Water borne Diseases

Waterborne Diseases

Waterborne diseases are conditions caused by pathogenic micro-organisms that are transmitted in water. These diseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water.

A report by the United Nations says that more than three million people in the world die of water-related diseases due to contaminated water each year, including 1.2 million children.
In India, over one lakh people die of water-borne diseases annually.
It is reported that groundwater in one-third of India’s 600 districts is not fit for drinking as the concentration of fluoride, iron, salinity and arsenic exceeds the tolerance levels.
About 65 million people have been suffering from fluorosis, a crippling disease due to a high amount of fluoride, and five million are suffering from arsenicosis in West Bengal due to high amount of arsenic.
A World Resources Report says: about 70 per cent of India’s water supply is seriously polluted with sewage effluents.
The UN reported that India’s water quality is poor - it ranks 120th among 122 nations in terms of quality of water available to its citizens.
Click for more data on water pollution and it effects in India – Aspire IAS website - Water Resources, AspireIAS website - Water Pollution

Waterborne illnesses have two main causes:

Pollution e.g. dangerous levels of chemicals, nitrates or heavy metals in the water supply due to industrial pollution or the over-use of agricultural chemicals.

Dirt & Contamination - Bacteria, viruses and parasitic organisms invisibly contaminate the water and cause disease. Much of this contamination is through water coming into contact with animal and human waste.

Waterborne diseases such as cholera, acute diarrhoeal diseases, typhoid and viral hepatitis continue to be prevalent in India and have caused 10,738 deaths, over the last five years since 2017. Of this, acute diarrhoeal diseases caused maximum deaths followed by viral hepatitis, typhoid and cholera.

According to ICMR, Annually about 37.7 million Indians are affected by waterborne diseases, 1.5 million children die of diarrhoea and 73 million working days are lost leading to an economic burden of $600 million a year.

Uttar Pradesh has recorded the highest deaths due to diarrhoea followed by West Bengal, Assam, Odisha and Madhya Pradesh.

Why are waterborne diseases still rampant in India?

Poor accessibility of water, only 44% has access to piped water, only 32 percent of it is treated.
Untreated sewage disposal
Open defecation
Poor access to safe water sources and toilets and poor WASH practice
Severity of weather-related events such as floods and droughts, as heavy rains and resultant floods can create conducive environments for numerous waterborne diseases such as diarrhoea, cholera, dysentery, typhoid and other bacterial and viral diseases.
Droughts can also trigger waterborne diseases due to increasing water shortages compromising sanitation and hygiene.

The World Health Organisation (WHO) has developed international norms on water quality that are used for regulation and to set standards in developing and developed countries. For detailed analysis visit WHO website.

Some diseases spread through vectors breeding on water:

1) Malaria

Malarial fever is spread by the Plasmodium parasite mosquito that breeds in water bodies like lakes, paddy fish and stagnant water.

Malaria can kill a child who does not have the immunity against the disease.

2) Filariasis

It is a parasitic disease and affects people who live near unsanitary water bodies or sewages.

Filariasis is spread by mosquitoes that breeds in fresh and stagnant water bodies and is the host of the filarial nematode worm. This worm affects humans and leads to elephantitis.

Diarrhoea- Most common Water Borne disease prevalent in India

Diarrhea is the third leading cause of childhood mortality in India, and is responsible for 13% of all deaths/year in children under 5 years of age. Click to know more
Diarrhoeal infection is spread through food and drinking water that has been contaminated. Its usually a symptom of gastroenteritis (a bowel infection). It can be caused by Norovirus or Rotavirus
A diarrhoeal attack can last up to 2 weeks and leave the person completely dehydrated.

Health policies and programmes directed at waterborne diseases

• The National Health Policy 2017 reaffirms the government’s commitment to reforming the health sector and achieving universal health coverage. It focuses on disease elimination, reduction in mortality and improvement of health services.

• The main strategy to control diseases caused by drinking of contaminated water is provision of safe drinking water. The Government of India supplements the efforts of the states by providing technical and financial assistance under the centrally-sponsored National Rural Drinking Water Programme (NRDWP) for providing safe and adequate drinking water supply facilities in rural areas of the country.

• The National Centre for Disease Control (NCDC) provides assistance to state and Union Territory governments to prevent and control waterborne diseases and in investigating outbreaks of such diseases under the Integrated Disease Surveillance Programme (IDSP).

Diseases by type of pathogen

Protozoa

Disease and transmission	Microbial agent	Sources of agent in water supply	General symptoms
Acanthamoeba keratitis (cleaning of contact lenses with contaminated water)	Acanthamoeba	widely distributed free-living amoebae found in many types of aquatic environments, including surface water, tap water, swimming pools, and contact lens solutions	Eye pain, eye redness, blurred vision, sensitivity to light, sensation of something in the eye, and excessive tearing
Amoebiasis (hand-to-mouth)	Protozoan (Entamoeba histolytica) (Cyst-like appearance)	Sewage, Untreated water, flies in water supply, saliva transfer(if the other person has the disease)	Abdominal discomfort, fatigue, weight loss, diarrhea, bloating, fever

Bacteria

Disease and transmission		Microbial agent	Sources of agent in water supply	General symptoms
Botulism		Clostridium botulinum	Bacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract through consumption of contaminated drinking water or (more commonly) food	Dry mouth, blurred and/or double vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea. Death is usually caused by respiratory failure.
Cholera		Spread by the bacterium Vibrio cholerae	Drinking water contaminated with the bacterium	In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea, cramps, nosebleed, rapid pulse, vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours.
E. coli Infection		Certain strains of Escherichia coli (commonly E. coli)	Water contaminated with the bacteria	Mostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness.
Dysentery		Caused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriae	Water contaminated with the bacterium	Frequent passage of feces with blood and/or mucus and in some cases vomiting of blood.
Leptospirosis		Caused by bacterium of genus Leptospira	Water contaminated by the animal urine carrying the bacteria	Begins with flu-like symptoms then resolves. The second phase then occurs involving meningitis, liver damage (causes jaundice), and kidney failure
Typhoid fever	Salmonella typhi		Ingestion of water contaminated with feces of an infected person	Characterized by sustained fever up to 40 °C (104 °F), profuse sweating; diarrhea, muscle aches, fatigue, and constipation may occur. Symptoms progress to delirium, and the spleen and liver enlarge if untreated. In this case, it can last up to four weeks and cause death. Some people with typhoid fever develop a rash called "rose spots", small red spots on the abdomen and chest.

Viruses

Disease and transmission	Viral agent	Sources of agent in water supply	General symptoms
Hepatitis A	Hepatitis A virus (HAV)	Can manifest itself in water (and food)	Symptoms are only acute (no chronic stage to the virus) and include Fatigue, fever, malaise, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice, and depression.
Hepatitis E (fecal-oral)	Hepatitis E virus (HEV)	Enters water through the feces of infected individuals	Symptoms of acute hepatitis (liver disease), including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice, dark urine, clay-colored stool, and joint pain
Poliomyelitis (Polio)	Poliovirus	Enters water through the feces of infected individuals	90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium, headache, fever, and occasional seizures, and spastic paralysis, 1% have symptoms of non-paralytic aseptic meningitis. The rest have serious symptoms resulting in paralysis or death