SHORT NOTE (10 MARKS) 1. 1.

Health hazards from improper waste disposal (EH4)

The accumulation of solid wastes in man's environment constitutes a health hazard because of the following reasons: 1. There are many harmful agents in the wastes. The most important biological agents which pollute water and food and cause intestinal infections are cholera, typhoid, dysentery, infectious hepatitis (Hepatitis A), polio and some parasitic infestations. 2. The organic portion of solid waste ferments and favours the breeding of flies and other insects which transmit infections. 3. Refuse is the main source of food for rats and in rubbish dumps they quickly proliferate. Diseases for which rats may be a reservoir include plague, murine typhus, leptospirosis, rat bite fever and salmonelosis. 4. The pathogens may be conveyed to man through flies (which transmit infections mechanically) and dust (may harbor tubercle bacilli). 5. Carelessly dumped refuse can pollute both surface and ground water, and soil. 6. There is risk of atmospheric pollution if there is accidental or spontaneous combustion of refuse. 7. Constitute a nuisance of sight and smell from an aesthetic point of view. 8. Heavily dumped refuse can cause road block, flooding and even accidents. 9. Some of the refuse and waste from construction sites can become non-essential water receptacles and favour the breeding of vectors like 1. Aedes mosquito which transmits Dengue and Dengue Haemorrhagic fever, Yellow fever, and other arboviral infections, 2. Culex mosquito which transmit Filariasis, Japanese Encephalitis etc. 3. Can cause smouldering fire.

1. 2.

Drop latrine and health hazards (EH3)

a) A latrine built over the sea, river, or other body of water into which excreta drop directly is known as an overhung latrine. b) If there is a strong current in the water, the excreta are carried away.

c) It may be the only feasible type for communities living over water, but it will give serious health risks of faecal water-borne diseases.

1. 3.

Jitra bowl pour flush latrine (EH3)

a) It is a simplified version of low-cost, pour-flush, water-seal, pit latrine which is now recommended for use in rural areas of Malaysia. b) The water-seal prevents the escape of gases from the digestion of organic wastes in the pit into the latrine superstructure. c) It is similar to the conventional water-closet bowl except the pit is situated behind the latrine and provided with a short length of pipe or channel from the pan to the pit, and a small vent pipe is provided to allow the escape of gases into the atmosphere. d) It is easy to dislodge if the pit has concrete lining with proper cover so that it can be used for a longer period of time. e) It is being introduced via the health services and by means of sanitation campaigns throughout the country.

1. 4. a)

Water seal or pour flush latrine (EH3)

This is a variation of the pit latrine.

b) Instead of the 'keyhole' orifice in the concrete slab over the pit, a receptacle or bowl with a shallow water-seal is provided to receive the excreta. c) After defaecation, the person using the latrine flushed away the excreta in the water-seal bowl with a small bucket of water. d) As water is poured to flush the water-seal bowl, this type of latrine is sometimes called the pour-flush latrine. e) A water-seal prevents flies, mosquitoes and odor reaching the latrine from the pit.

f) It has accordingly gained wide acceptance by rural communities in many countries in South-East Asia -e.g. Siamese bowl pour-flush latrine. g) The disadvantages are, it need reliable water supply, and cannot be dislodge when the pit is full.

1. 5.

Stabilization pond (Oxidation Pond) (EH3)

a) A more recent method employed for small communities is the Stabilization Pond (also known as Oxidation Pond or Sewage lagoons).

b) In this system, raw or partially treated sewage is discharged into a pond and is "purified" by natural processes under sunlight. c) The organic matter is broken down by micro-organisms into carbon dioxide and other substances, some of which act as nutrients of green algae whose chlorophyll apparatus activated by sunlight liberates oxygen. d) This oxygen converts the unstable material in sewage into stable harmless compounds and deodorises the process at the same time. e) f) This system is used for most of the new housing projects in Peninsular Malaysia. New housing schemes with 100 or more units be required central stabilization pond.

1. 6.

Dumping methods in final waste disposal (EH2)

Can be either open dumping or dumping at sea. a) Open dumping: Refuse is dumped into low-lying areas. Hauling is the only cost, and therefore a cheap method of refuse disposal. It is widely practiced, but is a very insanitary method. The drawbacks of open dumping are: i. ii. unsightly appearance iii. wind iv. b) Dumping at sea: 1. Practiced in coastal areas and islands, and may be used as a method of land reclamation. 2. Disadvantage - the rubbish may float back to the beaches and shores and may also cause toxicity to fish and flora. 3. WHO Expert Committee (1967) condemned dumping as "a most insanitary method that creates public health hazards, a nuisance, and severe pollution of the environment." 1. 7. Sanitary land fill (EH2) pollution of surface and ground water air pollution caused by loose refuse dispersed by the the refuse is exposed to flies and rodents it is a source of nuisance from the smell and

a) Ideally, a sanitary landfill site should be on inexpensive land within economical hauling distance, have year-round access, and be at least 1,500 m downwind from residential and commercial neighbors. b) Preparation of the site involves fencing (pagar), grading, stockpiling of cover material, construction of beams, landscaping, and the installation of leachate collection and monitoring systems. c) Wells for gas collection may also be provided. Landfill liners are natural or synthetic materials used to line landfills so that leachate cannot leach into the groundwater. d) Advantages - similar to controlled tipping, but more sanitary and proper gas and leachate collection to prevent pollution to ground water sources. e) Disadvantages -more expansive, technical expertise is necessary and leachate need to be collected and properly treated at the same site.

