

• About 45% of all deaths in under five children (U5) is due to diarrhea etc.
CONT…
• Global climate change has become a concern in the world:

• Deforestation, draught, earthquakes,

Ethiopian Situation

• About 75% registered OPD cases are associated to lack of basic hygiene and
sanitation:

• diarrhea, skin and eye infections, helminthiasis, protozoal infections.

• Proportion of diarrhea among U5 is 45%.


Basic Requirements for a Healthy Environment
• Clean air
• Safe and sufficient water
• Safe and adequate food
• Safe and peaceful settlements
• Stable global environment
Improving Human Health and Environment: 3 Models
Environmental Intervention models (Improving Human Health and
Environment): 3 Models
The figures shows health
intervention models for the
prevention and control of
communicable diseases.
(1) The clinical intervention model
focuses on the treatment of
patients,

The public health intervention model concentrates on


(a) The maintenance of health through education and
(b)keeping the environment safe.

• The red arrows indicate the points of intervention.


• Intervention - is a way of stopping the disease from
being transmitted. The broken lines
Historical perspectives of environmental health
• Hygiene and sanitation have a long history at various levels of human
civilization. We can roughly divide the historical events into two periods:
• the ancient and the modern.
Prehistoric and ancient civilization
• Religious laws, played major roles in the lives of ancient peoples; mainly
concentrated on the provision of personal hygiene.
• The importance of body cleanliness before praying was a motive for
maintaining the integrity of hygiene with a religious practice.
Historical perspectives of environmental health – ancient civilizations
• The importance of hygiene and sanitation flourished at the times of Greek,
Roman and Egyptian civilization.
• The use of private and public baths and latrines,
• cleaning of the body, shaving the head for protection from lice infestation,
and
• the construction of water pipelines and sewage ditches were widely
observed.
• The transmission of schistosomiasis (bilharzia) was linked to bathing and
swimming in the Nile River.
• In these civilizations, the focus was on personal hygiene (hygiene) and
human waste management (sanitation).
Historical perspectives of environmental health - Modern times

• A number of discoveries in the 19th century were important events for the
understanding of communicable diseases.
• For example, the link between contaminated water and cholera was
discovered by John Snow in 1854;
• The importance of hygienic handwashing before attending delivery of a
baby was noted by Dr. Semmelweis in 1845; and
• the discovery that microorganisms (very small organisms only visible under
a microscope) cause disease was made by Louis Pasteur around this time.
• The period following the industrial revolution in Europe in the 19th century
showed that improvements in sanitation, water supply and housing
significantly reduced the occurrence of communicable diseases.
Hygiene and Sanitation development in Ethiopia
2. COMMUNITY WATER SUPPLY AND HEALTH
2.1. Introduction to water supply
 Physiological needs:
• 70% of our body by weight: Body needs about 2.0-2.5 liters per day
• Survival with out water is very hard
• Most food contains rich in water such as milk about 90%, fish about 80%.
• Water is the most widely occurring substance in the world.
• The problem is that the distribution, quality, quantity and mode of occurrence is highly
variable from one locality to another.
• The tiny usable portion is about 0.8% of the total, which is neither evenly distributed nor
properly used.
• Globally: 23% urban and 64% of rural population in developing countries lack safe water

• More than 80% of diseases in developing countries is due to lack of safe water supply and
sanitation.
2.1. Introduction to water supply

 Terms commonly used in water supply:


• Hydrology - the study of water
• Raw-water: natural untreated water from sources that is considered
polluted such as Rivers, Lakes or from unprotected wells or springs.
• Potable water (drinking water): water, which is free from harmful
substances and pathogenic organisms.
• Palatable water: water, which is pleasant or enjoyable to drink.
 This is not necessary potable
 It may actually be contaminated.
2.1. Introduction to water supply

• Contaminated water: water which may contain harmful microbes or


chemicals which makes it unfit for use. Generally the contamination cannot be
detected by the sense of sight, smell, or taste.

• Polluted water: water that has contact with substances that alter its physical
qualities so that it changes in color, turbidity, taste or smell and causes
detrimental health problems. Polluted water can be detected by the sense
organs.
• Sedimentation: the action of settling down or depositing matter in a liquid.
• Turbidity: disturbed, muddy appearance of water.
Sources of water - Global Total Water and
Freshwater Reserves
The Hydrologic Cycle
2.2. Sources of water
„ Groundwater
- Available at point of need at little cost
- Until recently was not polluted
„ Surface water
- Usually requires extensive purification
„ Protected runoff (Rain water)
- Rain water is the purest of all natural water, it is relatively free of
dissolved minerals
„ Ocean and brackish (saline) waters
- Costly to desalinate
Water System Facts
2.3. The Importance of Water

• Essential for all living


organisms
• Shapes the continents of earth
• Moderates our climate
• Habitat for many species
(aquatic life)
• Mean of transport
• Source of food (fish)
• Source of power (hydropower)
Use of water
– Household
level

 The Issue of water


• The world is facing a drinking water crisis.
• Besides continuous population growth,
uneven distribution of water resources and
periodic droughts have forced scientists to
search for new and effective water treatment,
remediation and recycling technologies.
2.4. Water Pollution
• Water pollution is the occurred due to rapid expansion of industrialization and
excessive population growth, most of water sources are being increasingly
polluted.
• Water is regarded as “Polluted” when it is changed in its quality or
composition, so that it becomes less suitable for domestic, agricultural,
recreational, fisheries or other purposes.
• Water pollution is the contamination of water by foreign matter that
deteriorates the quality of the water directly or indirectly as a result of
human activities
• Any chemical, biological or physical change in water quality that has a
harmful effect on living organisms or that makes water unsuitable for desired
uses
• liquid pollution occurs in the oceans, lakes, streams, rivers, underground
water and bays.
Sources of water pollution
 Man-Made (anthropogenic) sources of Water Pollution
• The leading man-made sources of water pollution are
 Municipal
 Agriculture
 Industries
 Mining activities
 Commercial
• About 1 in 5 people in the world lack access to safe drinking water
• 72% of water pollution in rivers attributed due to agriculture. Chemical pesticides
and fertilizers may leach into soil and then into water.
Sources of Groundwater Contamination
Sources of water pollution

 Sources of water pollution:

1. Point source pollution: the discharge of pollutants arise from specific locations

such as factories, sewage treatment plants and latrines that are directly connected

to water bodies etc.

2. Non-point source pollution: It is scattered or diffuse, having no specific location

where they discharge into a particular body of water.

• Sources include runoff from farm fields, roads, and parking lots, etc.
Surface Water Contamination
„ Point and
nonpoint sources of
surface water
contamination
Classes/types of Water Pollutants
Major Causes of Stream and River Pollution
„ Goals of water
purification:
- Provides safe
source of water
that meets quality
objectives
- Reasonable cost
2.5. Water Associated Diseases
• Ethiopia's water and sanitation crisis
• 62 million Ethiopians lack access to safe water and 97 million lack access to improved
sanitation.
• Of those who lack access to improved sanitation, a staggering 23 million practice open
defecation.(WHO, 2016)
• many women and children walk more than three hours to collect water, often from shallow
wells or unprotected ponds they share with animals.
• Recurring droughts result in famine, food shortages, and water-related diseases, as people are
forced to rely heavily on contaminated or stagnant water sources.(water.org, 2018)
• Safe, adequate and accessible supplies of water, combined with proper sanitation, are basic
human needs.
• Therefore, water supply is taken as an essential component of community health.
2.5. Water Associated Diseases
• Most disease associated with water are caused by pathogens.

1. Water-borne disease: due to poor quality water


2. Water-washed disease: due to lack of adequate water.
3. Water-based disease: caused by contact with body.
4. Water-related disease: when the water served as a breeding medium for vectors,
insects & other animals. Vectors used the water for multiplication.
2.5. Water Associated Diseases
1. Water-borne disease: due to poor quality water
• Caused by ingestion of contaminated water by human or animal excrement, which
contains pathogenic microorganisms.
Eg, cholera, typhoid, bacillary dysentery etc
• In addition, it can be caused by the pollution of water by chemicals, that have an
adverse effect on health.
• Nitrates from fertilizers, DDT, Lead and other heavy metals
• Excess or shortage of chemical constituents
E.g. Fluoride
✓ Excess→ dental fluorosis (mottled teeth)
✓ Shortage → dental caries (tooth decaying)
E.g. Calcium and Magnesium- hardness to water
2.5. Water Associated Diseases
Nitrate:
Excess - methemoglobinemia (blue babies)
 Largely confined to infants less than 3 months old but may affect
children up to age six.
 It is caused by the bacterial conversion of the nitrate ion ingested
in water, formula, and other food to nitrite.
 Nitrite then converts hemoglobin to methemoglobin.
 Methemoglobinemia is not a problem in adults as the stomach
PH is normally less than four, whereas the PH is generally higher
in infants allowing nitrate- reducing bacteria to survive.
• Mitigation: Water treatment- pathogens and chemicals
2.5. Water Associated Diseases

2. Water-washed disease:
• Due to lack of adequate supply of water & poor sanitation (personal
hygiene)
 Eye infections : trachoma, conjunctivitis
 Skin infections: scabies & ring worm,
 Body louse : typhus, & RF
 Other flea, & tick-borne diseases.

• Mitigation: Adequate supply of water


2.5. Water Associated Diseases
3. Water based /impounding disease
• Caused by infectious agent come in contact with contaminated
water
• Diseases caused by parasites found in intermediate organisms living in
contaminated water
 Schistosomiasis, guinea worm
• Mitigation: Water management
4. Water related disease
• Water serves as development & breeding site of insects
• Malaria, onchocerciasis, trypanosomiasis & yellow fever
• Mitigation: Water management
2.5. Water Associated Diseases
Water associated Diseases (Example) Prevention/ intervention strategy
diseases
Water-borne Cholera, Typhoid Hepatitis - improve water quality
- prevent casual use of unimproved
sources
Water-scarce Roundworm (Ascariasis). - improve water quantity
(water-washed) Trachoma, Typhus - improve water accessibility
- improve hygiene
Water-based Bilharzia (Schistosomiasis) - decrease need for water contact
Guinea worm - control snail populations
- improve water quality
Water-related insect Malaria, River blindness, - improve surface water
vector Sleeping sickness management
- destroy breeding sites of insects
- decrease need to visit breeding sites
- improve design of storage vessels
2.6 Drinking water treatment
• Water treatment: - is defined as the processes of removing all those
substances (biological, chemical, or physical) which are potentially dangerous
or undesirable in water supply for human and domestic use.

