ENVIRONMENTAL ENGINEERING AND MANAGEMENT

WATER-BORNE DISEASES IN MALAYSIA

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TABLE OF CONTENT
No Contents 1 INTRODUCTION Malaysian Water Resources Water Borne Diseases: Worlds Leading Killer 2 WATER BORNE DISEASES Causes STAKEHOLDERS AND WATER RESOURCE MANAGEMENT CASE STUDIES Case 1- Malaysia Waterborne Disease Outbreak Case 2- Waterborne Disease (leptospirosis) in Salvador, Brazil Case 3- Waterborne Disease (leptospirosis) in South East Asia and South America Case 4- Sewage Pollution in Klang River contributed to waterborne disease Case 5- Cholera Outbreak: The Petaling Experienced ENGINEERING APPROACH OF WATERBORNE DISEASES Spatial Interaction Optimal Intervention Strategies Leachate Management in Sanitary Landfill Water Quality Control Waste Water Treatment Well Water Treatment Systems HOW IS WASTE WATER TREATED? CONCLUSION REFERENCES Page 2-3

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Malaysia Water Resources

In order to survive every lives in this world need water. As it is, water is an important resource. Water by itself can be a live saver or deadly to living organism. A long drought or contaminated water resources can paralyzes a country and its people. Fortunately, for Malaysia water is not an issue to bear on everyday as we have abundant of water reservoir. Luckily for us Malaysia lies in the equatorial zone. Yearly changing of the northeast and southwest monsoons gives us rain throughout the year. Basically, the water resources in Malaysia can be summarized in Table 1. Groundwater accounts for about 90 percent of freshwater resources. The summation of surface runoff and groundwater recharge have gives us 630 billion M3 renewable water resources. This translates into an annual average water availability of about 28400 m3 per capita. Thus, based on this fact, Malaysia can be categorized as one of the country with abundant water resources. Table 1. Water resources in Malaysia Annual rainfall Surface runoff Evapo-transpiration Groundwater recharge Surface artificial storage (dams) Groundwater storage (aquifers) 990 billion m3 (Ref 1) 566 billion m3 360 billion m3 64 billion m3 25 billion m3 (Ref 2) 5 000 billion m3 (Ref 3)

Waterborne Disease is Worlds Leading Killer

The World Health Organization (WHO) stated that every year there are millions of people suffered or worst die as a result of water borne diseases, thus making it the leading cause of disease and death around the world. Majority of the victims are children whom die of sicknesses caused by organisms that live in contaminated water sources. According to an assessment commissioned by the United Nations, it is estimated that around 4,000 children die each day as a result of diseases by ingestion of unsafe drink water. The report has reported that four of every 10 peoples in the world, mostly those who are in Africa and Asia do not have contact to a clean water to drink. Most common diarrheal diseases that always contract by them are Cholera, Typhoid fever and Hepatitis A which are caused by bacteria. Some common sources of these diseases are streams and lakes where people use as bathing and defecating but at the
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same time used it as for drinking water. Other than that water that is left as an outcome by natural disaster also one of the sources of waterborne disease as most of the sewage pipe are destroyed or unfunctional. Earlier this year, Japan tsunami had left victims in ankle-deep water, amid destroyed sewage pipes. On the other hand, diarrheal disease can infected people who eating food that is prepared by sick individuals who have not properly washed their hands, or physically in contact with something handled by an infected person and then putting their own hands into their mouths. One of the example of this particular cases are Severe Acute Respiratory Syndrome (SARS) which had it outbreak in Malaysia around year 2003. Most of the victims had been infected by SARS through contact with the infected persons. There are some precaution steps that can be taken into practices both for the short term and long term measures in order to prevent the spread of waterborne illnesses. By washing their hand frequently is one of the short term precaution steps, other than use a latrine (a communal toilet of a type often used in a camp or barracks) even if its just a hole in the ground, and lastly boil water and store it. People who are infected by a waterborne disease are usually confronted with related costs and financial burden. This is especially the case in less developed countries. As financial are already is an issue in less developed countries, it seems to them that there are no need to invest more in prevention or curing related programs. The financial losses are mostly caused by several factors like costs for medical treatment and medication, costs for medical treatment and medication cost for transport. In order to get treatment in proper hospital, many families in this less developed countries had to sell their assets to pay for treatment. Even before the establishment of the germ theory of disease traditional practices eschewed water in favor of beer, wine and tea. There is popular saying that the reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. This saying is recorded as early in the era of camel caravans that crossed Central Asia along the Silk Road. Before we go further into our discussion, firstly we need to understand what is all about these waterborne diseases. How it is transmitted, what caused it and more importantly ways that can prevent or reduces the risk to be infected.

