Bradley Mosquito

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GLOBAL ISSUES IN WATER, SANITATION & HEALTH

The Spectrum of

Water-Related Disease

Transmission Processes

David BradleyLondon School of Hygiene & Tropical Medicine and

Department of Zoology, University of Oxford


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DISEASE TRANSMISSION PROCESSES

1. Revisit critically the classification of W& S disease transmission processes.

2. Suggest unsystematized areas needing

attention, including behaviour, andprocesses in space and time

3. Use a small area of SW Uganda to show

the inter-related complexities andresearch issues.

A Waters-Eye View


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Social Uses of Classificationsl Bringing order & Clarity to thought

l Shining lights in dark corners

l To make explicit the assumed

[that may be less applicable elsewhere]

Eg health needs ACCESS to water

Water is not just for drinking

l Analogy with research is that:Draw attention to possible new data

Give validity and credibility to an area


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What is the function of a

Classification?

l Classification is a qualitative model of

distinctions that matter

l A means of (trans-sectoral) communication,

especially as water improvements are very

largely implemented outside the health sector

l A simplification to help public healthpractitioners


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WATER RELATED DISEASE CLASSIFICATION

1. WATER-BORNE

2. WATER-WASHED

3. WATER-BASED

4. WATER-RELATED

INSECT VECTORS

-Classical

-Other

-Diarrhoea

-Skin & Eyes

-Percutaneous

-Oral-Breeding

-Biting


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5. WATER-AEROSOL

TheLegionellapattern of transmission does

not fit well into any of the four existing

categories, which are defined by how the

diseases are contracted. None of the othersrelates to intake via the respiratory tract


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l WATER-BORNE

l WATER-WASHED

l WATER-BASED

l WATER-RELATED

INSECT VECTORS

-Classical

-Other

-Diarrhoea

-Skin & Eyes

-Percutaneous

-Oral-Breeding

-Biting


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COMPARATIVE FINDINGS OF THE TWO

Drawers of WaterSTUDIES

Water Use in Litres / Person / Day; 30 Years Apart

DOW I DOW II

Piped Urban 128 66.0 Down, Halved

Unpiped Urban 15.4 23.7 Up, By Half

Unpiped Rural 9.7 18.3 Up, Doubled


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WATER RELATED MODE OF DISEASE

TRANSMISSION CLASSIFICATION

l WATER-WASHED

Diarrhoea

Skin

Eyes: Trachoma

? Waterwashed Respiratory

Infections


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l WATER-BORNE

l WATER-WASHED

l WATER-BASED

l WATER-RELATED

INSECT VECTORS

-Classical

-Other

-Diarrhoea

-Skin & Eyes

-Percutaneous

-Oral-Breeding

-Biting


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CLASSIFICATION OF DISEASES

RELATED TO SANITATION

Excreted Load

LATENCYPERSISTENCE

MULTIPLICATION

Infective Dose


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Categories of Transmission by Excreta


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DISEASE TRANSMISSION RELATED TO SANITATION

# Lat. Persist Mult. Biology Focus Examples

I No Short No V,Pr,He Pers,Dom Rotavirus

Enterobius

II No Longer Yes Bact P,D,W Typhoid

Cholera

III Yes Long No Helm Field,C Ascaris

Hookworm

IV Yes [Long] Cow/PigHelm Field Taenia saginata

Taenia solium

V Yes [Long] Aquatic Helm Water Paragonimus

Schistosoma

VI Spread by excreta-related insects Some mosq. Wuchereria

Flies. Cockroaches:several above


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DISEASE TRANSMISSION RELATED TO SANITATION

l The categories feed into sanitary barriersl Give a sense of where control best:

Personal hygiene behaviour

Domestic water supply

Provision of toilets Treatment of Excreta

Specific measures (e.g. cooking fish)

l Close to biology (closer than for Water-related)

l

Levels of Action: Person Personal Handwashing Household. Toilet Provision

Community Sewage Treatment


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Where to next?

l Limitations of Strengths Speak to engineers; but they cannot provide the whole

solution

Show needs for behaviour change

Greater complexity of Rural and Periurban SitesAGENDA ITEM:

l Systematization of Hygiene Behaviour

Handwashing with soap !!!

Mechanisms for respiratory disease benefits ?Handling childrens excreta

Behavioural aspect of the plateau, etc. etc.