Why water treatment? main objectives of water treatment:


1.To remove pathogenic organisms and consequently to prevent water borne diseases.

2. To remove substances which impart color, taste or odor to water.

3.To remove excess or undesirable chemicals or minerals from the water.

4. To regulate essential elements or chemicals that may be in excess or lacking in a certain


water supply (e.g. fluoridation or de-fluoridation of water, softening of water etc).

5. To remove excess or undesirable dissolved gases. 54


Types of water treatment:
A. Homemade water (small scale) treatment:
1. Boiling: Boiling for 15 to 20 minutes, most forms of micro-organisms
or cysts, will be destroyed, without the most resistant spores.
2. Sand filter: A properly constructed and carefully maintained
homemade sand filter can remove most of the substances that cause
turbidity, taste and odor, the cysts and ova of parasites, and other
relatively larger organisms.
• The minimum depth of filter sand should not be less than 60 cm.
3. Candle filter: commercially made for filtering individual water
supplies.
• The core of the filter is a porous cylinder (shaped like a wax candle
(solid), made from high-quality unglazed porcelain (ceramic).
55
• The efficiency of filtration depends upon the pore size of the candle.
Household Water Filter

56
4. Chlorination
• Ex. Chlorine
tablet and weha-
agar

5. Storage
When household storage is well practiced in the community, turbidity will
be reduced, bacteria and eggs of parasites will be killed.
Use a clean water source or treat the water, either at home or in a storage
tank.

57
6. SODIS (Solar Disinfection )

Sunlight kills
microorganisms and could
be used for water
disinfection.
Plastic bottles are often
available as a waste
product and could be used
for a new water treatment
method.

58
B. Municipality (large scale) water treatment:
1. Ground water:
Aeration (The process of exposing to air) to remove
chemicals.
Disinfection (chlorination).
2. Surface water:
Screening (the large particles)
Pre-chlorination
Coagulation (The process of forming semisolid lumps
in a liquid)
Mixing
Sedimentation
Filtration (slow and rapid sand filtration)
Post chlorination
59
(disinfection)
Large scale water treatment:
Simplified Flowchart of Drinking Water Treatment

60
Water disinfection:
Disinfection means the destruction, or at least the complete

inactivation, of harmful micro-organisms present in water.


Why disinfection?

The single most important requirement of drinking water is that it


should be free from any pathogenic micro-organisms.

Pre-treatments of water can not assure that the water they produce
is bacteriological safe, i.e. Final disinfection will be needed. 61
Factors that influence the disinfection of
water:
1. The nature of water to be disinfected.
2. The type and concentration of the disinfectants used.
3. The temperature of water to be disinfected
4. The time of contact
5. The nature and number of the micro-organisms to be
pH of water
6. Mixing
• Good mixing ensures proper dispersal of the disinfectant
through out the water.
62
Chlorine and its compounds:
 Methods of calculating chlorine dosage:
– Too much chlorine is poisonous and too little is unreliable in disinfecting
water.
– An exact dose must therefore be determined for chlorinating a given
water supply.
• The effectiveness of chlorine is dependent on the water pH,
temperature, contact time, water clarity, and absence of
interfering substances.

63
 Water disinfection by chlorination:
 was perhaps the most important technological

development in the history of water treatment.


 massively introduced worldwide in the early 20 th

century,
 Even though chlorine and chlorine related substances

are not perfect disinfectants, they have a number of


characteristics that are highly valuable.
64
Chlorine and its compounds are the disinfectant of
choice, because:-
1. Comparatively in-expensive.
2. Relatively easy to handle and transport
3. Ready available almost everywhere.
4. Effective.
5. Simple to apply and relatively easy to detect in water.

65
Chemical agents used for disinfection of
water:

• Bleaching powder (chlorine lime).


• Chlorine tablets
• Quick lime (calcium oxide)
• High test hypochlorite (HTH)
• Alum
• Potassium permanganate
• Bromine and Iodine etc.

66
Tests of water:

 Complete tests should be made at laboratories for:


• Determination of different physico-chemical
components.
• Determination of residual chlorine (free & combined)
• Bacteriological examination for coli-form bacteria.
• Determination of PH.

67
Adequacy of supply:
• In understanding an assessment of the adequacy of the

drinking-water supply, the following basic service indicator


parameters of a drinking-water supply should normally be
taken into consideration:
 Quality

 Quantity(in service level)

 Accessibility

 Affordability(Cost)

 Continuity 68
Service level &quantity of water collected:

69
Water consumption at home:
 Purpose Consumption L/c/d
• Drinking 2.3
• Cooking 4.5
• Ablution 18.2
• Washing of utensils and houses 13.6
• Flushing of toilet 13.6
• Bathing 27.3
• Total 106.8

70
Use of water by different establishments:
Type of building consumption L/c/d
• Factories with bathroom 45
• Factories with no bathroom 30
• Hospitals with laundry/bed 340
• Nursing room 135
• Hostels 135
• Hotels/bed 130
• Offices 45
• Restaurant 70
• Day school 3-5
• Boarding school 40
71
3. Introduction to Solid Waste Management

Definition of terms
• Waste: Any substance or object which the holder discards or intends to discard.

• A holder means the producer of the waste or the person who is in possession of it.

• Producer means any person whose activities produce waste.


•Waste management: is associated with the control of generation, storage,
collection, transfer and transport, processing and disposal of wastes in a manner that
is in accordance with the best principles of public health, economics, engineering,
conservation.
72
Definition of terms

• Solid wastes: comprise all the wastes arising from human and animal
activities that are normally solid and that are discarded/useless/unwanted.
• Waste water/liquid wastes all the wastes arising from human and animal
activities that are normally liquid.
• Bioaccumulation: is an increase in concentration of a pollutant from the
environment to the first organism in a food chain.
• Biomagnifications: is an increase in concentration of a pollutant from one
link to another in a food chain

73
 Hazardous wastes:

• Dangerous or difficult to keep, treat or dispose.


• May contain substances which are corrosive, toxic, reactive, carcinogenic,
infectious, irritant or harmful to human health.
• May be toxic to the environment.
 Controlled waste: Wastes which are controlled e.g. household, industrial
and commercial waste.
 Uncontrolled waste: Waste which are not controlled.
• Includes agricultural, mine and quarry waste which are produced in large
tonnages.

74
 Household waste: Waste from private domestic accommodations, residential homes,
universities/schools, hospital premises, private garages, camp sites, prisons, meeting halls and
royal palaces.
 Industrial waste: Waste from any organization

• Ex. waste producers from the manufacturer of food products, textiles, wood products, plastic
products, motor vehicles, chemicals etc.
 Commercial waste: Waste from premises used wholly or mainly for the purpose of trade or
business or the purpose of sport, recreation or entertainment.
• Ex. waste from offices, hotels, shops, local authorities, market, fairs etc.
 Clinical waste: waste which consists wholly or partly of human or animal origin tissue, blood
or other body fluids, excretions, drugs or other pharmaceutical products, dressings, syringes,
75
 Municipal wastes: Waste collected and disposed by or on behalf of a local authority.
 Biochemical oxygen demand (BOD):
• A laboratory measurement of wastewater that is one of the main indicators of the quantity
of pollutants present.
• A parameter used to measure the amount of oxygen that will be consumed by
microorganisms during the biological reaction of oxygen with organic material.
 Classification of wastes according to their Properties:
 Bio-degradable: can be degraded (paper, wood, fruits and others).
 Non-biodegradable: cannot be degraded (plastics, bottles, old machines and others).
 Classification of wastes according to their effects on human health and the
environment:
hazardous wastes
Nonhazardous wastes
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Solid waste management:
– A systematic administration of activities that provide for the collection,
source separation, storage, transportation, transfer, processing, treatment
and disposal of solid waste.
• Solid Waste: comprise all the wastes arising from human and animal
activities that are normally solid and that are
discarded/useless/unwanted.

77
Solid waste management:

• Public Health importance of Solid Waste:


1. Can be best media for the growth of microorganisms.
2. Attraction of arthropods such as housefly.
3. Attraction of rodents/other animals, rats, dogs
4. Contaminate water sources
5. Contaminate food supply
6. Can create fire accident
7. Can create nuisance :-
 Bad odor, smoke, dust
 Aesthetical problem & discomfort: sneezing, coughing
8. Affects socio-economic conditions
9. Affects climate 78
ATTRACTION OF RODENTS & OTHER ANIMALS

79
Main sources of solid waste (waste generation):
1. Residential( domestic )
2. Commercial
3. Institutional
4. Construction Demolition
5. Municipal services
6. Treatment plant sites
7. Industrial
8. Agricultural

80
CLASSIFICATION OF SOLID WASTES:
1. Residential: Generated from living households (domestic), generally contain non-hazardous
solid wastes; kitchen waste, ‘‘Ketema”, and ash are common in Ethiopia.
2. Agricultural: Solid wastes due to agricultural activities: food residues, animal dung, crop
residues, etc. Such wastes are usually non-hazardous and negligible in rural Ethiopia.
3. Commercial: Wastes generated from business establishments, food establishments, shops, etc.

• non-hazardous waste such as paper, cardboard, wood, metals and plastic.


4. Industrial wastes: From various types of industrial processes.
• The nature of the waste depends on the type of industry and kind of raw material
involved.
• There may be toxic and hazardous wastes that have adverse effects to the
environment. 81
CLASSIFICATION OF SOLID WASTES:

5. Institutional solid waste : Generating from public and government


institutions: offices, religious institutes, schools, universities, etc.
• Generally not hazardous.

6. Hospital solid wastes : discarded, unwanted solid wastes from hospitals.


• It consists of both non-hazardous and hazardous waste.
• The above classification helps to identify whether the waste is hazardous
or not.

