Environmental Health pptx

well organized notes on environmental health

1. MODULE: ENVIRONMENTAL HEALTH MR ABDI MOHAMED

2. MODULE UNITS Q1. Discuss pollution under the following sub headings Define pollution Types of pollution Causes of pollution Effects of pollution Prevention and control NB: Group Assignment

3. Unit 1. Concepts of environmental health Learning Outcome The student will acquire knowledge on environmental health, develop skills and attitudes to enable her promote health and prevent illness in the individual, family and community through effective environmental management

4. Specific Objectives Describe environmental health Describe components of environmental health Discuss environmental impact assessment Describe safe water system Discuss environmental sanitation Discuss methods of waste disposal Discuss food safety and hygiene Discuss common food borne diseases Discuss housing and health

5. ENVIRONMENTAL HEALTH The environment is an important part of the overall picture of human life and behavior. Within the environment are many influences – biological, physical, social and economic - all of which have a bearing on how people live and behave

6. ENVIRONMENTAL MEALTH CONT… In turn, the way people live and behave can determine the diseases from which they may suffer. All the environmental influences interact with each other

7. DO YOU THINK THERE IS ANYTHING WRONG WITH THE ENVIRONMENT WE LIVE IN TODAY?

8. ENVIRONMENTAL HEALTH DEF OF ENVIRONMENT Is a the collective term used to describe all the living and non living things that make up our surroundings . Sum total of our surrounding to include physical , biological, socio-cultural, economic and political systems The multiple interactions between people and their environment is called ecology .

9. DEF OF HEALTH Health, according to the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity .

10. Pollution an undesirable change that can adversely affect humans or other living organisms The 2 main types of pollutants are Biodegradable pollution is those which are decomposed by natural biological agents. Non- biodegradable pollutants that do not decompose

11. Biodiversity I s the number of different species present in one specific ecosystem

12. Environmental health Environmental health may be defined also as “the theory and practice of assessing, correcting, controlling and preventing factors in the environment” that negatively affect health

13. Environmental Health Engineering Means modification and enhancing the quality of the environment to promote health. Involves:- Protection of people from the effect of adverse environmental factors The protection of the environment from the potentially causing harm of human activities. The improvement of environmental quality for human health and well-being

14. Why Nurses Are Involved With Environmental Health Nurses provide healing and safe environments for people. Nurses are trusted sources of information . Nurses are the largest healthcare occupation. Nurses work with persons from a variety of cultures. Nurses effect decisions in their own homes, work settings , and communities.

15. Cont.. 6. Nurses are good sources of information for policy makers . 7. Nurses translate scientific health literature to make it understandable . 8. Nurses with advanced degrees are engaged in research about the environment and health. 9. Health organizations recognize nurses’ roles in environmental health

16. Principles Of Environmental Health For Nursing Nurses have a right to work in an environment that is safe and healthy . Knowledge of environmental health concepts is essential to nursing practice Approaches to promoting a healthy environment reflect a respect for the diverse values, beliefs, cultures, and circumstances of patients and their families. Nurses participate in assessing the quality of the environment in which they practice and live

17. Principles Of Environmental Health cont.. Nurses participate in research of best practices that promote a safe and healthy environment. Nurses must be supported in advocating for and implementing environmental health principles in nursing practice

18. ENVIRONMENTAL COMPONENTS. Biological environment Physical environment Socio-cultural environment Economic and Political environment

19. Biological Environment Refers to living things part of the environment Include plants , people and animals .

20. Plants and influence on health Vegetation prevents soil erosion thus protects water sources .... Trees act as windbreakers, provide firewood, charcoal, timber and paper, influence weather patterns. Flowers are a natural beauty Plants provide vegetables, fruits, tubers and seeds as food .

21. Plants and influence on health cont........ As herbal medicine; muarobaine for malaria, Garlic for hypertension, aloe vera for prevention of cancer of the stomach and healing of wounds. Some plants may adversely affect health; pollen grains leading to hay fever or asthma in allergic pple Some plants are poisonous eg cactus

22. PEOPLE AND INFLUENCE ON HEALTH These influences arise from activities of man Urbanization can lead to overcrowding and slum settlements ; promote the transmission diseases that are spread through droplets and contact . Explosions from quarries; noise n dust-causes respiratory, eye problems n ear problems.

23. PEOPLE AND INFLUENCE ON HEALTH cont... Quarries collect water and become breeding sites for mosquitoes and risky places for children . Felling of trees to provide firewood and charcoal but, destroys the water sources . Cultivating along riverbanks may contaminate the water supply through seepage of the fertilizers and pesticides Overgrazing causes soil erosion, destroys vegetation and contaminates water sources

24. ANIMALS AND INFLUENCE ON HEALTH Domestic animals source of meat, milk, hides, wool, manure, Wildlife is often a tourist attraction Cats and dogs are kept as pets, but they can also transmit diseases such rabies Other hazards include snake and insect bites leading to.... Houseflies are vectors of dysentery and other diarrhoeal diseases. Bacteria, rickettsia and fungi are disease-causing organisms in man

25. PHYSICAL ENVIRONMENT Non living part of the environment. The physical components of the environment are divided into; Geographical and Man-made components.

26. The physical agents Levels of noise Levels of heat and humidity Levels of dust Vibration Electricity or lighting ƒ Radiation

27. Physical environment cont… Land is used for settlements , agriculture Fertile vs infertile land n effects….. The type of soil , climate and altitude determine the type of crops grown Cold climates encourage respiratory diseases and joint problems Warm climates associated with malaria . Snakes are also common in hot areas

28. Physical environment cont… Disease outbreaks for cholera, typhoid common in rainy seasons Dry seasons -- shortage of food-- malnutrition . Weather pattern Influence clothing . Dams constructed source of vectors Industrial wastes that consist of chemicals and toxic substances, may pollute environment.

29. Socio-Cultural Environment Refers to peoples traditions, beliefs, ways of life in general

30. Socio-Cultural Environment Affects food habits and cooking practices..staple food among different tribes Food taboos –restrictions in taking food..health effects Wife inheritance and polygamy practices - spreading STI and HIV/AIDS. Tattoos performed for beautification Circumcision rites of passage... neg n pos effects Female genital mutilation can lead to difficult deliveries. Some people discourage breast-feeding Use of prenatal and delivery services. ...

31. ECONOMIC AND POLITICAL COMPONENTS These components include work , money and government . Irrigation schemes for growing rice.. income/ disease People of low economic status...reduced affordability to health care, access to food The rich prone to life style diseases.. obesity , gout , hypertension ... Government develop policies.... Gvts implement and enforce laws. Political instability causes unrest , insecurity and psychological problems.

32. ENVIRONMENTAL IMPACT ASSESSMENT(EIAs) Is the study of the effects of a proposed action on the environment( i.e physical, biological, economical environments) Its is based on predictions of the possible impacts as result of the proposed action

33. Principles of EIA Accountability ; project officers, gvt and other stakeholder are held accountable for the information and decisions they make Community participation ; adopts open participatory appproach GOAL To ensure that the environment impacts are accounted for by the key decision makers throughout the entire life cycle of the project

34. Objectives of EIA Identify significant impacts of a project Predict the extent of environmental changes as a result of the project Present information on the impact of alternative dvpt project plan Propose appropriate mitigating measures Generate baseline data for M&E mitigation measures

35. Common limitations of EIAs in developing nations Lack of guidelines and procedures for preparing EIAs Inadequate funds and human resources No legal requirements to conduct EIAs Lack of environmental standards Weak enforcement of existing environmental standards Absence of EIAs legislation to ensure that policy statements are implemented

36. Screening in EIA Is the process of determining whether or not a proposal requires detailed environmental assessment. Entails carrying out initial environmental examination to allow categorization of the proposed project.

37. Categories of projects for EIAs Category 1 projects ; are project anticipated to have significant multifaceted environmental impacts. Impacts could affect human health, incr polution , adversely affect endangered species. They require a full EIA study Include industrial project e.g mining/ maufacturing firms and agric firms like mega dams/airport/sewer lines

38. Categories of projects for EIAs cont’d Category 11 projects; hv a potential for narrower environmental impacts. Can be controlled by applying scientific measures or changes in project design. Requires partial EIAs Industries and infrastructure…road rehab/power transm lines; small scale irrigation Category 111 projects; are not anticipated to result in adverse environmental impacts; EIAs are often unnecessary. Include educational prog , nutritional prog / family planning

39. WATER AND SANITATION By the end of this section the learner will be able to: Describe the importance of water in relation to health Explain different types of waste Describe various methods of waste disposal

40. WATER Water is essential for life. It is found in every cell in our body Is necessary for most basic functions of the body. More than 50% of human body weight is made up of water. Water is thus vital to health and survival Can be a source of diseases, should be properly treated and made safe for domestic use.

