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Niranjani, Aishwarya Menon, Arvind Kumar
"Water is the soul of the Earth." – WH Auden
India is a land of paradoxes. “Jal hi jivan hai (Water is life)” is a household saying in the subcontinent, while another thing specific to the subcontinent is the concerning fact that it has recorded approximately 10 million cases of typhoid fever in 2021. This makes India the country with the highest burden of typhoid worldwide. Water – which cleans our deities and purifies souls – comes with a scythe.
Typhoid is a potentially life threatening illness, caused by the bacterium Salmonella typhi. It is spread through contaminated food and water, specifically when miniscule particles of faecal matter contaminate drinking water and food. The primary demographic afflicted by the illness are populations that lack safe access to clean water and sanitation, and children between the ages of 6 months and 14 years.
To prevent typhoid fever in a community, it is necessary to provide clean tap water service to 35.5% of the population. And one individual requires about 173 litres of clean water daily.
According to the WHO, 1.4 million people each year were estimated to have died as a result of inadequate drinking-water, sanitation and hygiene (WASH). We are, therefore, interested in exploring two factors that affect the transmission of typhoid – access to clean water and government policies. According to the World Health Organization, at least 10% of the world’s population is thought to consume food irrigated by wastewater. This is according to the estimates published in the 4 volume publication by World Health Organization and United Nations Environment Programme, called ‘Guidelines for the safe use of wastewater, excreta and greywater’. In 2020, an estimated 44% of the household wastewater generated globally was discharged without safe treatment. Open defecation is also a major contributor and risk factor when it comes to water contamination, with 1.5 billion people lacking access to private toilets and nearly 419 million people defecating in the open. About half of the world’s population does not have access to safely managed sanitation service.
To tackle the burden of WASH-related diseases, several government policies have been implemented around the world. It is important to note that typhoid risks of each country are unique and therefore require just as unique solutions to tackle the spread of the disease. For example, Chile’s intervention is primarily in the agricultural sector – with the banning of wastewater for irrigation, educating farmers, constructing wells for irrigation. India on the other hand has focused on implementing rigorous regulations on food handling, building safe water infrastructure, and reducing open defecation by constructing toilets. Vaccination campaigns have also been organised to combat the disease, in endemic regions. A common intervention that shows promising results is educating people around WASH practices.
With increasing focus and concern on planetary health, the nested and interconnected nature of our relationship with each other and the planet, it is necessary to come up with solutions that respect the unique nature of the relationship between the people, the environment and the disease drivers. There is no one solution that is perfectly applicable in all countries and states. The history of the land and people, economic and social relations and cultural values of the place dictate the form the solution will take.
A common solution we observe is some form of community education and engagement. This is also shown to have clear, positive effects on reducing the spread of typhoid. What we propose is a solution that builds on this and adds the element of quantification, which is a solid measure of disease vulnerability.
We suggest a two part solution to the typhoid problem. At the policy level, a solution inspired by the Watershed Interventions for Systems Health (WISH) project. Public-private partnerships and community-based water management will form the heart of this solution. The solution starts at the grassroot level – at homes.
* Basic food and water hygiene practices must be followed – chlorination and boiling water before consumption.
* At the community level, measuring the water access and sanitation behaviours, community mapping exercises will plot where people get their water and which latrines are most likely to pollute those sources.
* At the national level, a database of real-time information on the layered factors that put people at-risk of waterborne and water-related diseases. Integrate this with meteorological and rainfall data, etc.
* Create a score for each community based on its risk of waterborne disease.
* Use this score for informed decision-making at both a local and national level.
The solution focuses on how community awareness could become actionable and generate value. It doesn’t stop at spreading awareness, but goes beyond to actively involve the community in preventing disease spread.
The second part is setting up a hotline or a website – specific to water supply management, that could be used to report any damage to the water supply pipes, etc., that serves as a caution or warning system to alert people of contamination and advise them against using that supply till it is repaired. The website could also detail the measurement of common water pollutant levels for public knowledge. Involving the people of the community and gradually expanding from there is in alignment with the One Health approach.
A future ideal would be to study the context in which the disease is located – the environment, cultural practices, economic activities – that affect the disease and its transmission. This will help come up with a solution that truly respects the dwellers of the region – human and otherwise. Water is indeed life; it has shaped the earth as we know it. It is the duty of the inhabitants to protect it and care for it; water is the soul of the Earth, after all.
Niranjani Adikessavane, Aishwarya Menon, Arvind Kumar are BTech students at Plaksha University, Mohali.
