Debre Berhan University

Institute of Medicine and Health

Science
College of Medicine
Course Instructors:
1. Asmamaw A. (BSc, MSc EnST)
2. Tufa K. (BSc, MPH)
Course title:

Ecology and Environmental

Determinants of Health
Department: Medicine
Year: 1 Academic year: 2014 (2006 E.C)
Total time:7weeks (2hrs/week lecture) & 4hrs/week community work
Consultation hour: Thursday 02:00pm-05:00pm
Address: E-mail: asmenst13@gmail.com

CourseDescription
thebasicconceptsandfundamentalsof
environmentalhealthandEcology

itdealswiththeconceptrelatedtoenvironmentaland
ecologyactivitiesrelevanttohealthpromotionand
diseasesprevention

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Ecology and Environmental Determinants of Health

Environment and health

Ecological model of health and disease

Water supply
Waste management
Food Hygiene
Vector control

Housing and institutional sanitation (self-reading)

Occupational health and safety
Biosphere and pollution
Human and environment

CourseObjectives
Attheendofthecourse,studentswillbeableto:
1.Defineenvironmentalhealth/sanitationandEcologicalmodel
ofhealthanddisease
2.Describetheimportanceofpublicwatersupply
3.Differentiatedifferentgroupsofwasteanditsmanagement
4.Explainfoodsafetyandhygieneprocess
5.Identifypublicimportanceofinsectsandrodents
6.Identifyhealthfulcharacteristicsofhousingandinstitution
7.Describethescopeofoccupationalhealthanddifferenttypes
ofoccupationalhazards
8.ExplainaboutBiosphereandpollution
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Teachingandlearningmethods
1.

Classroomlectures,Relevantfieldvisits,groupdiscussion,
readingassignment,hometakeassignment
Studentswillbeevaluatedbasedonthefollowingcriteria:

1.Groupassignments
2.Individualassignment
3.Classroompresentation
4.Quiz
5.Attendance,classdisciplinesandparticipation
6.writtenexamination
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References
1.AllLecturenotesforEnvironmentalhealthstudents.
2.KatyleTimmyandM.Satake(Prof.).Environmentalpollution;
2006:India.
3.EhlersR.,PickfordJ.andReedR.Aguidetodevelopmentof
onsitesanitation;1992:WorldHealthOrganizationGeneva.
4.EhlersR.Publicwatersupplydistributionsystems:Assessing
andreducingrisk;2005:USA.
5.J.S.SalvatoEnvironmentalEngineeringandsanitation;1992,
4thed.USA.

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CHAPTER ONE

INTRODUCTION TO
ENVIRONMENTAL HEALTH

BasicConcepts/definitions
Healthisastateofcompletephysical,mental,andsocialwell
beingandnotmerelytheabsenceofdiseaseorinfirmity.
DeterminantsofHealth
Health/illhealthistheresultofadifferentfactors
differentperspectivesinexpressingthedeterminantsofhealth
accordingtotheHealthfieldconceptthereare4major
determinants

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A.HumanBiology(Hereditaryfactors)
everyhumanbeingismadeofgenes
geneticallytransmittedfromparentstooffspring
E.g:Leukemia
B.Lifestyle(PersonalBehavior)
is an action that has a specific frequency, duration, and
purpose
isassociatedwithpractice(whatwedoandhowweact)
E.g.Cigarettesmoking,Feedinghabit,etc
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C.Healthcareorganization(MedicalCheckup)
healthcareorganizationsintermsoftheirresource
early intervention will minimize the occurrence of complex
condition.
E.g.:TB,Rheumaticarteritis

D.Environment
thosearefactorsoutsidethehumanbody
affectpeopleshealthmorestronglythananyoftheothers
E.g.Safewatersupply,Foodhygiene,wastemanagement
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Environment
isthesumofallexternalinfluencesandconditionswhicheffect
health,lifeandgrowth
itincludesthephysical,biological,chemicalandpsychosocial
Components
Physical:air,water,food,soil,climate,heat,light,noise,radiation
Biological:viruses,microbialagents,insects,animalsandplants,etc.
Psychosocial:culturalvalues,customs,beliefs,habits,attitudes,religion

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Sanitation
istheestablishmentofenvironmentalconditions
favorabletohealth
itisthepreventionofdiseasesbyeliminatingor
controllingtheenvironmentalfactorswhichform
linksinthechaintransmissionWHO,1948