41. USES/PURPOSES OF WATER Human consumption for body needs e.g... Agricultural purposes; Animal watering, irrigation, sustaining of aquatic life Industrial purposes; manufacturing industries like the iron..and hydroelectric generation need a lot of water Public purposes; recreational activities such as swimming, fire fighting, public cleanliness Household/domestic purposes like washing, drinking, cooking, personal hygiene, flushing latrines

42. REQUIREMENT OF WATER The consumption depends on; Climatic conditions Standard of livings Habits of individuals Daily consumption of 50 litres per head is considered adequate allowance drinking, bathing, cooking n sanitation(WHO)

43. Potable/Acceptable water Water which is physically, chemically and bacteriologically suitable for drinking Features of potable water Free from harmful chemicals Free from pathogenic agents Pleasant to taste, Colourless Odourless

44. Role Played by Water on the Transmission of Diseases Inadequate water supply; poor sanitation; diseases like scabies, non-specific diarrhoeas, dysentery and trachoma spread. Such diseases are called water-washed (water scarce) diseases. Improving the quantity of water can prevent them.

45. Cont… When it carries a specific disease-causing organism. Examples are typhoid , cholera , amoebiasis , hepatitis A , or poliomyelitis . Such diseases caused by contaminated water are called water-borne diseases, Controlled by improving water quality i.e cleanliness of the water.

46. Cont… When it is necessary in the life cycle of a disease vector , for example malaria and schitosomomiasis . These diseases are called water-related diseases. Other water related diseases include: onchocerciasis (river blindness) and dracunculosis (guinea worm).

47. Summary of water associated disease Type of Disease Cause Example Water- washed Due to lack of adequate water For washing hands ,utensils and vegetables b) For washing face, eyes and body 1.Dysentry 2. Diarrhoea Skin disease Eye disease Water -Borne Due to water containing disease causing organism 1.Typhoid 2.Cholera 3.Amoebiasis 4.Hepatits A Water –related The vector needs water for its life cycle 1.Malaria 2.Schistosomiasis 3.Onchocerciasis

48. SOURCES OF WATER Water does not stay in one place for very long - it goes round in a cycle. It evaporates from seas and lakes and falls back to the earth as rain. After rainfall, some evaporates and others drain into streams, rivers, lakes and ponds. NB........Draw hydrological cycle

49. Cont… The most important water for a community is the water that is held in the soil, by the roots of the trees in the forest. This is a community’s long-term underground water store . Therefore communities need to preserve their forests

50. MAIN SOURCES OF WATER Rain Water , Surface Water , Underground Water And Sea Water .

51. RAIN WATER Main source of all water This water is relatively pure and clean. Chemically very soft Its state of cleanliness depends on levels of atmospheric pollution and how it is collected(sulphuric and nitric acid) Disadvantages ; difficult to collect from thatched roofs, tasteless, does not contain minerals

52. SURFACE WATER Is the commonest source of water Includes shallow springs and shallow wells, streams, rivers, dams, ponds and lakes. A spring is a natural issue/exit of underground water. Water flows freely under natural pressure Water sinks into the ground until it reaches the impermeable layer of rock, which it cannot go through. All the water above this layer is called surface water.

53. Cont… If it finds a point of issue it is called a shallow spring . Shallow springs dry up quickly during dry seasons If a well is dug into it, it is called a shallow well , despite its depth. Water levels vary with season. Liable to contamination by latrines.

54. Cont…. A river is a large mass of flowing water. Turbid during rainy seasons Dry season they are clear. Has a lot of impurities from.. Provide fresh water

55. Cont… The quality of water depends on the location of its sources/catchment . Forest, hills and valleys,..it is clean;no human settlement, thus less polluted Streams, rivers and lakes around or within towns and villages are likely to be contaminated by human and animal waste.

56. Sea Water Is salty Requires expensive purification processes to make it suitable for drinking. In Kenya; Lake Magadi , Lake Bogoria and Lake Elementaita . There are also the salty waters of the Indian Ocean.

57. UNDERGROUND WATER The water that gets under the impermeable layer of rock is called underground water. It is the water between two impermeable layers of rock Finds an outlet through a fissure or crack in the upper layer of the rock. Is obtained as a deep spring, a well or a borehole.

58. Underground Water cont... Wells can be deep or shallow, also can be dug or tube(consists of a pipe(usually galvanized iron) Water plentiful, Less polluted with pathogenic agents Does not normally dry off during dry seasons. This water is usually salty (calcium and magnesium) It also needs to be pumped into tanks or reservoirs before use which is costy

59. Difference btn shallow and deep well Shallow well Deep well 1.Taps the water from above the first impervious layer Taps water from below the first impervious layer 2. Moderately hard Much hard 3.Often grossly contaminated Taps pure water 4. Usually goes dry in summer Provides a source of constant supply

60. MAIN SOURCES OF WATER CONTAMINATION Sewage discharges in water bodies-contain pathogens and decomposing matters Industrial effluent-contain toxic substances such as arsenic materials, sulphur dioxide, carbon dioxide, lead, mercury Agricultural pollutants; fertilizers and pesticides thru seepage and surface run offs Physical pollutants to include heat which cause deoxygenation of water and also cause thermal pollution. Radioactive substances—carcinogenic effects

61. Sources of water contamination cont… Contaminated collecting surfaces Use of dirty containers for drawing water Wells fitted with pumps can be contaminated by oil from the pump. Excreta and refuse may contaminate shallow wells thru surface run offs Bathing, urinating, defecating in water

62. Cont… Piped water may get contaminated from leaks in the pipes. If it is uncovered or stored for too long in a pot or cistern. If it is drunk from dirty or communal drinking vessels

63. INDICATORS OF WATER CONTAMINATION Amt of suspended solids Biochemical oxygen demand at 20 degrees celcius Concentration of chloride, phosphorus, flouride ions

64. WATER ANALYSIS Three main methods applied are; Bacteriological analysis e.g for E. coli indicates contamination wth excreta Chemical analysis…levels of cl -, na +, fl-, nh4-, ca+2; essential elements, h2o hardness Physical analysis of water; a process of determining substances which affect the colour , flavour and colour of water

65. Protection of Water Sources Rain Water Gaseous industrial effluent to be treated before release to atmosphere, Use of clean energy...hydroelectric/wind/solar Use of gutters led by pipes into a small waste drain tank before a clean closed tank.

66. Surface Water Limit settlement and farming activities around springs, streams and rivers. Water catchments areas, should be free of human activities. Springs; Clear the bush around the site of the spring. Put up a fence around the spring. Dig a drain about 15 metres from the spring to divert surface water. Build a strong retaining wall around the 'eyes‘- point from which water flows out from underground

67. Protection of spring cont’d Fix the delivery pipe..easy fetching Build platform on which to place the containers when collecting waters. Design an area for washing and for watering the animals. Select/hire a caretaker to maintain the protected springs.

68. Protecting Wells The site should be at least 100 metres from a pit latrine The sides of the well should be built with stones, rocks, or cement culvert...Seepage A sloping water-proof area around it to avoid dirt from getting into to the well. A strong well cover. NB;The well should be dug during the dry season to obtain adequate depth, filtration and constant water supply.

69. SAFE WATER SYSTEM The safe water system is a household-based water quality intervention in response to the need for inexpensive , alternative means of water treatment and storage in the short to medium terms.

