Provision of safe and adequate

drinking water supply

Medical students

Dr Abera Kumie, SPH/CHS/AAU

2022

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 Learning outcome of this lecture
Background
• Identify and describe the health importance of water
• Describe the hydrologic cycle of water (occurrence of water)
• List impurities of water

Definitions
• Describe what is safe drinking water
• Know the classification of diseases transmitted due to contaminated
water

Community water Sources and arrangements

• Identify sources of drinking community water supply
• Describe development of safe drinking water sources
• Describe large and small scale water treatments

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 General issues

Importance and use of water

• Physiological needs
• Domestic use
• Spiritual purpose
• Personal hygiene and cleanliness
• Recreational purposes
• Economical uses:
– Business: Yes, Fham, Arki, One, Cool, Highland, etc
– Agriculture, transportation
– Green economy: Power production, industrial use, etc.

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 Occurrence and sources of fresh water
• The earths surface is covered by 72% of water,
of which 97.2% is saline ocean; 2% water in
frozen state, 0.8% only fresh water.
Sources of drinking water (Natural)
• Surface (streams, rivers, lakes, ponds);
• Ground water (aquifers: springs and wells);
• Rain water rarely.
Man made: Dams, wells, springs, irrigation
canals, etc
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 Source of drinking water

Lake
Spring

Dam

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 The global situation
Is water a scarce resource?
72% earth’s surface is water Ocean

The 2.5%

<1% of the fresh water out of

the 2.5% is accessable
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 Global inequity in water sources

Where is water abundant? Accessible? (Water per person: Water/Pop)

abrKdwtr2022 http://pubs.acs.org/doi/pdf/10.1021/es0871457
 What is Water?
• Chemistry: H2O: distilled water?? Rain water??. It is
impossible for water to exist in such form in nature.
Water contains some kind of impurities.
• Physical characteristics: odorless, colorless,
tasteless, liquid, density 1.0.
• Clean Water: Dissolve oxygen (DO): clear fresh
water at 25oC contains 8-10ppm (mg/L) of oxygen;
threshold for aquatic life is 4.0ppm;
• Polluted water: Biochemical oxidation demand
(BOD): the amount of oxygen needed for
biodegradation of organic matter by microorganisms
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 Water impurities: Health Risk
Forms of impurities in water Adverse effect to human health
Suspended & colloidal:
Microbes; solids; Bacteria, Infections (refer else sections)
algae, eggs, cysts, protozoa
Soil, silt, soot Turbidity, taste, colour, odour
Dissolved: gases, salts, plant Water acidity, photosynthesis
dyes with CO2, H2S, O2,
Nitrates Met-haemoglobnamia (also called
blue baby)
Salts of heavy metals: Pb, Toxicity
As, Cr, Hg, etc.
Salts of Ca, Mg, Fe Hardness of water, disease to
kidney, loss of soap
Excess or low flouride dental caries or mottling
Salts of Na, K Water Alkalinity
Q? How do we remove out all this dirt?
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 Ambo Water- Sparkling mineral water

Chemical Composition 02 July 2018 by a label

Na 252 HCO3 1128

K 35 Cl- 32.5
Ca 72 SO4 0.77
Mg 46 Phosphate 0.06
Mn 0.15
Iron, total 0.08
Water has essential chemicals that are required to our body
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 Hydrologic cycle (renewable resource)

Condensation

Precipitation
Transpiration

Snow melt, runoff

Evaporation

Surface Runoff

Is rain water Clean? Safe for drinking? f( air pollution) 11

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 Community water development

Categories by investment
• House hold level
• Community supply: Small scale water development
• Large scale or municipal type of drinking water
(Municipal)

Classification of water safety handling

• At the point of the source (small and large scale)
• At distribution
• At the point of use/ consumption (HH level)

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 What is safe water?