1. 8.

Incineration (EH 2)

a) A method of choice where suitable land is not available. It is a process by which solid, liquid and gaseous combustible wastes are converted through controlled combustion to a residue which contains virtually no combustible matter and to gases which are released into the atmosphere after passing through the filters. b) Advantages - No nuisance if properly planned, no air pollution if temperature is high (at least 1000 degrees C). It is a very efficient method and it can run 24 hours a day in large cities where not enough land for landfills. c) Disadvantages - it is an expensive method with high technicality, and materials like bottles and cans remain.

1. 9.

Sources of water pollution (EH7)

a) Definition: The presence of impurities in water in such nature as to impair the use of water for a stated purpose. Any physical, chemical or biological changes in surface water or ground water that can harm living organisms or make water unfit for certain uses. 1. Direct Discharge i. ii. Heavy metals Sewage

iii. 1. Diffuse Sources i. ii. iii.

Industrial toxic waste

Acid Nitrates Pesticides

1. 10.

Water related infections (EH4)

A water related disease which is infectious and may be transmitted from one person to another. Classification of Transmission Routes/Mechanisms: 1. Water borne Mechanism Truly water borne transmission occurs when the pathogen is in water which is drunk by a person or animal which may then become infected. Water borne diseases include the classical infections, notably cholera and typhoid, and also infectious hepatitis (Hepatitis A), diarrhoeas, and dysenteries. All water borne diseases can also be transmitted by any route which permits faecal material to pass into the mouth ie faecal oral route. 2. Water washed Mechanism Many infections of the intestinal tract and skin may be significantly reduced following improvements in domestic and personal hygiene, and related to increased availability and use of increasing volumes of water for domestic and hygienic purposes. They are known as water washed diseases, and are of three main types.

a) Firstly, there are infections of the intestinal tract, such as diarrhoeal diseases, which are all faecal-oral in their transmission route and are therefore potentially either water-borne or water-washed. eg bacillary dysentery (Shigellosis). b) The second type of water-washed infection is that of the skin and eye. eg. Bacterial skin sepsis, scabies, fungal infections of the skin and eye infections such as trachoma c) The third type of water-washed infection is those infections carried by lice or mites which may be reduced by improving personal hygiene and therefore reducing the probability of

infestation of the body and clothes with these arthropods. Examples are louse-borne typhus and louse-borne relapsing fever. 3. Water-based Mechanism A water-based disease is one in which the pathogen spends a part of its life cycle in a water snail or other aquatic animal. All these diseases are due to infection by parasitic worms (helminthes) which depend on aquatic intermediate hosts to complete their life cycles. An important example is Schistosomiasis, and especially common in parts of West Africa is Guinea worm (Dracunculus medinensis). 4. Inset Vector Route/Mechanism The fourth and final mechanism is for water-related diseases to be spread by insects which either breed in water or bite near water. Examples are Malaria, Yellow fever, Dengue, Japanese Encephalitis, Onchocerciasis (River blindness) and West African Trypanosomiasis (Gambian sleeping sickness).

1. 11.

Drinking water quality (EH4)

Define as carrying out physical, chemical, biological and bacteriological examinations, by taking water samples to assess the quality of water and its suitability for particular purposes. a) Physical quality: Depends on a number of factors. These include the amount of total solids in the water, the turbidity of the water, its colour and whether there are objectionable tastes and odours. b) Chemical Quality: Is affected by substances which alter the potability (drinkability) of the water supply (iron, zinc, etc.). Some chemical substances present in a water supply may affect health (flourides and nitrates) and others are toxic and dangerous (lead, arsenic, cyanide etc.).Standards of allowable concentrations for the above substances are given in Tables I and II. c) Biological Quality: Growth of algae, protozoa and other organisms are found in most bodies of surface water. The algae in particular are capable of rapid multiplication at certain seasons and may cause difficulties in water supply by blocking filters and producing undesirable taste. d) Bacteriological quality: The bacteriological quality of drinking water is typically expressed in terms of the concentration and frequency of occurrence of particular species of

bacteria. Polluted water may contain pathogenic bacteria, viruses, protozoa, or helminths eggs. It is a normal practice to detect and enumerate them by 'indicator bacteria. The presence of indicator bacteria in water is therefore indicative of faecal contamination of that water and faecal contamination suggests the potential presence of pathogens and thus a health hazard. The most commonly used indicator bacteria are the coliforms (gram negative, non- spore-forming rods). Water is tested either for the presence of the total coliform group or for the presence of faecal coliforms only. Faecal coliforms, mainly comprising Escherichia coli, are a subgroup of the total coliform group and they occur entirely or almost entirely in faeces. If E. coli is not found, a further test for Streptococcus faecalis can be carried out. If S. faecalis is found, even if E. coli is absent, then this is regarded as confirmatory evidence of pollution with sewage or faecal wastes. e) Viral quality: The presence of free chlorine inactivates virus. In water that contains free chlorine and in which coliform organisms are absent, virus will also generally be absent. f) Radiological standards: Have now been formulated for the purpose of controlling radioactivity in water supplies used for drinking. g) Biochemical indicators: May also be used as indices of water pollution e.g. the biochemical oxygen demands (BOD) of a water sample.