70. SAFE WATER SYSTEM CONT… The intervention has three components: Water treatment in the home Safe storage Behaviour change techniques

71. The main goals of safe water systems To improve the microbial quality of water in the home by means of sustainable technology To reduce morbidity and mortality of diarrhoea diseases related to contaminated water To improve hygienic behaviour related to water use

72. PURIFICATION OF WATER Objective: Remove dissolved and suspended impurities of H2O to make it safe and wholesome.

73. SIMPLE WATER PURIFICATION METHODS Storage; the three –pot system…24 hr period storage in pot 1&2 Storage purify through sedimentation, n death of bacteria. Slowly pour or siphon by a pipe Skhistosomia for example die if water is stored for 48hrs, and many bakteria Pot 3 contain water for drinking; when used/ utized the process begins; washed n may be scalded by hot water Bucket for fetching water POT-2 POT-3 POT- 1

74. At household cont’d Filtration—ceramic candle water filter/ sieve Sterilization- chemical by use of chlorination n iodinisation . 2% iodine tincture; two drops to one litre of water. 1% of chlorine; Minimum contact period of 30 minutes. 3drops to 1L of water Physical through boiling- bring water to ‘rolling boil’ for 15-20min to give sterilized water; Kills spores, bacteria, cysts, ova; Removes temporary hardness of water; Boil in the container in which it is going to be stored; Does not offer protection against subsequent microbial contamination Flat taste due lost of dissoved gases…co2 n o2..and other minerals

75. Qualities water disinfectants Must be capable of destroying pathogens in water Products of disinfection reactions should not make water toxic Available, affordable and easy to use Ability to protect against recontamination, residual value Amenable to detection by practical and rapid analytical method

76. PURIFICATION OF WATER IN LARGE SCALE Method depends on the nature of raw water and desired standard of water quality Under ground water eg water from wells and springs(deep)..just disinfection Surface water e.g river water tend to be more polluted; extensive treatment Water purification system comprises of storage , filtration and disinfection processes

77. 1. STORAGE Storage chambers provides reserve for water, where further contamination is minimised . Water is stored for about 10-14 days Is a natural purification process involving physical, chemical and biological processes. Physical process; 90% of suspended impurities settle by gravity within 24hrs of storage;

78. Storage cont… Chemical process; aerobic bacteria oxidize organic matter present in water reducing level of ammonia in water Biological process; with storage bacterial counts in water drops due to cell death NB: Long period of storage leads to growth of algae which gives water bad smell and colour

79. 2. FILTRATION 2 nd stage of water purification Removes 98-99% of bacteria There are two types of filters(biological/slow sand filters and mechanical/rapid sand filters Biological filters; m ade up of 4main elements. Supernatat /raw water A bed of graded sand An under-drainage system A system of filter control valves

80. A. SUPERNATAT H2O Above sand bed; depth 1-1.5m; water settle for 3-12hrs; water get purified through sedimentation, oxidation B. SAND BED; 1metre thick; rounded sand gravel; supported by a layer of graded gravel; provide a large S/A for mechanical straining, sedimentation, adsorption, oxidation; filtration rate---0.1-0.4m3/hr/m2

81. Cont….. The surface of sand bed after sometime gets covered by a slimy growth known as ‘ schmutzdecke ’ vital layer, zoogleal layer or biological layer The layer is slimy, geletinous consisting of thread-like algae. Primary to functioning of sand bed; it removes organic matter, holds bacteria and oxidises amnionical nitrogen into nitrates thus yielding bacteria free water

82. C. UNDER-DRAINAGE SYSTEM Consist of porous/perforated pipes; for outlet of filtered H2O; form base for filter medium D. Network of valves and devices; maintain control rate of filtration Advantages Simple to construct and operate Cheaper to control and maintain Physical, chemical and bacteriological quality of filtered H2O is very high

83. MECHANICAL/RAPID SAND FILTER Are of 2types; gravity type and pressure type Steps in rapid sand filtration Coagulation ---Raw water Rx with chemical coagulant e.g alum; dose can be 5-40mg/ litre depending on the turbidity, temp and PH of water Rapid mixing- --violent agitation for a few minutes to allow quick and thorough dissemination of alum throughout the water Takes place in the mixing chamber

84. Steps in rapid sand filtration cont… Flocculation ----slow and gentle stirring of Rxd water for about 30min in a flocculation chamber. This process lead to formation of thick copious flocculent of aluminium hydroxide which settle down in the chamber Sedimentation ; the coagulated water is detained in the sedimentation tank for abt 2-6hrs for the flocculent, impurities and bacteria to settle down Filtration –partially clear water is passed through filter beds

85. Advantages of rapid sand filtration Can deal with raw water directly no need for preliminary storage Filter bed take less space Filtration is rapid 40-50 times>slow filtration More flexible in operation Washing of the filters is easier

86. 3. Disinfection Sterilization of water using chlorine or solar disinfection Chlorination is the addition of chlorine to water that has been filtered In form of gas/tablets/liquid forms

87. PRINCIPLES OF CHLORINATION The water should be clear i.e free from turbidity . Chlorine demand to depend on the level of contamination Chlorine should be properly mixed The contact time 30-60min The minimum recommended concentration of free chlorine is 0.5mg/l of water; The amount of chlorine should be proportional to the volume of water.

88. Role of community health nurses in safe water supply Survey/ identify water sources Chlorination of public water supply sources Being observant n report ; pipes damage Educating the public on safe drinking water Advising on proper methods of water storage Advising methods for water disinfection Responding during water borne diseases epidemics; rx / supplyin disinfectants

89.   SANITATION AND WASTE MANAGEMENT Is defined as systematic method of applying physical, chemical, biological and social procedures and measures aimed at controlling environmental factors that promote disease transmission in order to safeguard human health and the general well-being of human beings.

90. COMPONENTS OF SANITATION Practicing personal and food hygiene Safe management of solid and liquid waste Vector control – control of insects and rodents that can spread diseases

91. CONSTRAINTS TO GOOD SANITATION Lack of policy guidelines or poor enforcement Poor community motivation Cultural, beliefs and taboos Poor perception of sanitation Scarcity of resources Lack of data and information Lack of effective collaboration and coordination Flood prone areas Difficulty soil conditions

92. STRATEGIES TO IMPROVE SANITATION Create demand for sanitation services at the community level..benefits of Gud Sani Develop a comprehensive national sanitation policy Mobilize both external and internal resources towards sanitation Strengthen the existing sanitation programs Research to develop locally feasible technology options 4sanitation Raise sanitation profile as a development agenda…mark of dvmt Initiate, strengthen n harmonize existing legislation on sanitation

93. WASTE MANAGEMENT Undertaken in two ways i.e. solid waste mgt and liquid waste mgt Solid waste/refuse Refers to discarded materials or by – products of human activities that are no longer required for further use by the initial producer . Does NOT include nightsoil /excreta

94. Liquid waste Refers to all other wastes in free flowing liquid form i.e. waste water, soil water and excreta Sources: Municipal waste which includes domestic and commercial waste water Industrial waste- from various industrial processes

95. Objectives of solid waste management To prevent and control refuse related diseases To prevent aesthetic problems To prevent obnoxious odors To prevent pollution of soil, water To prevent physical hazards To salvage some materials of economic value..recycle To avoid occupying of space for other useful purposes To create awareness through health education to the people

96. Types/classes of solid waste Based on source Domestic waste Agricultural waste Commercial/trade waste Industrial waste Hospital waste etc

97. DOMESTIC WASTE Refers to all the garbage that emanates from inside a house e.g food leftovers, clothes, shoes, broken utensils, bottles and tins STREET WASTE This type of refuse consists of paper, food and commercial refuse in public places such as markets and hotels. Scrap metals included.

98. INDUSTRIAL WASTE Wastes from industrial processes The wastes may be toxic, caustic, acidic or flammable. Should be processed b4 discharge. HOSPITAL WASTE Generated from hospital related activities Include; Sharps, that is, needles and syringes-incinerate Gauze and cotton wool swabs Vials and Lotions Drugs and vaccines Tubing, gloves and papers Foetuses--- marceration

99. Categories of hospital wastes Clinical wastes..used gloves, bandages, dressing materials---yellow liner bag Pathological wastes; amputation, tooth extracts..red liner bags Sharps; needles , scaples ; sharp boxes/ jerrican General wastes; waste papers black liners Food remains; white liners NB:Highly infectious/infectious/non infectious

100. Garden/Agricultural Waste Agricultural waste from coffee, sugarcane, sisal, pesticides and fertilizers. May result in the pollution of natural resources such as air, food, and water.

101. PRINCIPLES OF WASTE MANAGEMENT Waste segregation/separation Storage Collection Transportation Disposal Recycling/refuse Nb. Considered steps of mgt

102. SOLID WASTE DISPOSAL METHODS Controlled tipping Composting Incineration Crude dumping Barging to sea Recycling Burrying

103. 1. Dumping Is where solid waste is deposited in the sea, river or on low lying areas This becomes a health hazard and the littering is unpleasant sight. 2. Burning For combustible refuse Can take place in Simple open air burning Burning in a trench Using a simple mud-brick incinerator Not effective and pollute environment

104. DISAV Often leaves tins and broken bottles littering the surrounding area can cause accidents, The smoke and odour contribute to air pollution. There is a fire risk Breeding place for rodents and insect vectors

105. INCINERATORS Are an improved way of burning combustible refuse. Example; bin incinerator made out of a drum with fire bars across it and air holes underneath. Others are built out of brick and fitted with chimneys. Allow more complete combustion and produce less smoke. Most hospitals use incinerators

106. 3. COMPOSTING Composting is a process in which aerobic micro-organisms break down organic matter to fairly stable humus. For biodegradable wastes Wet and dry refuse is heaped in alternative layers on to a plot about 2.5 square metres to a depth of about 1.5 square metres. The refuse is then covered with grass and earth.