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EnvironmentalSanitation
is the control of all those factors in mans physical
environment which exercises or may exercise a deleterious
effectonhisphysical,mental,andsocialwellbeing.WHO,1948

Environmental Health
isabranchofpublichealththatisconcernedwithallaspects
of the natural and built environment that may affect human
health
is targeted towards preventing disease and creating health
supportiveenvironments
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EnvironmentalHealth
is the theory and practice of assessing, correcting,
controlling, and preventing those factors in the environment
which exercises or may exercise a deleterious effect on the
physical, mental, and social wellbeing of present and future
generation
WHO,2004
PublicHealth
is the science and art of preventing disease, prolonging life,
and promoting physical and mental health and efficiency
throughorganizedcommunityefforts

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THECHAINOFCOMMUNICABLEDISEASES
sixrelatedcomponentsmustoccurforinfectionanddisease
isreferredtoastheChainofInfection.
thesixstepsorlinksinthechainare:
A.Etiologicagent
B.Reservoir
C.PortalofExit
D.ModeofTransmission
E.PortalofEntry
F.SusceptibleHost
Selectdiseasewriteallthesixstepsofcommunicabledisease??
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each case of CD is the result of an orderly progression in a

seriesofevents
seriesofeventsmaybedescribedasathreelinkchain
Theselinksare:
(1)Theagent
(2)TheEnvironment
(3)Asusceptibleperson(host)

=> To stop the spread of communicable

disease the chain can be broken

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Chapter Two
Public Water Supply

Terminology
Aquifer: an underground zone, which is a relatively good source
of water
- is a rock formation that bears and yields water
Palatable water: is pleasant to drink because its taste is good but
it may not be safe to drink
Potable: safe for drinking, free from pathogens
Raw water: water that has not been purified

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Per capital

demand (Per capital consumption):

=
Where it is expressed in litter/day
Safe/ clean water is an absolute prerequisite for healthy living
Public water system the provision of water for human
consumption through pipes or other constructed conveyances
earths surface is covered by 72% of water
=> 97.2% ocean (unfit for human consumption)
=>2% in water in frozen state in glaciers (unreachable)
=> tiny usable portion is about 0.8%
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Importance and use of water

1. Physiological needs:

70% of our body

Dehydration is the adverse consequence of inadequate water intake

=> fluid loss at 1% of body weight impairs thermoregulation
=> numbness of extremities can be seen at 6%
=> collapse can occur at around 7% dehydration
=> 10% loss of body water through dehydration is life-threatening
NB: 92 Niger illegal migrants were died
at Sub-Sahara desert (BBC, 2013)
2. Domestic use, Recreational purposes,
agriculture, Transportation, power production, industrial
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Health Importance
clean and safe drinking water in affected areas is a necessary step in
any effort
safe, adequate & accessible supplies of water, combined with proper
sanitation, are basic needs (water supply is taken as an essential PHC)
health risks to consumers from poor quality water
the poor quality may due to
Microbiological

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Chemical

Physical/radioactive contamination

21

Water-associated Disease
there are five categories of water-associated disease/illness:
1. water borne disease
2. water-washed disease
3. water-based disease
4. water-related disease
5. chemical-related water illness

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1. Water borne disease

the pathogen is in the water
quality matters
several infections enteric or intestinal diseases of man are
transmitted through water contamination by fecal matter
pathogens excreted in water by an infected person
water acts only as a passive vehicle
E.g. Typhoid and paratyphoid fever , Cholera, Diarrheas, Bacillary

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2. Water washed disease

these comprise diseases linked to a lack of water
quantity matters
lack of good personal hygiene and inability to wash clothes
encourages the proliferation of lice
Examples: scabies, trachoma and conjunctivitis, louse-borne
diseases (louse borne typhus and relapsing fever)

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3. Water based (contact) disease

disease caused by infectious agents that are spread by contact
with water
the essential part of the life cycle of the infecting agent takes
place from an aquatic animal
the infection often occurs by penetration of the skin rather than
by consumption of water
E.g. schistosomiasis and dracunculiasis (guinea worm)

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4. Water-related insect disease

diseases transmitted by insects that live close to water and bite
near it
the incidence of diseases can be related to the proximity of
suitable water sources
infection is no way connected with human consumption or
contact with the water
E.g. Malaria (Anopheles mosquitoe), sleeping sickness, yellow
fever, onchocerciasis (black fly), etc