1. 12.

Drinking water quality surveillance (EH5)

v Objectives are to raise the standard of health of the people by ensuring the safety and acceptability of the drinking water provided to the consumer. The key elements are: 1) 2) 3) 4) 5) Monitoring, Sanitary survey Data processing Remedial action and Institutional examination.

v In Malaysia, the various agencies are involved in drinking water supply. Water Supply Authorities are - Public Works Department, Water Supply Department or the Water Board in the various states.

v The water treatment plants are usually run by the private companies to treat the raw water from the rivers. v Urban water supply systems are under the state water authorities, and rural water supply is under the water authorities, Ministry of Health, and Ministry of Rural Development. v Ministry of Health is the Surveillance Agency especially for the drinking water quality standards. v The pollution of the various sources of raw water is monitored by the Department of Environment (DOE). v Water samples are taken from points in the water supply system which include at intake, the treatment plant outlet, the reservoir outlet, the main pipeline as well as the rest of the distribution inclusive of the consumer's tap. v Simple tests are done at field by the health inspectors, and other samples are sent for further analysis to the various chemical laboratories. v Minimum number of monthly samples for piped drinking-water in the distribution system is about 1 per 5,000 populations.

1. 13.

Housing and home accidents (EH10)

a) Home accidents may result from any of the following:

a defective state of repair of the house unprotected fires and defective electrical installations badly designed or located stairways' lack of storage place for inflammable materials or substances which are poisonous poor lighting

b) Mortality and morbidity statistics reveal three highly accident-prone population groups: children, elderly people and handicapped persons. c) Patterns of domestic accidents change with time, and there are marked differences within and between countries. d) The major causes of accidental injuries include falls, burns and scalds, electrocution, suffocation, poisoning (including gassing), pedestrian accidents and bicycle accidents.

1. 14.

Sanitary water supply (EH4)

It may be considered under two headings; for small scale and large scale. A. Purification of water on a small scale i. Household purification of water a. Boiling b. Chemical disinfection: bleaching powder, chlorine solution, hypochlorite solution, tablets of chlorine preparations "Halazone tablets", potassium permanganate, iodine solution C. Domestic filters ii. Disinfection of well determine the volume of water in a well Determine the amount of bleaching powder required for disinfection chlorination of water test for residual chlorine in the well water

B.

Purification of water on a large scale The principle of Conventional Treatment process is be summarised as follows: 1. 15. Food quality control

a)

Control at source (harvesting, slaughtering, capture)

sanitary control of the production of the raw food item (proper handling, avoidance of slaughtering diseased animals, proper sanitary condition of premises, equipment and utensils). b) Control at food processing

- premises maintenance and the physical environment of the food processing plant (floor, walls, ceiling, vectors) - The equipment used in the process - Personnel and the workers of the plant (uniforms, routine medical examinations, health education)

- The quality of raw food items used - Acceptability of any additives used - The quality of final product (quality assurance and regular checking) c) Control at transportation and storage

-perishable foods like meat, fish, milk, vegetables, ice-cream etc. require special temperatures to prevent spoilage d) Control at retail/distribution points

-requires the regular physical inspection and chemical analysis of food items offered for sale e) Control at food preparation. This is especially important in terms of commercial preparation of food as any contamination will result in a large number of people from being infected. In mass cooking there is also a higher chance of introducing contamination

i. Physical Environment of the Kitchen - all surface (floor, wall ceiling) and equipment used should be clean - free from flies and pests - adequate water supply and utensils for washing - raw and cooked food to be kept separately - washing area to be separated from preparation and cooking area - proper disposal of left-over food and refuse ii. Food - cooked food should not be touched by hand -appropriate method of keeping cooked food must be used (steam table, cold table) -must be kept away from flies and other vectors iii. Food-handlers

-regular medical examination to exclude carrier infectious hepatitis)

state and other illnesses (typhoid, cholera,

-education regarding good standards of personal hygiene, clothing -education on food handling techniques

1. 16.

Evaluation of food premesis (EH6)

Legislation and codes of practice for the sanitary control of food and food vending are as follows: a. Food Act 1983, Act 281. b. Food Regulations, 1985. c. Code of practice for Food Hygiene, Ministry of Health, 1980. d. Buku Panduan - Kantin Sekolah, Kementerian e. Local Government Act, 1976, Act 171. f. Pesticides Act, 1974, Act 149.