107. CONT… Compost turning after 30 days then after 60 days. This turning helps to expose all parts of the heap to the high temperature of the interior. After 90 days the refuse is ready to be used as manure Aerobic composting is normally odour free. Is cheap, convenient and recommended in rural agricultural areas.

108. 4. CONTROLLED TIPPING Involves depositing refuse into depressions or large holes in the ground. The method consist of three steps: Deposit refuse Spread and compact refuse Cover it with earth and compact earth cover. These tips should be situated at; least 1/2km away from settlement, Preferably out of sight and down wind. Effective for hygienic disposal of refuse Used where sufficient land is available.

109. 5. Recycling This is a method of re-using non-biodegradable refuse such as bottles, plastics, metal cans.. Requires special processes to render the items suitable for reuse Should be encouraged. 6. Use of manure pits; in rurals

110. Effects of improper refuse disposal It may produce an offensive smell It attracts vectors; particularly flies, cockroaches and rats; Spreads diseases It can cause pollution of air, water or food It can cause accidents e.g fires, cuts and falls

111. LIQUID WASTE/WASTE WATER Refers to all wastes in free flowing liquid form i.e. waste water and soil water Objectives of waste water treatment To kill pathogenic organisms, ova and cysts To reduce pollution effects of effluent To render obnoxious materials harmless Recovery of useful by-products e.g. dry sludge can be used as fertilizers, effluent for irrigation. To reduce cost of treatment of water supply To avoid nuisance

112. Effects of discharging untreated wastewaters into water body Reduction of dissolved oxygen (DO) levels may cause death of aquatic life. Setting up septic conditions; health hazards Loss of social amenities e.g . swimming pool Reduce self-purification capacity of the H2O Promote excessive growth of aquatic life. Aesthetically objectionable – bad odours

113. Human excreta Disposal In rural areas is a pit latrine, while toilets are suitable for urban areas. WHY DISPOSE EXCRETA PROPERLY To prevent gastro-enteric disease and parasites To reduce fly and other vermin Ro reduce smell nuisance To protect water from contamination To prevent soil from contamination To reduce unsightliness To improve hygiene and promote health To promote sense of cleanliness

114. Factors affecting sanitary disposal of human excreta Knowledge on health danger posed by human excreta Affordability of the disposal system Socio-cultural practices…poor Attitude of community members Hydro-geological conditions of an area..h2o table Availabilities of practicable technologies

115. THE EXCRETA DISPOSAL SYSTEMS Water carriage system Non-water carriage system .

116. WATER CARRIAGE SYSTEM Excreta are disposed by the use of a flush toilet, which is also called a water closet. The flush toilet is the most permanent and hygienic method of excreta disposal. Used where there is a permanent, continuous and adequate piped water supply system. The excreta are carried by water pressure into a septic tank or sewer line

117. SEWERAGE TREATMENT Is based on biological principle. Purification is achieved through the action of anaerobic, aerobic bacteria n facultative anaerobes Conventional stages in sewage treatment include preliminary treatment, primary treatment(sedimentation), secondary rx , and tertiary rx

118. Preliminary treatment Main aim is to protect the treatment works/systems Involves removal of materials such as grease , grit n logs which may hamper the system Screening ; sewage arriving passes thru network of screens to remove large floating objects e.g logs, boulders; prevent clogging of treatment plant Sewage is then passed thru grit chamber to remove sand and gravel

119. Primary treatment Aims to remove settleable solids Sewage is moved to primary sedimentation tank, where its retained for 6-8hrs. To remove solids which settle under gravity and coliform organisms

120. Secondary treatment Is the treatment of effluent from primary sedimentation tank which still contain a lot of micro-organism; this effluent has high oxygen demand; it is subjected to aerobic oxidation in the aeration tank for 6-8hrs thru mechanical agitation; organic matter is oxidised into NO3.CO2, H2O with the help of aerobic bacteria in the sewage

121. Secondary rx cont’d The effluent is moved to secondary sedimentation tank; where oxidised sludge settle for 2-3hrs to form sludge; the liquid part is moved to the last tank awaiting discharge Sometimes for highly polluted waste water there is tertiary tx ….disinfection process.. chlorination

122. Fate of Sludge(by-product) Digestion ; Aerated sludge process Drying n incineration Burying Discharge into existing sewage works Recycle fertilizer

123. Tests before treated wastewater is discharged Biochemical oxygen demand…level of contamination wth microorganism Chemical oxygen demand…organic contamination e.g with petroleum products

124. NON-WATER CARRIAGE/ CONSERVANCY SYSTEM. Is where excreta is disposed minus use of water e.g in a pit latrine. In its simplest form, the pit latrine consists of the following: A hole in the ground A squatting place for sitting or standing A hut or shelter for privacy/superstructure

125. The main advantages of a pit latrine It does not require piped water supply It is cheap to construct as materials can be locally sourced Employ simple technology in construction Easy to use

126. Guidelines for constructing pit latrines Pit latrines and cesspools(underground hole or container for holding liquid waste) should be at least 2m and 3m respectively above the water table. Latrines should be located at least six metres away from the buildings

127. Guideline cont… Wells should be located upstream to avoid contamination of the well by ground water passing through the pit latrine or cesspool... atleast 15m away frm water source if on th same or below and >30m if above th source

128. Types of pit latrine The borehole latrine- a hole is bored into the ground about six metres deep and four metres in diameter instead of digging a pit. Faster to install Appropriate following disasters where there is urgent need to install many latrines. Has a smaller volume. Fills up faster than a pit.

129. The trench latrine Is a latrine where a trench is dug and a number of holes with dividing partitions constructed over it. These types of latrines are used in temporary work camps.

130. Bucket latrines Are also known as pail closets and are used where the water tables are high. A squatting slab or seat is placed above the bucket, which is filled within a few days. DISADV ; The unpleasant job of emptying it and the spillage, which attracts flies. Composting pit latrine Is suitable where the water table is too high for a deep pit latrine to be dug.

131. ASSIGNMENT 1. Make short notes on ventilated improved pit latrines Definition Features Advantages Disadvantages

132. FOOD SAFETY AND HYGIENE Objectives By the end of this section you will be able to: Describe the sources of food Describe methods of food storage Describe preparation and preservation of food

133. INTRODUCTION Food is essential for growth, development and in the provision of energy. The aim of food hygiene is to prevent the contamination of food at any stage processing. These stages are production , collection , storage , sale , preparation and consumption .

134. SOURCES OF FOOD Reared animals( meat,eggs , milk) Buying from markets, Crop production. NB: Should be safe and free from contamination

135. FOOD STORAGE Depends on the type and packaging of the food. Dry Foods; include maize, beans, and wheat (cereals). Should be stored in dry , airy conditions in improved granaries Bagged Foods; s hould be stored on raised shelves at least 45cm above the ground level. For easy cleaning. Easy inspection for pest detection. Prevention of dampness

136. Food storage kont,d PERISHABLE FOODS These are foods that go bad within a short time. Include dairy products, meat and fish. Should be refrigerated to inhibit the multiplication of bacteria

137. FOOD PRESERVATION Refers to treating food for the purpose of prolonging its life without appreciable loss of its quality and appeal . REASONS FOR PREVERVING FOOD Increase its shelf-life, for example, canned foods Render the food safe for consumption i.e highly perishable foods like milk Conserve the food for use during the periods of scarcity. Avail seasonal foods, like fruits, throughout the year

138. PRINCIPLES OF FOOD PRESERVATION By Destroying/killing organisms causn spoilage through heat treatment . By Inhibiting the micro-organisms through cold treatment . AGENTS CAUSING FOOD SPOILAGE Moulds :Affect foods containing high sugar and salt and damp ones Yeasts; Affect foods that have acid or sugar in high concentration e.g dried fruits, and concentrated fruit juices. Bacteria ; Affect foods under various conditions apart from dry food Enzymes in food substance

139. METHODS OF FOOD PRESERVATION 1. Heat Treatment Are methods which destroy organisms causing food spoilage. Cooking Blanching Pasteurisation Sterilization Canning

140. Cooking Cooking destroys or reduces micro-organisms and potential toxins in food. Cooked food stays longer than raw foods as long as re-contamination is minimised. Cooking also inactivates undesirable enzymes in food. May cause loss of nutrients e.g over cooking vegetables destroys vitamin C.