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5. Chemical-related water illness

concentrations of most potentially harmful impurities
some chemical find their way in to surface and ground water
Example:
A. potentially carcinogenic (polyaromatic hydrocarbon (PAH),
trihalomethans (THM), organochlorine, organophosporus)
B. methano globinemia/blue baby diseases (syndrome) <6month
C. Fluoride
=> very low produce tooth day particularly in young children
=> very high causes yellow staining of teeth and bone damage
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Sources of Drinking Water

=> Ground water (well & spring)
=> Surface water (rivers, streams, ponds and lakes)
=> Rain water
=> Sea water

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1. Ground water
is portion of the total precipitation which has percolated
downward into the porous space in the soil and rock
is by far the most practical and safe in nature
the most important source of water supply for most rural
communities
classified in to well and spring water
comparatively likely to be free from disease causing microorganism
it may contain excess amounts of dissolved minerals
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2. Surface Water
is found non-uniformly distributed over the earths surface
rain reaches the surface of the earth, it becomes surface H2O
is less naturally dissolved minerals
quantity & quality depend upon the conditions catchment area
has to be polluted by industrial & municipal effluents
Laga dadi dam-----

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3. Rain Water
is reasonably clean and safe for drinking if properly collected
main source of water in arid and semi-arid areas
can be harvested in storage tanks dams and ponds
is a reliable source even if it rains once/twice a year only
is cheap and a safe means of water supply
little soap is needed for laundry purposes

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4. Sea Water
is unfit for human consumption even though it comprises the
largest portion of water on the earth's surface
is also too salty for irrigation and for domestic purposes
to make the ocean water fit for different purposes
=> it must pass through desalination

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Sources of Drinking Water in Ethiopia

EDHS 2011:

Overall: 54% of households have access to any improved

sources of drinking water, with a much higher proportion
among urban households (95%) than among rural households
(42 %).

46% non-improved sources

Nationally, the proportion of Ethiopian households with
access to piped water has increased from 18 percent in 2000
to 24 percent in 2005 and 34 percent in 2011.
33

Drinking Water Treatment

the process of removing all those substances, whether biological,
chemical or physical, which are potentially dangerous or
undesirable in water supply for human and domestic use
production of adequate and safe drinking water is the most
important factor contributing to a decrease in mortality and
morbidity
water-borne diseases are prevalent among communities that
consume such untreated contaminated water
In any case, surface water shall never be used as a source of water
supply without treatment (Fikrie et al, 2005)
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Public water treatment can be classified in to 2

A. small scale
B. large scale

A. Small Scale Water Treatment

emergency situations, temporary settlement areas, at household level
and areas where the municipality is not well organized
Some of examples of small scale water treatment are
=> Boiling
=> Filtration
=> Chemical Disinfection
=> Household Water Storage
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1. Boiling
is one of the most reliable methods of disinfecting
water is brought to the boiling point, and is kept boiling for 15
to 20 minutes, all forms of micro-organisms
is effective for all kinds of raw water, except toxic
is its flat taste, due to the loss of dissolved gases (CO 2 & O2)
and minerals

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2. Filtration
is a process of passing water through porous materials
carried out by simple filtration systems, such as:
=> Homemade Sand Filters
=> Home Candle Filters
=> Stone filters
=> Cloth filtration

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2.1. Homemade Sand Filters

can be set up in individual homes, in containers such as steel
barrels, drums, etc.
a properly constructed and carefully maintained can remove
most of the substances that cause turbidity, taste and odor, the
cysts and ova of parasites, and other relatively larger
organisms

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3. Chemical Disinfection
A) Chlorine or its compounds
can be applied to disinfect water on a small scale
3 drops of 1% chlorine stock solution applied to every liter
tablet forms of chlorine (dose:1 tablet per liter of clear water)
B) Iodine and its compounds
have also been effectively used for individual water
disinfection
iodine is believed to be a better disinfectant than chlorine

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is relatively expensive for ordinary use, and in addition

imparts to the waters
4. Household Water Storage
is well practiced in the community
turbidity will be reduced
bacteria and eggs of parasites will be sedimented
schistosomiasis will be prevented because the chances of
cercaria survival after 24 hours of water storage will be
reduced