Pelajaran Malaysia, 1983.

The purpose of registration of premises is to provide a record of the particulars such as location, occupier, nature of food establishments and the purposes for which they are to be used. Such particulars are necessary to enable proper surveillance and to make periodic assessments or evaluations of the premises at sufficiently frequent intervals. To ensure the required degree of uniformity, the inspections and evaluations should be of the same pattern and this is best achieved by using a standard report form. The evaluation schedule for food premises adopted by the Ministry is based on the provisions of this Code of Practice and should be used by each of the inspectors engaged in food sanitation work in all States. The check points of inspections have been confined to basic requirements and the assessment of demerits reflect the opinion of the inspector, as to whether each feature is merely satisfactory or unsatisfactory, at the time of the inspection. Each unsatisfactory item earns a demerit of 4 points and the total when subtracted from 100 gives the rating of the premises in a percentage (%) of complete compliance with the recommendations of this Code of Practice. To serve as a reminder, to help anchor judgement and to achieve a desirable level of consistency, guidelines based on specific clauses of this Code of Practice, have been laid down and these should be referred to when determining whether any particular feature or check point is satisfactory or not.

The Evaluation Schedule should not be a substitute for the detailed inspection report following the inspection of the individual food premises, but instead should complement the report.

1. 17. Sick building Syndrome 2. 18. Urban housing and health hazards (EH10) 3. In addition to the appalling housing conditions, the increasing shortage of desperately needed dwellings especially an acute shortage of housing for low-income families in urban area, is one of the most serious problem in urban area. The urban poor bears the greatest burden of the mismanagement of the urban environment. 4. The housing problems of the metropolitan areas of the developing countries such as scattered housing developments, mixed land use, high rents, overcrowding and clandestine land occupancy, are also a cause for concern and action. Contributing factors are:

rapid and uncontrolled influx of people from rural areas into towns unpreparedness of local authorities in the face of this social upheaval resulting from industrialisation lack of control by building authorities over exploitation by property owners

Health Hazards associated with rapid urbanization

unplanned unsafe construction of poor quality housing overcrowding overtaxing of public health systems -water supply, waste disposal, drainage failure of environmental services -street cleaning, refuse collection, transportation air pollution due to emissions prostitution, dependence on alcohol and drugs, increase in crime rate, social and psychological problems.

1. 19.

Rodent control methods in a community (EH9)

Rodent Control Methods o Rats cannot be eradicated, they can only be controlled. This is because there are areas where anti-rodent measures cannot be implemented -forests and jungles, ravines, etc. o Therefore rat control must be a continuous process. o There are two basic complementary elements to every rat control program:

o o

rats must be denied access to food and harbourage (shelter), by environmental improvement; at the same time, they must be actively destroyed.

Rat killing without environmental improvements is ineffective because: o rats and mice rapidly regain the original population level through their high birth rate and the greater survival of young as a result of less competition; o a continuous killing program is necessary, which is costly in terms of labour and materials; o continuous use of most poisons can result in resistance and bait shyness. o Three Techniques of control; Permanent, Temporary and Naturalistic are in use against rodents. Permanent control is the only means that can produce a lasting reduction in communal rodent numbers. Temporary measures are necessary in the face of disease outbreaks, population eruptions and an aroused public demand for immediate action.

1. 20. House fly control (EH8) 2. Flies (musca domestica) is an important mechanical vector of disease. They carry organisms which may cause diarrhoeal diseases. 3. The Fly has filthy habits and is frequently in contact with faeces and breeds in garbage or decomposing matter. 4. Fly control is primarily a matter of good excreta and garbage (waste) disposal. 5. In urban areas, it is affected by proper removal and disposal of garbage and sewage. 6. In rural areas, unsanitary latrines, undisposed animal excreta and other refuse tend to promote breeding of flies. 7. Elimination of breeding places is the most effective and satisfactory method of control. 8. Fly Control Measures i. Elimination of breeding places e.g. improvement of environmental sanitation especially refuse and sewage disposal. ii. iii. with insecticides. iv. v. Manual killing Baiting e.g. by using poisoned baits, solid or liquid. Prevention of entry e.g. wires gauze proofing. Trapping e.g. use of cords and strips impregnated

vi. vii. among people.

Insecticide spray e.g. residual spray, space spray. Health education e.g. create a "fly consciousness"

1. 21.

Public health importance of rodents (EH9)

Rodents are animals with strong incisors and no canine teeth (e.g. rat, squirrel, beaver).

Public health importance of Rodents

Rats and other rodents are the reservoir and source of several diseases of man, either directly (as by biting, or contamination of human food with their urine or faeces), or indirectly (by way of fleas and mites). Rat-bites create a serious health problem and are far more common than most people realize. Helpless infants and defenseless adults (invalids or unconscious persons) are particularly subject to attack.

1. 22.