141. Blanching This is the process where vegetable foods are heated at temperatures of 70 - 100°C for 2 - 10 minutes while immersed boiling water or exposed to steam. This process inactivates enzymes, drives out air bubbles trapped in food, enhances retention of green colours and reduces micro-organisms. Blanching is used before freezing, canning or drying.

142. Pasteurisation Carried out by heating food (milk)at a temperature of below 100°C; kills organisms that cause spoilage A relatively slow method of heat treatment. Sterilisation Heat is used to kill all micro-organisms and their spores at a temperature of above 100°C . Sterilised food is stored in an airtight container to prevent recontamination .

143. Canning Food is first heated at a temperature that kills all bacteria and it is then sealed up in sterile cans or bottles. Sealing prevents bacteria re entering. For nuts and fruits

144. Cold Treatment Methods Freezing: Food must be deep-frozen at 0-4°C to remain palatable. When properly done, food retains the colour, texture, flavour and nutritive value.

145. Salting This is the saturation of food with salt or sugar, for example, ham, jam and jelly. The added solute reduces microbial activity due to its dehydrating effect. Smoking and Drying Drying and smoking makes food unsuitable for the bacteria to grow and multiply. The heat will dry the fish or meat Smoke gets inside the food to act as a preservative Fish or meat may be preserved by these methods. 3.Preservation by preservatives e.g salts, vinegar, benzoic acid

146. FOOD SAFETY ASPECTS Food handlers Adequate personal hygiene Should be healthy; not suffering frm RTI/ typhoid/ dysentry /skin eruption/cuts Wear clean washable outer garments/aprons Head Covering Wash hands before handling the food Nails should be kept short and clean.

147. Food Clean vegetables before preparation for cooking. Fruits should be washed before eating. Utensils be cleaned after use and left to dry before being stored Environment Be dust free; floors and all the surfaces used for food preparation. The facility be clean With adequate ventilation and lighting .

148. Common Food Borne Diseases and Their Causes Diseases Causes Illness affecting mental function Some naturally poisonuos plants Poisoning Chemical such as lead, Arsenic Ascariasis Taeniasis Amoebiasis Parasites such as Ascaris lumbrecoides Taenia Solium / Sagnata Entamoeba histolytica

149. CONT… Typhoid fever Salmonnella Typhi Para typhoid fever Salmonalle Para typhi Food poisoning Salmonella typhinunium Baccilliary Dysentry Shigella Milliary Tuberculosis Bovine Tubercullosis Brucelosis Cholera Brucella vibrio

150. FOOD SAFETY REGULATIONS The safety of food is governed by Kenya Public Health Act cap 242 Is an Act of Parliament to make provision for securing and maintaining health. This act is divided into 15 parts. Each part deals with a specific aspect of public health Health officers e.g PHOs are generally responsible for enforcing these laws. Agricultural personnel assist them, where necessary.

151. CONT… Part X of the Act deals 'with protection of foodstuffs'. This part regulates the construction of buildings used for storage of foodstuffs. It prohibits residing or sleeping in kitchens or food stores . Part (XI) deals with 'milk, meat and other articles of food'. This part prohibits the sale of unwholesome foods. It gives powers to authorised officers to inspect and examine food, seize and recommend disposal at any time.

152. AREAS THAT NEED CLOSE SUPERVISION. Slaughterhouses and butcheries..hygiene/ butcher health status/healthy animals Diaries and shops where milk is sold.. hygiene, expiry date, integrity of the packets, storage. Healthy cows/ tb bovine FARMS; acceptable fertilizers/ pesticides; harvet when crops are fully ripe to ease preservation Markets : should have different stations for different types of food; clean and proper refuse disposal; PHOs have the power to close markets and condemn foods to prevent disease outbreaks

153. Hotels Be inspected under hygiene regulations . Regular medical examination of food handlers Meet Licensing requirements. Laboratory examinations may be necessary for food such as pre-cooked meat. The use of uniforms, aprons, head coverings be observed in the hotels.

154. HOUSING By the end of this section you will be able to: Describe the types of houses Describe the criteria for an adequate house Describe a suitable building site Describe the characteristics of poor housing Describe how you would involve the community in improving housing

155. Introduction The provision of good housing is an essential aspect of environmental health. Good housing is a requirement for every human being. Good housing provides shelter and protection from environmental hazards.

156. Types of Housing A house can be permanent, semi-permanent or temporary. Permanent Houses Has a stone foundation, a cemented floor and plastered walls. Roofed with iron sheets, tiles or stones in the case of flats or maisonettes. Easy to keep the floor and walls clean . Floor be dry to avoid accidental falls Not cheap to construct

157. Semi-Permanent Houses This is a type of house whereby the floor is usually cemented but does not necessarily have a stone foundation. The walls are made of iron sheets or sometimes timber. The house is iron roofed. It is satisfactory and easy to keep clean. In some cases mud bricks are used

158. Temporary Houses The floor is earthen, the walls are made of cardboard, polythene paper, grass or mud. The roof is thatched with the same material as the walls. Does not provide for privacy Can easily catch fire. Are a health hazard

159. Criteria for an Adequate House A good house should meet biological, physical and social criteria. 1. Biological Criteria Good housing should minimise the risk of transmission of diseases. The criteria is met thru; Good water supply Good food storage, preservation and preparation Adequate facilities for washing utensils Adequate methods of refuse disposal

160. 2. Physical Criteria The house should be safe for every occupant i.e home accidents are minimised. 3. Social Criteria Good housing should be designed to enable the family function effectively in regard to its cultural background i.e required privacy for adults should be catered for. It should have a suitable setting for bringing up children.

161. Characteristics of Adequate Housing Presence of Natural light ; the sun provides natural light; for physical growth, proper vision, Killn some micro-organisms n keepn away some insects. Artificial Lighting... for night vision; sources are electricity, oil lamps and gas. Proper Ventilation Ventilation is the removal of impure air and pouring in pure air. Achieved through windows, door (natural ventilators) and artificial ventilators Adequate rooms ; provide separate accommodation for adults and children; for animals; food storage

162. Characteristics of good housing cont… Permanent house; cemented floors/stone F Adequate and reliable water supply Good latrine and a clean compound. Proper methods of refuse disposal Satisfactory cooking arrangements

163. Qualities of a Suitable Building Sites The soil should be firm The site should be dry, sunny and exposed to free air. The surroundings should be hygienic Be away from noisy factories, cinema halls and heavy traffic. It should be on high ground for good drainage

164. Characteristics of Poor Housing A poor house does not protect its inhabitants from environmental hazards. Characteristics Dampness due to poor drainage. Overcrowded Earthen floors and walls; encourage breeding of fleas and bed bugs Unscreened windows; encourage entry of mosquitoes.

165. Characteristics of poor housing cont… Unprotected fire places- home accidents  Water supply and storage poor Poor storage of clean utensils Poor personal hygiene in the preparation and serving of food. Lack a good latrine Compounds with tall grass, pools of water

166. Community involvement in improving housing; steps Meeting the Health Team Members. To explain the need for community involvement...outbreak of diseases Deliberation on the need for community sensitisation Identifyin ways of improving housing in the community. Team members include PHO/CHN/

167. Steps cont… 2. Sharing Health Messages Daily at the Health Facility about Improving Housing 3. Meeting the Community Leaders to deliberate on need for improving housing; both formal and informal community leaders Assist them identify and suggest ways of improvement. Guide them on the techniques of carrying out the health activities. Use clinical records to confirm the health problem and the need for community involvement

168. 4. Identifying Ways of Improvement Select the best alternative for improving housing. Plan and organise their resources, that is, manpower, money, materials, and time to carry out the selected activities. e.g Provision of outreach clinic services. ..to mobilize and share health messages

169. 5. Implementation Inspect the houses to identify areas which need improvement. Organise school health service ; shared messages passed to parents Conducts regular supervisory visits to families and communities Mobilize resources Initiate and sustain advocacy

170. 6. Evaluation of Housing Activities To Determine level of community participation and impact of health activities...conduct special surveys, determine number of home accidents, A period of about six months would be appropriate

171. Control of Vectors and Pests Objectives Describe diseases associated with vectors and pests Describe methods of control of vectors and pests Describe how you will involve the community in the control process

172. Diseases Associated With Vectors A vector is an organism, usually an insect, which transmits a pathogen from a source of infection to a susceptible host.