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Waterborne Disease
Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed. Contaminated fresh water, used in the preparation of food, can be the source of foodborne disease through consumption of the food. Based on the World Health Organization, diarrheal disease accounts for an estimated 4.1% of global diseases and is responsible for the death of 1.8 million people annually. It was estimated that 88% of that global burden of disease is because of unsafe water supply, lack of sanitation and hygiene. It is mostly concentrated in children in developing countries and also more frequently in less developed countries. Bacteria, protozoa, viruses or bacteria and many of which are intestinal parasites are the caused that contributed to the waterborne disease.

Stakeholders and Water Resource Management

The conservation, use, and management of water resources, freshwater or marine, is everyone concerns. The general public, private sector, national and local governments, non-governmental organizations and international agencies have a role and responsibility to ensure proper and sustainable use of water resources is carried out by Federal and various state government agencies. The Federal Government sets the policies and indertakes studes at the national level for pverall planning and development process. Recently the Federal Government started the National Water Resource Studies and established the National Water Resource Council with the responsibility of streamlining water resource development and management activities of all states. Besides the state and federal agencies, some of the local community groups and NGOs that are active on environmental issues include: Friends of the Earth (Sahabat Alam Malaysia), World Wildlife Fund for Nature, Malaysian Institute of Marine Affairs (MIMA), Malaysian Nature Society, Malaysian Fisheries Society, Environmental Protection Society of Malaysia, Public Media Club and various charity organizations.

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CASE STUDIES
Case 1: Malaysia Waterborne Disease Outbreak

Malaysia warns of waterborne disease after deaths

August 23, 2010
(AP) -- Malaysia has closed parks and warned the public about swimming and dumping trash in rivers after up to 10 people died from a disease spread by rats. The latest reported death from the bacterial disease leptospirosis was Saturday. The 17-year-old boy in northern Kedah state had swam in a river and had a picnic with friends at a recreational park last month, the New Straits Times and The Star reported. Several parks throughout the country have been closed since the first deaths were reported last month. Some deaths were believed to have been caused by a separate waterborne disease, and a Health Ministry official could not immediately say how many were caused by leptospirosis. The Health Ministry's website warns people not to swim in public rivers when it rains and to avoid taking a dip if they have cuts on their body, which makes an infection more likely. Health Minister Liow Tiong Lai was quoted by the Times on Monday as saying his ministry would distribute leaflets and posters to raise awareness of the disease. Leptospirosis is caused by exposure to water contaminated with urine of infected animals and absorbed through the skin. Rats are the main carriers, and the ministry's campaign urges people not to dump rubbish near water sources that could attract rats, he said. Cases of the disease have been increasing in Malaysia. It killed 62 people last year, up from 20 in 2004. In the same period, the number of infections rose more than fivefold to more than 1,400 cases, up from 263.

Case 2: Waterborne Disease (leptospirosis) in Salvador, Brazil

Urban slum conditions are a source of leptospirosis

August 23, 2010
A study conducted in an urban slum setting in Salvador, Brazil has found that open sewers, accumulations of refuse, and inadequate floodwater drainage are acting as sources for transmission of the disease leptospirosis. The study is published in this week's PLoS Neglected Tropical Diseases.

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The huge growth of urban slum communities worldwide has produced conditions for rodent-borne transmission. In the new study, Dr Albert Ko (Centro de Pesquisas Gonalo Moniz, Fundao Oswaldo Cruz, Ministrio da Sade, Salvador, Brazil) and colleagues tested 3,171 slum residents for Leptospira antibodies, which are a marker of past infection with the bacterium. The researchers then used Geographical Information System (GIS) and modeling approaches to identify deficiencies in the sanitation infrastructure of the slum that were linked to Leptospira infection. They also investigated whether there was a link between poverty and Leptospira infection. Dr Ko and colleagues found that the households of those with Leptospira antibodies clustered in squatter areas at the bottom of valleys. The risk of acquiring Leptospira antibodies was higher in people living in flood-risk regions with open sewers, or near to accumulated refuse, and those who saw rats or lived in the presence of chickens. In addition, being poor was a risk factor for infectionan increase of US$1 per day in per capita household income was associated with an 11% decrease in infection risk. "These findings," say the researchers, "indicate that effective prevention of leptospirosis will need to address the social factors that produce unequal health outcomes among slum residents, in addition to improving sanitation." Source: Public Library of Science