Aedes control methods (EH8)

a. Source reduction

remove/reduce non-essential water containers receptive to mosquito breeding avoid/protect water storage containers from larval breeding by proper covering environmental sanitation reduce water storage containers by provision of pipe water supply regular changing of water in household receptacles once a week

b. Larviciding

use of larvicide; Abate I % sand granules or temephos 10 gm per kg especially in highrisk localities before outbreaks are expected, to be put into water storage drums, flower vases, ant-traps etc. biological control by keeping Larvivorous fish like Gambushia.

1. Anti-adult mosquito measures (adulticiding)

focal spray (Thermal Fogging)

Focal spray is carried out by using thermal fogging machine such as swing fog (hand-held type) for a radius of 200 meters around the house of the patient reported to have Dengue or Dengue

Haemorrhagic Fever. Suitable insecticide such as Malathion, Resilin, Sumithion and Aquaresigen pyrethroid are used. Repeat fogging after 7- 10 days is necessary.

ULV spray (Ultra Low Volume Fogging)

For a locality having an epidemic outbreak (more than 1 case within 14 days), vehicle-mounted ULV cold aerosol fogging machine spraying is done to carry out the rapid adulticide operation covering an area of about 20 square kilometers. Repeat after 7-10 days. Preventive fogging can be done in high Aedes Indices areas with the same method. 1. Health education and community participation 2. Legislation and Law Environment v The main legislation empowering the health authorities to take action in the control of arthropods is the "Destruction of Disease-Bearing Insects Act" (DDBIA) of 1975 (Act 154). This Act defines 'a disease-bearing insect' as "any insect carrying or causing or capable of causing, any disease of human beings or domestic animals, and includes the eggs, larvae and pupae of such insect". v Medical Officers of Health and Health Inspectors are given powers of entry and seizure under this Act. They are also empowered to cause certain works to be carried out by the occupier of a building. Penalties for non-conformance are also prescribed. The Ministry of Health has a Vector-borne disease Control Program which deals with the control of vector-borne diseases in Malaysia and this is the section which will enforce the Destruction of Disease Bearing Insect Act.

1. Vector Surveillance Vector surveillance is one of the activities in the control of dengue and dengue haemorrhagic fever. The following are the indices used to monitor Aedes aegypti population in terms of vector density in dengue transmission. Ovitrap index (egg sampling)

1. 23.

Malaria prophylaxis (EH8)

a. Anti-larval Measures

i. Elimination of breeding places (source reduction) -It includes permanent measures of environment such as: a) Filling of low lying places where water may accumulate. This is particularly important for controlling breeding of Anopheles. b) Weekly emptying of household collections of water, particularly to prevent breeding of Aedes. c) d) Covering of drains, ditches, cess pools and sewers near the houses, where Culex breeds. Removal of vegetation on shores of slow moving streams where A. fluviatilis breeds.

e) Removal of water plants such as Pistia Stratiotes and water hyacinth, manually or by herbicides, checks the breeding of Mansonia. ii. Larvicidals a) Mineral Oils: Kerosene, diesel, fuel oil and malariol are used for this purpose.

b) Paris green (copper acetoarsenite): it is used to kill surface feeding of anopheline larvae. It is dusted at the rate of 840 g/ha (one hectre = 10000 sq m) of surface. c) Synthetic insecticides: Most larvicides are organophosphorus compounds like chlorpyriphos, fenthion and Abate, which quickly hydrolyse in water. Abate (500E emulsion) is the least toxic of these and is very effective at concentration of 1 ppm. iii. Biological control v Some fish (Gambusia affinis and Lebister recticulatus) are known predators of mosquito larvae. v They may be introduced into tanks, lakes, farms and oxidation ponds for this purpose. v Bacillus thurengesis, a biological larvicide can also be introduced. B. Surface or residual spray: In this method, a slow acting insecticide with prolonged residual effect such as (DDT), BHC, Dieldrin etc. is sprayed on floor, walls and other surfaces where it kills the resting insects. This could be in the form of:

regular spraying focal spraying special spraying

For Aedes, (DDT 3.5%), dieldrin 1%, lindane 1%, malathion 2.5% and fenthion 1 % can be used as emulsion or suspension. For Mansonia, in addition to insecticides, herbicides have to be used to destroy the weeds whose roots support the larvae. C. Genetic control:

Males sterilised by gamma irradiation and chemosterilants are released. They mate with females but the latter produce unfertilized eggs which do not develop further. This is a potentially useful method that has yet to be tried on a large scale.

D. Prevention of Mosquito Bites: a) Use of repellents: Diethyl toluamide (deet) and butyl ethyl propanediol applied on clothes repels culex for 6-1.3 hours. Others in use are DMP, indalone, dimethyl carbate and ethyl hexanediol. They are applied to the exposed parts of the body b) Preventing entry into houses: Mosquito- proof wire gauze is used on doors, windows and ventilators. c) Sleeping in mosquito nets: using insecticide impregnated bed-nets (with permethrin), and using veils, socks and gloves etc. as necessary.