173.   Ways a vector may transmit pathogens. 1. Mechanical Transmission Is where the vector carries the infective pathogen or agent on its body or limbs . Or Ingestion of infective agent by the vector and excreted unchanged in its faeces where it causes contamination e.g housefly

174. 2. Biological Transmission The vector acquires the infective agent from the blood or skin tissue of the infected host and the infective organism undergoes some development in the vector. The infective vector then inoculates the infective agent from its salivary secretion into a new host to cause disease e.g mosquito and malaria

175. Ways continued 3. Contamination of Skin or Mucous Membranes of the host with infective feaces of the vector e.g in louse borne relapsing fever 4. Ingestion The host may acquire infection by ingesting the vector, for example, guinea worm.

176. Pest-Related Diseases A pest is an organism, which in a given circumstance (when numerous) adversely affects human health or the economy. Rats and mice are pests and they belong to a group of animals called rodents. Insects such as white ants, weevils, aphids are also pests. Pests have to be numerous in order to cause a serious problem

177. Vectors and Pest Control Measures Personal Hygiene Hand washing Daily births Short and clean nails Wearing of shoes ; jiggers and hookworms . The hair should be kept short and clean ...lice The use of shampoo; head lice. Clothing washed and ironed at least weekly Bedding cleaned weekly and dried in the sun

178. Proper Food handling Food stores, cupboards and tables should be kept clean... Cockroaches n rats All foodstuffs be covered to prevent flies All food utensils kept clean and dry. Environmental Hygiene Ensure proper water drainage to destroy all mosquito-breeding sites. All receptacles likely to retain water, properly disposed of. Canalise slow moving streams Clear bushes Roof gutters cleaned  

179. Improved Housing  Floors and Walls should be cemented The floors should be cleaned after meals. Crevices and cracks in the walls be plastered Beds and Other Furniture- regularly taken outside in the sun to kill any lice, mites and bed bugs. Joineries of furniture with cracks and crevices should be filled up with plastic wood filler

180. Buildings and Food Stores Be Rat proof Be mosquito proof, with wire gauze to cover all ventilation openings e.g windows Regular inspection of buidings for pests . Use of Chemical Substances such as Pesticides and Insecticides The floors and walls of houses be treated with insecticides regularly. Mattresses and bedsteads can be treated Heavily infested buildings be treated with residual insecticidal sprays. Kerosene to kill bed bugs and white ants Insecticides and larvicides sprayed on the water surface to kill insects in water

181. Community Involvement CHN and other health workers have to share health messages with community members to facilitates community participation in keeping their environment free of pests and rodents. Ensuring clean environment

182. Unit2: O cc upational health & safety

183. Specific Objectives Introduce OH; hx , epide oh problems Describe possible effects of work on health Describe concepts of occupational health Describe the aims, objectives, rationale of occupational health services Describe occupational health hazards and their management Outline characteristics of OD Describe the concept of OHN Describe the roles and functions of an occupational health nurse  Outline advantages of occupational health care

184. 1/9/2022 Occupational Health Services. ENdirangu 2006 188 What are OHS?

185. Workers spent 1/3 of days in the workplace; 2/3 at home Working envn can expose to health hazards; injuries, respiratory diseases, cancer, musculoskeletal ets … Workplace fatalities, injuries and illnesses remain at unacceptably high levels. Lead to economic loss amounting to 4–5% of GDP WHO estimates that there are only 10-15% of workers who have access to a basic standard of occupational health services. T1:INTRODUCTION

186. Intro kont’d Occupational health and safety issues are anchored in the ministry of Labour, department of Occupational Health and Safety The factories Act Cap 514 came into operational on 1st September 1951. The Act focuses on sanitation of the factory, safety devices, machine maintenance, safety precautions in case of fire, gas explosions, electrical faults, provisions of protective equipment et….

187. Intro kont’d It also provides for registration factories and other workplaces by the Department of Occupational Health and Safety In the year 2013 data indicates; that mining, construction and transport accounts for 41% of accidents in Kenya, machine operators and assemblers 28% other occupations share 31% of workplace accidents.

188. Intro kont’ In relation to age groups 44.4% of the injuries occurred in the age group of 20 to 29 years, 25% to the age group of 30 to 39 years and 24% to the age group below 20 years. Most of the reported accidents are those seeking compensation under the Workman’s Compensation Act.

189. T2: Hxkal background of OH The first OHS were started by large companies for workers in dangerous jobs such as mining, large tea farms or factories. Then it was referred to as industrial medical services, later industrial hygiene then occupational health Was concerned with the treatment and prevention of injuries and special diseases, for workers in mines and factories. Gradually it has broadened to cover workers in all occupations including: Agriculture Transport Commerce ets ....

190. CONCEPTS OF OCCUPATIONAL HEALTH SERVICES 1. OCCUPATIONAL HEALTH --is defined as the physical, mental and social well being of a person in relation to their work and working environment, as well as their adjustment to work and the adjustment of work to them. ILO/WHO (1950) defined occupational health as “The highest degree of physical, mental and social well-being of workers in all occupations.” Workers require special health services The care offered includes promotive , preventive , curative, rehabilitative services

191. 1/9/2022 195 Concepts kont’d 2. Occupational diseases Is a disease having a specific or a strong relation to occupation generally with only one causal agent and recognized as such e.g. occupational dermatitis and respiratory anthrax, silicosis, lead poisoning.

192. 1/9/2022 196 Concepts kont’d 3. Work-related diseases Is a disease considered to have multiple causal agents, and factors in the work environment could be one of them…depression, psychosomatic disorders, HTN, KHD 4. Diseases aggravated by working conditions Without causal relationship with work but which may be aggravated by occupational hazards to health; bronchial asthma vs dust exposure; kidney disease vs mercury exposure

193. 4. O CC UPATIONAL A CC IDENTS Is an unexpected and unplanned occurrence, which can lead to bodily injury in occupational setting Situations in which accidents occur generally can be foreseen. Many accidents can be prevented, before they occur. 5. O CC UPATIONAL ENVIRONMENT Is the combined effects of external conditions and influences which prevail at the place of work and have a bearing on the health of the working population.

194. 6. Ergonomics Is the field of study which deals with fitting/ matching the job to the worker e.g work layout, machine designs, to achieve greater efficiency of man and machine Workers placed in jobs they are best suited for

195. 8. Occupational health team Include environmental hygienist, occupational nurse, physician, safety supervisor, employer, workers representatives 9. Occupational health hazards Those harmful condition, material, in the work place which can have harmful effects on the health of workers 10. Accident is a sudden event that result injury, damage or misfortune

196. T3:Effect of Work on People’s Health Can have both negative and positive effects on people’s health. Q1. State positive effects of work on health workers Negative effects of work to health Physical Injuries Poor handling tools and machine leading to cuts crushing injuries; physical injuries can also be sustained from fumes, dust, noise and extreme temperatures. Chemical Injuries Risk of poisoning from chemicals, for example pesticides; corrosive effects, suffocation carbon monoxide

197. Effects kont’d Diseases Infections, for example, anthrax due to poor handling of animals or animal products. Other diseases like cancer may result from exposure to toxic substances. Emotional Injuries Stress related effects from work environment or people; psychosomatic disorders

198. Characteristics of Occup Dis Many of the symptoms and signs of OD do not differ from the same diseases when they occur as a result of a non-occupational etiology, (Asthma, Lung Cancer). Many times there is no good dose – response relationship. Some prone/susceptible individuals will already react to low levels of exposure.

199. Characteristics of OD ( cont ’ d ) 3. Many of OD have a (very) long latency period exposure latency clinical signs (early) 4. Recall bias – patients / workers tend to “ blame ” only recent exposure(s) as casually related to their symptoms.

200. Characteristics of OD ( cont ’ d ) 5. Workers are exposed to many simultaneous and sequential exposures in their working career. Which one should be “ blamed ” ? 6. As a rule, only a small proportion of the exposed group develop a clinical disease.

201. Characteristics of OD ( cont ’ d ) 6. Sometimes occupational and non occupational factors interact in the complex, multi factorial, in the etiology of the concerned disease. DM + vibration white finger(raynaud syndrome)

202. Characteristics of OD ( cont ’ d ) 7.Industrial processes and materials change constantly, it is very hard to keep record of all materials in use. New chemicals are introduces daily. 8. No good epidemiological or toxicological data for many occupational related diseases and exposures. 9. Affected by confounders – smoking, alcohol, diabetes.