82
Waste Management Hierarchy
Most Preferable

Least Preferable

83
CLASSIFICATION OF SOLID WASTES:

 Avoid : avoid wastes from the production .


 Reduce: Source reduction
 Minimize the amount of waste being generated
 Make products last longer
Reuse
 Repeated use of items prior to disposal
 Repair the item like plastic

84
 Recycling
1. Resource conservation
 Recycling reduces pressure on renewable & non-renewable resources
2. Energy conservation
 Recycling consumes 50–90% less energy than manufacturing the same item
from the previous material
3. Pollution abatement
 Reduces level of pollutant emissions
 Recover:
 using solid materials as source of energy
 Treatment(Incineration)
• Reduces waste volume by 80–90% by incineration for solid wastes
• but odor and smoke are negative effects.
85
Functional elements of solid waste management system:
• There are six elements of a waste management system.
1. Waste generation:
• Includes activities in which materials are identified as no longer value and are
either thrown away or gathered together for disposal.
2.Waste handling, separation, Storage and processing at the source:
 Waste handling and separation involves the activities associated with management
of wastes until they are placed in storage container for collection.
• Handling also encompasses the movement of loaded containers to the point of
collection.
 Separation of waste components is an important step in the handling and storage
of waste at source.
 To recover sale materials, best separate at source). 86
Functional elements of solid waste management system:
3. Collection:
• It involves not only the gathering of wastes and recyclable materials,
• but also the transport of these materials, after collection, to the location
where the collection vehicles emptied.
 This location may be material processing facility, a transfer station or a
landfill disposal site.
4. Separation, processing and transformation of waste:
• It all occurs primarily in locations away from the source of waste generation.
• The separation and processing of wastes that have been separated at the
source and the separation of commingles wastes usually occurs at materials
recovery facilities, transfer stations, combustion facilities and disposal sites.
87
Functional elements of solid waste management system:
5. Transfer and transport:
 It involves two steps:
• The transfer of wastes from the smaller collection vehicle to the larger
transport equipment.
• The subsequent transport of the wastes, usually over long distances, to a
processing or disposal site.
• Although motor vehicle transport is most common, rail cars and barges (flat
bottom large boats) are also used to transport wastes.

88
Functional elements of solid waste management system:
6. Disposal:
• The final functional element in the waste management System is disposal.
• In many parts of the world, even today, land-filling or land spreading is the ultimate
fate of all solid wastes.
 Methods of solid waste treatment and disposal system:
1. Ordinary open dumping
2. Controlled tipping/burial
3. Hog feeding
4. Incineration
5. Sanitary landfill
6. Compositing
7. Grinding and discharge into sewers 89
Methods of solid waste treatment and disposal system:
1. Open Dumping
• Some components of solid waste such as street sweepings, ashes and non combustible rubbish are
suitable for open dumping.
• Garbage and any other mixed solid wastes are not fit or suitable because of nuisance and health
hazard creation.
2. Controlled tipping/burial
• Indiscriminate dumping of garbage and rubbish creates favorable conditions for fly-breeding,
shelter and food for rodents, nuisances etc.
• In order to avoid such problems, garbage and rubbish should be disposed of under sanitary
conditions.
• This can be done by digging shallow trenches, laying down the waste manually or mechanically
and covering by ash at the end of each days work.
3. Hog Feeding
• The feeding of garbage to hogs has been practiced for many years in different parts of the world.
90
Methods of solid waste treatment and disposal system

4. Incineration
• Incineration is a process of burning the combustible components of
garbage and refuse.
• Can be effectively carried out on a small scale in food service
establishments as well as in institutions such as hospitals, schools etc.
5. Sanitary Landfill:
• Is an engineered facility used for disposing of solid wastes on land or
within the earth’s mantle-
• without creating nuisances or hazards to public health or safety, such as
breeding of rats , insects and the contamination of groundwater.
• It is one of the most widely used means of solid waste disposal system .
91
Methods of solid waste treatment and disposal system

• The natural anaerobic decomposition of the waste in the


landfill produces landfill gases which include Carbon Dioxide,
methane and traces of other gases.
• Methane can be used as an energy source to produce heat or
electricity.
• Thus some landfills are fitted with landfill gas collection (LFG)
systems to capitalize on the methane being produced.

92
Main features of a modern landfill
93
Methods of solid waste treatment and disposal system

6. Composting
• Composting is an effective method of solid waste disposal.
• Biodegradable materials break down through natural processes and
produce humus.
• The metabolism of micro-organisms breaks down the waste aerobically
or an aerobically.
• Aerobic respiration, typical of composting, results in the formation of
Carbon dioxide and water.
• While the anaerobic respiration results in the formation of Carbon
Dioxide and methane.
94
Methods of solid waste treatment and disposal system

• In addition to generating the humus which is used as a soil enhancer,


Anaerobic Digestion is also used as a method of producing biogas which
can be used to generate electricity.
7. Grinding and Discharge into Sewer Lines:
• The location of central grinding stations at convenient points along the
sewer system or at the sewage treatment plant is required.

95
Hazardous and infectious waste management:

• Hazardous waste(HW): is a term used all over the world for waste
which is dangerous or difficult to keep, treat or dispose of.
• May contain substances which are corrosive, toxic, reactive,
carcinogenic, infectious, irritant or harmful to human health and which
may also be toxic to the environment.

96
Hazardous wastes…..
 Wastes that require special handling due to serious threat to human health & the
env’t if mismanaged.
 Ignitability- Catch fire (Flash point of 140F0 or more).
 Corrosively-Substances that corrode (pH <2 or >12.5).
 Reactivity- Chemically unstable & may explode (cyanide).
 Toxicity- Injurious to health when ingested or inhaled (e.g., chlorine, pesticides).
 Infective- suspected or containing infectious agents.
• Pose a substantial present or potential hazard to human or other living organisms.
• Because: Such wastes are non-degradable or persistent in nature.
• Can be biologically magnified.
• Can be lethal.
• May otherwise cause or tend to cause detrimental cumulative effects. 97
Sources of Hazardous Waste:
• The sources of hazardous wastes can be seen from two types of perspectives.
• Specific Vs nonspecific Sources
 Non Specific sources of wastes:
• Produced in a variety of manufacturing/industrial processes.
 Specific sources of wastes:
• Which are produced by specific industries.
SOURCEs:
They can be from:
• Households
• Institutions
• Agriculture
• Industries
• Health care facilities and,
• From Nature 98
4. Liquid Wastewater management
 INTRODUCTION

• Sewage and other liquid wastes: water borne waste derived from
homes(toilets, bathrooms, laundry, lavatory, kitchen-sink wastes etc. i.e.
domestic wastes)and animal or Food processing plants.
• The waste matter eliminated from body is known as excreta and is about
27grams/capita/day (dry basis) and 100-200 grams/capita/day wet basis.

99
 Sanitary sewage also called domestic sewage contains:
• human wastes and wash water from homes, public buildings or commercial
and industrial establishments.
• Excreta is associated with the spread of the following diseases:
• Bacterial: Cholera( Vibrio cholera); Bacillary dysentery /Shigellosis;
Typhoid/paratyphoid fever(Salmonella typhi).
• Viral- Polio/poliomyelitis(poliovirus); Viral diarrhea (rotavirus); hepatitis.
• Protozoa- Amoebiasis (Entamobea histolitica); Giardia lambiasis(Giardia
lambila).
• Schistosomiasis is a water contact disease caused by helminthes(parasite).
• Hook worm, Ascaris, Tape worm are common parasites associated with
water.
100
 Mode of transmission of excreta associated disease:
• The four “F’s” i.e. fingers, flies, fields, and fluids are responsible for contacting
the feces and transmitting the pathogens to foods.
• However proper hand washing and water protection are effective means to
control their transmission.

Objectives of human waste management


• Avoid direct contact with man;
• Prevent surface and ground water contamination;
• Make inaccessible to vectors (flies, mosquitoes, roaches, rats);
• Prevent food contamination;
• Prevent public nuisance (odor, fly breeding, etc.) 101
Types of excreta disposal system

1. Non water carriage: traditional pit latrine, VIP latrines, pour-flush latrine,
bore hole latrine.
2. Water carriage system: municipal sewerage system and local small scale
system.
General considerations of excreta disposal system
1. Proper sitting: in relation to housing unit, kitchen, ground and
source of water, direction of wind, available site;
2. Size of the underground structure: depends on users number and
minimum service years;
3. Construction material: availability of wood, cement, nails, stones,
gravel, sand, etc. 102
General considerations of excreta disposal system
4. Technology feasibility and sustainability: simplicity, acceptability,
affordability, community concern for participation in planning,
construction, financing, maintenance, and use;
5. Final disposal options: Burial? Vacuum truck? Seepage? Sewerage?
6. Users type: house hold, community, camps, etc. that will determine the
latrine technology
Types of treatment schemes
• There are two treatment schemes: small scale and municipal
sewage system:
1. Small scale treatment system:
This is a low cost type used at individual and community level.
103
Types of treatment schemes
2. Municipal sewage system:
Purpose: to remove the organic, inorganic, and bacterial load of the
sewage to an extent it is safe for final discharge or reuse
 Requirements (infrastructure based):
• Installation of piped water in liquid waste generating sites (residential
houses, etc);
• Installation of sanitary fittings inside houses (latrine, bath, shower,
kitchen sinks, septic tanks);
• The construction of sewerage lines and treatment plants.
• Limitations: Operational and operating costs, land and water
availability, level of operators performance, sewer management
capacity (blockage, maintenance, etc.); final disposal site conditions104
Processes involved:
• Mechanical separation of solid components;
• Aeration/ oxygenation for aerobic bacteria;
• Organic matter decomposition;
• Sludge processing and drying;
• Neutralization;
• Destruction of pathogens (usually chlorination).
• The above process can be classified into physical, biological, and
chemical process that makes the waste safe for final disposal.

