ASSESSMENT OF WATER BORNE DISEASES OUTBREAK AND THEIR PREVENTION MEASURES A CASE STUDY OF CHOLERA AMONG INFANT OF 0-5 YEARS ATTENDING GENERAL HOSPITAL NINGI LOCAL GOVERNMENT AREA OF BAUCHI STATE

ASSESSMENT OF WATER BORNE DISEASES OUTBREAK AND THEIR PREVENTION MEASURES A CASE STUDY OF CHOLERA AMONG INFANT OF 0-5 YEARS ATTENDING GENERAL HOSPITAL NINGI LOCAL GOVERNMENT AREA OF BAUCHI STATE

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Background of the study

Water is essential to human life, agriculture and animal husbandry, and modern industrial society. The absence of water precludes human existence. People must have access to adequate amounts of water as well as clean water that does not harm them when drunk. Both the quantity and quality of water are important. Reuse of water is common and through this mechanism human pathogens (of animal, human, or environmental origin) can be introduced into water that may be used multiple times between the time it falls from the sky and enters the sea. Waterborne diseases are intimately linked not only to the ingestion of, or exposure to, water, but also how human and animal feces are separated from water and food supplies (sanitation), and the availability of clean water for handwashing and bodily cleansing (hygiene). Fecal pathogens, through inadequate or absent sewerage, may enter surface waters (rivers, lakes, and recreational pools) or groundwaters (accessed through wells and boreholes) to infect new hosts. Some pathogens do not survive for long periods of time in water. Others may fail to achieve the concentration of organisms needed to reliably cause infection (‘the infectious dose’) if they are diluted in large bodies of water. Historically, humans often relied upon time and dilution to mitigate the risks of sewage or animal wastes entering their water supplies. However, some pathogens (such as cholera) are well adapted to survival in fresh or brackish waters, or may cause human illness after only a tiny number are ingested (such as Cryptosporidium). Growing global populations, growing agricultural water use, and new patterns of water scarcity driven by climate change and pollution, have led to renewed global efforts to provide clean water and sanitation to everyone. Well over 400 organisms have been documented to cause waterborne diseases. In this article, we will focus on key principles of transmission and prevention, while mentioning important specific diseases as needed. Waterborne diseases, as a group, contain some of the most historically important illnesses known to humans, such as typhoid fever (enteric fever), rotavirus diarrhea, and the pandemic disease cholera. Each of these is, or has been, a leading human cause of death. Diarrheal diseases remain a leading cause of death in children globally. While most deaths from diarrhea occur in low-income countries, the risk of waterborne disease outbreaks remains a constant threat even in richer nations should the barriers to water contamination (such as sanitation and water treatment) be compromised. There are many examples of modern water treatment failures in ‘developed’ countries which have resulted in epidemics of waterborne diseases such as gastroenteritis or hepatitis A. While waterborne diseases have their greatest impact on children, they are fully capable of causing significant death and morbidity in adult populations. For example, when cholera was reintroduced into South America in the early 1990s, many adults died, shocking the sensibilities of societies where child, but not adult, deaths were common. Recent authoritative World Health Organization (WHO, 2013) estimates are that unsafe water and a lack of basic sanitation lead to approximately 760,000 deaths per year in children under the age of 5 years. This number represents a significant improvement from the estimated 2.2 million deaths, including adults but mostly in children, from diarrheal diseases that occurred in 1998. Prüss-Üstün and Corvalán (2006) estimated that at least 88% of diarrheal episodes globally are attributable to poor water, sanitation, and hygiene. Thus, a focus on prevention via the provision of these services is an obvious goal. This progress can be monitored by tracking the incidence of clinical syndromes such as diarrheal disease or typhoid. Recent studies have shown that this progress varies widely across countries, and that the trajectories followed by individual countries over time can be used to identify which countries need additional resources or capacity development. Approximately 660 million people, or 9% of the global population, do not have access to an ‘improved’ source of drinking water. In 1990 this figure was 24%, so access to improved water has markedly improved (UNICEF, 2015). An improved water supply can be as simple as a borehole well, a public water pipe shared by a community, a protected well or spring, or collected rainwater. In and of itself improved water does not mean microbiologically safe, potable water. Improved water supplies do not necessarily meet modern criteria for potable water, yet they may represent substantial improvements over open surface water sources as they often lower the risk of waterborne diseases. Indeed, a number of recent studies have shown that piped water is often contaminated. It is appropriate to think of improved water as being held or delivered via some improved structure, rather than thinking of it on the microbiological continuum from unsafe to safe water. The two domains (structural and microbiological) can intersect. For example, boreholes are often a microbiologically clean improved water source because the ground acts as a filter to remove infectious pathogens. In contrast, far less progress in sanitation has been made over the past 25 years. More than 2 billion people in 2004 did not have access to basic sanitation facilities (Prüss-Üstün and Corvalán, 2006). In 2015 UNICEF estimated that 13% of the world population still practiced open defecation and another 10% used unimproved toilet facilities. In these circumstances the immediate environment is fecally contaminated, and any rainfall can sweep human (or animal) feces into water supplies. The challenge of eliminating waterborne diseases, especially in densely packed poor urban areas, and dispersed rural populations, remains large, despite recent improvements

