LECTURE NOTES 1

FUNDAMENTAL PRINCIPLES OF SANITATION IN PUBLIC HEALTH, WITH IN-

DEPTH EXPLORATION OF THE NATURE AND ROLE OF ENVIRONMENTAL
FACTORS IN CAUSATION OF HEALTH AND DISEASE (HIV AIDS, TB, MALARIA,
CHOLERA ETC)

INTRODUCTION

The course will be undertaken by open discussion organized and led by the lecturer initially.
The relevant notes and references etc will be prepared and sent to the students through the
Moodle program in advance to enable effective reading and preparation by the students then
open discussion will take place during the lecture time as indicated on the time table.
This will be a student centered learning approach.

1. What work do you do now and how is it related to Environmental Health and Sanitation?
2. What are your expectations?
3. Relate your current employment to the course work provided and comment

A. FUNDAMENTAL PRINCIPLES OF SANITATION IN PUBLIC HEALTH

Sanitation: Commonly Used Terms Total Sanitation: Refers to total sanitary condition for
healthy living. Therefore includes: • Hygiene latrine facilities; • Proper management of solid
waste; and • Proper disposal of household wastewater 100% Sanitation: At the very last, the term
100% sanitation includes all of the following: • No open defecation; • Hygiene latrine available
to all; • Use of hygienic latrines by all; • Proper maintenance of latrine for continual use; and •
Improved hygienic practice

Definition of Sanitation System: A sanitation system involves all arrangements necessary to

store, collect, process and deliver human waste or other forms of waste back to nature in a safe
manner. Sanitation system with respect to human waste management may be considered to have
the following functions: Excretion and storage; Collection and Transportation; Process/
Treatment; Disposal/ Recycle

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List the fundamental Principles and explain how they relate to public health

ENVIRONMENTAL HYGIENE AND SANITATION

  
This refers to the total environment in which food is prepared and consumed.
The preparation and service of food requires handling of materials which are extremely
vulnerable to becoming the media of contamination thereby leading to the spread of infection
and disease. To assess the hygiene and sanitation requirement of an establishment, the following
aspects need to be considered.
 
Environmental Hygiene and Sanitation
 
This refers to the total environment in which food is prepared and consumed.
 
1. Site
 
The place should be scrutinised for the amount of air pollution or whether it is free from the
potential of infestation by insects, rats, flies, etc.. The water lines and sewage disposal lines
should not run too close to each other because in the event of a leak, the water supply can get
contaminated.

2. Structure
 
The cleanability of floors, walls, ceilings or any other surfaces is the basis for maintaining a
structure free from the hazards of infection. The materials selected therefore should be non
absorbent, non - corrosive and easy to keep clean. The kitchen should be subjected to regular
pest control treatment.
 
Fac ilities for proper sewage disposal and the construction of adequate plumbing for kitchen
is of consequence in sanitation. All sewage lines must be directed into the public sewage system.
Faulty plumbing can prove a hazard if it leads to frequent blockages of drains that results in
backflows.

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3. Equipment, Furniture and Fittings
 
These should be designed so that they do not harbour dust or dirt, which is the source of
microorganisms. Any equipment, which are chipped or damaged, should be discarded. In
addition, knowledge of the use of proper detergents is essential to avoid leaving chemical
residues on surfaces that may contaminate food.
 
4. Ventilation
 
Ventilation plays a very important role in clearing the hot air and bringing down
temperature as well as the carbon-di-oxide content. All kitchens must be provided with exhaust
fans and extraction hoods to provide proper ventilation.
 
5. Lighting
 
All areas should be well lighted to make dirt, grease and infestation easily detectable.
6. Water Supply
 
The water supply should be treated to ensure that it is fit for drinking, cooking of food and
washing of utensils.
 
All natural water supplies contain mineral salts and organic materials in addition to
dissolved gases from the air. Microbial activity also influences the colour, odour and taste of the
water. Water for food preparation purposes may be considered hygienic when it is sufficiently
pure to have only very small quantities of substances dissolved in it which do not prove injurious
to health.
 
Impurities in water may be present as fine suspensions or dissolved form of salts of metals
like lead, iron, zinc or others like carbonates, chlorides and sulphates of calcium and magnesium
which tend to cause hardness of water. The other impurities may include particles of sand,
pathogenic micro organisms, eggs of parasitic worms and excessive amount of chemicals used as
preservatives which generally leads to diarrhoea, cholera, typhoid, dysentry, weakness and loss
of appetite.
 
7. Waste Disposal
 
Kitchen waste which consists of peelings, spillage, empty cans, etc. must never be allowed
to remain anywhere near the kitchen because they can attract insects, which can become agents
of contamination to wholesome food. Improper disposal can pollute water and through it,
contaminate equipment and food.

