Waterborne Diseases, Sanitation and Community Health
Unsafe water is frequently a vector for disease. When a community relies on unprotected water sources, everyone’s health suffers.
Last month, we discussed the situation in Kahama, Uganda, and the role of water access in preventing disease. In the middle of the COVID-19 pandemic, having water available for hygiene was a matter of life and death for many communities. As seniors in Kahama had to forego basic hygiene for weeks in order to save water, they heightened the risk of getting sick and lost one of their most likely defences against the spread of COVID-19.
The installation of rainwater filtration systems in the town’s community center and its primary school, as well as the five water systems installed into individual seniors’ homes in the region, may go a long way to protect the community and its elders from the spread of COVID-19 and other contagious diseases. However, when it comes to disease prevention, water can be a danger to a community as often as it is a protector.
Unprotected or contaminated water sources can be a vector for waterborne diseases, which can wreak havoc on communities without safe water. 3.4 million people around the world die of waterborne diseases every year, most of them young children. Many of these diseases are almost nonexistent in developed countries in the 21st century, but families in water-stressed communities risk typhoid and cholera every day when they bring their water home.
There are several ways to protect people from many of these diseases, including vaccines, better medical care for the sick, and protective hygiene. However, the risk can be avoided in the first place if we can address the primary causes of these diseases in water-stressed communities: inadequate water source protection and a lack of proper sanitation.
What Makes an Unsafe Water Source?
The World Health Organization defines a safely managed drinking-water service as a water source that is located immediately on-premises, readily available when needed, and free from contamination. While many communities in developed countries are able to take all of these factors for granted, nearly 30% of the world’s population lacks access to a safely managed drinking-water service.
Furthermore, one-tenth of the world’s population lack access to even basic drinking water services. WHO defines a basic drinking water service as an improved drinking water source within a 30-minute round trip to collect water. An improved water source may be a borehole, a rainwater collection system, or a well or spring with adequate protection from outside contamination. An unimproved or unprotected source, on the other hand, may include uncovered wells or open streams and lakes. Without proper protection or filtration, unimproved sources can be easily contaminated by animals, spreading disease to humans who depend on the water source.
Another massive factor in water source safety is the lack of proper sanitation. A 2017 report states that less than half of the world has access to safely managed sanitation services. More than two billion people only have access to basic toilets or latrines, which may lead to wastewater being returned to the water system without proper treatment. In addition, 892 million people defecate out in the open, without any sanitation at all.
The combination of unprotected water sources and inadequate sanitation often leads to faecally contaminated water sources. According to UNICEF’s 2014 progress report on sanitation and drinking water, almost a quarter of the global population relies on faecally contaminated water. In regions where plumbing and safe waste disposal are unavailable, water sources can quickly become contaminated when people dispose of waste outside their homes.
Unsafe Water and Disease
Faecally contaminated water is one of the main causes of waterborne disease. Many of these diseases can be debilitating or even fatal; typhoid, cholera, and dysentery, along with other diarrhoeal diseases, claim the lives of hundreds of thousands of people every year in communities that rely on faecally contaminated water. Anyone who drinks from a faecally contaminated water source, uses that water for hand washing or bathing, or cooks with that water puts themselves and others at risk of infection. People may also contract these diseases by eating unwashed fruits and vegetables.
Some of the most common diarrhoeal diseases stemming from water contamination include typhoid, cholera, and dysentery. Typhoid fever is a bacterial infection that is characterized by high fever, stomach pain, and constipation or diarrhea. Symptoms may show up several weeks after exposure to the disease and tend to grow more severe over time, beginning with mild pain, headaches, and fatigue and ending in high fever, delirium, and life-threatening complications. Typhoid usually lasts for a few days and can be treated with antibiotics, but without treatment, it can be fatal.
Cholera is an infection caused by the bacterium Vibrio cholerae, and it tends to spread rapidly in areas with unsafe water, poor sanitation, and poor hygiene. People with cholera tend to suffer from diarrhea and vomiting, which rapidly leads to severe and possibly fatal dehydration. Without treatment, cholera patients may die from dehydration and electrolytic shock. Cholera symptoms may last for several days, but severe cases can kill within a few hours.
Dysentery is an intestinal infection that can be caused by either bacteria or a single-cell parasite. People who contract dysentery tend to suffer diarrhea, bloody stool, fever, vomiting, and dehydration. In most cases, symptoms last about a week at most. As with cholera, dehydration may be fatal if it goes untreated.
In addition to being a vector for waterborne diseases, unsafe water may facilitate the spread of disease by making hygiene difficult to maintain. As we’ve all learned many times over during the past year, just having safe water to wash your hands with can make a world of difference when it comes to protecting you from disease. The World Health Organization estimates that hand washing alone could reduce diarrhea-associated deaths by 50%.
Hand washing can also greatly reduce the spread of food-borne or waterborne diseases. However, with contaminated water, hygiene practices like bathing or hand washing can actually be vectors for waterborne diseases instead of protective factors. Therefore, unsafe water can contribute to the transmission of contagious illnesses even outside the context of waterborne disease.