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B. Conventional Water Treatment /

Large Scale

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the selection of a water source important;

=> minimize the cost of treatment
=> reliability to provide an accurate and constant
ground water supply requiring little or no treatment
surface supply may require considerable and perhaps
seasonally varying treatment
water treatment on a large scale utilized for large population
it is different from treatment of water on a small scale

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Main objective of water treatment

to remove pathogenic organisms
to remove substance which impart color, taste or odor
to remove excess or undesirable chemicals or minerals
to regulate essential elements or chemicals (e.g. fluoridation or
defluoridation of water)
to remove excess or undesirable dissolved gasses

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The most important factors in selection of treatment

processes are:
treated water specifications
raw water quality and its variations
local constraints (availability of skill, manpower and funds)
relative cost of different treatment processes

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Steps in Conventional Water Treatment Plant

1. Preliminary water treatment
-The source and intake of the raw water
- Screening
2. Aeration and pre-chlorination
3. Coagulation and flocculation
4. Sedimentation
5. Filtration
6. Post-chlorination
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1. Preliminary Water Treatment

to protect the main units of a treatment plant
to aid in their efficient operation
is necessary to remove any large floating and suspended solids
these materials include leaves, twigs, paper, rags etc
river water frequently contains suspended and floating

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2. Aeration and pre-chlorination

Aeration
exposing the water atmospheric air
freshwater is exposed to the earths atmosphere
surface water absorbs mainly O2, N2, CO2, H2S etc
for gas exchange in simplest and the most direct form
Addition of O2 to oxidize dissolved iron and manganese
Removal of CO2 to reduce corrosion and interference

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=> removal of H2S to eliminate odor and taste, decrease the

corrosion of metals and disintegration of cement
=> removal of methane
=> removal of volatile oils and similar odor and taste producing
substances released by algae and other micro-organisms

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Pre-chlorination
replaces aeration in some water purification plants
accomplishes a similar objective to aeration, and in addition, it
helps to control the growth of algae
Use of Pre-chlorination will:
improve coagulation
reduce taste and odor caused by organic sludge in the
sedimentation tank
reduce excess growth of algae and other organisms
reduce frequency of cleaning sand filters
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3. Coagulation and flocculation

impurities in water are present as colloidal solids, which will not
settle
Colloids are minute particles that exist in dispersed state in a
liquid
their removal can be achieved by promoting agglomeration of
such particles by flocculation
Most commonly used coagulants are:
A) Aluminum Sulphate

B) Ferrous Sulphate

C) Ferric Sulphate

D) Magnesium Carbonate

E) Polyelectrolyte

F) Copper Sulphate

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when a solution of aluminum sulphate is added

its molecules dissociate into Al3+and SO4-2
=> Al3+ + Colloid

Al Colloid

at the same time some of the Al3+combines with the OHin

water
=> Al3+ + 3OH- Al (OH)3
=> Al (OH)3 + Colloid Al (OH)3Colloid
forming relatively heavy flocs

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4. Sedimentation
is the removal of suspended solids through the settling of
particles moving through a tank at a slow rate
settling of suspended particles heavier than water
Factors that influence sedimentation processes are:
1.

Size, shape and weight of particles, or floc (precipitate)

2.

Effective average period available for sedimentation

3.

Effective depth of the tank or basin

4.

Inlet and outlet position of the tank

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5. Filtration
is a process where the suspended matter is separated or purified by
passing it through a minute porous material or medium
the raw water passes through a fixed depth of carefully arranged sand
medium
is one of the most important and oldest practices of water purification
Objective of filtration
1. to produce clear sparkling water
2. to reduce number of micro-organisms
3. to minimize the contaminants (taste and odor)
4. to remove any suspended solid in water

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6. Post-chlorination
disinfecting water supplies is to prevent the spread of water
borne disease
previously will remove most of the microorganisms to some
extent
very small numbers of microorganisms bring about disastrous
epidemic

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Reading Assignment
Hardness of water classified in to 2
1. Temporary hardness
2. Permanent hardness

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Community Assignment.11/07/2014
1.
Calculate per capital water consumption of community
near to DBU and report current capital consumption of
water
2.
Write organizing reports on house hold management of
drinking water
3.
Visit Debre Berhan drinking water treatment and write a
report
Submitted at 22/07/2014

QUESTIONS???

THANKS!!!