Water Availability

April 25, 2011

Though water is the body’s principal chemical component the World Health Organization (WHO) reports that 1.1 billion people lack access to a potable water source. In addition, approximately 2.6 billion people – half the population of the developing world – do not have access to even a simple latrine. While this raises concerns regarding quality of life and lack of resources in general, individuals who do not have access to clean drinking water and sanitation services are at an increased risk of contracting diarrheal illnesses, including cholera. Though these conditions are easily treated, the regions where they are most prevalent frequently also do not have the necessary medications. By increasing awareness about ways to improve the availability of safe water and sanitation services, it may be possible to reduce transmission and infection rates.

Reports  indicate that each year the deaths of 1.6 million people – approximately 90 percent of them children under five years of age – are due to diarrheal illnesses that can be attributed to a lack of access to safe drinking water and basic sanitation. The WHO defines “basic sanitation” as “the lowest-cost technology ensuring hygienic excreta and sullage disposal.” Further, individuals are said to have “access to drinking water” – “drinking water” defined by the WHO as “water which is used for domestic purposes, drinking, cooking and personal hygiene” – if they are within 1 kilometer of a source that can reliably produce 20 liters per household member per day. According to Siemens, more than a billion people worldwide currently survive on only 3.8 liters (one gallon) of water per day, though experts suggest an intake of approximately 1.5 liters per day.

According to UN Secretary-General Ban Ki-moon, over the past decade, the number of individuals living in urban areas who lack access to drinking water in their home or the immediate vicinity has increased by an estimated 114 million, while the number who lack access to basic sanitation facilities has risen by 134 million. An estimated 51 million people in the Democratic Republic of Congo have no access to safe drinking water, and between 30 and 60 percent of the urban population of sub-Saharan Africa has no access to the municipal water supply. In these and other regions worldwide where access to potable water and sanitation services are limited, individuals may employ alternative methods of purifying water, such as boiling, chemical disinfection, and filtration. While these methods offer an effective means of generating a supply of safe drinking water, the quality of water used in farming is also critical, as water-borne pathogens on crops can cause diseases such as typhoid and cholera.

Both governmental agencies and non-profit organizations have established initiatives aimed at increasing the availability of water, purifying existing water sources, and improving sanitation services worldwide. By ensuring that safe water is available for consumption and farming, and that sanitation services are sufficient, the transmission of water-borne illnesses can be mitigated. In addition, providing individuals in regions facing shortages of potable water with information about water purification options and treatments for cholera and other diarrheal illnesses can improve the healthcare infrastructure in these areas.

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On Cholera Worldwide

November 1, 2010

Though the last major outbreak in the United States occurred in 1911, cholera remains a persistent health concern in many parts of the world, including Asia, the Middle East, Latin America, and sub-Saharan Africa. Recent outbreaks have been seen in Nigeria,  where cholera has killed more than 1,500 people this year, and in Haiti, where survivors of the massive January earthquake have been affected by an outbreak that has infected an estimated 2,300 people and killed at least 200. Due to cholera, there are an estimated three to five million new cases reported worldwide and between 100,000 and 120,000 deaths each year. Like other diarrheal illnesses, cholera is easily treatable and can be prevented through the provision of safe water, improved sanitation services, and education about the importance of hygiene.


Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Though three-quarters of individuals infected with V. cholerae do not exhibit any symptoms, they may shed the bacteria in their stool for seven to 14 days, potentially infecting others. While V. cholerae is the direct source of cholera infection, the deadly effects of the disease are caused by a toxin called CTX, that the bacteria produce in the small intestine of the host. CTX binds to the intestinal walls and interferes with the normal flow of sodium and chloride, causing the body to secrete large amounts of water and leading to diarrhea accompanied by dehydration. In individuals exhibiting the severe form of the disease, the rapid loss of fluids can lead to dehydration and shock, and without treatment death can occur within hours. Approximately one in 20 individuals infected with the bacteria develops symptoms associated with cholera, which include: severe, watery diarrhea; nausea and vomiting; muscle cramps; dehydration; and shock.

The rapid loss of fluids in a short period of time – often as much as a quart in an hour – associated with diarrhea due to cholera, makes the disease particularly deadly. In order to replenish the fluids and electrolytes that an individual with severe cholera has lost, Oral Rehydration Salts (ORS) must be administered. If a pre-formulated solution is not available, experts suggest combining one-half teaspoon salt, one-half teaspoon baking soda, and three tablespoons sugar in one liter of safe drinking water. With the prompt delivery of ORS, up to 80 percent of people can be treated successfully, with a fatality rate below one percent. Antibiotics may be used in conjunction with ORS to shorten the course and lessen the severity of the illness, however their delivery is less critical to cholera patients than rehydration. To help control the spread of the disease, two types of oral cholera vaccines are also available, but according to experts they provide only a short-term effect and should be administered in areas where ongoing water and sanitation improvement programs are in place.

Despite the simplicity of the cure, thousands of people die each year in regions that lack effective sanitation and water purification systems. Following man-made or natural disasters, the risk of an initial outbreak of cholera growing into an epidemic is greatly increased. As seen recently following floods in Pakistan and Nigeria, the spread of cholera becomes a major public health concern when there is a lack of clean water. By providing treatment as well as information about the importance of boiling water before drinking and maintaining personal hygiene, it may be possible to slow or even stop the spread of cholera and other communicable diseases.

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Flooding in Pakistan

September 1, 2010

Reports indicate that recent flooding in Pakistan has affected the lives of at least 15.4 million people and left a third of the nation – including approximately 7.9 million acres of cultivated land – under water. At least 900,000 homes have been destroyed by surges of water, and a reported six million people do not have access to food, shelter, and potable water. In addition, the United Nations indicates that 1,600 have died and more lives are at risk as the threat of water-borne illness continues to rise.

Floods began in late July following a period of particularly heavy monsoon rains and have continued through August. Many have sought shelter in camps established by aid organizations, but public health experts warn that the crowding associated with displaced persons camps could exacerbate the spread of disease. Scabies, a skin infection caused by mites that burrow and cause pimple-like irritation, is becoming increasingly common in the camps. According to some reports, tens of thousands of infected individuals are among the 600,000 people in relief camps set up in Sindh province. In these tented camps which have been established in army compounds, schools, and public buildings, healthcare providers are struggling to contain outbreaks of acute diarrhea, the precursor to fatal cholera.

According to Mark Ward, acting director of the U.S. Agency for International Development’s office for foreign disaster assistance, “When you are dealing with this much water and that many people it [cholera] is almost unavoidable.” In addition, the World Health Organization (WHO) has reported 204,000 cases of acute diarrhea, 263,300 cases of skin diseases, and 204,600 cases of acute respiratory diseases in flood-affected regions. Thousands of cases of suspected malaria have also been documented and the conditions for mosquito-borne as well as water-borne illness are present.

The delivery of treatment for these fast-spreading communicable diseases has been compounded by the lack of adequate clinical facilities. Reports indicate that 200 health facilities were damaged or destroyed. Vaccination programs have been established in Charsadda and Peshawar regions and more than 100,000 children have received polio shots. Despite these efforts, millions, including 3.5 million children are at risk of contracting disease, and require water, shelter, or emergency care. Radio and text messaging campaigns have also been put in place to distribute information about the importance of hand washing and good hygiene.

While funding for humanitarian aid has been limited to date, the UN and other international organizations continue their efforts to garner support. Assuring that food, water, shelter, and medical treatment are available for those who need them is the primary concern of aid organizations currently working in Pakistan. By delivering effective medical treatment in a timely fashion while also working to prevent the spread of diseases, outbreaks can be contained.

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