203. Importance of early recognizing OD Some OD are “ pathognomonic ” to specific exposures: Asbestos mesothelioma (signal tumor) When diagnosed early in a particular individual from a group, intervening early and protecting the rest possbl . Persons diagnosed with OD are, usually, entitled for workmen ’ s compensation. To allow for investigation on cause- effect relationship

204. T4: Occupational health care Actors involve in occupational health programmes The health team Employers The employees The community’s formal and informal leaders

205. AREAS OF FOCUS IN OHS The effect that work may have on health that is in causing injury or disease The effect that injury or disease may have on ability to work The effect of hazardous industrial fumes or toxic wastes, which pollute the air, sewers and rivers.

206. Aims of Occupational Health Services The promotion and maintenance of the highest degree of physical, mental and social well being in all occupations. The protection of workers in their employment from risk resulting from factors adverse to health. The placing and maintenance of the worker in an occupational environment adapted to their physiological abilities

207. The group (workers) conveniently cared for at a single service point. At work, healthy people can be exposed to health risks. The work sites sometime are in isolated areas where no other health services are available. To easily identify and prevent sickness caused by certain occupations. Illness among workers creates a loss to both individual and national productivity. Rationale for occupational health services

208. Principles of OH Health education n community participation Prevention of health hazards from the source Team work; dr , nurse, employer, employees/ across sectors Equity; no discrimination on gender, collar of the job Accessibility; in plant services n off plant facilities Affordability; services should be within reach financially; use of simple technology

209. Objectives of Occupational Health Services There are three main objectives which occupational health services are set to address. These are: Primary Prevention Secondary Prevention Tertiary Prevention NB: Same with measures for prevention and kontrol of O hazards

210. a. Primary Prevention In OH PP refers to anticipating problems and trying to avoid them before they occur. Reducing the risk of the disease or injury occurrence Primary preventions activities in OHN include: Good construction of machines and buildings. Training of the workforce on how to work with machines. Proper utilisation of protective, safety equipment and clothing.

211. PP in OH kont’d Good personal hygiene and health. Adequate rest when working with machines Substituting more toxic material with less toxic; zinc-based paints instead of lead-based paints Enclosure or special ventilation to equipment or industrial process which release hazardous substances

212. PP in OH kont’d Accidents from toxic gases e.g , carbon monoxide; Gas detection warning systems be installed. Oxygen cylinders availed, preferably in the supervisor’s office. Risk of liquid or chemical burns; plunge baths or showers should be sited alongside the working area. Deployment of vulnerable groups, such as the elderly, hypertensives , diabetics, or epileptics away from areas where they can easily injure themselves.

213. PP kont’d The workplace should have employees who are ; trained in first aid and are familiar with the treatment of such illnesses; A first-aid box stocked and assigned a responsible person. There should be a system in place that ensures immediate treatment of all injuries anticipated at the work place and referral for further management. Through legislation; public health act, factory act

214. PP kont’d Pre- placement medical examination Good record keeping-easily retrievable information on the health of the individual and of groups of workers. Health education n counselling... hand washing Mechanization ; 2reduse human contact to hazardous substances e.g instead of hand mixing of chemicals special devises should b used Controlling dust at points of origin thru wet drilling of rocks, spraying wood with water before sawing Isolation ; dangerous processes done in far from other staffs to avoid unnecessary exposure; or done at night when staffs are few at work place

215. OH MEDICAL EXAMINATIONS There are two main types of medical examinations: Pre-placement examinations Periodic examinations Routine and special surveys

216. Pre-placement Examination This is the medical examination that is done before a person is employed; include workers medical, family, occupational & medical hx ; physical examination/lab n radiological exams; vision testing Objectives of Pre-placement Examination Determine suitability of an employee for a particular job. Detect untreated pathological conditions and 'asymptomatic' disease. Provide a baseline record against which any future findings or routine examinations can be compared.

217. IMPORTAN C E OF PRE-PLA C EMENT EXAMS The results enable OHW to advise the HRD on the suitability of the applicant for the particular job. The applicant is able to discover a medical condition he was unaware of and seek early rx May help to reduce a high labour turnover, absenteeism, injury and illness thus increasing productivity.

218. b. Secondary Prevention Accomplished by identifying health problems before they become clinically apparent n prompt action Entails three types of screening: Screening of employees at risk of a particular hazard.eg measuring blood lead levels in workers exposed to lead Regular screening for non occupational illness during employment..DM, cancer Screening of the working environment to check that recommended preventive measures are put in place by employers, n being used by employees

219. Periodic Medical Examination This is an effective method which enables the occupational health worker to stay informed about the health of individuals and groups, and at the same time detect adverse trends which may be caused by work. Allows for early detection of intoxications and other effects of occupational hazards, for early management.

220. KONT…. Ordinarily workers are examined yearly Also workers returning to work after leave General surveys should be performed at least once every six months. The use of a standardised design format should assist one to capture and cover all the areas of importance

221. c . Tertiary Prevention Tertiary prevention includes the whole spectrum of healthcare from first-aid to treatment and rehabilitation. The main emphasis is placed on first aid in order to minimise complications and disabilities. E.g treating lead poisoning presenting with headache, joint pain, kidney dysfunction by administering chelating agents Assessing workers fitness to return to work.

222. T4:Occupational Hazards An occupational hazard is any condition of a job that can result in illness or injury, a source of danger, a possibility of incurring a loss or misfortune. The types of occupational hazards are categorised according to the agents, which cause the hazard or disease. The categories include: Physical Hazards Chemical Hazards Mechanical Hazards Biological Hazards Psychosocial Hazards

223. 1. Physical Hazards Physical hazards are any hazard associated with a physical harm/injury, Includes exposure to excessive levels of heat, cold, light, noise, vibration and ultra violet light. Hot and Cold The effects of exposure to heat range from burns, heat stroke, and heat cramps, while the effects of exposure to the cold include erthrocyanosis , immersion foot, frost bite,  vasoconstriction and hypothermia.

224. Physical hazard KONT… Light The effects of poor illumination result in eye strain, headache, eye pain, lachrymation congestion around cornea and eye fatigue, and blurring of vision; defective illumination in the mines can lead to miners nystagmus (rapid, involuntary mvt of the eyes); accidents Noise Pollution Auditory effects leading to temporary or permanent loss of hearing. Vibration track drives, miners drilling— pelvic and abdominal congestion. Segmental vibration may produce injuries to joints, elbows and shoulders...numbed hands/ white finger- Raynaud syndrome

225. KONT… Non-ionizing radiations Ultraviolet Radiation This occurs mainly in welding work causing intense conjunctivitis and keratitis (welder flash). Infrared radiation ; in front of furnaces in steel mills, glass industry, black smith; to the eye can cause cataracts; also skin burns; use special goggles Ionizing radiation; x-rays n radioactive isotopes leading to bone marrow suppression n gene mutation;; reduce time exposure, distance btn the worker n the source, use of protective shields

226. 2. CHEMICAL HAZARDS Are harmful kpds in form of dusts, mists, solids, gases et.. Exposures may occur in the following ways: Contact Inhalation Ingestion a. Contact; being in close proximity/ touch Toxic chemicals include teratogens , systemic poisons, mutagens, carcinogens, or behavioural toxins according to the nature of damage caused.

227. 2. Chemical hazards kont’d Frequent skin contact with chemical substances can lead to occupational dermatitis, eczema, ulcer, and cancer

228. b. Inhalation Inhalation of dust is responsible for dust allergy, anthracocis, silicosis, asbestosis, cancer of the lung, siderosis. Inhalation of gases may cause asphyxia due to carbon monoxide and cyanide gas. Presence of metal and other components in air may cause toxic effects to body organs when inhaled.

229. 3. Biological Hazards Workers may be exposed to infective and parasitic agents at the place of work. This can result to infection with diseases such as brucellosis, anthrax, hydatidosis , tetanus, encephalitis, fungal injection, and HIV infection

230. 4. Mechanical and Electrical Hazards Machinery including its parts, tools, objects and materials used are often a source of mechanical hazards leading to injuries. Power supply systems, can also create electrical hazards, leading to severe or fatal accidents—electrocution Main causes of accidents in work place are faulty machines, unsafe acts-poor handling, unsafe personal factors- influence of drugs

231. 5. Psychosocial Hazards Psychological hazards effect the mental and physical well being of people. The most significant psychological hazard in the workplace is occupational stress which results from negative harmful stress or distress. ..poor human rship , lack of job satisfaction, frustrations, exposure to trauma or violence at work ( critical incident stress). Effects; fatigue, PUD, HTN, heart diseases, absentism Occupations that see and work with trauma include the paramedical health care professionals, community care workers, police and prison officers.