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 B. THE NATURE AND ROLE OF ENVIRONMENTAL FACTORS IN CAUSATION
OF HEALTH AND DISEASE (HIV AIDS, TB, MALARIA, CHOLERA ETC)

Topics to be Covered:
a. Classification of Wastes
b. Definition of Sanitation
c. Relationship between Sanitation and Health/ Disease
d. Classification of Sanitation System

1. Classification of Wastes:

a. Human Waste or Human Excreta: refers to only human feces and urine. Also known
as “night soil” when collected without dilution in large volumes of water. Municipal
Sewage/ Wastewater: Liquid waste conveyed by sewer and may include domestic and
industrial discharge as well as storm water, groundwater infiltration and inflow.
Domestic/ Sanitary Sewage: Liquid waste which originates in sanitary conveniences,
e.g. water closets, urinals, baths, sinks, etc. of dwellings, commercial facilities and
institutions in a community. Sometimes it is also referred to as “Sanitary Sewage”.
Black Water: Wastewater containing human waste (fecal matter, urine), i.e., toilet
wastewater. It contains pathogens and must be treated before releasing into
environment.

b. Sullage/ Greywater: Water coming from domestic equipment other than toilets (e.g.,
bathtubs, showers, sinks, washing machines). It is often separated from “Black water”
to reduce the amount of water that gets heavily polluted. Separation of blackwater and
greywater nowadays happens with all ecological/ smart buildings. Greywater could
be reused for different purposes (other than potable use) after primary treatment.
Industrial Waste: Liquid discharges from spent water in different industrial processes
such as manufacturing and food processing. Storm Water: Surface runoff
immediately and after rainfall, which enters sewers through inlets. Storm water is
usually not very polluted, and could be carried through open drains/ channels and
disposed of in rivers/ streams/ small channels. Solid Waste: Includes all materials
which are normally solid and discarded as useless or unwanted.

2. Sanitation (Definition)
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 a. “Sanitation” may be defined as the science and practice of affecting healthful
and hygienic conditions, and involves the study and use of hygienic measures,
such as:  Safe and reliable water supply  Proper disposal of all “human
waste”  Proper drainage of wastewater  Prompt removal of all refuse (solid
waste) WHO includes food sanitation, rainwater drainage, solid waste
disposal and atmospheric pollution under sanitation. However, the term
“sanitation” commonly refers to disposal of “human waste/ wastewater”.
b. Commonly Used Terms Total Sanitation: Refers to total sanitary condition for
healthy living. Therefore includes: • Hygiene latrine facilities; • Proper
management of solid waste; and • Proper disposal of household wastewater
100% Sanitation: At the very last, the term 100% sanitation includes all of the
following: • No open defecation; • Hygiene latrine available to all; • Use of
hygienic latrines by all; • Proper maintenance of latrine for continual use; and
• Improved hygienic practice.
c. Definition of Sanitation System: A sanitation system involves all
arrangements necessary to store, collect, process and deliver human waste or
other forms of waste back to nature in a safe manner. Sanitation system with
respect to human waste management may be considered to have the following
functions:  Excretion and storage  Collection and Transportation 
Process/ Treatment  Disposal/ Recycle

3. Sanitation & Disease

a. Proper sanitation can control many “human waste/ excreta” related diseases. •
Important to have clear understanding of such diseases and their transmission
routes. • Excreta-related diseases are caused by disease producing micro-
organisms, called pathogens that are excreted by people already infected with
disease. • Common diseases cause by pathogens include:  Bacteria: Cholera,
Bacillary dysentery, typhoid, and para-typhoid.  Viruses: Hepatitis,
Poliomyelitis, Diarrhea  Protozoa: Amebic dysentery, Giardiasis  Helminths:
Schistosomiasis (bilharzia or snail fever).

b. Classification of Excreta-Related Diseases: (1) Excreted Infections (Direct

Transmission of Pathogens): Cholera, Typhoid (also insect vector) Infected
Excreta New Infections Direct Transmission Infected Excreta New Infections (2)
Vector Transmitted Diseases: Schistosomiasis Vector Insects (Flies, Mosquitoes);
Cockroach; Rat; Animals (Cow, Pig);

c. Transmission of Excreted Pathogens depends on: (1) Excreted Load (Number of

pathogens excreted in the environment is termed as “excreted load”); (2) Changes
in number of pathogens in the Environment. Changes in number of pathogens
during environmental transmission are governed by three key properties: 
Latency (i.e., how long it takes for the pathogens to become ineffective) 

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 Persistence (i.e., how long pathogens survive in the environment) 
Multiplication (i.e., ability of pathogens to multiply)

d. Category Transmission Features: Examples of infection Transmission Focus 1.

