Tigray Regional Health Bureau

Hygiene and Environmental Health Case Team

Key Intervention Areas for WASH related

outbreaks including AWD

April, 2021
Mekelle, Tigray
 Contents of presentation

• Risk factors for WaSH related out breaks & AWD

transmission
• Risk Assessment methods
• Access to safe and adequate water supply
• Calculating Water treatment chemicals
• Waste mgt and practices
• Hygienic practices
• Food hygiene & Communal feasts and public gatherings
 Key WASH Intervention Areas

1. At risk population assessment and Risk Area Mapping;

2. Access to safe and adequate water supply

3. Access to and use of appropriate sanitation

4. Proper hygienic practices

5. Waste management/Solid and Liquid

6. Monitoring and Evaluation

 Assessment of Risk population
Risk Area Mapping

Poor access to and use of water and/or limitations

Risk factors to monitoring and maintaining water quality
for WaSH
related out Open Defecation practice/poor access to and
use of appropriate sanitation
breaks &
AWD
Poor hygiene practice (hand washing, unsafe food
transmission preparation)
 Risk Assessment....

• Crowded Settings: dense urban slums, refugee or

displaced sites (IDP), institutions (schools prisons)
gatherings (weddings, funerals);
• Seasonal Upsurges: increase spread during dry
season with water shortage or during rainy season
with flooding and contamination of water sources;
• Displacement or population movement;
 Risk Assessment….

Risk Assessment methods include:

─ Review of existing data on coverage, use & knowledge
of safe water, sanitation & hygiene services and health
services
─ Observation of risk areas
─ Conducting Sanitary surveys on water sources
─ Measurement of Free Residual Chlorine, FRC
─ Key stakeholder interviews and FGDs
 1. Access to safe and adequate water supply
• Ensure community water schemes are operating well
and protected from contamination;
• Map functional and non functional water schemes by
Tabia or kushet and deal with water office to rehabilitate
malfunctioned ones;
• Monitor the quality of water sources through sanitary
survey and when needed complement with
bacteriological test;
 1. Access to safe….

• If the water source is found at risk/contaminated:

 Locate and avoid the source of contamination

 Disinfect the water source using chlorination

 Retest for bacteriological quality and close follow up

• Other public, religious and social institutions need to be also

considered and targeted during water provision and quality
monitoring;
• Communities that don’t have access to safe water supply
need to have alternative provision to ensure they have access
to basic survival water needs (7.5-15 lit/c/day);
 1. Access to safe….

• Water trucking, deployment and installation of EM WAT Kits and

water Purifying chemical provision are among the options we have
to fulfill the basic survival water needs, as appropriate;

• During emergency make sure water from all sources is chlorinated ;

 At family level through provision of water purifying chemicals

 Unprotected water collection points through assigned chlorinator
 Mass chlorination at water storage facilities/water tanker/water truck
 1. Access to safe….

• During Outbreak, WHO recommends presence of the

following free residual chlorine across the water supply chain;

Water Source Minimum level of FRC

• Reservoir ≥ 1.0 mg/L
• Roto/Tanker Truck 0.8-1.0 mg/L
• Bono or Well 0.8-1.0 mg/L
• Piped Water at Household 0.5 mg/L
• Household Storage Container 0.5 mg/L
 1. Access to safe….

• Organize spot checks to ensure proper and consistent

chlorination is taking place;

• In the case of specific diarrheal epidemics, ensure that

there is Free Residual Chlorine of above 1mg/l;

• There are no fecal coliforms per 100ml of water at the

point of delivery and use
 1. Access to safe….

Calculating Water treatment chemicals

Assumptions

• Total number of people who don’t have access to safe water supply =
20,000 people
• Family size = 4.6 people/Household
• Daily basic survival water demand = 7.5 lt/person/day
• Nature of water cleanliness/turbidity
Based on these assumptions calculating water treatment chemicals for a Tabia
Water Purifying Chemical Estimation.xlsx
 Water Chemical need Planning Template
Required Unit Total
Treatment chemical Unit
Qty
Available Gap
Price Price
wuha Agar of 150 ml Litre