Safe water is water that does not contain harmful

chemical, physical substances, or microorganisms in
concentration that could cause illness in any form
(WHO)

Drinking water must be:

a. Physically
b. Microbiologically
c. Chemically safe

• Water has Health value and esthetical value

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 Adequateness and accessibility
General guideline: WHO

Criteria Rural Urban

Amount (adequateness) 20 l/c/d within 1 km 50 l/c/d
access
Timing (accessibility) 15 minutes Same
Walk/transport
Distance 30 min round trip same
(Single trip) = 1 km

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 Role of Water in the transmission of
communicable diseases: The F diagram

Water

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 Health importance: consequences
• Water related diseases (four categories):
– Water borne
– Water washed
– Water based
– Water related

• Results of water Pollution: Toxicity criteria

(excess chemicals above the standard: examples
heavy metals such as Hg, Pb, Be, Cd, etc;
Pesticides; salts)
–Examples??
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Table 1. Bradley classification system for water-
related diseases? Biological origin; White et al., 1972?;

Category Example Category Example

Water-borne Diarrheal diseases, cholera,
(water qlty) dysentery, typhoid, infectious
Hepatitis (A); giardiasis
Water-washed Skin and Eye Infections:
(water qnty) trachoma, scabies, ARI
Diarrheal disease, cholera,
dysentery,
Intervention
• Improve drinking-water
quality,
• prevent casual use of
unprotected sources
• Increase water quantity
used
• Improve hygiene

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Table 1. Bradley classification system for water-
related diseases? Biological origin; White et al., 1972?;

Category Example Category Example

Intervention
Water-based Schistosomiasis, guinea worm Reduce need for contact with
contaminated water, reduce
(intermediate host) surface water contamination

Water-related Malaria, onchocerciasis, dengue • Improve surface water

insect vector fever, Sleeping sickness, yellow
fever, oncho, filiarisis
(Insects that bite or bread near
water)
management,
• destroy insect breeding
sites, use mosquito netting

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 Contamination of drinking water

What must be done??

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Water Related Diseases and their Causes
Diseases
Infections Bacteria Viruses
• Diarrhea • E. coli
• Schistosomiasis • Hepatitis A & E
• Salmonella typhi
• Intestinal virus
• Shigella spp.
Worms • Adenovirus
• Yersinia • Enterovirus
• Guinea Worm enterocolitica
• Hepatitis • Rotavirus
• Cholera
• Malaria
• Trachoma
• Typhoid
Chemical poison
• Arsenicosis
• Fluorosis
• Blue baby
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E. coli bacteria Hepatitis A Virus
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 Diseases due to chemicals
Poisoning: acute and chronic
• Arsenic: in Bangladesh
• Flouride: in the rift valleys
• Nitrates from fertilizers: blue baby
• Carcinogenic pesticides (DDT)
• Lead (from pipes)
• Heavy Metals

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 Dental Flourosis

abrKjun2011
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 Summary of health impacts
• Diseases transmission
• Acute and chronic toxicity
• Socio-economic
– Loss of work days
– Missed educational opportunities
– Economic loss

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 Drinking Water Management
Water Treatment
• Quality criteria
• Types of development
• The process

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 Objective of drinking water supply

1. To supply safe and wholesome water:

– Microbiological safety (Pathogenic organisms);
– Removal of excessive and undesired chemicals
(Fluorides, metals);
– Addition of essential chemicals (example Fluoride)
– Removal of impurities that interfere with water colour,
taste, transparency, and odour;

2. Adequate supply for all purposes: cooking,

washing, personal hygiene,

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 WHO Criteria water quality
• Physically palatable
– Transparent, colorless, odorless
• Biological safety
– E. coli or thermotolerant coliform (facal coliforms)
bacteria, Must not be detectable in any 100-ml
sample
• Chemical safety (dissolved)
– Should not be beyond the set guideline values

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 Ethiopian Drinking Water Quality
Standard - Standards Agency
• Follows international quality standards
• Adopted WHO Std criteria
• Characteristics that affect palatability of drinking water:
hardness, TSD, salts of Fe, NA, CA, Mg, Al,
• Toxic Chemicals: AS, Pb, Cd, Ba, NO3-, Cr, Se, Cr, F-,
Pesticides,
• Diseases causing organisms: Total coli form; Streptococci,
Coliforms, Ecoli,

