Medical Lab

Hossana College of Health Sciences
Department of Medical laboratory

Generic Degree program (P)
Course: Environmental Health
Prepared by Andualem Girma(MSc)
July, 2022
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Health and disease: concepts, definitions and
perspectives
There are various definitions and determinants
of health.
For the purpose of this monograph, we consider
definitions from lay point of view, professional,
World Health Organization (WHO).
Lay Point of view: Persons are healthy when
they are doing their activities with no apparent
symptoms of disease in them. The New oxford
Dictionary of English describes health as ‘the
state of being free from illness or injury’.
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perspectives
Professional points of view: From this point,
health is defined as s a measure of the state of
the physical bodily Organs, and the ability of the
body as a whole to function.
It refers to freedom from medically defined
diseases.
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perspectives
Professional points of view: From this point,
health is defined as s a measure of the state of
the physical bodily Organs, and the ability of the
body as a whole to function.
It refers to freedom from medically defined
diseases.
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perspectives
WHO definition: The world Health Organization
(WHO) described health in1948, in the
preamble to its constitution, as “A state of
complete physical, mental, and social well-being
and not merely the absence of disease or
infirmity”.
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perspectives
Recently this statement has been expanded to
include the ability to lead a “socially and
economically productive life”.
The World Health Organization definition of
health cannot be considered as an operational
definition because it does not lend itself to
direct measurement.
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perspectives
 The WHO definition envisages three specific dimensions
(physical, mental, and social), some other dimensions
like spiritual, emotional may also be included.
 Physical health- is concerned with anatomical integrity
and physiological functioning of the body.
 It means the ability to perform routine tasks without
any physical restriction. E.g., Physical fitness is needed
to walk from place to place.
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perspectives
According to this definition, the concept of
health is viewed as being of two orders.
In broader sense health can be defined as “a
condition or quality of the human organism
expressing the adequate functioning of the
organism in given conditions, genetic or
environmental”
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perspectives
Mental Health- is the ability to learn and think
clearly and coherently. E.g., a person who is not
mentally fit (retarded) could not learn
something new at a pace in which an ordinary
normal person learns.
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perspectives
Social health- is the ability to make and
maintain acceptable interaction with other
people. E.g. to celebrate during festivals; to
mourn when a close family member dies; to
create and maintain friendship and intimacy,
etc.
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perspectives
 Emotional health - is the ability of expressing emotions
in the appropriate way, for example to fear, to be happy, and to

be angry.
 The response of the body should be congruent with that of the
stimuli.
 Emotional health is related to mental health and includes
feelings.
 It also means maintaining one’s own integrity in the presence
of stressful situation such aseh tension,
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perspectives
Spiritual Health - Some people relate health
with religion; for others it has to do with
personal values, beliefs, principles and ways of
achieving mental satisfaction, in which all are
related to their spiritual wellbeing.
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Different perspectives on health
the enjoyment of the highest attainable

standard of health is one of the
fundamental rights of every human being
without distinction of race, religion,
political belief, economic or social
condition”.
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Different perspectives on health
Others view health as an important
individual objective of material aspect i.e.
as consumption good.
The third view considers health as an
investment, indicates health as an
important prerequisite for development
because of its consequence on the overall
production through its effect on the
productive ability of the productive force.
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Determinants of health
Health or ill health is the result of a
combination of different factors.
There are different perspectives in
expressing the determinants of health of
an individual or a community.
The health field concept
According to the “Health field” concept.
There are four major determinants of
health or ill health.
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A. Human Biology
Every Human being is made of genes. In
addition, there are factors, which are
genetically transmitted from parents to
offspring.
As a result, there is a chance of
transferring defective trait. The modern
medicine does not have a significant
role in these cases.
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A. Human Biology
Genetic Counseling: For instance
during marriage parents could be
made aware of their genetic
component in order to overcome
some risks that could arise.
b. Genetic Engineering: may have a
role in cases like Breast cancer.
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B. Environment: is all that which is
external to the individual human host.
Those are factors outside the human
body.
Environmental factors that could
Influence health include:
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a. Life support, food, water, air etc
b. Physical factors, climate, Rain fall
c. Biological factors: microorganisms, toxins,
Biological waste,
d. Psycho-social and economic e.g.
Crowding, income level, access to health
care
e. Chemical factors: industrial wastes,
agricultural wastes, air pollution, etc
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C. Life style (Behavior): is an action that
has a specific frequency, duration, and
purpose, whether conscious or
unconscious.
It is associated with practice. It is
what we do and how we act.
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Recently life style by itself received an
increased amount of attention as a
major determinant of health.
Life style of individuals affects their
health directly or indirectly.
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For example:
Cigarette smoking
Unsafe sexual practice
Eating contaminated food
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D. Health care organization
Health care organizations in terms of
their resource in human power,
equipment's, money and so on
determine the health of people.
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The other view of the determinants of
health is from the ecological
perspective.
Accordingly, there are four different
factors affecting health
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These are:
1. Physical Determinants -The physical factors
affecting the health of a community include: the
geography (e.g. high land versus low land), the
environment (e.g. manmade or natural catastrophes)
and the industrial development (e.g. pollution
occupational hazards)
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2. Socio – cultural determinants – The socio-

cultural factors affecting the health of a
community include the beliefs, traditions, and
social customs in the community.
It also involves the economy, politics and
religion in the community.
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3. Community organization - Community

organization include the community size,
arrangement and distribution of resources
(“relations of productions’).
4. Behavioral determinants- The behavioral
determinants affecting health include individual
behavior and life style affecting the health of an
individual and the community.
E.g. smoking, alcoholism and promiscuity
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Definition of public health
 Public health is defined as the science and art

of preventing diseases, prolonging life,
promoting health and efficiencies through
organized community effort.
It is concerned with the health of the whole
population and the prevention of disease from
which it suffers.
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 it is also one of the efforts organized by

society to protect, promote, and restore the
peoples’ health.
It is the combination of sciences, skills and
beliefs that is directed to the maintenance and
improvement of the health of all the people
through collective social actions.
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Key Terms in the definition