105
 Treatment strategies:
 Collection,
 Treatment and,
 Reuse.
• Collection includes water carriage system or other methods of night soil
collection.
• The principle behind treatment step is to destroy pathogenic agents.
• Re-use in agriculture and aquaculture.
 Performance criteria for waste water management system:

• Health criteria: Pathogens should not spread directly or indirectly.

• Reuse: Should yield a safe product for reuse.

• Ecological: When the waste cannot be reused, the discharge of effluent in to


106
surface water should not exceed the self purification capacity of recipient water.
• Nuisance: odor must be below the nuisance threshold.
• No part of system should become aesthetically offensive.
• Cultural: The method chosen should be compatible with local habits, social and
religious practices.
• Operational: The skills required should be available locally and can be acquired with
minimum training.
• Cost: Capital and running costs must not exceed the community ability to pay.
 Treatment of wastewater/municipal water/industrial wastewater/ sewage.
1. Primary treatment: utilizes physical processes such as screening, sedimentation and
disinfection.
2. Secondary treatment: is a biological process; mimics (stimulate) nature by utilizing
microorganisms to oxidize the organics.
3. Tertiary: or advanced treatment is mainly to remove nutrients and dissolved materials.
107
 Primary treatment
• The first stage of waste water treatment is usually the removing of large
particles or floating substances such as rags, pieces of wood, cloth, paper,
plastic etc. and heavy mineral particles(sand and grit).
• Screening: on entering a sewage treatment works, dirty water passes
through screens to remove paper, wood and other large articles that
could damage machinery or block pipe systems.
• Screens consist of vertical bars spaced close together.
• Grit removal: sewage contains grit and dirt from roads or cleaning
activities.
• Ex. removes rocks, gravel, broken glass.
108
 Secondary treatment(biological treatment)
• Normally utilizes biological treatment processes (activated sludge, trickling
filters).
• Typically utilizes biological treatment processes, in which microorganisms
convert non-settling solids to settling solids.
• Sedimentation typically follows, allowing the non-settling solids to settle out.
• Degrade biological content (dissolved organic matter) of the sewage.
• Dissolved biological matter is converted into a solid mass by using water-
borne bacteria
• 95% of the suspended molecules should be removed
• Ex: human waste, food waste, soaps, detergent
• Done with adding bacteria and protozoa into sewage

109
• Activated Sludge (aerated sewage containing aerobic micro-organisms which help
to break it down).
• The most common option uses microorganisms in the treatment process to break
down organic material with aeration and agitation, then allows solids to settle out.
• Bacteria-containing “activated sludge” is continually re circulated back to the
aeration basin to increase the rate of organic decomposition.
• . Trickling Filters- These are beds of coarse media (often stones or plastic).
• Wastewater is sprayed into the air (aeration), then allowed to trickle through the media.

• Microorganisms, attached to and growing on the media, break down organic material in
the wastewater.
• Trickling filters drain at the bottom; the wastewater is collected and then undergoes

sedimentation.
110
 Lagoon Systems
• Lagoons(oxidation ponds or
– hold the waste-water for several months
stabilization ponds): – natural degradation of sewage
• A wastewater treatment method that – Usually reeds are preferred
uses ponds to treat wastewater.
• Algae grow within the lagoons and
utilize sunlight to produce oxygen,
which is in turn used by
microorganisms in the lagoon to break
down organic material in the
wastewater.
• Wastewater solids settle in the lagoon,
resulting in liquid waste that is
relatively well treated, although it
does contain algae.
111
 Tertiary or Advanced wastewater treatment:

• The sewage from the secondary settling tank is chlorinated for final disposal.
• Any thing that follows conventional primary and biological treatment is
considered to be advanced treatment.
• The main purpose is to remove nitrogen and phosphorus (to avoid eutrophication
in water bodies) and to further decrease the BOD of partially treated waste
water.
• The removal of organics (BOD) and nutrients helps to protect the quality of
aquatic ecosystems.
• Tertiary treatment is any level of treatment beyond secondary treatment.
112
• Could include filtration, nutrient removal (removal of N and P) and removal
of toxic chemicals or metals.
• Also called “advanced treatment” when nutrient removal is included.
• Not all sewage treatment plant requires tertiary (advanced) treatment.
• One approach to nitrogen control, utilizes aerobic bacteria to convert
ammonium ions (NH4+) to NO3- , which is nitrification, followed by
anaerobic stage in which different bacteria convert nitrates to nitrogen gas
(N2), which is de-nitrification( remove nitrogen).
• Second approach to control nitrogen is known as ammonia
stripping/removing method.
• On the average, raw sanitary sewage contains about 35 mg/L of N and 10
mg/L of P.
113
•phosphates: Removing phosphates is most often accomplished by adding a
coagulant to the aeration tank when the activated sludge process is being
used, usually alum [Al2(SO4)3] or lime [Ca(OH)2]:
• Finally, the amount of pathogens in the wastewater is expected to be
proportional to the concentration of fecal coli-form bacteria.
• The coli-form concentration in raw sanitary sewage is roughly 1 billion
per liter.

114
Characteristics of Hazardous Waste:
1. Flammability and Ignitability : The waste burns or
explodes with the application of fire, friction,
electricity spark, or any source of heat.
• wastes with high ignitable potential and/or which
burn vigorously and persistently.
2. Corrosively: It is the ability of the waste to cause skin
115
4. Toxicity: A waste that is likely to produce mass acute
and chronic poisoning; long-term health effects.
5. Infectivity: A waste is a potential cause for infectious
diseases, such as hepatitis B.
6. Radioactivity: Wastes containing radioactive elements.
• Such wastes are mainly from biomedical training and
research institutes.
7. Bioaccumulation effect: Wastes that are not easily
degraded when exposed with the environment.
116
 Treatment technologies:

• The most common methods of treating hazardous waste


are divided into Physical, Chemical, and Biological.
• Physical treatment processes include gravity separation,
phase change systems such as air and stream stripping of
volatiles from liquid wastes and-
• various filtering operation including carbon adsorption.
• Ex. (drying, screening, grinding, evaporation,
sedimentation, filtration, fixation) etc.
117
• Biological methods: Use of enzymes (natural or genetically
engineered microorganisms)to eliminate hazardous substances
(found in sewage, waste stream sand sludge's and soils)or to
convert them into less hazardous or useful forms.
• (composting, aerobic and anaerobic decomposition, activated
sludge, enzyme treatment)etc.
• Chemical methods: Oxidation, reduction, neutralization,
hydrolysis, etc.
• Thermal methods: incineration, boiling, autoclaving, UV
treatment, microwave use, etc.

118
 Disposal methods of hazardous wastes:
1. Secure landfills
2. Incineration
3. Recycling
4. Deep well injection
5. Biological methods
 Infectious waste: is a waste which is suspected to
contain pathogens ( bacteria, virus, parasites or fungus)
in sufficient condition to cause disease on susceptible
host.
119
• Infectious waste includes human blood and blood
products, cultures, stocks of infectious agents.
• pathological wastes, contaminated sharps (hypodermic
needles, scalpel blades, capillary tubes), contaminated
laboratory wastes.
• contaminated wastes from patient care, discarded
biological, contaminated animal carcasses and body
parts infected with human pathogens.

120
 Health hazards:

• Health-care workers (particularly nurses and Physicians)


are at greatest risk of virus infections such as HIV/AIDS
and hepatitis B and C, through injuries from
contaminated sharps (largely hypodermic needles).
• Other hospital workers and waste-management operators
outside health-care establishments are also at significant
risk, as are individuals who scavenge at waste disposal
sites (although these risks are not well documented).
121
 Treatment of infectious waste:
• Waste minimization, recycling, and reuse
• Handling, Storage and Transportation of Health-Care
facility Waste .
• Treatment and Disposal Technologies for Health-Care
Facility Waste.

122
• The final choice of treatment system should be made
carefully, on the basis of various factors, many of
which depend on local conditions:
1. Incineration Technology
2. Open dumps
3. Sanitary landfills
4. Safe burial on health-care premises
5. Sterilization

123
• Health care waste: is the total waste generated by
hospitals, healthcare establishments & research facilities
in the diagnosis, treatment, or immunization of human
beings or animals, & other associated research & services
(WHO).
Healthcare waste categories:
a. Low risk waste- communal wastes.
• Approximately 85% of the general waste produced by
hospitals & clinics is non-contaminated waste & poses no
infection risk to persons who handle it.
b. High Risk Wastes 124
Health effects of Healthcare Wastes
 Needle stick injuries
 Transmission of infection example from re-use of
some type of waste -e.g., syringe
 Environmental pollution e.g., air, water
 Exposure to radiation
 Fires
 Public nuisance (offensive smells, unsightly)

125
Health Care Waste Management
 HCWM is defined as actions associated with the control
of generation, storage, collection, transport & disposal of
HCWs in accordance with the best principles of public
health.
 Importance of proper HCWM

 Minimizes the spread of infection

 Minimizes accidental injury

 Reduces environmental pollution

 Reduces odors & aesthetic problems 126


Category of HCWs Health effects
Respiratory infections, genital infections, skin
Infectious waste
infections,
meningitis, AIDS, Viral Hepatitis A, B and C
Cancer, burn & skin irritation, headache, dizziness, etc
Radioactive waste
Sharps Double risk: injury & potential transmission routes for
HIV & Hepatitis B & C from contaminated sharps
Pharmaceutical Ineffective medical care from consumption of expired
Waste pharmaceuticals, pollution of env’t
Hazardous chemical
Intoxication, burns & skin irritation, pollution of env’t ,
waste
possibility of fire, poisoning
Pressurized
Injury from explosion
containers
Genotoxic waste
Carcinogenic and mutagenic, skin/eyes irritation,
nausea, headache, or dermatitis 127
 Key steps in HCW management
a. Waste Minimization
b. Segregation/ separation
c. Handling
d. Transporting
e. Treatment
f. Disposal