Ethiopian Drinking Water Quality Standard 2013

Ethiopian Drinking Water Quality Standard 2013.pdf (133.3 kB)

https://www.cmpethiopia.org/media/ethiopian_drinking_water_quality_standard_2013
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 Improved Water Sources
Tap water
Protected well water

Protected spring Community piped water (Bono)

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 Unsafe Water Sources
(Not improved)

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 SDG Vs MDG

• 6.1.1 SDG Global target: By 2030, achieve universal and

equitable access to safe and affordable drinking water
for all
• 6.1.1 Global indicator: Proportion of population using
safely managed drinking water services

• Improved water source is not necessarily same as

safely managed drinking water services

• We use “improved water source” as an indicator in

Ethiopia
• JMP: SDG (safely managed drinking water sources Vs
improved water sources)
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 Definition Safely managed in SDG

Proportion of population using improved drinking water

sources:

• accessible on premises (distance)

• available when needed, and (quantity, sustained
supply)
• free from contamination (biological and chemical
quality)

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 % of population using
safely managed drinking water source
MDG 2019 JMP report

Progress in Africa generally is not Good

https://www.unwater.org/publications/whounicef-joint-monitoring-program-for-water-supply-sanitation-and-hygiene-jmp-
progress-on-household-drinking-water-sanitation-and-hygiene-2000-2017/
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 Accessing to improved water source at House hold level
(EDHS data- Ethiopia)
120

100 Urban Rural Counry

80
65
60 57
%

54

40 35
25
20

0
2000 2005 2011 2014 2016
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 Access to the nearest drinking water source
Welfare M data

60
50
40
% HHs

30
20
10
0
< 1 km 1-4 km >5 km
2004 50.1 42.9 7
2011 48.3 38.5 5.6
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 Conventional drinking water treatment
The process

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 Conventional drinking water treatment

The process

• Raw water reservoir

• Sedimentation/ clarifier
• Filtration
• Chlorination
• Treated water distribution

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 Size of suspended PM in water: Impurities

PM Size (dm) μm
Virus 15 to 300 nm
Bacteria most < 2-3 μm
the smallest about 0.15 μm
Avg bacterial: 0.5-2.0 μm
Amoeba cyst Usual range 10-20 μm; may reach
35 μm
Helminthic egg ?
RBC 7.5
1 μm = 10–3mm = 10–6m
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 Water quality criteria
• Chemical indicators
– Odorless, tasteless, transparent/Clear
– Low in concentration of compounds that are
acutely toxic or that have serious long-term
effects
– Non-corrosive, nor should it cause encrustation of
piping or staining of clothes

• Biological indicators
– Free from pathogenic organisms
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 Drinking Water Treatment Process
Water source

Pre-Treatment
Conventional Coagulation, flocculation

Sedimentation

Filtration
Disinfection

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Distribution 39
 Typical Surface Water Treatment Plant

Aeration
Alum Coagulation
Flocculation

Filtration

Chlorination

Sedimentation

Four actions 40
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 Addis Ababa Legedade Municipal Water Treatment Plant lay out (2003)

3 Sedimentation.
1. Chemical and
water mixer
2 Pulsator 4. Filtration 5. Chlorination
River water

1. Flash mixer: Raw

water+chlorine+lime+magnafloc 6. Reservoir
2. Pulsator with a pump
3. Sedimentation tank/Clarifier
4. Rapid sand filter
5. Chlorination
6. Treated water reservoir
7. Distribution to CITY 7. Distribution
41
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 Zeway Surface Water Treatment Plant:
Process Flow Chart

1. Raw water intake;

2. Pump house 6, Clarifier a. Pre-chlorination
3. Aerator 7. Filtration b. Alum and synthetic
4. Flash Mixer 8. Reservoir c. Post chlorination
5. Flocculater 9. Distribution
42
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 Drinking water Treatment Plant
Water source

Coagulation
and
flocculation

Sedimentation

Sedimentation
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 Coagulation and flocculation
• Coagulation is the destabilization of colloids by addition
of chemicals that neutralize the negative charges