Health promotion is a guiding concept
involving activities intended to enhance
individual and community health well-being.
It seeks to increase involvement and control of
the individual and the community in their own
health.
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Health promotion is a key element in public
health and is applicable in the community,
clinics or hospitals, and in all other service
settings.
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Prevention refers to the goals of medicine
that are to promote, to preserve, and to
restore health when it is impaired, and to
minimize suffering and distress.
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MAJOR DISCIPLINES IN PUBLIC
HEALTH
 Nutrition: is the science of food, the nutrients and
other substances therein, their action, interaction
and balance in relation to health and disease.
 Reproductive health: is a state of complete physical,
mental and social being not only absence of disease
or infirmity, in all matters relating to reproductive
system and to its functions and process.
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HEALTH
 Environmental Health The basic approach to
environmental control is first to identify specific
biologic, chemical, social and physical factors that
represent hazards to health or well-being and to
modify the environment in a manner that protects
people from harmful exposures.
 The principal components of environmental health
are water sanitation, waste
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HEALTH
 Health Education is defined as a combination of
learning experiences designed to facilitate
voluntary actions conducive to health. It is an
essential part of health promotion.
 Epidemiology is the study of frequency,
distribution, and determinants of diseases and
other related states or events in specified
populations.
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HEALTH
 Health Economics is concerned with the alternative
uses of resources in the health services sector and
with the efficient utilization of economic resources
such as manpower, material and financial resources.
 Biostatistics is the application of statistics to
biological problems; application of statistics especially
to medical problems, but its real meaning is broader.
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HEALTH
Health Service Management is getting people
to work harmoniously together and to make
efficient use of resources in order to achieve
objectives.
Ecology: is the study of relationship among
living organisms and their environment.
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HEALTH
Human ecology means the study of human
groups as influenced by environmental factors,
including social and behavioral factors.
Research is a conscious action to acquire
deeper knowledge or new facts about scientific
or technical subjects.
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HEALTH
Demography is the study of population,
especially with reference to size and density,
fertility, mortality, growth, age distribution,
migration, and the interaction of all those with
social and economic conditions.
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2.5. Core activities in public health
Preventing epidemics
Protecting the environment, work place ,food

and water ;
Promoting healthy behavior;
Monitoring the health status of the population;
Mobilizing community action;

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Responding to disasters;
Assuring the quality ,accessibility, and

accountability of medical care;
Reaching to develop new insights and
innovative solutions and
9. Leading the development of sound health
policy and Planning
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Responding to disasters;
Assuring the quality ,accessibility, and

accountability of medical care;
Reaching to develop new insights and
innovative solutions and
Leading the development of sound health
policy and Planning
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 Components of environmental health
Environment is the sum of all external

influences and conditions which effect health,
life, and growth. This includes the physical,
biological, chemical, and psycho-social
environment” (WHO); It is all that which is
external to the individual human host (Last
1995).
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Environmental Health is “the control of all

those factors in man’s physical environment
which exercises or may exercise a deleterious
effect on his physical, mental, and social well
being.” (WHO).
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Universal human rights: “ All people have the

right to a standard of living adequate for health
and well being of themselves and their family,
including food, clothing, housing, healthcare,
and the necessary social services” (UN 1948
universal declaration of human rights) .
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Historical background of environmental health
 Prehistoric times: Mose’s law for human waste
disposal;
 Spiritual/religion leaders: Prophet Mohammed his
law of personal hygiene;
 Sewage and water lines known in ancient Babylonia,
Egypt, Athens, and Rome civilization; Schistosomiasis
in ancient Egypt;
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Plague documented in the 3re century, pandemic
appeared in the 6th century (middle ages);
Edwin Chadwick in 1842 and later Fredrich Engels
in 1844 wrote a historic report on “The sanitary
conditions of the laboring population in Great
Britain
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 Louis Pasteur in the 2nd half of 19 century developed the germ
theory of disease transmission;
 Mid 19 century improvement of sanitation, housing, nutrition,
etc, in some countries have contributed to the decline of
communicable diseases, decrease of mortality rates and
increase of LE at birth.
 After 2nd world War: new events: antibiotics, vaccines
development; and creation of
06/07/2024 WHO in April 7, 1948;
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II. Human-ecology interaction outcomes: Three

kinds of outcomes/ interactions at macro level:
1. Man can affect the environment: deforestation,

fire, air pollution, noise pollution, waste dumping,
radiation pollution, etc. This is due human activities
for land search, industrialization, urbanization,
population explosion, migration, war, etc.
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2. Man can be affected by the environment:

flooding, draught, famine, disease, earthquakes,
lighting etc because of the various disturbances in
the environment.
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Components of environmental health
3. Man can maintain environmentally good
relationship: afforestation, pollution reduction,
disarmament, international conventions and legislations
on environment, etc.
 The role of human being in making the environment
clean safe and adequate is: resource, management
(planning, monitoring and evaluation), research and
development.
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3. Man can maintain environmentally good
relationship: afforestation, pollution reduction,
disarmament, international conventions and legislations
on environment, etc.
 The role of human being in making the environment
clean safe and adequate is: resource, management
(planning, monitoring and evaluation), research and
development.
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III. Man-Environment Relationships
Life Support system: Food (nutritive energy),
geophysical (air, water, land, shelter); biological
(macro and micro-organisms); built environment
(water supply system, waste management facilities,
communication, food processing, health service
facilities, etc.); psycho-social environment (religion,
culture, beliefs, etc.);
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2. Human activities: residential, working places,

recreational places, communication,
3. Residues and wastes: in the form of solid

waste, gases polluting air, liquid wastes, radioactive
wastes, energy residues (example: UV light when
welding).
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 environmental Hazards
Biological: Animals, insect vectors, Micro-organisms, Site and location: lighting, earthquakes, flooding,
vegetation: mainly causes diseases (viral, bacterial, drought, wind storms (hurricanes & cyclones),
protozoal, helminthic, fungal, food poisoning, volcanoes, land slides: causes displacement,
poisoning by animal bites), Allergic. injury, material damages, Disability, deaths
Chemical: organic and inorganic substances: are Psychological: low payment. Poverty, lack of
systematic poisons & toxins. Allergens. Irritants. social services, lack of privacy, traffic. Etc. causes
Fibrogens. Asphyxiants. Carcinogenic. Mutagenic stress, boredom, anxiety, depression
Physical: radiation, vibration, dust, light, humidity, air Sociological: overcrowding. Isolation.
velocity, forces, heat, equipments, noise, air pressure, Discrimination. Etc.
etc: causes diseases, skin and material damages, cancer.
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 environmental Hazards
 The biological hazard is most common
prevalent in our country causing high morbidity,
mortality, and disabilities. Chemical pollution is
on the rise since both domestic and industrial
effluents are often injected directly to natural
water bodies with out any treatment.
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Why do we concern on Environmental
health?
i.). Global situation: basic sanitation provision
1. 25% of world’s population and 60% population in developing
countries lack basic housing sanitation;
2. 23% of urban and 53% of rural population in the 3rd world
lack safe water;
3. 40% of urban and 84% of rural population in the 3rd world lack
basic sanitation.;
4. 80% of health problems in developing countries is due to lack
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safe water and basic sanitation;
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Why do we concern on Environmental
health?
i.). Global situation: basic sanitation provision
5. About 45% of all deaths in under fives is due to
diarrhea.
6. 15% of the USA population and one third of the
entire developed countries live in substandard housing
7. 50% of the 3rd world population lives in
conditions of extreme poverty.
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Why do we concern on Environmental health?
Other Global problems:

Ambient air pollution and indoor air pollution: the
health of 400-700 million people in the world is
endanger due to indoor air pollution;
Ozone depletion has raised the risk of skin cancer;
Loss of biodiversity has raised the need of basified in

many developing countries;
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Other Global problems:

 Global climate change has become a concern in the
world:
 Deforestation, draught, earthquakes, hurricanes (a
storm with a violent wind e.g Suname) etc. are wiping
out the lives of many people every year;
 A quarter of all irrigated land suffers from soil
salinisation
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V. Role of Environmental Health in community

health
i. Three basic strategies: Promotion, Prevention

and Control
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• Promotion: targeted to behavioural changes mainly

through IEC; housing improvement, basic sanitary provisions.
• Prevention of communicable diseases before it
happens: safe water, safe food, latrine provisions, personal
hygiene, proper solid waste management, vector control,
etc.
• Control of communicable diseases through various
environmental interventions.
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IMPORTANT VECTOR BORNE DISEASES AND VECTOR CONTROL
 Vectors are “arthropods and other invertebrates which

transmit infection by inoculation into or through the skin or
mucous membrane by biting or by deposit of infective
materials on the skin or on food or other objects” (the
classical definition).
 Vertebrates like dogs, rodents, cats are also considered as
vectors now a days. Vectors are involved in diseases
transmission, material and food damages, annoying man in
work and sleeping.
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Health importance:
 Disease transmission: Leishmaniasis, onchocerciasis,
trypanosomiasis, typhoid, etc. by different kind of flies
(sand fly, black fly, tsetse fly, house fly); Yellow fever,
filariasis, dengue fever, malaria by different kind of
mosquitoes; RF and typhus fever by lice; salmonellosis,
leptospirosis, rat bites, rat-bite fever by rodents; plague,
endemic typhus, by fleas; Chagas diseases, by bed bugs.
 Flies, mosquitoes, and lice are the most important
vectors in Ethiopia.
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Health importance:
 Food destruction/ damage: rodents and insects.
 Interference with human comfort: buzzing mosquitos,