Case 3: Waterborne Disease (leptospirosis) in South East Asia and South America

Bacterial slime helps cause serious disease

May 5, 2008
Leptospirosis is a serious but neglected emerging disease that infects humans through contaminated water. Now research published in the May issue of the journal Microbiology shows for the first time how bacteria that cause the disease survive in the environment. Leptospirosis is a major public health problem in South East Asia and South America, with over 500,000 severe cases every year. Between 5% and 20% of these cases are fatal. Rats and other mammals carry the disease-causing pathogen Leptospira interrogans in their kidneys. When they urinate, they contaminate surface water with the bacteria, which can survive in the environment for long periods. This led us to see if the bacteria build a protective casing around themselves for protection, said Professor Mathieu Picardeau from the Institut Pasteur in Paris, France. Previously, scientists believed the bacteria were planktonic, living freely in the water. But Professor Picardeau and his team have shown that L. interrogans can make biofilms, which could be one of the main factors controlling survival and disease transmission. Many different bacteria make biofilms, which protect them against harsh conditions and make them more resistant to antibiotics. They do this by producing a slime, in which the colony can grow unharmed. 90% of the species of Leptospira we tested could form

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biofilms. It takes L. interrogans an average of 20 days to make a biofilm, said Professor Picardeau. This ability may contribute to the long-term survival of the bacteria in environmental water and even help them cause disease in humans. Biofilm formation might also play an important role in keeping the bacteria alive in the kidneys of animals such as rats without causing disease. This finding is a step forward in our understanding of Leptospirosis. We now need to study the mechanism of biofilm formation in both fresh water and renal tubules in animal kidneys, said Professor Picardeau. We hope our research will lead to the identification of new strategies to diagnose and prevent this neglected emerging disease. Source: Society for General Microbiology Based on cases stated above, for information, leptospirosis is a waterborne disease that are caused by exposure to several types of the Lestospira bacteria, which can be traces in water that has been contaminated by animal urine. This disease mostly occurs in warmer climate like tropical climate in Malaysia. Meanwhile in above cases most of it caused by mouse or rat urine that become the source of leptospirosis disease. The disease can range its severity from a mid-flu to life threatening forms of the diseases, such as Weils disease which kills over 1 in 10 and severe pulmonary hemorrhafe syndrome which have a very high rate of fatality for the infected person (kills over 1 in 2). Leptospirosis disease is not a contagious disease. It is not spread from person to person, except in a very rare cases when it is transmitted through breast milk or from mother to her unborn child. The symptoms are dru cough, high fever, headache, muscle pain, nausea, vmitting and diarrhea. If the patient of this kind of disease late recheiving its threatment, he or she are probably in a high risk of fatality. It is possible to reduce the risks to almost zero even in highly-contaminatef environments if preventing infection relies on a combination of techniques and when applied correctly. Yes, you can avoiding from being expose to the bacterium if you can avoid contact with any contamnated water and animals. However, if you are in a high risk area, you should always attempt to minimise contact, as there are many hundreds of other bacteria, viruses and parasites you may be dealing with. Other than that, in other example, leptospirosis also is always confronted by wastewater treatment workers daily. This is because a wastewater treatment plant is in the business of processing untreated wastewater, sludge and sewage, and of course this can be a very risky business for any workers at the plant. A sample of raw sewage from a sewage treatment plant unit operation could potentially include almost all of the pathogenic microorganisms that may have a host in that work place. A recent announcement promoting sale of a work safety video for water/wastewater treatment plant personnel states: The bottom line is quite simple: Water/wastewater workers are exposed to just about every type of occupational hazard except nuclear
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radiation. This quotation is quoted by a researcher which reflect how dangrous it is to work in a wastewater treatment plant without any safe protection. The existence of pathogens in wastewater is not a questioned. Preventive measure has been made to prevent pathogen known to pose risk to wastewater plant treatment workers and one of it is vaccination. Other than personal protection equipment and engineering controls which are considered sufficient to provide workers protection against leptospirosis.