Non-Bacterial Fecal- Oral Diseases Non-latent High infectivity Low to medium
persistence Unable to multiply No intermediate host Hepatitis A & E Diarrhea
Giardiasis Personal Domestic 2. Bacterial Fecal-Oral Diseases Non-latent
Medium to low infectivity Medium to high persistence Able to multiply No
intermediate host Cholera Typhoid Personal Domestic Water Crops 3.
Geohelminthiases Latent Very persistence Unable to multiply Very high
infectivity No intermediate host Hookworm Ascariasis Domestic Field Crops 4.
Excreta-related insect vector diseases Infections 1-3 transmitted mechanically by
flies and cockroaches Water.

e. “Fecal-Oral” Transmission Route of Diseases Water Hands Insects/ Flies Soil

Milk Food Vegetables New Host Excreta

f. Interrelationship among Water, Sanitation, Hygiene Education and Health  The

importance of health education in improving health has been clearly demonstrated
in water supply and sanitation situation of Bangladesh.  Despite tremendous
success in improving access to safe water (over 90% coverage of rural population)
during the International Drinking Water Supply and Sanitation, IDWSS decade
(1981-1990), water and excreta related diseases remained the major cause of
mortality and morbidity in Bangladesh (Rashid and Rahman, 1994).  The infant
mortality rate came down by only 12 from 122 to 110 for every thousand live
births in 1990. The reasons identified were low sanitation coverage and overall
absence of health education and hygienic promotion. Figure: Interrelationship
among Water, Sanitation, Hygiene Education and Health (Source: Veenstra S.,
1994).

g. Important issues for controlling excreta-related diseases: • Sanitation is clearly the

most important intervention required for the control of excreta related diseases. •
Also important is improved personal, domestic and peri-domestic hygiene,
through improved water supplies and improved housing. • Animal excreta control
and effective sullage and solid waste disposal must also be addressed to control
all excreta related diseases.

4. Classification of sanitary systems.

a. On site Sanitation System: When the wastes are collected, treated and
disposed of at or close to the point of generation. Example: Pit latrines (rural),
septic tank system (urban).
b. On site Sanitation System (Contd.): Basic Principle: •Liquid infiltrates into the
soil (infiltration capacity of soil and location of ground water table are
important issues). •Solids are retained (confined) and anaerobically digested.
Solids have to be removed periodically, or a new pit has to be dug at regular

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 intervals. Features: •Designed to dispose of human waste only. •Wastewater
from other sources (kitchen, washing, bathing) has to disposed separately.
•Suitable for sparsely settled rural areas with low population density, and low
water consumption. •Not feasible in areas with: (a) high population density (b)
high water consumption (c) low infiltration capacity of soil (d) high
groundwater table
c. Of-Site Sanitation System: When the wastes are collected and transported to
somewhere else for treatment disposal. Example: Conventional Sewerage
System; Small-Bore Sewerage System (SBS); Bucket Latrines. Treatment
Plant Public Sewer Network House Connection Disposal Property Line
Figure: Conventional Sewerage System River/ Stream

d. Off-Site Sanitation System (Contd.): Basic Principle: • Basic elements of off-

site sanitation system include collection, transportation, treatment, disposal
and/ or reuse. •The waste is collected either through house sewers or manually
using buckets or vaults, transported either by sewer system, cart or truck to a
suitable distant place where it is treated prior to disposal or reuse. Features:
•Collection and transportation of waste through a sewer reticulation system
requires that the waste be diluted by water. •Hence piped water supply is
essential where this system is to be applied. •Most satisfactory system of
waste disposal, provided sufficient funds are available for its construction and
maintenance. •Because of high cost, preferable to introduce gradually; where
possible existing sanitation system (e.g., septic tank system) should be
upgraded and improved (e.g., SBS system utilizing existing septic system). In
this system, the costs can be significantly reduced because of smaller sewer
size and lower gradients.

e. Sanitation system may be further classified into: (a) Dry Sanitation System:
No water is used for the dilution of waste. Applied in areas with no piped
water supply. Example: Pit latrines (rural, on-site), Bucket Latrines (Urban,
off-site). (b) Wet Sanitation System: Waste is diluted with flushes of water (to
carry it away from the point of generation). Example: Septic Tank System
(on-site), Conventional Sewerage System (off-site).

f. Sanitation system may be further classified into: (i) Permeable System:

Allows infiltration of liquid portion of waste into the soil, causing potential
pollution of groundwater. Example: Pit latrines. (ii) Confined System: Does
not allow infiltration of liquid portion of waste into the soil. Example: Septic
tank (not septic tank system, which also includes a soakage pit).