232. 6.ERGONOMIK HAZARDS Related to lifting, holding, pushing, poorly designed tools, repetitive tasks,,, can lead to back pains, carpal tunnel syndrome

233. Common Ways of Dealing with O Hazards   Depends on the nature of the hazard or harmful substance and its route of absorption into the body Remove the Hazard or Toxic Substance from the Work Place The best preventive measure get rid of the substance, chemical or machine altogether and, find a less dangerous alternative

234. Dealing with Hazards KONT…. Reducing Exposure to the Hazard Sucking or blowing away the dust or fumes from the place where they are produced. Wetting a substance that gives off dust when cut or worked on dry, this is common in wood industries where there is a lot of drilling and grinding. Carrying out a process entirely in a closed system of tanks and pipes or in a closed room or space.

235. Dealing with Hazards KONT…. General Ventilation; The ventilation of work rooms is improved so that the atmospheric contaminants and heat are removed or reduced. This is mainly achieved by installing wide windows and ventilators in areas of work and ensuring that there is enough operating space for the workers.

236. Dealing with Hazards KONT…. General Cleanliness Good factory cleanliness reduces exposure, encourages tidiness and safer methods of working. Personal Hygiene G ood washing facilities should be available so that workers may wash dirt and chemicals off their hands before eating. Where the work is very dirty, or irritant chemicals are used, showers should be provided in changing rooms.

237. Dealing with Hazards KONT…. Protective and Safety Equipment Protective clothing should be worn all the time in order to protect oneself from health hazards. Examples of protective clothing include: Rubber gloves Goggles to protect your eyes and face during surgical procedures Respirator or masks Aprons and gumboots

238. OCCUPATIONAL HEALTH NURSING Is a specialty nursing practice that provides for and delivers health care services to workers and workers population It is the synthesis of knowledge gained from nursing, medicine, OH. Mgt & social behavior sciences to care for workers

239. PHILOSOPHY OF OCCUPATIONAL HEALTH NURSING Is based on the belief that the health and safety of the worker and workforce is the concern of the employer, employee and the nation at large. This should be reflected through: The promotion and protection of workers throughout the working community Respect for workers’ rights and adherence. Non discrimination in the receipt of quality healthcare. Employee confidentiality

240. Philosophy statements Kont … Dynamics of the work environment and diversity of the workers population Employer and employee responsibility for health and safety The benefits of the occupational health services to the worker population and company Collaborative multidisciplinary relationships that support and enhance worker’s health and safety The relationship of the occupational health and the community

241. ROLES OF OHN Professional Role Environmental Role Managerial Role Educational Role

242. 1. Professional role Entails assessing for evidence of both OD & nOD /injuries / doing physical examination/ follow-up/ emergency care/ prevention of injury & OD/ select, train n supervise auxiliary nursing personnel in matters OHN

243. 2. Environmental Role An occupational environment is the combined effects of external conditions and influences which prevail at the place of work and have a bearing on the health of the working population. For example in industry, the worker interacts with three different types of agents: Physical, chemical and biological agents e.g       Physical - heat, cold, radiation       Chemical - toxic dust liquids and gases       Biological - viral, bacteriological, rickettsia Machines and electricity Fellow man/human relations

244. EVI ROLE KTN’D Periodically assess the work environment to detect and appraise health hazards ; lighting, ventilation, temperature, humidity and cleanliness

245. ENVIR KTD’ To provide a safe environment in the occupational setting, particularly in industrial setting, it is recommended that: Working hours should be organised in such a way that they allow the worker to have breaks in between. Periodic inspection of the plant be carried out to check on ventilation, cleanliness, dust gases, light, sanitary facilities. Periodic medical checks up of the workers be undertaken to detect any signs of sickness. Precaution be taken to prevent accidents by the workers The management to supply of protective devices for the handling of machines and other hazards.

246. ENVI Kont’d Adequate lighting and ventilation to avoid hazards like eye defects, accidents, b provided There should be proper washing facilities to maintain cleanliness and prevent infection. Workers be given HE on safety, prevention of health hazards and need for regular medical check up. Measures to promote mental health and prevention of mental illness be in place.

247. 3.Managerial Role Reports and give recommendations on hazardous conditions and health condition of employees. Manage interaction between the industry and other systems e.g social, health, or welfare systems, to meet the overall health needs of the workers.  Involved in setting up a referral system to arrange care for workers and their families Involve compiling data on absenteeism owing to illness to be used in calculating illness rates among workers Taking part in planning, formulation and implementation of policies related to the health and welfare of the workers in the organisation

248. 4. Educational Role HE is essential for the promotion of optimal health for workers and their community. The OHN should plan, organise, and implement health education programmes for the workers and their community members. The topics for health education talk during occupational health services: The effects of work on health and vice versa. Importance of periodic examinations related to identified risk. Monitoring of the environment and development of control methods. Disaster planning. Health supervision of welfare facilities. Rehabilitation and resettlement.

249. Other roles Advisors Counsellors Educators Environmentalist Hygienist Rehabilitators Researchers Safety experts and supervisors.

250. Responsibilities of an Occupational Health Nurse Participating in the health assessment program; pre-placement and routine medical examination of workers. Keeping a continuous watch on working conditions, equipment and materials for safety precautions and possible dangers. Counselling workers regarding personal and family health problem. Cooperating with management in the application, enforcement and training on the use of protective measures.

251. Responsibilities of OHN Giving advice on environmental sanitation and safety education activities. Carrying out nursing administrative duties, which assure the efficient management of the occupation health services. Maintaining simple records on which to base surveillance, prevention and control of occupational illness or accidents. Evaluating health programme and activities

252. 1/9/2022 256 Advantages of Occupational Health Care Investigates and assesses health hazards in the working environment and gives expert assistance for eliminating them

253. 1/9/2022 257 Advantages of Occupational Health Care Estimates employees’ working ability and monitors their health condition Its knowledge and skills supports action for maintaining working ability in the development of individuals, working environment and working community Prevents occupational diseases and other work-related illnesses

254. 1/9/2022 258 Advantages of Occupational Health Care Prevents premature incapacity for work, reduces pension costs Reduces absenteeism due to sickness Can make calculations of the profitability of occupational safety and health and occupational health care.

255. 1/9/2022 259 Are we an occupational health conscious community / country or do we always have to wait for disasters to revive us from our coma?

256. END: Thank you for listening

257. THANK YOU ALL

258. ENVIRONMENTAL IMPACT ASSESSMENT Define Formal study process used to predict environmental consequences of proposed major developments. Aim To ensure that potential problems are fore seen and arrested at an early stage in the projects planning and design stages Function - ensure that decisions on proposed projects take the environment into account.

259. EIA AIMS Ensure potential problems are detected Process of EIA Project concept i.e site selection, screening, initial assessment, scope of significant issues Pre- feasibility study Feasibility Design and engineering Implementation, monitoring and post auditing Evaluation

260. WHO ARE INVOLVED IN EIA Developers Investors Competent authorities i.e NEMA Other Govt authorities Regulation Regional planner The community Politicians

261. PROJECTS THAT NEED EIA Urban development projects Transportation i.e pipeline, road, railways etc Mining activities including quarrying, open cast extraction, oil exploration Waste disposal-sewage Nuclear reactors Dams, rivers and water resources

262. EIA OFFENCES An offence is act that contravenes the provisions of a given Act General Offence- offence for which there are no specified penalties

263. Offences cont’d A person commits an offence if; They do not conduct EIA Fails to submit project report as per the requirements Fails to prepare EIA report in accordance to the requirement Knowingly give false information in EIA report

264. MISCONCEPTIONS ABOUT EIA THAT EIA IS: Antidevelopment Too expensive and a waste of money A waste of time Ineffective

265. Levels of environmental quality  Bare survival – control of major epidemics of disease and violent death, minimum food and water Control of disease and injury – control of endemic and dietary disease and accidental injury Efficient performance –adequate and proper diet, safe and clean environment Comfort – stimulating environment, aesthetic satisfactions, comfort control. 

266. SOLID WASTE DISPOSAL Refuse in towns should be stored in proper containers. These containers should be: Watertight plastic or metal with a tight-fitting lid or polythene bags Rust resistant Easily filled, emptied and cleaned Have side handles Rest on a concrete slab to ensure cleanliness of adjacent ground