In developed countries like the United States or Canada, travellers may be familiar with warnings to avoid drinking tap water or drinks with ice while visiting other countries, to avoid fresh fruit and vegetables, or to avoid street food. However, for water-stressed communities without access to proper sanitation, avoiding contaminated water may not be an option. Billions of people have to rely on contaminated water to survive, exposing themselves to deadly diseases — and putting their children at risk as well.
Waterborne Diseases and Children
When a community is at risk of waterborne diseases, children often suffer the most. Children tend to have weaker immune systems than healthy adults, which makes them more vulnerable to contagious diseases. In addition, the nature of diarrhoeal diseases makes children far more likely to suffer severe dehydration, which can quickly become fatal. In fact, almost 90% of the 1.8 million people who die of waterborne diseases each year are young children.
Unsafe water is a massive contributor to infant mortality worldwide. Diarrhoeal diseases are the second leading cause of death in children under five; around 1.5 billion children suffer from diarrhoeal diseases every year and more than 500,000 will die from it. Children suffering from malnutrition are especially vulnerable, as are children with impaired immune systems.
Even when the disease isn’t fatal, it can still take a massive toll on the child’s health and future. Some waterborne diseases may cause complications, which can negatively affect a child’s health even if they survive. In some cases, untreated typhoid can lead to organ damage in the digestive system, lungs, and heart, infections in the bones or joints, or severe psychological problems. While rare, these consequences can gravely affect a child’s health long after they recover from the initial disease.
In addition, nonfatal causes of diarrhoeal diseases are a leading cause of childhood malnutrition. Episodes of diarrhoeal disease can lead to the loss of water and vital nutrients, depriving children of the nourishment they need to grow up properly. From an early age, this deprivation can have a devastating effect on a child’s health; without proper nutrition, children cannot develop healthy immune systems to protect them from pathogens in their environment. This often means that children who are suffering from malnutrition may become even more vulnerable to diseases in their community’s water supply.
Waterborne diseases and childhood malnutrition affect millions of families every year. Not only do these diseases cause hundreds of thousands of deaths, but the effects of malnutrition also cause thousands of young children to develop persistent health problems that will negatively affect both their development and their ability to fend off future illnesses. When children suffer from disease and malnutrition, the community’s quality of life and its future also suffer.
Safe Water and Disease Prevention
Considering the scope of the problem, it seems almost strange that most waterborne diseases are easily treatable and can be prevented almost entirely by improving access to safe water and proper sanitation. H2O4ALL has made it our mission to help communities around the world avoid this issue by promoting safe water and sanitation access in vulnerable communities.
An important part of enacting this change is knowing where a safe water source is needed the most and where it will benefit the most people. Oftentimes, benefitting the community means bringing safe water to health centres and hospitals. When hospitals rely on unsafe water, they can often become vectors for waterborne disease and may pose a danger to vulnerable patients. With a safe and reliable source of safe water, on the other hand, the risk of infection is greatly reduced, and the whole community benefits from having a safe and clean medical center. Our multi-stage project approach at Kawolo Hospital beginning in 2012, 2014 and 2017 in partnership with Save the Mothers, was a testament to this. The installation of safe, reliable water sources greatly reduced the risk of waterborne disease infection at the hospital, improving overall community health and making Kawolo Hospital a safer place for patients and staff alike.
Since children are a vulnerable group, schools may also serve as a distribution point for safe water. That’s why many of our projects have involved installing water sources at schools and community centers, as we have done in the Colegio Luz, Amor y Vida in the Dominican Republic, and the Danchira Village school in Ghana. This year, schools in water-stressed communities benefit from several of our projects. The project in Nairiri will provide safe water access to three primary schools in the area as well as the health centre, and our recent project in Kahama included a rainwater filtration system in the town’s school. With schools providing safe water, children are less vulnerable to waterborne pathogens that can cause illness and malnutrition. They are healthier, less vulnerable and better equipped to learn — and their families benefit from having a water source in the community as well.
In addition, once safe water is available in a community, proper protective hygiene can drastically reduce the transmission of contagious diseases among its members. When water is no longer a danger, it’s often our main protection against spreading disease. And in the era of COVID-19, safe water and protective hygiene are more important than ever. Just the ability to wash our hands in safe water is a massive help in preventing the spread of COVID-19, one that people in developed countries often take for granted.
This year, H2O4ALL is addressing the need for safe water and protective hygiene in vulnerable communities around the world. The Clean Hands Initiative is providing communities in Uganda, the Dominican Republic, Kenya, Ghana, and Cuba with access to safe water and soap in order to combat the spread of COVID-19 with protective hygiene.
When a water-stressed community gains access to safe water, everything can change for the better. Life expectancy increases as the risk of waterborne diseases goes down and maintaining hygiene becomes easier. The future seems brighter as children are safe from waterborne diseases, allowing them to grow up stronger, healthier and safer. Unfortunately, billions of people around the world still rely on unsafe water in their daily lives. H2O4ALL and organizations like us have managed to make some progress into solving this issue by providing water access to vulnerable communities around the water, and we hope to continue doing so in the future.