Chemicals used
• Aluminum sulfate/ ferric salts
• Synthetic chemicals
• Removes suspended particulate and colloidal substances from
water, including microorganisms.
• Expected microbe reductions of 90-99%, if critical process
variables are adequately controlled
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 Coagulation process
• Dissociation of alum in water
• Al+3+ colloids =
Colloids
Al+3

• Al(OH)3 + Colloids
Al(OH)3
+

Coagulant "destabilize" colloidal suspensions. 45

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 Coagulation

1. Particles in
Brownian
motion;
2. Flock
3. Settling water treatment 46
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 Flocculation
• Flocculation is the agglomeration of destabilized
particles into a large size particles known as flocs
which can be effectively removed by sedimentation
or flotation.
• Slow mixing (flocculation) that provides for a period of time
to promote the aggregation and growth of the insoluble
particles (flocs).
• The particles collide, stick together and grow larger
• The resulting large floc particles are subsequently removed
by gravity sedimentation (or direct filtration)
• Smaller floc particles are too small to settle and are
removed by filtration
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 Flocculators integrated with settling

water treatment
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 Filtration
Filtration provides the
additional opportunity for
separation of small flocs or
particles

Types of filtration
• Granular media filtration
– Rapid sand filter
– Slow sand filter
– (Municipal water Rx)

Membrane filtration
Used for bottled water
– Microfiltration
– Ultra-filteration
– Nano-filteration

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 Filtration Processes
• Rapid filtration
– used in United States
– fast filtration rates through media (sand or
anthracite)
– backwashing needed

• Slow sand filtration

– common in United Kingdom and Europe
– slow filtration rates through media (sand and gravel)
– removal of biological layer needed
– higher removal rates for all microorganisms

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 How does filtration works

• Mechanical trapping
(sieving)
• Adsorption of
suspended materials
(Mn, Fe,,)
• Biologically active
layer by adsorbing
organic matter

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 Particle size (micron)

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 Water disinfection
Forms of chlorine
• Chlorine gas in a cylinder
• Calcium hypochlorite powder (Ca(OCl)2
• Sodium hypochlorite solution (NaOCl)
• Chlorine tablet
• “Wuha agar”

The process
• Cl2 + H20 = HOCl + HCL
• HOCl = H+ + OCl-
• HOCl (hypochlorous) acid and OCl- (hypochlorite ion)

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 3 4
1 2

Water quality assurance

Samples from:
1. Raw water; 2. After clarifier; 3. After sand filter ;
4. After chlorination 54
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 Small scale drinking water sources

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 Unprotected Spring

Protected spring

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 Protected well

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abrKdwtr2022
 The rope is contaminated with soil, wastes, etc. The
well is not providing clean and safe water
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 Types of water quality surveillance
• Sanitary surveillance
– Integrity of the system
• Laboratory surveillance
– Residual chlorine f
– Faecal coliform (E. Coli) determination.
• Epidemiological surveillance
– Counting diarrheal diseases and other
water associated diseases

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Sanitary survey:
checklist

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 Session Summary

• Water is a precious resource

• Contaminated/ polluted water is a factor of
many diseases
• Drinking water should be accessible, available,
and safe
• Drinking water must be treated and properly
handled (collection, storage, and drinking)
• The quality of water should be monitored

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 References
• Central Statistical Authority. EDHS 2000, 2005, 2011, 2016.
• Salvato JA. Environmental engineering and sanitation. 3rd edition, New
York, John Wiley & Sons, 1982.
• Julie Beth Zimmerman, James Smith. Global Stressors on Water Quality
and Quantity. https://pubs.acs.org/doi/pdf/10.1021/es0871457.
• Central Statistical Agency of Ethiopia. Drinking Water Quality in Ethiopia
Results from the 2016 Ethiopia Socioeconomic Survey. 2017.
• Keredin Temam Siraj, PVV Prasada Rao . Review on water resources and
sources for safe drinking and improved sanitation in Ethiopia. International
Journal of Applied Research. 2016.
https://www.researchgate.net/publication/297715000_Review_on_water_resources_and_sources_for_safe_drinking_and_improved_
sanitation_in_Ethiopia

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 Wash hands at critical times
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