128
a. Waste Minimization
 Waste minimization is the first & best way to:
 Reduce HCW quantities & costs
 Reduce env’tal impact on air pollution & landfill
capacity
 All purchases of material & supplies should be made
with waste reduction in mind
 Improving reuse & recycling practice
 Administrative controls
129
b. Waste Segregation/ Separation
 Is separating waste by type at the place where it is
generated.
 Waste should be separated immediately by the person
generating the waste.
 Waste handlers should never sort through waste after it
has been placed in the bin.
 Segregation must be maintained throughout until final
disposal
 Segregation will result in a clear solid waste stream. 130
131
c. Handling, i.e. collecting, storing…
 Protective clothing should be worn by waste handlers.
 Aprons, Heavy duty gloves, Footwear, Goggles/glasses and
masks, Hands should be washed.
• Waste collection : Collect, quantifying by volume, labeling as to
its source & recording.
• Storage: Placing waste in a secure place until it can be disposed
 Ideal storage area should be:-

 Designed, secure, kept clean, dry and pest free


 HCW should be stored no longer than one week
132
 Organic waste should be disposed daily
d. Transport: Transport of the wastes from the source to
the disposal or treatment area.
e. Treatment
 Methods used to render the waste non-hazardous
 Steam sterilization
 Incineration
 Thermal deactivation
 Gas/vapor sterilization
 Chemical disinfection

133
Types of Recommended Recommended
Waste treatment procedures

Microbiologi Autoclave As per instruction


cal waste with the machine

Pathological Liming Dig pit, place lime,


waste add waste, more lime,
add soil

Infectious Chemical 1% hypochlorite


fluid solution
Let sit for 10-15 min.
134
F. Disposal of Health Care Waste:
 Eliminating or transporting healthcare waste from
the facility
 Common disposal methods:
a. Bury
b. Incineration
A. Burial
– Advantage: Simple and inexpensive
– Concern:-
• Can handle small volume
• Presents a danger to community if not properly
buried
135
B. Incineration:
 Advantage:- Disinfects & greatly reduce waste
volume.
 Factors that influence effectiveness:
 Waste moisture content
 Combustion chamber filling
 Temperature/residence time
 Maintenance/repair.
 Concern:
 May produce emissions & hazardous ash
containing dioxins, metals & furans.
 May require pollution control equipment to
meet local env’tal regulations. 136
 Things that must not be incinerated:
PVC plastics( blood bags, IV lines etc)
• N.B Syringe bodies are NOT PVC plastic
 Mercury thermometers
 Batteries
 X-ray or photographic materials
 Aerosol cans or gas containers
 Glass vials

137
5. FOOD HYGIENE

Food: is any solid or liquid, when eaten and


absorbed by the body,
produce energy,
promote the growth and repair of tissue;
promotes resistance against diseases.
 Food hygiene: all conditions and measures necessary
for ensuring the safety, wholesomeness, and fitness
for consumption of food at all its stages from its
production, processing, storage, distribution,
preservation and service(WHO/FAO).
138
 Objectives of food hygiene:

• To control and prevent food born disease, be it


microbial or chemical.
• To ensure wholesomeness of food, i.e. to ensure that
food is in good condition, prepared and served clean,
free from adulteration and dangerous substances.
• To control importation of food related disease into the
country, and meet consumers expectation.

139
 Five keys to safe food:
• keep clean
• Separate raw food from cooked
• Cook carefully
• Use safe water
• Use safe raw materials
Foods of Concern:
 Any food can be a vehicle for food borne illness.
 High protein foods are most often responsible for food
borne illness
 Milk & milk products
 Egg, Meat, Seafood, Cooked potatoes, etc.
140
 Public Health significance of food:
1. Food borne diseases: Infection, intoxication
2. Chemical poisoning
3. Adulteration and misbranding
4. Food spoilage
 Factors of food borne diseases:
1. Raw foods: perishable foods
2. The environment: flies, rats, contaminated water and
equipments
3. Food handlers: skin lesions, spitting, coughing
4. From sick animals

141
1 .Food borne diseases
• Either infectious or toxic in nature,
• caused by agents that enter the body through the
ingestion of food.
Classification of food borne diseases:
 depending on the causative agent.
1. food-borne poisonings/intoxications
2. food-borne infections
Food borne infections: are diseases whose
etiologic agents are viable pathogenic
organisms ingested with foods.
142
• Is caused not because of toxins produced in the food,
• Thus referred as infection type.
Ex. bacterial infection- salmonella
viral infections- hepatitis
parasitic infection- tape worm
 Food borne poisonings/ intoxications:
• Ingestion of toxins released by microorganisms,
• Intoxications from poisonous plants or toxic animal
tissues;
• Consumption of food contaminated by chemical poisons.
Ex. Staphylococcal enterotoxin
clostridium botulinum
clostridium perfringes 143
2. Chemical poisoning:
• Certain chemicals or poisonous substances are
introduced into the food, directly or indirectly and
consumed.
• They may cause poisoning immediately, depending on
the type and dose of the chemical substance.
Example:
• Fertilizers
• Insecticides, herbicides, weedicides

144
Poisonous plants and animals:

• This could be naturally poisonous and be taken accidentally or


mistakenly as food products.
• This is a poisoning caused by consuming toxic foods in w/c
cooking do not help to destroy the toxins.
• Ex. Snake root, mushroom, ergotism & water hemlock

145
 Eating and drinking establishment sanitation:
 Control measures:

• food and drinks served should be licensed, properly


constructed and properly sited.
• Three compartment washing facility.
• food handlers: healthy all the time or medical
examination check up at regular intervals.

146
Cleanliness:
• Keeping hands and fingers away from hair, nose and
mouth parts.

• Keeping finger nails clean and short trimmed.

• Wearing clean outer while working.

• Wearing hair nets and caps.

• Restricting from smoking inside food preparing areas.

• Frequent practice of body washing , shaving hairs. 147


• frequent hand washing.
 during working hours
 after smoking

 after visiting toilets

 after coughing and sneezing over hands etc.


 Food equipment and utensils:

• Utensils should be repaired and no cracks, cleanable,


smooth, have no clips, pits, cause no corrosion, no
rusting, that should be accessible for cleaning and
148
inspection purpose.
Washing utensils:

• Washing- using lukewarm water with temperature of


(43.3 to 48.9 oC).
• Rinsing- using clean, lukewarm water.
• Sanitizing- using
hot water having a To of 76.7 oC for about 2 min or,
100 oC for at least 30 seconds or using
chlorine solution of 100ppm, should not fail to less
than 50ppm, for about 3 minutes.
149
 Sanitary facilities of food service:

• Adequate and safe water supply.


• Conveniently located and easily accessible toilet
facilities.
• Suitable and accessible hand washing facilities.
• Proper refuse storage ,collection and disposal of solid
wastes.
• Proper vermin and rodent control.

150
Food protection measures:-
1. Strict observation of food handlers’ personal hygiene
2. Keeping potentially hazardous foods refrigerated at all
times to their proper T0
3. Application of good sanitation practices in storage,
preparation, display & service of food.
4. Adequate cooking of foods
5. Through washing & proper storage of
fruits/vegetables.
6. Provision of adequate equipment & facilities.
151
• Factors that affect bacterial growth:
1. Temperature
2. Time
3. Water activity/ Relative humidity
4. Oxygen
5. pH
6. Light
7. Physical structure

152
3. Food spoilage:
• Alteration of food in color, odor, taste, texture, consistency due to
food decomposition, decaying, rotating & fermentation.
Courses of spoilage:
 growth and activity of micro organisms in food

 direct rodents or other animals activity

 Chemical reactions

 Actions of enzymes of plants or animals food, and

 Physical changes caused by freezing ,burning ,drying ,


pressure. 153
Classification of food on ease of spoilage:
• Perishable foods- have high moisture content.

Eg. meat , fish , egg ,milk ,most fruits and vegetables, etc.
• Semi-perishable- have medium moisture content and
protective covering .E.g. potatoes, apples ,nuts etc.
• Non –perishable or stable foods- dry and can be kept
long period .E.g. sugar, flour, and other cereals etc.

154
Milk borne diseases:
• Milk is a medium (hot bed) for bacterial growth.
• Common milk borne diseases
» Due to contamination of milk from:-
milk handlers like Diphtheria.

inanimate sources like typhoid and paratyphoid, cholera,

bacillary dysentery.
the cow like bovine TB and Brucellosis

155
Health importance of milk sanitation?
1. Good bacterial growth media
2. Easy for contamination during production and
processing;
3. High risk of spoilage under favorable condition;
4. High probability to be consumed as raw;
5. Milk usually used by vulnerable groups: infants,
elderly, the sick.
6. High risk of adulteration

156
Control measures for milk safety and its preservation

• Source prevention: sanitary cattle shed, cow


and the milk handler health;
• Environmental sanitation: utensil cleanliness,
safe water; proper waste management; etc.
• Boiling for a few minute;
• Pasteurization and immediate cooling at
<10C0;

157
Cont….d
• Preserve milk as dry milk powder made at high
temperature;
• Sterilization: 100C0 for 15 minutes in a closed
sterilizer;
• Condensed milk to 1/4th original volume by
heat and packing as creamed or skimmed milk

158
Meat borne diseases:
 Some common meat related diseases are:

• Bovine TB, tetanus or lock jaw , anthrax


• Viral like rabies,
• Parasites like tape worm.
Steps to be taken for meat hygiene control:
• Site of slaughtering
• Ante mortem and postmortem inspection
• Stamping and transporting using designed vehicle
• Sale of meat in a sanitary butcher shop.
159
Basic principles in food preservation:
 Three basic principles

1. Prevention of contamination of food from


damaging agents
2. Delay self decomposition & growth of
microorganisms in the food.
3. Destroy the microorganisms responsible for
contamination & spoilage of the food.
160
 Food preservation methods:
1. Use of high temperature
 Cooking/ boiling, Pasteurisation, Canning

2. Low temperature treatment


 Chilling , Freezing

3. Use of dehydration methods

161
4. Fermentation & pickling/ ex. Adding vinegar
5. Acid preservatives
 Benzoates, Sorbets, Propionates, Acetic &
lactic acids
6. Chemical preservation
 Salting , Sugaring, Spices, Smoking,
Fumigation

162
• Transmission of disease from excreta
Water

Hands
EXCRETA
Death

Food/milk, New
Vector Vegetables Host

Debility

Soil

163
Ten golden rules for safe food preparation
and consumption (WHO)
• Choose food processed for safety
• Cook food thoroughly
• Eat cooked food immediately
• Store cooked food immediately
• Reheat Cooked foods thoroughly
• Avoid contact between raw and cooked foods
• Wash hands repeatedly
• Keep all kitchen surfaces accurately clean
• Protect foods from insects, rodents, and other animals
• Use pure water
164
6. VECTOR CONTROL

Vector
 Arthropods/other invertebrates which

transmit infection through inoculation of


M/Os by biting, or
 depositing infective materials in the skin,

food or other objects.


