PART 7: WATER-RELATED DISEASES

Cholera and typhoid

Water provides a very good habitat for many living things. Because of the
presence of plants in water and their ability to photosynthesise (see Section
9.1), there is plenty of food in water. Water provides a nutrient-rich
environment for bacteria. Bacteria may enter drinking water from sewage if
sanitation is poor. If these bacteria are pathogens, and the water in which they
live is drunk untreated, diseases can be spread.
Two major diseases caused by water contaminated with human faeces are
cholera and typhoid. The main features of these two diseases are shown in
Table 1.
The crucial element in preventing these diseases being transmitted within a
population is to ensure that sewage and drinking water do not come into
contact with each other. Therefore, good sanitation is crucial, with sewage
being removed directly to a treatment works and water being treated before it
is delivered to people to drink.
Attention to good hygiene is crucial, as is the thorough cooking of food.
Contaminated water should not be used to wash food, and hands should be
washed after contact with any faecal material. Use of efficient latrines is
essential. If there is any doubt about whether water is safe to drink, simply
boiling it can eliminate most harmful organisms.
 Cholera Typhoid
Infective bacterium Vibrio cholerae Salmonella typhi or
(pathogen) Salmonella paratyphi,
which causes a less
severe illness
Time before onset of A few hours up to 5 6–6 days
Symptoms after days
infection
Symptoms Diarrhoea and vomiting Fever, abdominal pain
with a skin rash
Diarrhoea and vomiting
are not uncommon
Consequence Can be mild but can 3–3% of infected people
lead to dehydration and remain as carriers with
death no symptoms If
untreated, fatal
complications can arise
Treatment Rehydration Antibiotics
A vaccine exists A vaccine exists
Occurrence in 2015 172 454 cases were Around 21 million a
notified to WHO from year with about 161
42 countries, including 000 deaths worldwide
1304 deaths
Table 1

Malaria
Like cholera and
typhoid, malaria is a
water-related
disease, but the
similarity ends there.
Bacterial diseases,
such as cholera and
typhoid, are carried
in water and referred
to as water-borne
diseases.
Figure 1 The Anopheles mosquito
Malaria is caused by a microscopic organism called Plasmodium. Malaria is
water-related because the organism that passes the disease to humans
requires water to breed. This organism is an insect called a mosquito, which
lays its eggs in still water, where the larvae develop. Mosquitoes can pass
malaria on to humans, acting as a vector. The relationship between
mosquitoes, Plasmodium and human beings is best understood with a life cycle
diagram

Figure 2 The life cycle of malaria.

Malaria occurs in 97 (out of 193) countries around the world, mainly in Africa,
Asia and the Americas (Figure). These countries are home to 3.2 billion people,
nearly half the world's population. In 2015 there were 214 million cases of
malaria, with about 438 000 deaths. Sub- Saharan Africa suffered 89% of the
malaria cases, with 91% of the deaths.
The symptoms of malaria are flu-like and include fever and chills at first. The
disease can be fatal. Malaria can be treated but a much better option is
prevention.
Figure 3 Areas where malaria transmission is a risk.

Prevention and control is best achieved by avoiding bites from the mosquito.
Individuals can prevent being bitten by mosquitoes by:
• avoiding being outside between dusk and dawn in countries where
malaria mosquitoes are active, the species of the Anopheles mosquito
that transmits malaria only flies at night
• wearing clothing that covers most of the body and treat exposed parts
of the body with mosquito-repellent products
• sleeping under a mosquito net treated with an insecticide
• spraying the inside of accommodation with insecticide.
For governments, strategies for malaria control are focused on controlling the
vector. This can be achieved by:
• spraying insecticide inside buildings, including houses
• draining wetland areas to remove mosquito-breeding sites
• introducing fish, which eat the larvae and pupae of the mosquito, into
ponds and other bodies of water
• pouring oil onto the surface of the water where mosquitoes breed,
which stops the larvae from breathing and stops the adults from laying
eggs.
 KEY TERMS
Eradicating malaria means completely
removing the malarial parasite from the
Sewage: waste matter that is
carried away in sewers or drains
population. Controlling the vector is not
from domestic (or industrial) enough, so methods must be sought to actually
establishments destroy the parasite.
Pathogen: an organism, including
WHO now encourages a programme of
bacteria and viruses, that can
cause disease eradication of malaria from all countries of the
world. In the first half of the 20th century,
Vector: an organism that carries a
disease-producing organism, such malaria was eradicated from western Europe
as the mosquito which carries the and the USA. The main challenge for the 21st
malarial parasite century is to achieve eradication in sub-
Saharan Africa, where nearly 90% of all cases
occur.
Unfortunately, there is the possibility that malaria is favoured by global
warming. Recent studies have shown that it is now occurring in highland
regions of Kenya, Colombia and Ethiopia, where it has not been seen for over
50 years. However, another recent study using a predictive approach and
taking into account the subtleties of climate change, which involves more than
just a rise in temperature, concluded that few changes in distribution would
occur.
In the first 12 years of the 21st century, improvements in diagnosis, treatment
and prevention have led to a 25% decline in incidence in malaria and a 42%
decline in deaths from malaria. However, it is unlikely that these methods will
result in elimination. The mosquito vector is evolving resistance to insecticides
and the parasite is also becoming resistant to available drugs. Much more
attention needs to be given to people who are infected by the disease but have
no symptoms. It is clear that new methods for controlling malaria are needed.
Be careful not to confuse malaria with bacterial diseases, such as cholera and
typhoid. Bacteria breed in the water. Malaria is a caused by a parasite, which
breeds in an insect, which breeds in water.