biting of lice, bed bugs, rodents and other insects.
 Types of important vectors in Ethiopia: flies,
mosquitoes, lice, fleas, bed bugs, itch mite, cyclopes,
(arthropods), snails, and rodents.
 Disease transmission mechanism: mechanical and
biological;
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A) Arthropods
Insects (flies, mosquitoes, bed bug, cockroach);
arachnids (ticks, mites); and crustacean
(Cyclopes). Insects are the most important.
The transmission mechanism can be: mechanical
(flies, cockroaches) or biological carriers
(mosquito).
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A) Arthropods
Insects (flies, mosquitoes, bed bug, cockroach);
arachnids (ticks, mites); and crustacean
(Cyclopes). Insects are the most important.
The transmission mechanism can be: mechanical
(flies, cockroaches) or biological carriers
(mosquito).
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1. House Fly:
Body structure: has head with pair of antenna,
compound eye, and proboscis; thorax with 3 pair
of legs and wings; and abdomen, average length
about 6.5 mm;
Life cycle: 4 stages of development: eggs, larvae,
pupa, and adult. Its average life is 2-4 weeks.
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1. House Fly:
 Adult lays 200-500 eggs at a time on faeces, animal
dung or manure (horse, fowl, pigs, and cow), garbage,
sludge, and in other decaying matter. 5-6 times in life
time; Egg hatches into larvae within 1-3 days
depending on the ambient temperature; the larvae
(maggot) is voracious feeder which lasts 4-8 days.
 It develops into pupa further which develops into
adult in 5-7 days. The total life cycle ranges 8-20 days.
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1. House Fly:
An average adult fly can produce 1000-2500 flies
in life time.
An adult house fly is active in 30-320c; likes light,
organic matter, odor; lives about 2-4 weeks;
needs 8-20 days for its life cycle;
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1. House Fly:
Disease transmission mechanism: mechanical –
leg hairs, wings, body, vomitus, defecting on food;
Disease transmitted: filth borne diseases (faeco-
orale borne diseases; eye infections: typhoid
fever, amoebiasis, bacillary dysentery, helminthic
diseases, conjunctivitis;
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1. House Fly:
Fly control measures
1) Environmental sanitation:
 Control of breeding of flies (aimed at eggs, larvae) is a
primary control method through latrine provision;
elimination of in sanitary privies; and proper waste
management.
 Food protection: use covers and wire mesh;
 Proper solid waste management;

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1. House Fly:
Fly control measures
2) Mechanical and Physical methods:

destruction or killing or avoiding by physical means:
adhesives, leather or plastic flaps for flies direct
killing; use of nets and wire mesh, etc.
3) Chemical use: insecticides by spraying (DDT,

Malathion, chlordane), baiting;
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1.2 Mospuitos
Types: anopheles, culex, and aedes species;
Females are blood suckers, and can fly with a

blood meal two to three times their body weight.
Life cycle: Mosquitoes generally have 10-14 days
life cycle. Females lay about 200 eggs every four
days, hatching into aquatic larvae in 2-3 days.
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1.2 Mospuitos
Health importance: diseases transmission and
nuisance
 Anopheles: breads in clean fresh and stagnant water
(lakes, swamps, and pools); transmits malaria; needs
blood meal for the development of viable eggs.
 Culex: breads in dirty water (drains, cesspools),
transmit filariasis, encephalitis; interferes in human
comfort (disturbance during sleeping).
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1.2 Mospuitos
 The pupa last about 6 days that finally changes into an
adult in 2-3 days.
 The adult can fly 7 miles per hour (4 km/hr) if the wind
speed is less than 8 miles per hour (5 km/hr).
 Adult mosquitoes appear to be attracted by certain
odours and gases: carbon dioxide and lactic acid
generated as a result of respiration and perspiration,
respectively.
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1.2 Mospuitos
 Aedes aegypti: breeds in near houses in water
containers (cans, boottles, old tires), transmits yellow
fever and dengue fever that are arbo-viral origin.
 Can be identified by eggs, larvae, pupa, and adult body
structure and habits;
 Control of mosquitoes: control of mosquitoes is
complex because of the large number of species
involved, wide range of breeding places, different biting
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Mosquito control methods
1. Environmental management
2. Biological control: involves in the suppression of

pest population by natural enemies.
 Certain species of bacillus bacteria (Bacillus
thuringiensis israeliensis, BTI) and Gambusia affinis
fish are natural enemies of mosquitoes by feeding on
their larvae. They have been found to be effective
and non toxic when used widely in the USA.
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4. Protection against mosquito bites: use of
screens (wire and plastic mesh), bed nets (cotton or
nylon) impregnated with perymethrin, fast acting
insecticides spraying (pyrethrum); repellents
(indalone, diethyl toluamide), clothing (long
sleeves, head nets, gloves, knee-length boots);
5) Case treatment
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what is BTI
It contains spores that produce toxins that
 specifically target and only affect the larvae of

the mosquito, blackfly and fungus gnat.
EPA has registered five different strains of Bti
found in 48 pesticide products that are approved
for use in residential, commercial and agricultural
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 Bti can be sprayed over waterbodies such as ponds,
lakes, rivers and streams. Bti is used to kill developing
mosquito larvae by being applied to standing water
where those larvae are found.
 Bti can be used around homes in areas and containers
where water can collect, such as flower pots, tires,
and bird baths. Bti can also be used to treat larger
bodies of water like ponds, lakes and irrigation
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3. Lice
 Anoplura - Sucking Lice
 Bloodsucking parasites of mammals
 15 recognized families - 6 medically important
 Mallophaga - Chewing Lice
 Chewing parasites, feed on sloughed epidermal
 tissues, parts of feathers and sebaceous secretions of the

host
 Approx. 3000 species, most with little medical or
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3. Lice
All lice are wingless
 Body flattened in a dorsoventral axis
 Legs adapted for clinging to hairs and feathers
Simple metamorphosis (egg - nymph - adult)
PEDICULOSIS - infestation with lice, "Vagabond's

