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Feature

MANAGING WATER BORNE DISEASES

- Dr Chiranjeeb Kakoty

Water borne diseases are important causes of morbidity as well as mortality in human beings. This is more true in developing countries than in developed countries. Consumption of water containing disease causing organisms are primarily because of three reasons - one, lack of access to safe drinking water, two, ignorance of proper water hygiene measures and three, lack of opportunities to exercise water hygiene measures. These water borne diseases occur at any time of the year. They are, however, more frequent in the summer season and more so during and after floods or droughts and during and after such occasions when there is a large gathering of people spending days together as in camps etc. While governments have the responsibility of ensuring safety of water at a bigger level, all individuals have a greater responsibility of ensuring water safety at the individual and house hold levels.

Some of the most common water borne diseases are Hepatitis A, Typhoid and Paratyphoid fevers, Giardiasis, Amoebiasis, Cholera and Rota Virus Diarrhoea in children. Besides, poliomyelitis - as isolated cases or in groups may be water borne. Very often than not, the line of demarcation between water and other food borne diseases is thin. That is, when other food get contaminated with the water where the disease causing organism is present, the food can also transmit the disease which the water, by itself would have transmitted. Therefore, when talking about water or food borne diseases, it is important to understand that the hygienic status of any thing which is consumed orally is considered. For example, there has been number of instances when the water "consumed" by a person is of a high hygiene status but the water of the pond in which the person takes bath is contaminated and when such water enters the alimentary canal of the individual while swimming/having bath etc, the individual gets the water borne disease - if such organisms are present in that water .

Prevention of water borne diseases is possible. There should be a minimum standard of hygiene practiced at each individual's level. Depending on the understanding and accessibility, these practices may vary from individual to individual and place to place. Proper disposal of faeces is one of the most important requirements for prevention of water and food borne diseases. Disposal of faeces must be in such a manner that it is away from the source of drinking water. This will prevent contamination of the water with disease causing organisms. Proper hand washing before eating and after each act of defecation will help in preventing risks of water/ food borne diseases. Care of water meant for drinking can be taken care of by different ways. The most common method is by boiling. Water needs to be roll boiled, that is, boiled till the water rattles and then preserved in a clean container preferably with a narrow mouth. This stored water should be taken out for drinking only by pouring the water out. No smaller utensils should be introduced inside the vessel in which the boiled water has been stored so that no disease causing organism is introduced into it - the benefits of boiling is then reduced to naught. Another method of ensuring safer water is the use of home filters. These ceramic filters need to be boiled and scrubbed so that there is effective filtration. The candles need to be replaced when the filtration becomes ineffective. For filtering water during emergency situation at household and in situations where there are risks of contamination, Halogen tablets are available. These tablets can be dissolved in water (the amount of water against which these halogen tablets will be effective varies from one brand of halogen to another and as such the instructions should be looked for in the packages). Bleaching powder can also be dissolved in appropriate quantities based on the size of the well so that the source of the household drinking water can be decontaminated.

One of the important manifestation of water borne diseases is diarrhoea. Oral Rehydration Therapy form the main stay of treatment of diarrhoea. Diarrhoea is dangerous because it leads to loss of water and various electrolytes in the body such as sodium, chloride, potassium and bicarbonates though the stool. If this loss of fluid and electrolytes is not replaced, it causes dehydration which in a large number of cases cause extreme morbidity and even mortality. Further, diarrhoea may also cause malnutrition because along with the fluid and other electrolytes, other vital nutrients are also lost from the body, - this aggravates the morbidity. Further as the person having diarrhoea becomes listless and anorexic, there are chances that food intake may be grossly reduced. Further in case of children, the mother or other elders of the family may reduce the food intake of the child - this is usually because these people feel that if the child is given more fluids and food, the severity of diarrhoea will increase. Because children have small reserves of fluid, electrolytes and other nutrients, it is imperative to address their state of dehydration in order to prevent adverse consequences.

Oral Rehydration Salts are available in various forms and the most commonest one is the one in which the sachet contains a salt-sugar mixture comprising of 3.5 gm of Sodium Chloride, 2.5 gm of Sodium bi carbonate (or 2.9 gms of Tri Sodium Citrate dehydrate) 1.5 gm of Pottasium Chloride and 20 gm of glucose. This salt-sugar mixture is thoroughly mixed with 1000 milliliter of previously roll boiled water, which has cooled on its own. This solution has to be used within 24 hours of its constitution and care must be taken to ensure that it is not contaminated from the external environment. This can be done by ensuring that the solution is taken for consumption not by introducing any utensil from outside but by pouring the solution from the bigger to the smaller container used for drinking. It should usually be kept in a narrow mouthed container and should be kept covered. Based on the age and health condition of the person, the amount of the Oral Rehydration Solution to be taken by a person varies. Along with the intake of Oral Rehydration Solution other food also needs to be continued. A child who is on breast milk should continue to take breast milk. Others who are on other semi solid food should continue to take the same as long at it does not contain such irritants which are likely to increase the diarrhoea and/or vomiting. During the first 4 hours of Oral Rehydration Therapy (ORT), 75 ml of the solution per kilogram of body weight of the person should be given. A dehydrated person is said to have responded to the ORT if the tongue has become moister than it was before ORT was started, if on pinching the skin it retracts sooner than it was earlier and the urine output has improved than it was previously. In case the person is not responding to the intake of Oral Rehydration Therapy (ORT), intravenous fluids may have to be started. Use of ORT effectively has reduced, to a great extent, the need to hospitalise a person with diarrhoea. However, for tackling the organism responsible for the diarrhoea, other medicines may be required.

Water borne diseases are quite rampant but simple measures if taken in right earnest can reduce, to a great extent, the morbidity and mortality associated with such diseases. What is more important is that most of these water borne diseases are preventable without much extra effort. (PIB)