E. Personal Protection

drug prophylaxis : 1 week before until 4 weeks after leaving the malaria endemic area by taking Chloroquine 2 tablets with Fansidar 1 tablet every week. mechanical measures to reduce man-mosquito contact (nets, clothing, repellants) health education possibility of vaccines

F. Anti-parasite measures

effective treatment of cases e.g. in falciparum, and radical treatment to prevent relapse in vivax and ovale malaria mass blood survey and case finding (active and passive) in malaria

G. Law enforcement

Prevention and Control of Infectious Diseases Act, 1988 Destruction of Disease Bearing Insects Act, 1975 (DDBIA)

H. Health education and community participation

health education is one of the most effective and satisfactory method of control of vectorborne diseases. community participation is essential in ensuring continuous hygienic measures in the control of vector-borne diseases.

h. Integrated Vector Control

practical application of a combination of several feasible methods to control vectors as mentioned above.

1. 24.

Air pollution (EH7)

Definition: When potentially noxious substances are discharged into the atmosphere at a rate that exceeds its capacity to disperse them by dilution and air currents, the resulting accumulation is air pollution. a) Types of Air Pollutants Air pollutants may be gaseous or particulate in nature, and particulates may be either solid or liquid. 1. Gaseous Pollutants : These are derived from materials which have entered into chemical reactions or combustion processes. They include; 1. 2. 3. 4. 5. carbon-based compounds like hydrocarbon, oxides and acids, sulfur compounds such as dioxide, trioxide and sulfides, nitrogen compounds (ammonia, amines, oxides) and halogenated substances (organic and inorganic halides) Particulates i. from 0.01 to 100 mm in diameter. ii. The smaller particles are referred to as aerosols and can remain suspended, scattering and behaving much like a gas. Particle or droplet size may range

iii. penetrating to all sites in the respiratory tract.

Below 10 mm particles are capable of

iv. Industrial particulates are usually solid and are carbonates, metallic oxides, salts or acids and their porosity is such that they will absorb other gases and liquids. b) Smog 1. It is a combination of smoke and fog and is a popular term for a mixture of gaseous and particulate pollutants that accumulate over urban centers and persists for a prolonged period. 2. Smog is a brown or yellow haze, and it usually occurs as a phenomenon to temperature inversion when a high-level mass of cold air traps warmer air beneath it to prevent mixing and dispersion. 3. E.g. London Smog (fog) in 1952 lasted over a week and causes about 4,000 deaths, mostly from respiratory diseases. c) Haze 1. Haze consists of sufficient smoke, dust, moisture, and vapour suspended in air to impair visibility. 2. The term regional haze means haze that impairs visibility in all directions over a large area. 3. .g. Forest fire and Regional Haze in South-east Asia 1997. d) A. Sources 1. Naturally occurring i. ii. iii. hydrocarbons) etc. - Forest fires iv. 1. Combustion i. Stationary sources - Power production, Industrial, Fossil fuel, Waste treatment, Agriculture, Nature, Open burning ii. road mobile sources -CO, NO2, SO2, Hydrocarbons Mobile sources - Road transport, OffCO2 - Lake Nyos, Cameroon SO2 - Volcanoes Methane - Agriculture PAH (polynuclear aromatic

1. Chemical production and its use i. ii. (Chloroflorocarbons - CFC etc.) 1. Atmospheric chemical reaction (Secondary pollutants) i. 1. Waste treatment i. etc. ii. e) Health Effects Land fills - Methane organics Burning (Incinerators) - Dioxin, PAH Ozone from NOx and hydrocarbons Hydrocarbons Halogenated hydrocarbons

Acute Effects i. Short-term exposure to hazardous levels of air pollutants may result in irritation to the eyes and the respiratory tract, ii. Populations at high risks include the very young and the elderly, whose respiratory and cardiovascular systems are not fully functional, people with asthma, emphysema, heart diseases, and heavy smokers Chronic Effects iii. Long-term exposure to lower levels of pollution may result in, or aggravate, chronic bronchitis, pulmonary emphysema, bronchial asthma and lung cancer. iv. problems. v. Dust and other allergens, including pollen, 1-90 mm in diameter, can induce or trigger allergic reactions in susceptible people. Cigarette smoke will cause all these

Essays & problem Solving type questions (20marks)

1. 1. a.

Relationship between housing and health in a community. (EH10) Housing and Rate of Sickness:

It is a common observation that there is a higher rate of sickness in a poorly-housed population than in a well-housed one. But a clear cut cause and effect relationship is difficult to establish for the following reasons:i. Housing (residential environment) embraces many facets of the total environment, each influencing health in a separate and sometimes different manner; e.g. bad sanitary conditions may cause disease, while inadequate illumination affects vision and may foster an increase in home accidents. ii. Many other socio-economic factors which influence health may accompany poor housing; poverty, ignorance, poor nutrition and lack of medical care. iii. Lack of understanding of the unit of population that should be used as the basis for measurement; e.g. should it be the individual, the household, the community or any other unit. iv. There is no unified system of measurement of the hygienic quality of housing on the residential environment. b. Effects of Poor housing Conditions i. Physiological and Psychological It may not fulfill his physiological or psychological needs: or undue stress may be placed on the corresponding responses:

excessive noise, cold, heat or dampness noxious odours poor lighting lack of privacy for the family or for the individuals within the family