Disease" - hardened, deeply pigmented skin
associated with continual louse infestation
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3. Lice
All lice are wingless
 Body flattened in a dorsoventral axis
 Legs adapted for clinging to hairs and feathers
Simple metamorphosis (egg - nymph - adult)
PEDICULOSIS - infestation with lice, "Vagabond's

Disease" - hardened, deeply pigmented skin
associated with continual louse infestation
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Louse-Borne
Pathogens
Pathogens transferred
 Three significant pathogens are transmitted by the body
louse.
 These are the causative agents of epidemic typhus, trench
fever , and louse-borne relapsing fever, respectively.
 Under certain conditions , body lice can also transmit
Salmonella spp. , which cause food poisoning
(Salmonellosis, typhoid, etc,.),
 but these bacteria are more effectively transmitted by other
means.
 Other lice are enzootic vectors of human pathogens or (in
one case) serve as intermidate hosts of a tapeworm that
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Louse-Borne
Pathogens
 Epidemic typhus: is also known as jail fever , louse borne

fever and exanthematic typhus.
 It is caused by infection with the rickettisial bacterium
Rickettsia prowazekii .
 Body lice become infected after feeding on an infectious
(rickettesemic) person.
 Rickettsia ingested by the louse colonize the cells that line
the gut, where they replicate and later burst free into the
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Louse-Borne
Pathogens
 Some of these infectious rickettisia are then voided in the

louse feces, which are typically deposited on the host
while the louse is feeding.
 When the host later scratches the louse bite area,
rickettsia are abraded into the skin to initiate an infection.
 Infectious rickettisiae can remain viable in faeces for
about 30 days, suggesting that aerosol transmission may
also be possible.
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Louse-Borne
Pathogens
 Some of these infectious rickettisia are then voided in the

louse feces, which are typically deposited on the host
while the louse is feeding.
 When the host later scratches the louse bite area,
rickettsia are abraded into the skin to initiate an infection.
 Infectious rickettisiae can remain viable in faeces for
about 30 days, suggesting that aerosol transmission may
also be possible.
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Louse-Borne
Pathogens
 About 10-14 days after the initial exposure, early clinical signs of
epidemic typhus usually appear and include malaise, muscle aches,
headache, coughing, rapid onset of fever, and a blotchy rash on the
chest or abdomen.
 In severe cases, the rash can eventually cover most of the body. Large
stage symptoms in untreated cases include delirium, prostration, low
blood pressure and coma which may culminate in death.
 Case fatality rate of 10-20% are typical.
 But figures as high as 50% have been recorded in untreated

outbreaks.
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Louse-Borne
Pathogens
Prompt administration of an antibiotic such as doxycycline,

tetracycline, chloramphenical is usually curative.
Several different forms of epidemic typhus can be
recognized.
Classic epidemic typhus involves direct transmission of R.
prowazekii by body lice.
Another form of epidemic typhus, called recrudescent
typhus
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Louse-Borne
Pathogens
 Instead, it is a recurrence of the disease in

individuals who were infected months or years
previously.
 After the patient has recovered from the initial
epidemic typhus infectious rickettisiae can remain
dormant in human tissues and later cause a second
bout of disease in the presence or absence of body
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Louse-Borne
Pathogens
 Trench fever: This disease also known as 5-day fever

or wolhnia is caused by infection with the bacterium
Bartonella quintana .
 Human infection ranges from asymptomatic through
mild to severe, but death is the rare outcome.
 Body lice become infected with B. quintana when
feeding on the blood of an infectious person.
 Who may or may not show
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Louse-Borne
Pathogens
 The bacteria invade the louse mid gut, where

they replicate In the lumen and epithelial cells
eventually voided in louse feces. As in epidemic
typhus, B. quintana is transmitted by the
posterior station route from infectious louse
feces scratched into the skin.
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Louse-Borne
Pathogens
 Louse-borne relapsing fever: this disease is also known as

epidemic relapsing fever and it is caused by infection with
the spirochete bacterium Borelia recurrentis.
 Clinical symptoms include head and muscle aches,
nausea, anorexia, dizziness, coughing, vomiting,
thrombocytopenia (a decrease in blood platelets) and
abrupt onset of fever.
 However, the most characteristic symptom is the presence
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Louse-Borne
Pathogens
 These relapses usually occur two to five times

before the disease dissipates and reflect changes in
the bacterial antigens in response to host antibody
responses.
 However, in severe infections the liver and spleen
become swollen , breathing becomes painful and
the patient typically lies prostrate, shaking and
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Louse-Borne
Pathogens
Antibiotics commonly used to combat this disease

are penicillin and tetracycline. Body lice are the
vectors of B. recurrentis and they become infected
after feeding on an infectious person.
However, after ingestion by the louse, some
spirochetes pass through the gut wall and colonize
the hemocoel, where they multiply into huge
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Louse-Borne
Pathogens
Spirochetes are effectively trapped inside the louse and are

not secreted or excreted, the only way they can be
transmitted to a person is by crushing lice o the skin and
causing a small abrasion through which the spirochetes can
then enter the body.
Most case of louse-borne relapsing fever are recorded in
Ethiopia (1000-5000 cases annually). Reemergence of this
disease is possible under conditions such as war and famine.
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Louse-Borne
Pathogens
Double –pored tapeworm: Adults of the double