Case 4: Sewage Pollution in Klang River Contributed to Waterborne Disease

Other than that, there is another case that can be look through to discuss more about waterborne disease in Malaysia. The location of this case happen in Klang River in year 1978, where there has been reported there are unusually reading of faecal coliform in Klang River compared with other river in Malaysia at that particular time (Consumer's Association of Penang, 1978). The sources of high level of faecal coliform in Klang River is because of untreated domestic sewage are being discharge direcly to Klang River. Thus lead to polluting the river more and then caused an outbreaks of waterborne diseases in near resident areas. It has frequently been reported that the domestic sewage disposal system in Malaysia is inadequate and polluted rivers have sometimes caused outbreaks of water borne diseases. These are hence sufficient indication that our coastal water is being polluted with sewage discharge. Ke1ang River which courses through Kuala Lumpur is suspected to be heavily polluted by domestic sewage discharge. Based on the report published by Faculty of Fisheries and Marine Science, Universiti Pertanian Malaysia, Serdang. Selangor. Malaysia written by A.T.Law high faecal coliform counts detected in Klang River reveal that the River is being heavily polluted by domestic sewage discharge. The average faecal coliform counts in water from Stations I, II, III, IV, V and VI were 113/100 ml, 1 x 106 /100 ml, 1 x 105 /100 ml, 1.6 x 106 /100 ml, 5.8 x 103 /100 ml and 260/100 ml respectively. As compared to the WHO recommended guide limit of 100 faecal califorms/100 ml for bathing water, counts in all stations except Station I were much higher than the recommended limit. The average concentration of faecal coliforms in sediment of Stations I, II, III and IV were 17.9/g, 1 x 104 /g, 3.2 x 104 /g and 1.6 x 104 /g respectively. The faecal coliform counts at the estuary of Klang River were much lower than those of the coastal waters of Penang and Johor. The reason is not clear. Most probably the suspended solids play an important role in the disappearance of faecal coliforms in the estuary.

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For your illustration, there are 6 stations were chosen for sampling taking (Figure 1) Station I (Kemansah River), Station II (Gombak River), Station III (Kelang River at the heart of Kuala Lumpur), Station IV (0.5 Km upstream of Puchong Weir) Station V was located at about 4 Km from Port Kelang Station VI was located at South Port, Port Kelang The distance between Station I and Station VI is about 100 Km. As it is difficult to sample all the stations within the same day at that particular time, only three to four stations were sampled on every field trip. Stations I, II, III and IV were sampled between January and March 1979, while Stations IV, V and VI were sampled between April and May 1979. Meanwhile station IV was sampled throughout the study period. The faecal coliform counts in this station would indicate the level of sewage discharge from the Kuala Lumpur area which will flow through Shah Alam, Klang and then to the estuary. For your information, in this case water samples for faecal coliform counts were taken at a depth of two feet with a sterile 250 ml glass bottle. A total of one liter of water sample was collected and pooled for analysis. Sediment for faecal coliform count was sampled at a depth of 5 cm. This high phenomenon of faecal coliform in Klang River may be one of the reason why there are waterborne outbreak occurs at year 1978.

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Table 1

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Figure.1: Sampling stations along Kelang River and its estuary

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Case 5: Cholera Outbreak The Petaling Experienced

One of Malaysia infamous waterborne diseases outbreak happen at Petaling, Selangor in year 2000. Petaling, one of our most developed city is rapidly experiencing urbanization. However, due to the experience of squatters and disused estate areas which are lacks of basic hygiene and infrastructure, the water borne diseases is still a problem to public health. Factors associated with precarious living and environmental conditions are frequently cited as major obstacles for the control of cholera outbreaks and epidemics (Gerolomo M, 2000). For the past five years, there were eighty- two cases of cholera that has been detected in the Petaling. One of the areas that are heavily affected by Cholera Disease outbreak is Midlandss estate, with a population of 1,000 people is an example. Situated at the adjacent to the Federal Highway is the Midlands estate in Shah Alam City. The peoples there did not work in the estates anymore; they are working with the firms and other sectors. All of them who still occupied the estate will be shifted to a Selangor State Economic Development Corporation housing estate nearby, which is still under-construction. Midlands estate can be divided into two areas based on the terrain. Area that was earlier developed, is located on a higher ground compared with the other area. Almost all the facilities, such as basic housing, a clean water supply, toilet, sewerage and solid waste disposal is not provided and monitored. Thus caused the surrounding and the sanitation are dirty and neglected. Rubbish and solid waste, faeces and animals excrete were littered openly. Furthermore, the house compounds are dirty with poor sewerage system, and stagnant with water particularly at the lower area. The sewerage water from the higher ground flows through to the lower area of the houses compound and stagnated there. It is visible that the water pipe and its hose were joint to the main pipe by the residents for water supply and domestic consumption. Then as the studies resumed, it was noticed that the hose is leaked and unfortunately for them the clean water was mixed with the sewer water. Thus polluted their clean water sources. In May of that year, there was a cholera outbreak in this estate, which involved five cases. Most of the patients involved was staying in the higher ground. Three weeks after the outbreak, there was a flash flood in that area. All the area is submerged. One week after the flood, this present outbreak was notified. The first case reported to Petaling District Health Office, was 39 years old Indian lady who is a resident of this estate. She complained of abdominal pain and diarrhoea after taken her meals, which was cooked by her at home. She also drinks unboiled water from the pipe of her house. On the 29th June 2001, after four days admitted to the hospital, it was found from the analysis sample of her faeces, positive Vibrio cholerae serotaip Ogawa.