1. Disease Transmission It may encourage disease transmission:

overcrowding and/or poor ventilation inadequate or contaminated water supply defective sewage disposal system infestation with vermin attraction of insects communicable disease

iii. Home Accidents (Domestic Accidents) Home accidents may result from any of the following:

a defective state of repair of the house unprotected fires and defective electrical installations badly designed or located stairways' lack of storage place for inflammable materials or substances which are poisonous poor lighting

Mortality and morbidity statistics reveal three highly accident-prone population groups: children, elderly people and handicapped persons. The major causes of accidental injuries include falls, burns and scalds, electrocution, suffocation, poisoning (including gassing), pedestrian accidents and bicycle accidents.

iv. Social well-being and Mental Health

There is a relationship between good housing and good mental health and bad housing and poorer mental health. Many aspects of housing, such as crowded housing, excessive noise, shared accommodation, oppressive landlords, bad smells and dampness, give rise to considerable dissatisfaction, annoyance and stress, and may perhaps contribute to the development of interpersonal conflicts. v. Pollution and Residential environment

Water pollution Air pollution Soil & dust pollution

1. 2. Principles of prevention and control of aedes mosquitoes in urban areas of Malaysia. (EH9) a. Source reduction b. Larviciding 1. Anti-adult mosquito measures (adulticiding)

focal spray (Thermal Fogging) o ULV spray (Ultra Low Volume Fogging)

1. Health education and community participation 2. Legislation and Law Environment 3. Vector Surveillance

1. 3. 2. 4.

Adult control and larval control. (EH9) Methods of control of malaria vectors in Malaysia (EH9)

a. Anti-larval Measures i. Elimination of breeding places (source reduction) -It includes permanent measures of environment such as: ii. Larvicidals iii. Biological control B. Surface or residual spray: This could be in the form of:

regular spraying focal spraying special spraying

C. Genetic control: D. Prevention of Mosquito Bites: a) b) c) Use of repellents Preventing entry into houses Sleeping in mosquito nets

E. Personal Protection

drug prophylaxis mechanical measures to reduce man-mosquito contact health education possibility of vaccines

F. Anti-parasite measures

effective treatment of cases

mass blood survey and case finding (active and passive) in malaria

G. Law enforcement

Prevention and Control of Infectious Diseases Act, 1988 Destruction of Disease Bearing Insects Act, 1975 (DDBIA)

H. Health education and community participation h. Integrated Vector Control

1. 5. A. 1. 2. 3. 4. 5.

Principles of air pollution control in urban areas of Malaysia. (EH7)

Specific Process substitution Prevention of release at source Treatment of release at source use of non waste technology Waste management policy Centralised Decentralised

1. Environment monitoring B. General Governmental 1. 2. 3. 4. 5. 6. Laws and Enforcement e.g. Environmental Quality Act 1987. Environmental Impact Assessment (EIA) procedures. Land use planning and zoning for housing and industries Regulations to control emission of pollutants Public Education and awareness Environmental monitoring by Ministry of Environment, Science and Technology, Ministry of Health, Ministry of Agriculture, Ministry of Industry etc. 7. International collaboration with WHO and other countries. Non Governmental

1. Non Governmental Organizations (NGOs). 2. Community participation

1. 6.

Water related infections and transmission mechanisms, and their prevention.

Classification of Transmission Routes/Mechanisms: 1. Water borne Mechanism Truly water borne transmission occurs when the pathogen is in water which is drunk by a person or animal which may then become infected. 2. Water washed Mechanism Many infections of the intestinal tract and skin may be significantly reduced following improvements in domestic and personal hygiene, and related to increased availability and use of increasing volumes of water for domestic and hygienic purposes. a) b) c) They are known as water washed diseases, and are of three main types. Firstly, there are infections of the intestinal tract, The second type of water-washed infection is that of the skin and eye. The third type of water-washed infection is those infections carried by lice or mites

3. Water-based Mechanism A water-based disease is one in which the pathogen spends a part of its life cycle in a water snail or other aquatic animal. 4. Inset Vector Route/Mechanism The fourth and final mechanism is for water-related diseases to be spread by insects which either breed in water or bite near water.

Prevention: a) b) c) d) e) f) g) h) i) j) k) l) Improve quality of drinking water Prevent casual use of other unimproved sources Increase water quantity used Improved accessibility and reliability of domestic water supply Improve hygiene Decrease need for contact with infected watera Control snail populationsa Reduce contamination of surface waters by excretab Improve surface water management Destroy breeding sites of insects Decrease need to visit breeding sites Use mosquito netting

1. 7.