–pored tapeworm (Dipylidium caninum) typically
parasitize carnivores, but humans can also become
parasitized under certain conditions.
Eggs of this tapeworm are voided in the feces of
the definitive host , which is often a domestic dog
or cat
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Louse-Borne
Pathogens
As the host feces dry or dissipate, chewing lice or

flea larvae , both of which serve as an intermediate
hosts, can ingest them during feeding.
After ingestion by the dog biting louse, each
tapeworm egg hatches and develops into cysticercoid
stage inside the hemocoel, where it remains
quiescent , unless the louse is eaten by a definitive
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Louse-Borne
Pathogens
 Infection in humans occur when children with

wet or sticky fingers are playing with and then
place their fingers inside their mouth.
Various antihelminthics can be administered to
kill these tapeworms in humans or in pets.
what is definitive host
what is Intermediate Host

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Fleas, the siphonaptera
Morphologically, adult fleas are unique many
related to their ectoparasitic lifestyle and blood
feeding habits, including the lack of wings, laterally
compressed body and modifications of the hind
legs and metathorax for jumping.

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Fleas, the siphonaptera
Fleas undergo complete metamorphosis. Eggs are
round to oval and often white.
Adult females typically lay eggs singly rather than as
a large batch usually in protected environment of the
hosts’ nest or burrow, but occasionally on the host

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Fleas as vectors of pathogens
Fleas transmit microbial pathogens, serve as hosts for
parasitic worms and cause allergic dermatitis or other
conditions as a result of other feeding activities.
Plague: is an often fatal flea –borne zoonosis that is
best known as the cause of the Black death of the
Middle
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Fleas as vectors of pathogens
The causative agent of plague is Yersinia pestis ,
a gram-negative bacterium that is maintained in
nature through transmission between certain
rodent species and their fleas.
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PROVISION OF SAFE AND ADEQUATE WATER
SUPPLY
Importance and use of water:
Physiological needs: 70% of our body by weight;
about 2.0-2.5 litres per day needs; survival with
out water very hard; most food contains water:
milk about 90%, fish about 80%;

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SUPPLY
Importance and use of water:
Domestic/ social use: cleaning, washing, swimming,
livestock watering
Recreational purposes: swimming, boating, fishing,
skiing, (lakes Langano, Ziqay, etc.)

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SUPPLY
Globally: 23% urban and 64% of rural population in
developing countries lack safe water;
More than 80% of diseases in developing countries is
dur to lack of safe water supply and sanitation; dysentery,
typhoid fever, diarrhoeal diseases, helminthiasis, skin and
eye infections are the leading

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SUPPLY
What is water?
Chemistry: H2O (distilled water?? Rain Water??. It is
impossible for water to exist in such form in nature.
Water contains some kind of impurities.
Physical characteristics: odorless, colorless, tasteless,

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SUPPLY
Occurrence and sources of fresh water
The earth’s surface is covered by 72% of water, of
which 97.2% ocean, 2% in water in frozen state, 0.8%
only exists as available fresh water.
Sources of drinking water: Surface (river, lakes, ponds,
dams);
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Ground water (springs
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110
PROVISION OF SAFE AND ADEQUATE WATER
SUPPLY
 Dissolve oxygen (DO): clear fresh water at 25C0
contains 9-10ppm (mg/L)of oxygen; threshold
for aquatic life is 4.0ppm;
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SUPPLY
 Water impurities: three types: particles in
suspended and colloidal forms (inorganic,
organic, and biological), dissolved gases, and
dissolved chemicals
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PROVISION OF SAFE AND ADEQUATE WATER
SUPPLY (Water impurities)
Forms of impurities Adverse
effect/importance
Suspended & colloidal: Infection
Microbes; solids Bacteria, Turbidity, taste, colour,
algae, eggs, cysts, protozoa, odour
soil, silt, soot
Dissolved: gases, salts, plant Acidity, photosynthesis
dyes Hardness
Alkalinity
CO2, H2S, O2, Toxicity
Salts of Ca, Mg, Methaemoglobnamia
Dental caries or mottling
Salts of Na. K,
Salts of heavy metals: Pb, As,
Cr, etc. Nitrates,
Fluorides
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SUPPLY
Hardness of water
 Causes: Temporary hardness: Ca (HCO3)2, Mg (HCO3)2;
 permanent: Cl, SO4-2, CO3- of Ca, Mg, Fe,Mn.
Adverse effects: loss of soap &detergents; effects to kidney; scale

formation on boiling; disturbance of GI tract (mgSO4,), decreases life
fabrics;
 Methods of softening:
 Temporary hardness: boiling and use of hydrated lime, Ca (OH)2 in

large scale.
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SUPPLY
IV) Safe water
 It is water that does not contain harmful chemical
substances, or microorganisms in concentration that could
cause illness in any form or impurities that interfere with
color, taste, transparency, and odour (WHO).
 Drinking water must be physically, microbiologically, and

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SUPPLY
 Health importance
 Toxicity: Toxicity criteria (excess chemicals above
the standard causes a health risk of acute and
sub acute toxicity): example Pb<0.05mg/l,
Hg<0.001mg/l, etc. of WHO standard.