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Spatial Processes

In Control and in Service Provision

l Periurban complications for interventions.

l

Private Space & Public Space (Cairncross)e.g. Who constructs & who maintains?

l Successive circles of Space (Kolsky)

In Disease Persistence and Emergencel The 4 tsetse and 75% sleeping sickness


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GLOBAL ISSUES IN WATER, SANITATION & HEALTH

l Global has several components

Affects whole world together (e.g. global warming)

Universal, affecting everyone in same way.

Affects many people: small scale but relicated verymany times but there are local variations; one size

in practice does NOT fit all.

A local happening whose consequences affect

many; e.g. a human transmissible avian flu emerges

l Back to Global Threats; cf Global Endemics


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Spatial Processes

In Disease Persistence and Emergence

l Small populations sharing polluted water sources

l Untidy species-rich neglected water sites

l Recurrent motifs in water morphologyl Consequential reservations

l Ecotones

l Shared spaces between species: People, Livestock,

Wildlife

l Chronotones: Periods of massive change that can be

an opportunity


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Spatial Processes

In Disease Persistence and Emergencel Small populations sharing polluted water sources

l Untidy species-rich neglected water sites

l Recurrent motifs in water morphologyl Consequential reservations

l Ecotones

l Shared spaces between species: People, Livestock,

Wildlife

l Chronotones: Periods of massive change that can be

an opportunity


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Mooya Ifura

Ntuura

Rwabarata

Akatongore

Byanamira

Embale

Kaitanturegye

Kanya

ryeruR

esSchem

e

Kasaana

Kayonza

Macuncu

Mooya

Nyakasharara

RugongiRwemamba

Rwe

njubu

RwetamoRwetamo

Rwe

njubu

Rwemamba

Kaky

eera

Rugongi

Nyakasharara

Nyakahita

Mooya

Macuncu

Kasaana

Kaitanturegye

Rugaaga

Embale

Byanamira

Rwetamo

Rwe

njubu

RwemambaRugongi

Nyakasharara

Mooya

Macuncu

Katooma

Kasaana

Kaitanturegye

Embale

Byanamira

Mugore

Kiribw

a

20 0 20 40 Miles

Mapsima.shp# Mapofnyabushozi villages.shp

landuse

# boarderKakyeera# LCI# brick burning# centre

# charcoal burning homestead (P)$Z homestead (S)

%[ homestead (T)

# kakyeera centre

# kraal

# lake

# plantation# pond# swamp# village

N

EW

S

Map of Nyabushozi County showing the study area


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To bring alive the integrated nature of water problems:

l Consider settling nomadic pastoralists in SW Uganda On settling, water problems and malaria got worse

?deviation of An. Arabiensis to children as less available cattle? No

Privatized land without water planning first

Cut people off from usual water bodiesNeed more reliable sources if no migration

Everyone digs own farm ponds: moreAn. gambiae

People share the water sources of the cows

National Park lake is water source of last resort for them Ugandas good water policy & poverty policy not designed

to cope with this.


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Water, Sanitation & Health Agendas

l Blue Agenda of water availability fordomestic and agricultural needs.

l Brown Agendawith sanitary goal.

l Green Agendaof environmentalsustainability, biodiversity.

l Red Agendaof less vector-borne

disease.l Purple Agendaof less non-biological

pollution.


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Some Research Implications

l Need for analytical classification of

Behavioural aspects of W & S, including work on

perception of water as a basis for both changes towards

healthy behaviour and to multisectoral policies.

Water interactions in both conceptual and actual spacein relation to both disease emergence and disease

control

l Need for Long-Term Longitudinal Field Studies

Biological as well as Mathematical Process Modelling

Both in Laboratory and by field studies

Build up integrated bodies of locally relevant

interdisciplinary knowledge


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Acknowledgements

Ross Institute, LSHTM

Sandy Cairncross

Richard Feachem

Pete Kolsky

Tom Clasen

Valerie Curtis

Sylvia Struck

Sanga Project, Uganda

Joseph Okello- Onen

Charles Muchunguzi

and many others

Drawers of Water I & II

Gilbert F White

Anne U White

John Thompson

Mark Mujwahuzi

Munguti Katui-Katua

James Tumwine

Also

Hemda Garelick

Duncan Mara


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