1.2 Statement of the problem

In about 40 countries where 90% of all childhood deaths occur, the major causes of death are diarrhea, pneumonia, malaria, and neonatal disorders. Many neonatal deaths are due to infections, some of which are skin hygiene related. Clean water is important not only for drinking water purposes, but also because it allows related hygienic practices, such as handwashing, to be practiced. Handwashing with soap decreases not only diarrheal episodes by over 50%, but also pneumonia episodes by a similar proportion (Luby et al., 2005). This is because many respiratory diseases are spread through fomites in hand-to-mouth transmission, which can be abrogated through handwashing. Measures that eliminate the classically recognized waterborne diseases such as diarrhea have important effects on other communicable diseases such as viral respiratory infections and trachoma. Indeed, a 100 years ago, there was a widespread recognition in the public health community that for every case of typhoid prevented by water treatment or sanitation, somewhere between 3 and 10 other deaths could be prevented (the Mills–Reincke phenomenon; see discussion below). Bacterial pathogens such as Salmonella, Shigella, Escherichia coli, and Campylobacter cause much of the burden of waterborne diseases. Other high impact human diseases (viral, bacterial, and parasitic), such as hepatitis A, amebiasis, caliciviruses, leptospirosis, polio and the other enteroviruses, schistosomiasis, giardiasis, and cryptosporidiosis are also waterborne. These diseases share the common characteristics of water acting as vehicle for transporting pathogens from other humans, other animals, or the environment to new human hosts. Once they are infected by the organisms in the contaminated water, they can then in turn serve as a source of infection for others. Water can also act as the site for multiplication of a water-related disease, such as for schistosomiasis, where the parasite obligatorily multiplies in water-associated snails before it can infect humans.

In this study, we separate waterborne diseases from ones where a vector of disease requires water but the pathogen does not, such as mosquitoes that transmit malaria. It should be noted, however, that these two are socially and environmentally related, since building a reservoir to improve access to clean water can provide new habitats for vectors of disease. Many authorities divide water-related infections into ‘waterborne’ (the pathogen is ingested, such as typhoid or cholera); ‘water-washed’ or ‘water-scarce’ (person-to-person transmission because of a lack of water for hygiene); ‘water-based’ (transmission via an aquatic intermediate host, such as schistosomiasis); and ‘water-related insect vector’ (with transmission by insects that breed in, or bite near, water). These distinctions are useful intellectual constructs, but in practice the divisions are sometimes less clear, as explained below. Indeed, reservoir construction is associated with increasing incidences of both malaria and schistosomiasis. A disease that enters a population through water can then spread through other routes, via person-to-person transmission, or through contamination of crops by wastewater. Similarly, a disease that first spreads by person-to-person contact may then enter water supplies through the fecal stream, and then become waterborne. The same disease can be waterborne, foodborne, and transmitted directly person to person. When considering waterborne diseases, an ecological perspective is often useful to understanding the complex web of relationships that exist between humans and these diseases. One reason why the control of waterborne diseases is so important is that it can also decrease the likelihood of subsequent person-to-person or foodborne transmission. There is also merit in understanding that waterborne diseases relate to human behaviors and the local infrastructure. Some waterborne diseases, such as the parasitic infections schistosomiasis and dracunculiasis, require that humans have direct skin-in-water (dermal) contact with water bodies where the infectious forms of the parasites dwell (‘water-based’ transmission). Globally, much of this contact is due to the need for people to collect water for household use, to engage in agricultural activities, and for recreational bathing or swimming. It is in this circumstance that an improved water supply – such as piped water from a reservoir – can protect people from disease transmission. For example, the provision of piped water or wells (forms of infrastructure) in communities may alleviate the need for children and others to collect water by hand from infectious rivers or surface waters. However, it is unlikely to affect the normal desire of children in a hot climate to play in possibly contaminated water (forms of behavior).

The Ningi Local Government Area (LGA) in Bauchi State has been experiencing recurrent outbreaks of waterborne diseases, posing a significant threat to the health and well-being of its residents. The prevalence of waterborne diseases, such as cholera, typhoid, and gastroenteritis, has raised concerns about the adequacy of existing water supply and sanitation infrastructure in the region. This study aims to investigate the root causes and contributing factors leading to waterborne disease outbreaks in Ningi LGA, assess the current state of water quality and sanitation facilities, and identify gaps in preventive measures. By understanding the dynamics of waterborne diseases in this specific locality, the research seeks to propose effective interventions and preventive strategies to mitigate the impact of such outbreaks, ultimately improving public health outcomes in the community.