Poor housing conditions and health problems and how to prevent them. (EH10)

--Housing condition & health problem refer Q1 Housing can be improved in the following ways; a. Continuous Maintenance Inspection and Control This involves the periodic official inspection of housing to encourage owners, managers and occupants to maintain as high standards of sanitation, repair and occupancy as may be practicable. b. Conservation This is a more formal and systematic programme, usually in areas that have not become seriously substandard, designed to ensure that substandard properties are kept in an acceptable condition. c. Rehabilitation

This is a program for removing individual grossly unfit housing units and bringing all units into compliance with a good housing code. d. Redevelopment This consists in the re-planning and rebuilding of areas in which housing or environmental conditions or both are so far below standard that ordinary repair and rehabilitation would not produce satisfactory results. e. Slum clearance and Rehousing

This is a program for improvement of squatter or slum settlements in the same place or at a different location to meet an acceptable health standard, with the active participation of the community.

1. 8. Food quality control measures in Malaysia. 2. 9. Drop latrine in a riverine community and anticipated health problems and how to improve the situation. 10. Sanitary methods of final solid waste disposal. (EH2) 1. Dumping Can be either open dumping or dumping at sea. Open dumping: Refuse is dumped into low-lying areas. Hauling is the only cost, and therefore a cheap method of refuse disposal. It is widely practiced, but is a very insanitary method. Dumping at sea: Practiced in coastal areas and islands, and may be used as a method of land reclamation. b. Controlled tipping - this is a satisfactory method of refuse disposal where suitable land is available. It differs from ordinary dumping is that the solid waste is placed in a trench or other prepared area, adequately compacted, and covered with a layer of earth at the end of each day's operation or at such more frequent intervals as may be necessary c. Sanitary Landfill

Ideally, a sanitary landfill site should be on inexpensive land within economical hauling distance, have year-round access, and be at least 1,500 m downwind from residential and commercial neighbors. Preparation of the site involves fencing, grading, stockpiling of cover material, construction of beams, landscaping, and the installation of leachate collection and monitoring systems.

Wells for gas collection may also be provided. Landfill liners are natural or synthetic materials used to line landfills so that leachate cannot leach into the groundwater.

d. Composting

A method of combined disposal of refuse and night soil or sludge, in which organic waste is converted to useful manure. The organic content of refuse is converted into compost, a humus-like material soil conditioner which can improve the fertility and structure of agricultural soils. Methods include:

o o

Bangalore method (anaerobic) - layers of refuse and night soil are altered and top layer is covered with earth. Mechanical composting (aerobic) All reusable material is savaged from the refuse, and remnant is then pulverized <5cm) and mixed with sewage in the treatment plant.

e. Incineration (Burning in High Temperature)

A method of choice where suitable land is not available. It is a process by which solid, liquid and gaseous combustible wastes are converted through controlled combustion to a residue which contains virtually no combustible matter and to gases which are released into the atmosphere after passing through the filters.

f. Low Temperature Burning

Burning using oil drums and cages or open burning are unsatisfactory and causes the surroundings to be littered with cans and broken bottles.

g. Grinding and adding to sewage

Garbage is ground in household grinder and discharged into sewerage system.

h. Recycling/Salvaging

Recovery of usable and saleable material, conservation of resources and defrays cost of waste handling. Recycling of reusable materials such as tin cans, plastics, paper, cardboards from the general waste is encouraged. The hazardous chemicals are also to be recycled and reused whenever possible. A system is required to separate the reusable matters from the ordinary refuse. The segregation can be done by using either gravity or magnetic belt and the rest are disposed by one of the methods.

i. Mechanical size-reduction - can be done before the final disposal by the following methods;

Separation, Pulverization(crushing), Maceration(soaking), Grinding, Baling(packaging), Compaction

j. Integrated Waste Management - The concept of an integrated waste management is derived from the broad-based environmental and resource conservation concerns which incorporates waste reduction, reusing materials, recycling and only finally, disposal either by incineration, sanitary landfill or composting.

11. Sources of air pollutants and health hazards. 1. Naturally occurring 2. Combustion i. ii. 1. Chemical production and its use i. ii. CFC etc.) 1. Atmospheric chemical reaction (Secondary pollutants) i. 1. Waste treatment i. ii. Health Effects Acute Effects i. Short-term exposure to hazardous levels of air pollutants may result in irritation to the eyes and the respiratory tract, Burning (Incinerators) - Dioxin, PAH etc. Land fills - Methane organics Ozone from NOx and hydrocarbons Hydrocarbons Halogenated hydrocarbons (Chloroflorocarbons Stationary sources Mobile sources

ii. Populations at high risks include the very young and the elderly, whose respiratory and cardiovascular systems are not fully functional, people with asthma, emphysema, heart diseases, and heavy smokers Chronic Effects i. Long-term exposure to lower levels of pollution may result in, or aggravate, chronic bronchitis, pulmonary emphysema, bronchial asthma and lung cancer. ii. Cigarette smoke will cause all these problems.

iii. Dust and other allergens, including pollen, 1-90 mm in diameter, can induce or trigger allergic reactions in susceptible people.