165
Definition of terms:
• Entomology: is the study of insects and related organisms.
• Arthropods: “arthro” means jointed and “poda” means legs.
• Medical entomology: is a branch of entomology which
deals with arthropods which affect the health and well-being
of human being.
• Mechanical disease transmission: disease agents are carried
from one host to another by arthropods simply mechanically
carried by the body parts.
166
• Biological disease transmission: the agent will exhibit
changes in form and or number in the arthropod
before entry to the host.
• Mechanisms of disease transmission by Arthropod
1. Mechanical
2. Biological
1. Mechanical: When a vector transports M/Os on
its feet, body hair or other surfaces from filth to
human food or directly to humans.
Ex. House fly, cockroaches etc
167
2. Biological: When the disease causing organism
multiplies or undergoes changes in the vector.
1. Propagative: Multiplication/increase in number
 Plague in fleas, yellow fever in mosquitoes
2. Cyclo –developmental: Cyclical change
 Filariasis
3. Cyclo- propagative: Cyclical changes & multiplication
 Malaria
4. Transovarian/ hereditary: Disease transmitted to the
generation by infection of the egg; Tick- borne RF

168
 Factors that affect vector effectiveness in diseases
transmission:
1. Receptivity: Ability to support the pathogen to develop
2. Specificity: Exclusive to a specific vertebrate host
3. Longevity: Live a sufficient period of time
4. Frequency of feeding: Nature of vector- host contact
frequency.
5. Mobility: Superior mobility aids in the rapid
dissemination of pathogens over a wide area.
6. Number: Large number increases the chance of feeding
& infecting the host.
7. Physiological & behavioral plasticity: Ability to
develop resistant mechanism by physiological &
behavioral means. 169
Impacts of insects on public health:
1. Economical problems
2. Injure sense organs
3. Allergic reactions
4. Dermatitis, fever, blisters
5. Disease transmission/ vectors
6. Nuisance/irritating
7. Entomophobia

170
Most public health important vectors:

• HOUSE FLY
• the closest associates of man.
• One pair of wings characterizes them, most prevalent found inside
buildings.
• mechanical disease transmission:– leg hairs, wings, body, vomitus,
defecting on food;
• Disease transmitted: faeco-orale borne diseases; eye infections:
typhoid fever, amoebiasis, bacillary dysentery, helminthic diseases,
conjunctivitis;
 Fly control measures
• Environmental sanitation
• Mechanical and Physical methods
• Chemical use 171
1. MOSQUITOES:
• family Culicidae
notorious as proven
vectors of some of the
most devastating human
diseases.
also cause diseases like
Rift Valley fever (RVF)
and the equine
encephalitis in live stocks. 172
External morphology
• Dipterans/two winged insect
• Three pairs of long thin legs
• Long slender body
• Long needle shaped piercing mouth parts.
• Scales on the thorax, legs, abdomen, and wings.
• they can be sexed by examining their antennae (male-feathery,
female-short, invisible).
• The most important man biting belongs to the genera Anopheles.

1. Viral diseases: Dengue fever and yellow fever.


2. Mechanical transmitter: Some mosquitoes may carry fly eggs to
humans, inducing myiasis. 173
• Ex. Culex, Aedes, Mansonia, Hemagogus and Sabethes
• About 100 species are vectors of human diseases.
• Female mosquitoes bite and take a blood meal.
• An autogenous development: A few species, however,
can develop the first batch of eggs without a blood-meal.
• Mosquitoes have four distinct stages in their life cycle:
egg, larva, pupa, and adult.
– adult is an active flying insect.
– larvae and pupae are aquatic
174
Eggs of anopheles spp

Larvae of culex

175
pupae of mosquito
Adult behavior

• Governs the selection of control methods.


• Anopheles are active between sunset and
sunrise, usually they become active at twi-light.
• The resting position of adult anopheles is angled
or perpendicular,
• where as culex and aedes rest horizontally with
the resting surface.
• Mosquitoes are attracted by the body odors,
CO2 and heat emitted from the animal or
person.
176
Cont…
• Anthropophagic: feed from/bite human
• Zoophagic: feed from/bite non-human
 The anthropophagic mosquito can be divided in to:
• -endophagic- feed indoor
• -exophagic-feed outdoor
• -endophilic- rest in indoor
• -exophilic- rest in outdoor
Control of mosquitoes:
1. larval control: Elimination of breeding site like stagnant water
2. Adult control:
 Repellents,
 Insecticide treated nets and
 Long lasting insecticide treated nets
177
 Challenges of malaria control:

 Change in vector behavior e.g. An. arabiensis


• resistance to the most common insecticides

Ex. DDT (dichlorodiphenyltrichloroethane), pyrethroides

 Parasite component
• Anti-malarial drug resistance eg. Plasmodium species

 Public health component


• Lack of Political and financial commitment

• Health system in-effectiveness

• Shortage of trained man power and infrastructure


178
2.Black flies (simuliidae)

Figure 1.Black fly larvae

179
• Black flies:
• commonly called "buffalo gnats“,
• because of their humped back appearance.
• dark in color
• appear in a variety of neutral shades from light gray to
black.
• They belong to the order Diptera (Flies) and the family
Simuliidae.
 Onchocerciasis was first reported in southwestern
Ethiopia in 1939 by Italian investigators.
 Transmitted by the bites of black flies found near the
fast-flowing rivers.
• Endemic areas extend from the northwest to southwest
of the country that borders the Sudan. 180
 Habitats & Life Cycles:

• Black flies breed exclusively in running water.

• Some species live in large, fast-flowing streams;

• others live in small, sluggish streams.

• Large black fly populations indicate clean, healthy streams


since most species will not tolerate organic pollution.
• Females lay their eggs on vegetation, in streams or scattered
over the water surface.
• The eggs hatch in water and larvae attach to rocks, leaves,
181
grass or other submerged objects.
• Black fly transmit the parasite which causes
onchocerciasis and dermal Infection
• via the bite of a female black fly when feeding on blood.
• On humans, bites are common around the hairline, the
neck, behind the ears and around the ankles
• Attracted to mammals by the CO2 and moisture in
exhaled breath, dark colors, perspiration, perfumes, etc.
• Onchocerca volvulus: cause onchocerciasis- a
cutaneous filariasis-also called river blindness.
182
– Inflammatory dermatitis
– intense irritation results in raised papules on the skin, and
– darkening of the skin-“sewda”- black disease.
– In chronic onchocerciasis, the skin loses its elasticity
• “elephant skin”
• “Hanging groin”

– Spotted de-pigmentation of the skin-“leopard skin”

– The most serious complications of onchocerciasis is when


microfilaria in the skin of the face migrates in to the eye.

• Ocular onchocerciasis
183
Prevention and control:

– Destruction of simulium larvae by applying


insecticides in rivers.

– Avoid simulium bite by covering the parts of the


body at risk.

– Treating infected individuals.

184
3.SAND FLIES (PHLEBOTOMINAE)
• Sand flies are small blood sucking flies
that are important as vectors of
leshmaniasis and
• can cause a serious but localized biting
nuisance.
• Species that occur in the Mediterranean
region can transmit sand fly fever, a viral
disease also known as Pappataci fever or
three-day fever. trans-ovarious

185
• Species in three genera
-Phlebotomus,
-Lutzomia and
-Sargentomia suck blood from vertebrates.
• The first two genera are more important medically as
they contain disease vectors.

• Genus Phlebotomus are found only in the Old World


tropics.

• Most Phlebotomus species inhabit semi arid and


savannah areas in preference to forests. 186
• Lutzomia species on the other hand are found only in the
New World tropics, occurring mostly in forested areas of
South America.

• Sergentomia species are also confined to the Old World


being especially common in the Indian sub region,

• But also occurring in the other areas such as Africa and


C. Asia.

A few species of sergentomia bite people, but they are not


disease vectors. 187
Life Cycle of Sand Flies:
EGGS:
Are minute in size (0.3-0.4 mm)
ovoid in shape,
brown or black colored,
patterned when seen in a microscope
• some 30-70% of them are laid singly at each oviposition.
are deposited in small cracks and holes in poultry
houses, amongst leaf litter and in between buttress roots
of the forest trees

188
LARVAE: Are mainly scavengers (feed on organic matter
such as fungi, decaying forest leaves, etc.
PUPA: the skin then splits open and the pupa wriggles out.
Adult
• They are minute in size (1.3-3.5 mm in length).
• Limited home range- Horizontal flight: maximum 200
meters.
• Vertical flight: about 6 meters.
• Sand flies usually rest in the day in dark and humid sites.
 Medical importance
• Transmission of Leishmaniasis
• Obligate intracellular protozoa of the genus Leishmania

189
• Leishmania: Named after Leishman, who first
described it in London in May 1901.
• Leishmaniasis can easily classified clinically as
• Visceral leishmaniasis
• Cutaneous leishmaniasis
• Mucocutaneous leishmaniasis
• Diffuse cutaneous leishmaniasis
• These different forms of the disease is caused by the
different species of Leishmania

190
• Cutaneous Visceral
leishmaniasis(CL) leishmaniasis(VL)
– L. tropica L. donovani
– L. major
L. infantum
L. Chagasi
– L. aethiopica
– L. panamensis
– L. guyanensis
– L. peruviana Diffuse cutaneous
Mucocutaneous leishmaniasis(DCL)
leishmaniasis(MCL) • L. amzonensis
L. panamensis • L. aethiopica
L. guyanensis
L. Brazilliensis 191
• In Ethiopia
– Four species of Leishmania are found, namely,
▪ L. aethiopica,
▪ L. major
▪ L. tropica
▪ L. donovani

• The disease is widely spread in different area in


Ethiopia: Gondar, Tigrai, Jimma, Diredawa, Lekempt,
Harar, Arbaminch, Dessie.