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SUPPLY
Water related diseases:
1. Water borne: the pathogene is in the water

(cholera, typhoid, giardiasis, etc). Quality matters
2. Water washed: the water is inadequate

(conjunctivitis, scabies, trachoma). Quantity
matters. All water borne diseases are water
washed.
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SUPPLY
3. Water based (contact): the pathogen spends part of its life cycle
in water snail or other aquatic animals (schistosomiasis, guinea
worm).
4. Water-insect related: the pathogen carrying insect is breeding

near the water and bite near it (yellow fever a viral, by Mospuitoe
Aedes Egypti, malaria by Anopheles mosquitoe, dengue fever viral by
Aedes mosquitoes, filariasis helminthic by mospuitoes Aedes, Culex,
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SUPPLY
5. 20-30 diseases different etiologies are transmitted through

water;
6. Adequate water can decrease diarrhea by 25%; Water

quality alone by 16%, both by 37% (some studies);
7. Improved latrine provision decreases diarrhea by 20% (some

studies)
8. Water supply, latrine provisions, and hygiene education

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SUPPLY
Ground water:
 Definition: “Ground water is that portion of the
rainfall water which has percolated into the earth
until it reaches an impermeable stratum”
 Advantages: likely to free from contamination and
pollution; does not need treatment plants if properly
protected (a protected well, spring); can be accessed
for individuals where it ehisby abundant
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SUPPLY
Surface water supply

 Occurrence: fresh water – river, lakes, ponds;
 Characteristics: Physical: less naturally dissolved minerals;

has dissolved oxygen: 8-12 ppm;
 Pollution: likely to be polluted by industrial & municipal
effluents affecting the water physical, biological and
chemical characteristics;
 Self purification: sedimentation, dilution, oxidation,
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SUPPLY
Surface water supply

 Occurrence: fresh water – river, lakes, ponds;
 Characteristics: Physical: less naturally dissolved minerals;

has dissolved oxygen: 8-12 ppm;
 Pollution: likely to be polluted by industrial & municipal
effluents affecting the water physical, biological and
chemical characteristics;
 Self purification: sedimentation, dilution, oxidation,
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quiz
• define or describe the ff words or terms (10%)
1. public Health
2. Environment
3. Health
4. Disease
5. illness
6. sickness
7. infection
06/07/2024 eh by A.G 123
Solid and Liquid Waste Management
Definitions of technical terms used in solid
and liquid waste management
Ashes: residue from fires used for cooking and heating

Biodegradable: capable of being breakdown by
biological process.
Biodegradation: metabolic process by which high
energy organics are converted to low energy, CO2, and
H2O
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Biological Oxygen Demand (BOD): amount of
oxygen, used by microorganisms in the
biodegradation process.
Bulky Refuse: materials that are non-
combustible including metals cans furniture dirt
glass. etc.
Decomposition: reduction of net energy level
and change in chemical composition of organic
matter because of actions of aerobic or
anaerobic microorganisms.
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Dumping: The final disposal of all refuses by
uncontrolled, indiscriminate deposition on sand
areas, in pits or quarries, rivers, etc.
Effluent: out flowing liquid and broken by the
action of anaerobic bacteria.
• Garbage: Organic and general biodegradable
wastes from the preparation and processing of
foods in homes, restaurants, food processing and
packaging plants
abattoirs and other similar establishments.
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Garden trash: Grass clippings, flowers,
shrubbery and tree trimmings, leaves, and
other tree droppings.
Influent: inflowing liquid
Municipal wastes: normal sized wastes from
street cleaning and litter collections from
playgrounds, schools, hospitals, parks, dead
animals and public slaughtering house.
06/07/2024 eh by A.G 127

 Recyclable (salvageable): Materials or items which can
economically sorted out and removed from refuse for sale,

refuse by private enterprise.
 Residues: Solid material which is left (discharged) at the end
of burning (incineration)
 Rubbish: combustible wastes including paper, card board
boxes, barrels, wood, tree branches yard trimmings, furniture

originating from homes institutions hotels, markets, Stores, etc.
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Sewage disposal: the act of disposing sewage
by any means.
Sewage treatment: covers any process in which
sewage is subjected in order to remove or alter
its objectionable constituent to make it less
dangerous or offensive.
Sewer: a pipe containing sewage or wastewater
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Sewerage: a system of sewer pipes for collecting
sewage or wastewater into the treatment and
disposal.
Solid wastes: is all the wastes arising from human
and animal activities that are normally solid and
that are discarded as useless or unwanted.
Street Refuse: street-sweeping dirt.
Sullage: domestic dirty water not combined with
excreta
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1.2 Public Health importance of solid waste
It can be best media for the growth of

microorganisms
 Attraction of arthropods such as common
housefly, mosquito, etc
Attraction of rodents and other animals e.g. rats
mice dogs cats
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Open dump can contaminate water sources

Can contaminate food supply and cause food
borne disease
 Hospital and pathological wastes are
potential disease carrying waste products
Radioactive wastes are highly dangerous
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It can create fire accident