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Case Studies Spesifications The Case was defined as patient identified as having clinical symptom i.e. abdominal pain and prolonged diarrhoea together with positive Vibrio cholarea in the faeces. An early statement was put forward to guide for epidemiological investigation plan in identifying the cause of the outbreak and to control it effective and efficiently. The earlier hypothesis of the outbreak is due to drinking water that was contaminated with the Vibrio cholarae bacteria. The hypothesis was made based on the epidemiological research case and the carrier was found as below, 1. Majority of those positive were housewives and primary school children who gave no history of consuming food outside this estate. 2. All cases and the carriers history shown that they always drink from the un boiled water pipe. 3. Splash floods occurred a week from the outbreak and had submerged the leaking hose pipe. 4. Their houses are in proximity and they get their water supply from the same source. Shah Alam City Council (SACC) has provided the machinery to maintain the existing drain and to clean the estate. Fifteen units of the mobile toilet were also provided to the estate residents. Alam Flora that is responsible for the rubbish collection of this area had increase the frequency of rubbish collection to this area. Indah Water Consortium, the national sewerage operator came to improved the sewerage system and clear the septic tank. Selangor State Economic Development Corporation also allocate and distribute some of the low cost houses to Midland estate resident. Selangor Water Department provided the estate with static water tank for potable water supply. All illegal connections of water supply were disconnected. The chlorine content and quality inspection of the water supply was also check regularly to ensure safe drinking water to the consumers.

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Engineering Approach of Waterborne Diseases.

Example of engineering approach Let see an example of engineering approach in counter measuring cholera outbreak in Haiti. Haiti is one of the poorest country in the Western Hemisphere and is in the midst of a cholera epidemic who has reportedly recently killed more than 4000 people and infected about 217 000. These numbers are reported as of 30 January 2011. Most of those who are infected by this waterborne disease have been hospitalized, and casefatality rates in both community and hospital have been approximately 2%. The first laboratory-confirmed case was reported in the region of Artibonite, but cases are now reported in all 10 administrative regions in the country. However as the outbreak spread throughout the country, there are some control measures are taken and these control measures for the epidemic do seem to slow down the transmission of the disease. The initiated of a vaccine campaign as suggested by Pan American Health Organization and low-cost approaches to the provision of cleaner water supplies have been implemented. By the data that has been recorded since the disease outbreak start, research engineer has come with solution or formula models to detect the severity of cholera disease in a reigons. Then after analyze the models we can conduct the correct control measures or strategies to defeat this cholera disease from spreadout further to other regions.

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Combined with geographic and geographic information of a country's administrative regions,epidemic data can be used to formulate and calibrate models of epidemics. As i said earlier, these models then can provide valuable approach into the nature of disease spread, thus help project the timeline of the epidemic, and then provide measures on optimal control strategies. In this case of attention, (Viboud and colleagues and others) are researcher that have demonstrated that spatial patterns of epidemic spread can be represented by using gravity models that characterize the interaction between geographic regions, with respect to epidemic spread as a function of population mass and distance. They used this gravity model to accurately predict the sequence and timing of regional cholera epidemics by using earlier recorded available data. Then by using a model based on the best available data to reproduce the initial reported epidemic curve to determine the probable time course of Haiti's cholera epidemic in the absence of effective intervention. Other than to explore the probability of effects of competing and effective control strategies, including vaccine distribution and provision of clean water.

Spatial interaction
Gravity models or spatial interaction predict the flow of people, material or information between locations in a geographic manner. The factors can include origin propulsive variables such as the number of cars in neighborhood areas, destination attractiveness variables such as the numbers of kiosk in given areas, and approximatility relationships between the locations measured in terms such as travel time or driving distance time. In addition, identification of the topological, or connective, relationships between areas is a must, this is because by considering the often conflicting relationship between distance and topology. Lets take an example like two spatially close residentials may not display any important interaction if they are separated by a highway. The models analysts then can be estimated the model parameters after spend some time specifying the functional forms of these relationships, by using observed flow data and standard estimation techniques. One of the standard estimation techniques used are ordinary least squares or more known as maximum likelihood. Furthermore, computational methods such as artificial neural networks can also predict the spatial interaction relationships among locations and can control noisy and qualitative data.