1.3 Objective of the study

1. Assess the Prevalence and Incidence of Cholera among Infants (0-5 years) in ningi local government area of bauchi state.

2. Investigate the causes of cholera outbreaks among infant of 0-5 years in ningi local government area of bauchi state.

3. Investigate the prevention measures of Cholera Outbreaks among infant of 0-5 years in ningi local government area of bauchi state.

1.4 Research Questions

1. What is the Prevalence and Incidence of Cholera among Infants (0-5 years) in ningi local government area of bauchi state?

2. What are the causes of cholera outbreaks among infant of 0-5 years in ningi local government area of bauchi state?

3. What are the prevention measures of Cholera Outbreaks among infant of 0-5 years in ningi local government area of bauchi state?

1.5 Research hypotheses

Hypothesis 1:

(H0): The Prevalence and Incidence of Cholera among Infants (0-5 years) in ningi local government area of bauchi state is low.

(H1): The Prevalence and Incidence of Cholera among Infants (0-5 years) in ningi local government area of bauchi state is high.

1.6 Significance of the study

1. Public Health Impact: Waterborne diseases pose a significant threat to public health, leading to widespread illness and, in some cases, fatalities. Understanding the dynamics of waterborne disease outbreaks in ningi local government area of bauchi state can contribute to the development of targeted interventions to reduce the incidence of these diseases, ultimately improving the health and well-being of the community.

2. Community Well-being: The research can provide valuable insights into the specific challenges faced by the community in ningi local government area of bauchi state  related to waterborne diseases. By addressing these challenges, the overall well-being of the community can be enhanced, fostering a healthier and more resilient population.

3. Resource Allocation: The findings from the research can guide policymakers and local authorities in allocating resources effectively. Understanding the prevalent waterborne diseases and their contributing factors enables the prioritization of interventions, ensuring that resources are directed towards areas and measures that will have the most significant impact on disease prevention.

4. Environmental Sustainability: Investigating the water infrastructure and sanitation practices in ningi local government area of bauchi state  contributes to the sustainable use of environmental resources. Identifying gaps and challenges in the existing systems can lead to recommendations for improved water management practices, promoting environmental sustainability and long-term health benefits.

5. Community Empowerment: The research can empower the community by providing them with knowledge about the causes and prevention of waterborne diseases. Community members can actively participate in the implementation of preventive measures, fostering a sense of ownership and collaboration in maintaining a healthy living environment.

6. Policy Development: Research findings can serve as a basis for the development and enhancement of policies aimed at preventing waterborne diseases. Evidence-based policies are more likely to be effective in addressing the unique challenges of ningi local government area of bauchi state , promoting sustainable health outcomes.

7. Capacity Building: The research process itself, involving local stakeholders, health professionals, and researchers, can contribute to capacity building within the community. Training and collaboration can empower local entities to take an active role in ongoing health monitoring and response efforts.

8. Regional and National Impact: The insights gained from the research can have broader implications beyond ningi local government area of bauchi state . Successful preventive measures and strategies developed based on this research can serve as a model for other regions facing similar challenges, contributing to a broader national impact on waterborne disease prevention.

1.7 Scope of the study

This study focuses to assess the Prevalence and Incidence of Cholera among Infants (0-5 years) in ningi local government area of bauchi state, Investigate the causes of cholera outbreaks among infant of 0-5 years in ningi local government area of bauchi state, and Investigate the prevention measures of Cholera Outbreaks among infant of 0-5 years in ningi local government area of bauchi state. Hence health care personnel in general hospital ningi bauchi state shall serve as enrolled participants for this study.

1.8 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are:

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.9 Definition of terms

Waterborne Diseases: Illnesses caused by the ingestion of contaminated water, typically resulting from the presence of pathogenic microorganisms such as bacteria, viruses, or parasites. In this context, the study concentrates on cholera as a specific waterborne disease affecting infants aged 0-5 years.

Outbreak: The occurrence of an elevated number of cases of a particular disease within a defined geographical area and time frame, exceeding what is normally expected. The assessment focuses on identifying and understanding the dynamics of cholera outbreaks among infants attending General Hospital Ningi.

Prevention Measures: Strategies, interventions, and actions implemented to mitigate the occurrence and spread of waterborne diseases, particularly cholera among infants. This includes examining existing preventive measures and proposing improvements to enhance the overall health outcomes.

Cholera: An acute diarrheal infection caused by the Vibrio cholerae bacterium, often transmitted through the ingestion of contaminated water or food. The assessment focuses on understanding the characteristics and impact of cholera outbreaks specifically among infants aged 0-5 years.

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