Key responses – Water Water supply priorities in cholera / AWD response

1. WASH Cholera / AWD EP&R training Session 3.1 Key responses – Water Water supply priorities in cholera / AWD response

2. Learning objectives By the end of the session the participants will be able to explain cholera / AWD transmission risks associated with most common water sources and possible ways to intervene if sources are identified as contaminated describe priorities for provision of water in cholera / AWD response list most common field tests used for water quality analysis compare appropriateness of most common HHWT methods in cholera / AWD response WASH cholera / AWD EP&R training 2

3. Water sources Consider that water might be contaminated with vibrio cholerae where there is contact with: People who have cholera (remember they may be asymptomatic) Contaminated articles such as buckets, cups and clothes e.g. washing of patientsbeddings and clothes Faecal material e.g. when latrines are close to wells WASH cholera / AWD EP&R training

4. Surface water WASH cholera / AWD EP&R training

5. Groundwater WASH cholera / AWD EP&R training

6. Other ways of accessing water Vendors Water trucking Standpipe WASH cholera / AWD EP&R training

7. Water trucking • Provides immediate supply • Water source and quality can be controlled Considerations: • Number of trucks to ensure adequate water supply • Cost very high • Requires close monitoring • Offloading to storage facility WASH cholera / AWD EP&R training

8. Importance of proper assessment Have the different sources of contaminated water been identified? Can and have these sources been disinfected? If not; are there any measures taken to ensure safe water at household level, or have other water sources been provided? If wells are chlorinated is monitoring of residual chlorine levels taking place? Is there any system to provide safe water to high risk areas during an outbreak? Does population receive at least 15l of water /person /day? If chlorine tablets are provided at HH level does the population know how to use them properly? WASH cholera / AWD EP&R training

9. Water Quality vs. Quantity You see a card in 3 corners of this room Walk around and decide which would be your priority for water in cholera / AWD response WASH cholera / AWD EP&R training

10. Water Quality Fluids (water sources) Sanitation Cholera (Faeces and vomit) New Host Soil Food Water Quantity Hands Hand washing Blocking of transmission of cholera by water interventions WASH cholera / AWD EP&R training

11. Transmission routes and prevention strategies Source Cairncross & Feacham (1999, 2nd edn) Environmental Health Engineering in the Tropics WASH cholera / AWD EP&R training

12. Water quantity Source The Sphere Project (2004) WASH cholera / AWD EP&R training

13. Water Quality • Physical • E.g. turbidity, colour • Chemical • E.g. iron, arsenic • Microbiological and biological • E.g. bacteria, protozoa WASH cholera / AWD EP&R training

14. During a cholera outbreak the most significant parameter to follow up are the bacteriological parameter WASH cholera / AWD EP&R training

15. Sphere key indictors for water quality • Turbidity (cloudiness index) - less than 5 NTU • Faecal coliform - 0 FC/ 100 ml • Residual chlorine (if water is disinfected) – 0.5 mg/l (for piped systems and during outbreaks) WASH cholera / AWD EP&R training

16. Turbidity • Refers to clarity of water i.e. the greater the amount of total suspended solids the higher the turbidity • Affects disinfection: high turbidity protects micro-organisms from the action of disinfectants WASH cholera / AWD EP&R training

17. How to test turbidity ? • Turbidity tube (most common field method) • Secchi disk • Electronic devises WASH cholera / AWD EP&R training

18. Microbiological and Biological Water Quality • E-coli is used as an indicator for faecal contamination • Testing for E-coli is not always required if the water is going to be treated anyway • SPHERE key indicator Faecal coliform - 0 FC/ 100 ml Recommendation is to treat (chlorinate) all drinking water and water used for cooking during a cholera outbreak WASH cholera / AWD EP&R training

19. How to test microbiological quality in the field • DelAqua kit • Wagtech • H2S • No field tests to detect V.C from water source WASH cholera / AWD EP&R training

20. Use of DelAgua 4 – 6 hours ON 16hrs incubation source Medair Madagascar WASH cholera / AWD EP&R training

21. Hydrogen Sulphide (H2S) tests Result: Yes / no (presence/ absence) Turns black when it comes in contact with hydrogen sulphide Eric Fewster, BushProof An on-site testing method for microbial quality of drinking water Faeces contain a high concentration of hydrogen sulphide (H2S) producing bacteria so water contaminated with faeces will react WASH cholera / AWD EP&R training

22. Common Household Water Treatment Methods • Chemical e.g. Chlorination • UV disinfection • Boiling • Filtration WASH cholera / AWD EP&R training

23. Data leads to some controversy, partly of the difficulty of splitting impacts of interventions. For example: * Hand-washing is not possible without a water supply, so ‘hand-washing’ is in fact ‘water supply and hand-washing’ ** Water quality at household will also have involved some hygiene promotion when setting up the household water treatment processes WASH cholera / AWD EP&R training

24. Let’s think of appropriateness of different HHWT methods in a cholera / AWD outbreak response Boiling Filtering Chemical UV disinfection WASH cholera / AWD EP&R training

25. Water storage WASH cholera / AWD EP&R training

26. Water storage WASH cholera / AWD EP&R training

27. Learning objectives By the end of the session the participants will be able to explain cholera / AWD transmission risks associated with most common water sources and possible ways to intervene if sources are identified as contaminated describe priorities for provision of water in cholera / AWD response list most common field tests used for water quality analysis compare appropriateness of most common HHWT methods in cholera / AWD response WASH cholera / AWD EP&R training 27