Water and Sanitation

Water, an essential basic need to every living thing, is now receiving increase international attention. Its quality as well as quantity is of serious concern and access to it is not equitable, a condition often seen in the low and mid income economies of the world.
To discuss the issue of water, health and disease, there are some terms which should be made clear to readers:
• Water-borne diseases: transmitted by faeco-oral route from faeces to the body through food and drinks by means of fluids, fingers, flies, fields e.g. diarrhoeal diseases, poliomyelitis
• Water-related diseases: transmitted by insects e.g. malaria, filariasis, yellow fever, onchocerciasis etc
• Water-based diseases: transmitted either through skin penetration or ingestion e.g. schistosmiasis, guinea worm etc
• Water-washed diseases: transmitted due to lack of adequate water for washing e.g. trachoma.
The low and middle income countries bears the brunt of the problems of water and sanitation for reasons which includes: qualitative and quantitative scarcity of water (making water related illnesses a greater source of ill health and death), the consequences of unregulated industrialization and the resultant effect of poverty afflicting those countries thus preventing their governments from treating the contaminated water to be able to make the it available to its citizenry.
The United Nations (UN-Habitat 2003) says that at least a third of the world’s population lives in areas with moderate to high ‘Water stress’. Water stress is said to be present in an area when the annual supplies drops below 1,700 cubic metre per person; if the annual drops further to less than 1,000 cubic metre per person then it could be referred to as ‘Water scarcity’.
Sanitation, which goes hand in hand with the availability of quality water, is an important component of maintaining environmental quality thus minimizing diseases from emanating.
The problems of sanitation are most commonly seen in the low and middle income countries; these problems are often due to inadequate methods of waste disposal from sewerage further compounded by lack of commitment and political will from the governments, lack of collaboration between nations of especially the sub-Saharan African continent on shared management of water resources and lack of intersectoral and multidisciplinary working approach.
Faecal contamination is the world’s leading environmental health problem responsible for millions of deaths and DALYs (i.e. disability adjusted life years) every year which could be avoided through adequate water supplies, sanitation and domestic hygiene; it poses a great threat to humans considering the different pathogens it contains (e.g. bacteria, worms, protozoa etc) thus predisposing humans to faeco-oral diseases like diarrhoea, cholera, typhoid fever, amoebiasis, intestinal worms etc.
In developed economies, sanitation problems are much less or virtually absent because of the fact that they have advanced methods of sewage collection and disposal. The few cases seen are often as a result of contamination of the environment in situations when some of wastes are discharged into water sources especially if not well treated.
In some rare instances and due to increasing industrialization seen across the globe, problems of chemical water pollution are seen in all the three economies (low, mid and high income); some of these industrial waste water may be composed of harmful substances (e.g. sediments, nutrients, organic matter, trace metals, pesticides etc) which when released into the source of water may adversely affect the entire food chain and thus human health.
I would like to discuss an interesting piece of UN article which I read in a report by the UNEP on ‘Time to Cure Global Tide of Sick Water’, Nairobi (Kenya), 22 March 2010 – transforming waste water from a major health and environmental hazard into a clean, safe and economically attractive resource is emerging as a key challenge in the 21st century. The report highlighted the challenges that the world is facing because of rapid urbanization, industrialization and increasing demand for meat and other foods urging for a decisive action to be taken. It observed that most cities lack adequate waste water management either due to absent or inadequate sewage infrastructure. The report further stated that in the next 40 years, urban populations are likely to reach to over 6 billion from the present 3.4 billion.
A lead author on the report, Christian Nellemann, estimated that around 2 million tons of waste is spilled into sewage systems daily producing well over two billion tons of polluted water into our freshwaters and oceans.
Also Achim Steiner, UN Under-Secretary General and Executive Director of the UN Environment Programme (UNEP) said in the report that: ‘the facts and figures are stark, pollution from waste water is quite literally killing people, indeed at least 1.8 million children die annually as a result of contaminated water. The impacts on the wider environment and in particular the marine environment are also sobering”.
The report also made mention of how waste water is being discharged daily into the rivers and seas, a key factor in the rise of deoxygenated dead zones emerging in those seas and oceans across the globe, thus damaging our ecosystems and increasing the risks of spreading diseases to humans. This is why now more people die from contaminated and polluted water related illnesses than from all forms of violence including wars. The report reviewed the composition of waste water pointing at the nitrogen, phosphorus, potassium, valuable micronutrients and organic matter contained in the effluent which could judiciously be used as fertiliser for agricultural purposes, generate gases to fuel small scale power stations or be used for cooking in households.
In the report, a list of must do items was given with a view to attend to these problems as listed below:
• reduce the volume and concentrations of waste water through multiple actions which ranges from reducing run off from livestock and crop lands to better treatment of human wastes
• water sewage treatment and recycling plants, citing evidence based practice as seen in the Bali coastal resort of Nusa Dua in Indonesia
• use of nature’s natural purification systems (e.g. wetlands, mangroves and salt marshes) through investing and re-investing in that area
• small scale approach as applied in the coral coast of Fiji where it was estimated that up to 40 per cent of harmful nutrients being discharged into the marine environment were from pigs, which produce three times more concentrated nitrogen waste  than humans
• use of sawdust beds to soak up the liquid run-off from pig pens and the soiled sawdust shipped to nearby farms as fertilizer, cutting emissions to coastal waters have been cut and increasing yields for the farmers, saving from fertilizer costs, conserving ecological infrastructure such as wetlands and creating new business and employment opportunities in engineering and natural resource management.
In many European countries, improved waste water management has resulted in significant environmental improvements. There is a need for governments of the low and mid income countries to have the political will, show commitments and judiciously use the meagre resources. According to the UNEP Green Economy Initiative ‘every dollar invested in safe water and sanitation has a pay back of $3 to $34 depending on the region and the technology deployed’.
Before I round-up the review of this report, I would like to list the enormous benefits of proper waste water management which include the following:
• prevents deaths of the under fives from faeco-oral diseases,
• reduce government spending on preventable diseases thereby channelling the meagre resources to something else in the health sector,
• prevent damages to coral reefs and fishing grounds,
• avoiding the issue of managing waste problems from used water polythene sachets (as seen in the developing countries) and plastic bottles as million litres of water are produced every year,
• cut the amount of methane that is generated from waste water (a climate gas which is 21 times more powerful than C02) and nitrous oxide (which is 310 times more powerful than C02.),
• avoid worsening climate change which will adversely aggravate the problems of droughts and flooding thus concentrating waste water pollution in rivers and lakes.
The report provided six major recommendations as follows:
1. Countries should adopt a multi-sectoral approach,
2. Establish national plans including ecosystem management to cope with rising waste water production,
3. Financing and investment to address design, ecosystem restoration, construction, operation and maintenance of waste water infrastructure,
4. Provisions should be made by communities and nations for increasing incidents of extreme weather and rising urbanization in the future,
5. Consideration be given to social, cultural, environmental and economical aspects for effective waste water management,
6. The crucial role of education in water and waste water management has been highlighted to be able to help at ensuring that water, nutrients and future opportunities for employment and development are not wasted.
Further readings:
1. FAO: “Addressing water scarcity requires actions at local, national and river basin levels. It also calls for actions at global and international levels, leading to increased collaboration between nations on shared management of water resources (rivers, lakes and aquifers), it requires an intersectoral and multidisciplinary approach to managing water resources in order to maximize economic and social welfare in an equitable manner without compromising the sustainability of vital ecosystems.”
2. WaterAID Nigeria: Hygiene and sanitation- important for my development!

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