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Optimal Intervention Strategies

In Haiti case, as evaluation of the case proceed, the effect of 3 different strategies for the use of 1 million doses of vaccine which enough to vaccinate of approximately almost 500 000 persons are giving its result. Strategies that being used are: 1. allocation in proportion to the population 2. equal allocation to each of Haiti's 10 departments 3. Allocation based on optimization, such that the total cases were reduced maximally. However, surprisingly is for each strategy, earlier completion of vaccination was related with a greater reduction in case counts than was later completion of vaccination, although even vaccination before the peak of the epidemic did not reduce total case counts by more than 3.2% because of the limited quantity of vaccine available. The relative advantage of using an optimized distribution strategy, compared with either vaccination based on proportional or equal allocation, increased the later that vaccination occurred; although the relative benefit of vaccination in all strategies diminished with time. Nonetheless, the benefit associated with vaccination was far greater than allocation of clean water. An estimation has been made that 1.7 to 2.0 times as many people would need to be given access to clean water to achieve an equal reduction in cholera cases that can be achieved through optimal allocation of vaccine. The combination of clean water and vaccination was projected to have a superadditive effect (projected reduction in cases resulting from both interventions was greater than the sum of the effects of individual interventions)

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Figure: Projected relative benefit of competing vaccination strategies and of vaccination versus allocation of clean water. Top. Optimized allocation was always more effective than either equal or proportional allocation of vaccine, although the difference between strategies increased with delay in vaccination. Bottom. Compared with allocation of clean water, vaccination was projected to reduce far more cases of cholera.

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Table: Number of Persons Needing Clean Water to Achieve a Reduction in Case Counts of Cholera Equal to That Achievable Through Vaccination

Figure: Projected effect of equal allocation of clean water to all departments, optimized allocation of vaccine, and a combination of these strategies.

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Based on the mathematical models produced, such as the one we describe earlier, it give an insight of how these mathematical models represent a simplified version of complex disease systems, but they may also predicts the behavior of these systems. On the other hand it also can serve as a tool for decision making under uncertainty of this epidemic. By using this model as a technique to evaluate the optimal strategies for distributing the vaccine, it can be conclude that, regardless of the timing of vaccination, optimized distribution is more effective than equal distribution to all departments or distribution based on population Gravity models have been served it purpose as to predict the movement of influenza in affluent countries, and have also been used to model the dynamics of measles and influenza in the United Kingdom in the prevaccination era. For your information, the present contribution is the first application of a gravity model of epidemic spread in a less developed country. This will then later became a stepping stone to other less developed country that may or already be affected by waterborne diseases epidemic to be used as one of preventive measures to control the epidemic. Thus they can gain a great benefit from this control measure. .

Sanitary Landfill
Sanitary landfill is a specific bioreactor in which wastes are decomposed under influence of aerobic and anaerobic conditions and microorganisms in chemical, physical and biological processes. Rainwater penetrates the wastes and dissolves products in the above-described biochemical processes and forms leachates. The chemical composition and physical properties of leachates originating from the sanitary landfill depend on: kind of stored wastes, climatic conditions, age of the landfill, the way in which wastes are disposed of and the landfill exploitation phase. In Malaysia, there is still a large number of sanitary landfills where environmental protection standards are not fulfilled. Therefore, on these areas, the remedial works aimed at protecting the environment against progressive degradation should be carried out immediately. The example of engineering solutions of groundwater protection (cutoff bentonite barrier and peripheral drainage for leachate collection) applied for remediation of large embankment sanitary landfill in Air Hitam Sanitary Landsfill situated at Selangor State (Final Risk Assessment Report for Air Hitam Sanitary Landfill Site, Selangor, Malaysia, Hatfield Consultants, March 2009). In the case of the analyzed landfill, the basic remedial problem is connected with protection against leachate migration and groundwater pollution. The schemes of the old landfill before and after remedial works are presented in Figure 1.

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A sanitary landfill involves proper attention to all technical aspects of landfill development which is long-term environmental impacts, design, siting and operation. Operating techniques vary only slightly such as example is the amount of daily soil cover applied, the thickness of the layer in which waste is compacted, the organization of tipping fronts and are usually being influenced by landfill administration. However, leachate management and control approaches, can be varies. There are three different strategies can be identified with respect to leachate management: 1. Entombment or the dry tomb approach aims to prevent water from coming into contact with waste. While this approach reduces the volume of leachate produced, it slows down the decomposition of the waste so that the potential hazard of the waste is not reduced after time. The entrance of water into waste at any time in the future will cause the encapsulation to fail and, consequently, generate significant pollution of water resources. This strategy can be characterized as a preliminary waste storage approach and is not a viable long-term leachate management or landfill option. 2. The containment strategy protects the environment by containing leachate and treating it before discharge. Success of the operation will rest on the continuing operation of the leachate treatment facility. Problems such as power cuts and inadequate maintenance may cause the approach to fail eventually, releasing uncontrolled leachate and posing environmental risks in the long-term future. Without coordinated with other options, the containment strategy is an unsustainable alternative. 3. The controlled containment release allows leachate to enter the environment in such a way that it is not means to have a serious effect. This approach takes into account proper environmental considerations, siting and careful monitoring. This strategy can be said as one of the best for hydrogeological settings and semi-arid climates, but it could be problematic in wet climatic zones where leachate containment

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release goes from controlled to uncontrolled. This may result in pollution of surface water.