192
Cutaneous Leishmaniasis
(Oriental sore)

• chronic ulcerated,
papular, or nodular
lesion
• lesion is painless, non-
tender, non- pruritic
and usually clean

193
Muco-cutaneous Leishmaniasis
(espundia):

194
Visceral leshmaniasis
(kala-azar)
• incubation period
• generally 2-6 months
• can range 10 days to years
• fever, malaise, weakness
• wasting despite good appetite
• spleeno- and hepatomegaly,
enlarged lymph nodes
• depressed hematopoiesis
• severe anemia
• leucopenia
• thrombopenia  petechial
hemorrhages in mucosa

195
Adult behavior
• females suck blood from a variety of vertebrates.
• Biting is usually restricted to crepuscular and
nocturnal periods
• but people may be bitten during the day in
darkened rooms, or in forests during overcast
days.
• Most species feed out of doors (exophagic) but a
few also feed indoors (endophagic).

196
Cont…
• biting may be localized to a few areas.
• However, it is known that adults of at least some species can
fly up to 2.2 km over a few days.
• several short flights and landings before females settle on their
hosts.
• Windy weather inhibits their flight activities and biting.
• Because of their very short mouthparts, they are unable to bite
through clothing.
197
Prevention and control of Leishmaniasis
• Most cases of CL heal without treatment, leaving
the person immune to further infection.
• In many parts of South-west Asia, infections were
deliberately encouraged on the buttocks of
babies in order to immunize them (avoiding
disfiguring scars on the face or elsewhere).
• Prevent sand fly bites through the repellents and
Insecticides.
• residual sprays applied to walls, screens, fences,
etc.
198
4.Tsetse flies:
• Vectors of animal and human
trypanosomiasis.
• Male and females feed exclusively on
blood.
• Adults mate only once and lay one larva
every 9 days.
• Females are larviparous.

• Fully grown larvae is deposited in sandy


habitats, under vegetation, fallen leaves
199
and trees.
Public health importance
• Responsible for 2 forms of sleeping sickness
 Gambiense form (caused by T. brucei gambiense)

– West and central Africa, chronic


 Rhodosciense form ( caused by T. brucei rhodoscience)

– East Africa, acute


 50 million people are at risk of the disease, in 36
countries, 2009.

200
Control Measures: -
• Animal culling and clearing of wooded vegetation.
• Clearing forest and bushy habitat of tsetse fly
• Clear 10-12 meters on both sides of forest crossing
roads.
• Close highway of tsetse infested areas.
• Trapping adults, killing pupa using nets or / odor
attracted traps.
• Aircraft pesticide applications can be effective in
areas where it is not practical to eliminate or reduce
thick bush.

201
Cont…
• Use animals as bait / visual targets to trap.
• Inspection of people and treating cases.
• Genetic control: sterile males by radiation.
• Insecticide application / with care (Aerial spraying,
Ground spraying, and Fumigation).
• Use of repellents: Oils, lotions or creams applied to
exposed body parts or applied lightly on clothing.

202
5. Flea and lice:
• ORDER: Siphonaptera (Fleas)
• Small, wingless and laterally flattened.
• Possess piercing & sucking mouthpart which is
distinctly pointed down wards.
• Both sexes are exclusively blood suckers.
• Legs are specialized for jumping.
• Combs & compressions facilitate movement.
203
• Only the body louse has been implicated as a vector
of disease, i.e. of epidemic typhus (R.prowazeki),
endemic relapsing fever, flea-borne endemic typhus
(Rickettsia typhi), plague (yersinia pestis) and trench
(Quintana) fever.
• Epidemics of these diseases are often associated with
wars or natural disasters.
– When standards of hygiene are low and people are
living in crowded conditions.
204
Control measures of fleas
• Insecticide application
• Insect growth regulators: such as methoprene have been incorporated
in to sprays often combined with a pyrethroid such as permethrin for
treating household infestations.
 Such sprays may remain effective for 10 week.

205
6. Medical importance of ticks:

• Dermatosis: inflammation, itching , swelling at site of bite.

• Anemia: blood loss can result from heavy infestation.

• Otoacariasis: infestation of the inner ear canal by ticks that


causes irritation and sometimes secondary infection.
• Tick paralysis (envenomization): Due to the release of toxic
secretions when persons are bitten at the base of the skull.
• Pathogen transmission (virus, rickettsia, bacteria,
spirochaete, protozoa, filarial worms).
206
7. Bilharzia Snail:
 Include almost all types of freshwater bodies ranging
from small temporary ponds and streams to large lakes
and rivers.
• Within each habitat, snail distribution may be patchy and
detection requires examination of different sites.
• In general, the aquatic snail hosts of schistosomes occur
in shallow water near the shores of lakes, ponds, marshes,
streams and irrigation channels.
207
208
 Public health importance:
• Schistosomiasis is one of the most widespread of all
human parasitic diseases, ranking second only to malaria
in terms of its socioeconomic and public health
importance in tropical and subtropical areas.
• Endemic in 74 tropical countries, and over 200 million
people living in rural and agricultural areas are at risk.
• Snails are also important intermediate hosts for Fasciola
species which infects human and animals.
209
210
 Snail control:

• Snail control is perhaps employed less often as a means


of combating the disease.
• It remains an important and effective measure, especially
where transmission occurs to a significant extent through
children playing in water.
• Prior to undertaking snail control measures, health
authorities should screen water for the presence of snail
intermediate hosts.
211
 Env’ tal management and reduction of snail habitats:

Alteration of water levels and flow rates


• Raising and lowering water levels and increasing flow
rates can disturb snail habitats and their food sources.
• Rapid complete drainage reduces the amount of
vegetation and kills the snails by desiccation.
• This method may be of interest in areas with irrigated
crops.

212
Removal and destruction of snails
• Snails can be removed from canals and watercourses with
dredges and crushed or left to die of desiccation.
• This happens in irrigated areas of Egypt and Sudan as a
beneficial side-effect of efforts to improve the flow of
water by removing mud from canal bottoms .

213
Plants with molluscicidal activities
• Endod is the Ethiopian name for the soap berry
plant Phytolacca dodecandra (Synonyms: P.
abyssinica, Pircunia abyssinica), a member of the
Phytolaccaceae family.
• The distribution in east, west, central, and southern
Africa and parts of South America and Asia.

214
Vector control tools

A. Personal protection methods


B. Chemical Control of vectors
C. Biological control method
D. Genetic control
E. Environment management/Ecology

215
Vector Control tools…
Personal Protection methods
• They are usually simple to use
• Includes:- 1) Repellents

2) Insect vaporizers
3) Mosquito nets

Biological control method


• exposing vectors to their natural enemies.
216
Genetic control:
• Genetically manipulated (changed) insects are released
among the wild populations to make the mating sterile or
to introduce lethal genes into the eggs of the females so
that they do not develop beyond a certain stage.
Eg .Sterilization-types
• Sterile male technique, sterile insect technique-
sterilization of a portion of the wild population itself
(both male and females) by chemosterilants.

Environmental management /ecological approach:


• Includes clearing of sites suitable for breeding of
vectors, improved housing.
217
• VECTORS OF PUBLIC HEALTH IMPORTANCE

Vector Disease
Sand fly Leishmaniasis
Black fly Onchocerciasis (Eye blindness)

Tsetse fly Trypanosomiasis (African sleeping


sickness)
House fly Typhoid
Mosquitoes (Aedes, Culex, Yellow fever, Filariasis, Malaria.
Anopheles).

Lice Relapsing & Typhus fevers

Fleas Plague, Endemic Typhus


Rat Salmonellosis, Leptospirosis 218
Side effects of pesticide use and biological control

• Toxicity during handling and application (Bhopal case in India


killed 2500-7000 people).
• Toxicity to non-targeted species (loss of biodiversity, ecological
disturbance).
• Bioaccumulation in the environment (soil and water bodies).
• Pest resistance

219
7. HOUSING AND INSTITUTIONAL HEALTH

• Housing (house): A physical structure that man uses for


shelter & its env’ts ( services, facilities, equipment &
devices) needed for the physical, mental, & social well
being of the family and individual (WHO 1961).
• Institution: An organization established for determined
purposes such as educational, social, religious, political,
etc.
 Schools, colleges/universities, hospitals,
kindergartens, prisons, etc. 220
Public health importance:
1. Increased infections due to overcrowding
& lack of basic sanitary facilities
 Respiratory, GI, skin, & eye infections.
2. Increased infestations with rats, bed bugs,
lice, flies, mosquitoes etc.
3. Increased accidents: falls, fire, etc.
4. Increased social problems: -
 Juvenile delinquency, alcoholism,
prostitution, narcotics, etc.
221
Basic principles of healthful housing:
WHO adopted healthful housing criteria
1. Fundamental physiological needs.
2. Protection against diseases (infections).
3. Protection against accidents: injuries,
poisoning.
4. Reducing psychological & social stresses.
5. Improving the housing env’t.
6. Protecting the population at special risk.

222
1. Fundamental physiological needs:
 Adequate living space
 Adequate & clean air
 Adequate ventilation
 Protection against excessive noise
 Maintenance of thermal comfort
 Adequate indoor lighting

223
2. Protection against diseases (infection):
 Safe water supply
 Safe waste management
 Personal & domestic hygiene
 Safe food hygiene
 Vector control

224
3. Protection against accidents:
 Structural features provide safety protection
against falls, collapse, & other mechanical
injuries.
 Indoor air pollution
 Chemical safety
 Electrical control & safety provisions
 Fire control & safety provisions
 Protection against gas poisoning
 Traffic accidents

225
 Causes of accidents:-
 Structural faults during design & construction
 Lack of maintenance
 Human activities
• Slippery floor
• Improper electric wires protection
• Improper chemical use & storage
• Cooking with biomass fuels, etc

226
4. Reducing psychological & social stresses:
 Reinforcement of personal/family security

 Provisions of recreational sites for children, elders

 Provision of clean air, water, & noise free

5. Improving the housing environment


 Access to fire rescue & medical emergency
services.
 Access to social services ( market, school, cultural
centers, etc).
227
6. Protecting the population at special risk:
 Priority to high risk population groups such as
children, women, elders, disabled, & displaced
population.
S.N Number of rooms Number of persons

1 1 2

2 2 3

3 3 5

4 4 Seven and half

228
8. Institutional health:

 Institution is any organization established for Educational, Social,


Religious, Political, etc purposes.
 An institution accommodates a group of people at a time.
 Schools, prisons, Hospital, University, kindergartens, etc.