 Slum areas
 It can create nuisance:
Bad odor, smoke, dust Aesthetical problem
Discomfort: sneezing, coughing
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1.3 Classifications of solid waste
Solid waste can be classified into two categories
by its characteristics. These are:
 Organic solid waste
 Inorganic Solid waste
Organic solid waste: Wastes that are generally
• biodegradable and decompose in the process of
which emits offensive and irritating smell when
left unattended.
• ⇒ Putrescible wastes e.g. Garbage
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1.3 Classifications of solid waste
Inorganic solid waste: Solid matter that
does not decompose at any rate This
category of waste matter may be combustible
depending on the type of the nature of the
material they constitute.
⇒ Non-putrescible wastes e.g. Rubbish
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1.4 Functional Elements of solid
waste management system
 There are six functional elements in the activities
associated with the management of solid wastes
from the point of generation to final disposal site.
These are:
1. Waste generation
2. On-site handling (sorting, storage and processing)
3. Collection
4. Transfer and transport
5. Processing and recovery
6.06/07/2024
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Description of the six main functional
elements of solid waste management
system:
Waste generation: those activities in
which materials are identified as no longer
being of value and are either thrown away or
gathered together for disposal.
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On-site handling, storage, and
processing: activities associated with the
handling, storage, and processing of solid
wastes at or near the point of generation.
Collection: those activities association with the
gathering of solid wastes and the hauling of
wastes to the location where the collection
vehicle is emptied.
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Transfer and transport: Those
activities association with
(1) the transfer of wastes from the smaller
collection vehicle to the larger
transport equipment and
(2) the subsequent transport of the
wastes, usually over long distance, to
the disposal site.
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Processing and recovery:
Those techniques equipment and
facilities used both to improve the
efficiency of the other functional
elements and to recover useable
materials, conversion products, or
energy from solid wastes.
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Disposal: Those activities
associated with ultimate disposal
of solid wastes
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Figure 1: Interrelationship of functional elements
comprising a solid waste management system
06/07/2024 eh by A.G 142

1.5 Main sources of solid waste generation
Residential (domestic or house hold)

 Commercial
 Institutional
Construction Demolition
Treatment plant sites
Industrial
Agricultural
06/07/2024 eh by A.G 143

Waste types not to be incinerated:
 Pressurized gas containers

 Large amount of reactive chemical waste
 Silver salt and photographic or radiographic wastes
 Halogenated plastics such as polyvinyl chloride(PVC)
 Waste with high mercury or cadmium content, such as
broken thermometers, used batteries, and leadlined
 wooden panels
 Sealed ampoules or ampoules containing heavy metals
06/07/2024 eh by A.G 144

Examples of Plastics
Plastics are often referred to by the

acronyms for their chemical formulas:
Polyethylene terephthalate: PET or PETE
High-density polyethylene: HDPE
Polyvinyl chloride: PVC
Polypropylene: PP
Polystyrene: PS
Low-density polyethylene: LDPE
06/07/2024 eh by A.G 145
Liquid Waste Management
Plastics are often referred to by the

acronyms for their chemical formulas:
Polyethylene terephthalate: PET or PETE
High-density polyethylene: HDPE
Polyvinyl chloride: PVC
Polypropylene: PP
Polystyrene: PS
Low-density polyethylene: LDPE
06/07/2024 eh by A.G 146

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Hossana College of Health Sciences

Department of Medical laboratory

in the appropriate way, for example to fear, to be happy, and to

the enjoyment of the highest attainable

2. Socio – cultural determinants – The socio-

3. Community organization - Community

 Public health is defined as the science and art

 it is also one of the efforts organized by

Key Terms in the definition

Key Terms in the definition

Key Terms in the definition

Protecting the environment, work place ,food

Monitoring the health status of the population;

Mobilizing community action;

Assuring the quality ,accessibility, and

Assuring the quality ,accessibility, and

Environment is the sum of all external

Environmental Health is “the control of all

Universal human rights: “ All people have the

Historical background of environmental health

II. Human-ecology interaction outcomes: Three

1. Man can affect the environment: deforestation,

2. Man can be affected by the environment:

2. Human activities: residential, working places,

3. Residues and wastes: in the form of solid

Other Global problems:

Loss of biodiversity has raised the need of basified in

Other Global problems:

V. Role of Environmental Health in community

i. Three basic strategies: Promotion, Prevention

• Promotion: targeted to behavioural changes mainly

 Vectors are “arthropods and other invertebrates which

 Interference with human comfort: buzzing mosquitos,

 Proper solid waste management;

2) Mechanical and Physical methods:

3) Chemical use: insecticides by spraying (DDT,

Females are blood suckers, and can fly with a

2. Biological control: involves in the suppression of

It contains spores that produce toxins that

 specifically target and only affect the larvae of

 Bloodsucking parasites of mammals

 15 recognized families - 6 medically important

 Mallophaga - Chewing Lice

 Chewing parasites, feed on sloughed epidermal

 tissues, parts of feathers and sebaceous secretions of the

 Body flattened in a dorsoventral axis

 Legs adapted for clinging to hairs and feathers

Simple metamorphosis (egg - nymph - adult)

PEDICULOSIS - infestation with lice, "Vagabond's

 Body flattened in a dorsoventral axis

 Legs adapted for clinging to hairs and feathers

Simple metamorphosis (egg - nymph - adult)

PEDICULOSIS - infestation with lice, "Vagabond's

 Epidemic typhus: is also known as jail fever , louse borne

 Some of these infectious rickettisia are then voided in the

 Some of these infectious rickettisia are then voided in the

 But figures as high as 50% have been recorded in untreated

Prompt administration of an antibiotic such as doxycycline,

 Instead, it is a recurrence of the disease in

 Trench fever: This disease also known as 5-day fever

 The bacteria invade the louse mid gut, where

 Louse-borne relapsing fever: this disease is also known as

 These relapses usually occur two to five times

Antibiotics commonly used to combat this disease