WATER QUALITY MONITORING

Analysis of water quality on surroundings (Ann. Warsaw Univ. of Life Sci. SGGW, Land Reclam. 41, 2009) is conducted according to local monitoring system which includes: 17 piezometers used to control the fi rst groundwater layer, 1 deep well used to control the second water-bearing layer, 6 sampling points situated at surface watercourses (ditches), 4 sampling points of raw leachates, 1 sampling point of rainwater from the compostory area.

This network of points enables the appropriate control and estimation of the water quality. Chemical analysis for underground water has been conducted since 1997. The analysis of water quality results reveals that introduction of the vertical barrier has positively changed the basic parameters of the fi rst groundwater layer. Detailed results of the monitoring research and its analysis are presented in annual reports.

After closing the vertical barrier, the quality of groundwater (first layer) has improved. Simultaneously, after closing the vertical barrier the main pollution concentration has been moving towards groundwater flow direction.

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Waste Water Treatment

Most of the waterborne disease outbreak occurred are because of improper treatment of waste water by industry or any other residential areas. Waste water treatment are important as it can prevent or reduce the amount of contaminated waste water or even concentration of microorganisms in waste water before it being directly discharged into river or open public water resources. This may eventually reduce the risk of any water borne diseases that can be contract by any consumer. As that being said, lets take an insight of waste water treatment process.

Methods of Wastewater Treatment

Process where both domestic and industrial contaminants are removed from wastewater, in order to produce waste stream or solid waste safe enough to be able to be discharge. Process of wastewater treatment can be categorized into three groups: 1. Physical, 2. Chemical and 3. Biological

Physical Methods
For the treatment of waste water, physical processes such as sedimentation, aeration and filtration are used. Sedimentation is one of the most popular wastewater treatment methods, which is often used at the beginning and the end of several other water treatment processes. 'Sedimentation' is the process where coarse screening of waste water is done in order to remove contaminating objects after allowing some time for them to settles down at the base of sediment tank. This is one of the most efficient physical water treatment method used in most of water treatment plant. The removal of cleared waste stream or effluent becomes easier after that as the more heavy contaminants settle down. Aeration and filtration are other widely used methods of physical wastewater treatment. Air is added to the wastewater manually in aeration, to provide oxygen to the contaminated water. Meanwhile in filtration, to separate the contaminating solids from the water, contaminated water is passed through several various filters. The most common used filter in this filtration process is sand filter. On the other hand, semi-solid contaminants such as grease and oil, are allowed to float on the surface of the water, and are eventually removed physically.

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Chemical Methods
Chemical treatment involves the use of chemicals to get rid of contaminants in it. Chlorination is one of the most common methods used to treat water chemically. As the name of this process stated chlorination it is indeed the use of chlorine as the oxidizing chemical. This is because of the chlorine chemical nature which is a very strong oxidizing agent, and of course it is used to kill the bacteria which lead to decomposition of water. Whereas another chemical water treatment method is 'Oxidization'. Where polluted water are being treat with oxidizing agents like ozone. These oxidizing agents make water reusable by hampering the biological growth process of bacteria which happens to be the main cause of decomposition of water. When it comes to industrial wastewater treatment, a chemical process known as 'neutralization' is quite common. This process involves adding acid or base to the water to adjust its pH value and bring it back to neutral level. One of the best examples of base being used in this neutralization process is lime. It is used to neutralize acid wastes.

Biological Methods
On the other hand, for biological methods treatments of water waste bacteria and other such microorganisms are used to biochemically decompose the wastewater and stabilize the end product. This process are important in order to get rid of bacteria in waste water treatment. Biological water treatment processes can be categorized into two: aerobic bacteria consumes the organic matter and convert it to CO2 in the presence of O2. anaerobic the sludge is being fermented at a particular temperature in the absence of O2.

Well Water Treatment Systems

Well Water Chlorinators
Well water is one of the most popular water resources in Malaysia particularly in East coast Malaysia. As it is necessary to remove the pollutants before using it for the household purposes, thus selecting an effective well water treatment system is important. One of the cost-effective and most popular treatment for well water is the use of chlorinators.

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Chlorinators
When testing the sample for well water some of the specifications that are being given attention to are: hardness, pH level, mineral test, heavy metal test, pesticide test and volatile gas analysis.