Aqua tab of 10 tablets/ strip Strip

PUR (Purifier of Water), 1 sachet = 4g Sachet

Bishangari , 1 sachet = 2.5gm Sachet

Remark:
Dose required
1 cap of water guard bottle (3 ml) treats 20 lt of water
1 tablet of Aqua tab treats 20 lt of water
1 Sachet of PUR treats 10 Lt. of water
1 Sachet of Bishangari treats 20 Lt. of water
Packaging
1 carton of water guard = 120 bottle
1 carton aqua tab of 10 strip = 3,200 strips
1 carton of 4 gm of PUR = 240 sachets
1 carton of 2.5 gm of Bishangari = 1000 sachets
 How to make water safe to drink
If water is dirty

1 2 3 4 5

If water is dirty, first filter Then add 4 tablets every Wait 30 minutes Water is now safe
20 liters
Mix well
with a cloth before drinking to drink

If water is clean

1 2 3 4 DO NOT
SWALLOW
THE
TABLET!
If water is clear, add 1 Wait 30 minutes before Water is now safe to
Mix well
tablets every 20 litres drinking drink
 Household water treatment
Aquatabs tablets Wuha Agar

PUR

Bishangari water
2. Access to and use of Safe excreta Disposal

• Safe disposal of human excreta creates

– the first barrier to reduce diseases transmission through
direct & indirect routes;

• Safe excreta disposal is therefore,

– a major priority during disasters, like Cholera Outbreak
to block transmission;
 2. Access to and use….

Key Actions:ቀንዲ ተግባራት

• Implement appropriate excreta suppression measures immediately at
all level (HH, institutions, public places, business areas, holy water
sites …);
• Latrines need to be constructed and managed in a way that blocks
feco-oral transmission;
• Discourage people not to defecate in the open (if they don’t have
access to latrine – they always bury their feces);
• Children’s feces are disposed of safely in a latrine or buried;
 3. Waste management

• Waste management includes proper storage, collection, transportation and

disposal of solid and liquid wastes;

• Improperly managed wastes can pose public health risks and enhance the
spread of outbreaks by breeding flies and polluting the surface and
ground water;

• Waste pickers who gain small income from collecting recyclable materials
and children are the most at risk.
• People who use vegetables grown by sewage are also at risk
 3. Waste management Cont’d

Key Actions:

• Advocate for proper solid and liquid waste management;

• Create access for regular solid waste collection service;

• Bury infectious and hazardous waste as per the national CASH

implementation manual;

• Municipal authorities are supported to establish and sustain an effective

waste management systems in urban/peri-urban areas with particular
attention to markets and other public places;
 3. Waste management Cont’d

Key Actions:
• Organize Hygiene promotion sessions on Proper Waste management to
the entire community including public institutions and places such as
schools, churches, prisons, refuge camps, slum areas.
• Connection of sewerage with storm water drainage should be
prohibited/discouraged;
• Avoid use of sewage for irrigation purpose to cultivate vegetables and
fruits;
• Solid/liquid waste should be disposed in a way that couldn’t pollute the
surrounding environment including water bodies and should be properly
fenced and guarded;
4. Hygiene Practice
• Ensure proper household water treatment and storage;
 Place water containers elevated from the ground level, not easily accessible by
children and domestic pets;
 Water is stored safely in a covered container with a tap, narrow neck or with a cover
and a dedicated cup for extracting the water
 Water is properly treated by boiling, disinfecting, sedimentation and/or filtering if it
is collected from unreliable sources;
• Ensure proper hand washing practice with water and soap/ash at critical
times;
• Ensure latrine facilities are clean and safe to use;
• Ensure hygienic food preparation and storage at all level, family and
caterings;
5. Food hygiene & Communal feasts and public gatherings

• Encourage installation of proper hand washing facilities at caterings

posted with key hygiene messages

• Train food handlers on food safety, water quality, personal hygiene,

vector control, waste management, and the need for regular medical
check up;

• Monitor the preparation, handling and storage practice of caterings

including street food vendors;
 5. Food hygiene….

• Encourage local authorities to enforce public health regulations;

• Due attention for hand washing with soap, water and food safety
during marriage, religious festivals, funerals, and other public
gatherings

• Approach local and religious leaders to find ways of reducing the

risks of the ceremony without damaging its cultural and religious
significance;
6. Monitoring and Evaluation

• Strict follow up in a regular basis and emergency when

necessary
• Action plan development and feedback
• Documentation
Source

• Hygiene promotion in emergency, IRC

• Excreta disposal in emergency
• Water supply in emergency
• Lecture note water supply
• The sphere hand book
Thank you