229
1. School Health Service:
 A school health program should generally include the
following important services:
 Communicable diseases control

 Accident prevention

 Minimizing non-communicable defects

 Provision of health essentials in the school env’t

 Provision of aid in nutrition

 Provision of adequate activity for children to

promote their physical fitness


 Health education

 Integration of school & community health program

230
2. Health institution/hospital:
 HIs have many potential hazards that can pose a
threat to employees, patients and visitors.
 Main health hazards in the hospital setting are
bacterial infections (streptococcus & staphylococcus)
& viral infections (Hepatitis B & C)
 Objectives of sanitation in HI are aimed at
maintaining a high degree of cleanliness & effective
sterilization techniques in order to prevent
nosocomial infections.

231
Control procedures of nosocomial infections:
a. Laundry
 Clothes of the patients to be admitted should be
disinfected & washed as soon as possible.
b. Proper wastes disposal
 Best methods of disposal of infectious wastes are,
incineration & burying (non-combustible wastes).
c. House keeping
 All wastes should be properly stored in a watertight
covered, corrosion & wet resistant containers (bins)
until properly disposed.
 Wet mopping specially with disinfectant chemicals is
best to minimize the risk of infection.
232
d. Health care staff
 PPEs such as gowns, masks, gloves, & caps must
be worn &
 removed before entering clean areas such as lunch

rooms, lounges, cafeteria, & patient rooms.


e. Dietary
 Employees working in food preparation areas

should be encouraged to stay home when sick & to


visit HIs before returning to job.
 Thorough washing of food ingredients before

preparation & separate from the unwashed food.


 Refrigeration of the perishable food products at

proper temperature prevents the growth of M/Os.


233
f. Personal hygiene
 All hospital staff should wash their hands with
soap & adequate water-
 after attending a patient,
 before touching another patient &
 at all other critical times such as after
visiting the toilet.
g. Maintenance of physical structure
h. Central supply
 Central supply & sterilization area is responsible
for sterilizing any soiled materials used in
surgery & treatment rooms.
234
STERILIZATION
I. Heat Sterilization
a. Steam sterilization/autoclaving
 At 121oC for 15 minutes for unwrapped & 30

minutes for wrapped.


 100% moisture in the steam.

b. Dry heat sterilization method


 The recommended temperature & time is170
o
C for 60minutes & 160oC for 120minutes.
II. Chemical Sterilization
 Soaking items for 10 hrs in a glutar-aldehyde

or for 24 hrs in 8% formaldehyde.


235
g. Formation of infection control committee:
 Establishment of this committee is important to
coordinate & ensure that medical, nursing,
housekeeping, maintenance & supportive staff
are following good practices & procedures.

236
III. Prison health:
Prison is an institution where prisoners are kept under
custody for a certain period of time.
 Source of disease in the prison
 Some prisoners may join the prison with apparent or
unapparent infection from outside and infect other
prisoners;
 Infection that originate in the prison it self because
of poor environment (Poor housing, inadequate
ventilation, overcrowding, malnutrition, poor
hygiene, due to lack of facilities, inadequate water
supply, etc).
237
Aims of prison health service:
1. To solve the immediate physical & mental health
problems.
2. To prevent the infectious disease especially the
chronic ones such as TB.
3. To teach prisoners the basic principles of healthy
living
• so that when they are released from the prison to join
their community once again, they can convey
whatever health messages they gate in the prison.
4. To advise prison administration on health and
environmental conditions of the prison.

238
Prevention & control methods of CDs in prison:
a. Buildings
 Should be structurally sound, secure and fire
resistance
 Cells should be designed to provide at least 5m2 of
floor area for each prison inmate.
 Cells should be provided with a minimum of 30 ft-c
illumination.
 A minimum of 4m2 sleeping area per person is
required to avoid overcrowding.
 Height of the ceiling should not be less than 2.35m.
 Beds should be raised by 30cm from the floor.
 Minimum space of 90 cm b/n two beds and 120 cm if
double beds are used. 239
b. Physical examination of inmates & inspection of
the basic necessities.
c. Lighting & ventilation
 All rooms should receive natural and artificial
light as well as adequate ventilation.
d. Water supply & sewage disposal system:
 At least one drinking tap should be provided

outside of the physical structure for 100


prisoners.
 At least one shower should be provided per 50

prisoners.
 At least one seat hole of pit latrine per 50

prisoners.
240
e. Control of vectors such as rodents & insects
f. Food hygiene
 Regular inspection of food preparation
 Proper training to food handlers
 Regular medical check up of food handlers
g. Appropriate refuse disposal facilities provision
h. Temperature regulation
 The prison is recommended to have a day
temperature of 20-22.2OC & a night temperature
of 15.5 OC in cells, offices, & similar areas.

241
9. OCCUPATIONAL HEALTH

7.1. Definitions
Occupational health & safety service:
 Science & art devoted to the anticipation,

recognition, evaluation, & control of those env’tal


factors/stresses arising from the workplace-
 that may cause sickness, impaired health & well-

being, or significant discomfort among workers or


citizens of the community.
242
• Hazard: Potential of some thing to cause adverse effect.
• Risk: Probability that something undesirable will happen
as a consequence of exposure to a hazard.
• Anticipation: To foresee the potential for disease or
injury.
• Accident: unanticipated, sudden event that may cause
an undesired outcome such as property damage, injury or
death
• Injury: Physical damage to tissue

243
Ergonomics:
 Work place design
 Study of human characteristic for the appropriate design
of work env’t.
 Application of human biological science in

conjunction with engineering science-


 to achieve the optimum mutual adjustment of man &

his work

244
7.2. Scope of occupational health:
 Occupational health encompasses prevention ,
control, curative & rehabilitative programs.
 Health promotion in the work env’t
 Establishment of sound env’tal conditions
 Organization of health services including first aid
 Diagnosis & treatment of occupation related
diseases & accidents
 Rehabilitation of those that have been injured

245
7.3.Elements of the work environment:
 Associated with different hazards
1. Worker: Differ in susceptibility to disease
2. Tool: Range from very primitive like a hammer/needle
to automated equipments & associated with d/t hazards
3. Process: Raw material used may be toxic or the process
may release toxic substances.
4. Work environment: Associated with d/t types of hazards

246
7.4. Classification of occupational hazards:
1. Chemical hazard: Particulates, solvents, gases.
2. Physical hazard: Noise, extreme To, humidity &
dust.
3. Biological hazard: Insects, rodents, M/Os,
poisonous plants & animals
4. Ergonomic hazards: Poor work place design
5. Mechanical hazards: Vibrating & rotating tools,
repetitive movement of hands etc.
6. Psychosocial hazard: Work over load, work under
load, poor job management, work shift, career
development, & lack of job security
247
7.5. Occupational Diseases
1. Disease of respiratory system

2. Musculoskeletal disease

3. Skin disease

4. Eye diseases

5. Disease of the nervous system

6. Reproductive disorders

7. Cardiovascular disease

8. Coronary heart disease

9. Hematological disorders

10. Liver diseases (hepatic disorders)

11. Hearing loss

248
1. Disease of the respiratory system:
 Occupational asthma
 Hypersensitivity pneumonites
Bagassosis= inhalation of sugarcane dust

 Byssinosis= inhalation of cotton dust

 Pneumoconiosis
 Silicosis: silica (SiO ) dust
2
Asbestosis: asbestos dust
 Bronchitis
 Emphysema:- Destruction of alveolar walls

249
2. Musculoskeletal disease: Tendonitis, Neck tension
syndrome, Back pain
3. Skin disease: Dermatitis, Frostbite, Skin cancer
4. Eye diseases: Cataract, Conjunctivitis
5. Disease of the nervous system:
 Neuralgic disorders
 Central Nervous system

 Peripheral Nervous system/ neuropathy

 Behavioral disorders
 Occupational stress

250
6. Reproductive disorders
 Male: Spermato-toxicity and Hormonal alteration.

 Female: abortion, stillbirth and developmental deficits

7. Cardiovascular disease: Coronary heart disease


 Arsenic

8. Hematological disorders
 Hemolysis

 Arsine gas (AsH3)


 Leukemia

 Benzene

 Suffocation

 CO
251
9. Liver diseases (hepatic disorders)
 Liver cirrhosis
 Alcohol whiskey producer

 Viral diseases
 Hepatitis B virus

 Liver cancer
 CCl
4

10. Renal & urinary tract disorders


 Renal cancer- lead
 Urinary bladder cancer
 Urinary tract cancer
 Acute nephropathy- Arsine (Arsenic hydride; SbH 3)
252
7.6. Occupational health hazard control
Objective: To ensure that employees' exposure to harmful
chemical, physical & biological agents does not result
in occupational illness.
Occupational Hazard Control Methods:
1. Engineering Controls

2. Administrative Control

3. Personal Protective Equipments (PPE)

253
1. Engineering controls
 First line of defense against work place hazards
i. Ventilation to minimize dispersion of air borne
contaminants
ii. Isolation of a hazardous operation or substance by
means of barriers
iii. Substitution of material, equipment, or process

2. Administrative control
 Work period reduction
 Job rotation
 Appropriate work practices
 Bonus
 Proper management
254
3. Personal protective equipments (PPE)
 Least effective method

1. Respiratory organ (respirator)

2. Protective clothing ( gloves, boots, aprons, gown)

3. Eye & face protection (chemical goggles, eye


glasses, face masks))
4. Hearing protection (ear plugs & muffs)

5. Head protection (helmet)

255
End
Thank you

256

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