Other than that, methane, hydrogen sulfide, bacteria, iron level and manganese content are tested to detect any color and odor problems. It is advisable to take a regular monitoring of well water, at least once in six months. Based on resulted water quality of the well, the treatment system of well water can be selected. One of the safest methods for purification of well water is the use of chlorinators. Chlorination is the process in which a specific amount of chlorine containing compound which usually sodium hypochlorite (bleach) is added in the well water. Chlorinators are available in various concentrations. Hence, for a particular quantity of well water, ones must know how much of the compound should be used. Less amount of chlorinator may result in the retention of contaminants even after the treatment. Whereas, excess amount of chlorinators may produce a strong chlorine smell in the treated water. There are several advantages of chlorinators used for the treatment of well water. One of it are, chlorinators are effective for killing disease causing pathogens in this case bacteria, viruses and also minimized rotten egg smell produced by hydrogen sulfide. Besides well water chlorinators, there are several other water treatment methods such as ozone treatment, ultraviolet purifier, anion exchanger, activated carbon filter and reverse osmosis

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How is Waste Water treated?

One of the processes used to recycle water is the primary treatment process, here are the steps that are involved in this process. 1. Screening - conducted when waste water enters the waste water treatment plant. In this step the solid items like rocks, wood and removed. 2. Pumping - waste water has to be pumped up to the aeration tanks. This is because process waste water treatment plants is usually build on low ground usually beside a river, in order to release the treated water. 3. Aerating - dissolved gases that taste and smell bad are released from the water. When this happens it uses up oxygen, which is replenished by aeration. 4. Sludge is removed - settles out sludge of the dishwater is pumped out of the tanks. In this process some of the water is removed in a step called thickening and then the sludge is processed in large tanks named digesters. 5. Removal of scum - done by slow-moving rakes that skim off the scum on the surface of the waste water. 6. Scum is pumped to the digesters along with the sludge. 7. Addition of chlorine into chlorine contact tank- bacteria which flows into contact tank is killed. Later the chlorine in the water is neutralized by adding other chemicals. 8. Discharged of treated water-also known as effluent is now discharged to a local river or the ocean.

Figure: Sewage treatment process

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Conclusion
Basically from this term paper, after done doing some readings whether it is virtually, web surfing or physical reality which mean books and journals reading, we can say that effective and affordable intervention that provide the access of safe drinking water and adequate sanitation are needed in order water-borne diseases to be controlled. For that to be realize, there are several approach that can be done through advance engineering means. One of the approaches are by using spatial analysis or known as gravity models to analyzed the water borne disease situation in a region on a particular time and then choose the most suitable strategies to control the diseases from spread out further. Other than that, proper sanitation is important and waste water treatment are one of the approaches that must be given the most attention as it controlled the amount of safe pure effluent being discharge into river. However the best way to defeat waterborne diseases are the awareness of our people about the need to maintain proper good hygiene. By always practicing a good personal hygiene, they are actually one step ahead in preventing from being infected by water borne diseases.

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22. Ashleigh R. Tuite, MSc, MPH, Joseph Tien, PhD, Marisa Eisenberg, PhD, David J.D. Earn, PhD, Junling Ma, PhD, David N. Fisman, MD, MPH, (March 7, 2011), Cholera Epidemic in Haiti, 2010: Using a Transmission Model to Explain Spatial Spread of Disease and Identify Optimal Control Interventions, http://www.annals.org/content/early/2011/03/07/0003-4819-154-9-20110503000334.full . Last accessed on 20 November 2011 23. Lars Mikkel Johannessen with Gabriela Boyer, (1999), Observations of Solid Waste Landfills in Developing Countries: Africa, Asia, and Latin America, http://wwwwds.worldbank.org/servlet/WDSContentServer/WDSP/IB/1999/11/04/000094946 _99101505321144/Rendered/INDEX/multi_page.txt . Last accessed on 10 November 2011. 24. Lars Mikkel Johannessen with Gabriela Boyer, (1999), Book of Observations of landfill in developing country, http://www.scribd.com/doc/9941140/book-ofobservations-of-lanfill-in-developing-conutry . Last accessed on 24 November 2011. 25. Ishani Chatterjee Shukla, (April, 2007), Types of water borne diseases, http://www.buzzle.com/articles/types-of-waterborne-diseases.html . Last accessed on 21 November 2011. 26. Shahrizaila Abdullah, 1999. Towards a Malaysian and global vision for water, life and the environment. Workshop on the sustainable management of water resources in Malaysia - a review of practical options, Shah Alam, Malaysia 27. MALAYSIAS WATER VISION: THE WAY FORWARD - The Malaysian Water Partnership, http://www.fao.org/DOCREP/004/AB776E/ab776e02.htm. Last accessed on 21 November 2011.

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