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Drinking Water Sources that Represent Health Risks to

PLWHATom Mahin, Advisor for HIV/AIDS Activities

Laura Schuelert, Director of Education

Kathmandu, Nepal, April 28, 2010

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General Situation in Nepal

“Most drinking water supplied in Nepal is not fit for consumption.”

“In Kathmandu valley, 40% of the water available through wells, spouts and pipe were found to have high contamination of fecal coliform bacteria, i.e. 10 to 1000 per 100 mL.”

“Of the 67 gravity flow water supply schemes tested under the Fund Board program, 91% were contaminated with bacteria out of which 64% were highly contaminated.”

(Winrock International, 2007. Nepal Country Environmental Analysis: Revised Draft. Prepared for the World Bank)

3Slide from “ Climate Change and Human Health (Typhoid cases in Kathmandu, Nepal” presentation by Regmi BR, Pradhan B & Lama P

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Even Tube Wells & Spouts have Significant E. coli Contamination

Pradhan Rural communities’ knowledge on water quality and water borne disease: the case of Bungamati Locality in Kathmandu Valley, Journal of Nepal Health Research Council Vol. 2 No. 1 2004

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Pathogen Persistence in Water

(Adapted from WHO)

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Giardia Cysts by Water Source

(Shortt et al., 2006. Cryptosporidium and Giardia as Determinants for Selection of an Appropriate Source of Drinking Water in Southern Sri Lanka. J HEALTH POPUL NUTR

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Cryptosporidium Oocysts by Water Source

(Shortt et al., 2006. Cryptosporidium and Giardia as Determinants for Selection of an Appropriate Source of Drinking Water in Southern Sri Lanka. J HEALTH POPUL NUTR

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Surface Water

In Nepal, monsoon rain flushes Crytosporidium oocysts from animal and human feces into surface water bodies

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Rainfall & Cryptosporidium

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(Ayalew et al., 2008. Cryptosporidium and Giardia infection and Drinking Water Sources Among Children in Lege Dini, Ethiopia. Trop Med Int Health)

Cryptosporidium in Wet/Dry Seasons

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Typhoid in Wet/Dry Seasons

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(Tuli L, Gulati AK, Sundar S, Mohapatra TM, 2008. Correlation between CD4 counts of HIV patients and enteric protozoan in different seasons – An experience of a tertiary care hospital in Varanasi (India). BMC Gastroenterology 2008, 8:36)

Seasonal Variation and Diarrhea

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Rain Water

Collected rainwater should not represent a risk of Cryptosporidium, Giardia or Entamoeba histolytica infection to PLWHA

Bacterial contamination is always a potential issue due to the possibility of household contamination (treatment required)

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Discussion Questions

Regardless of whether it is from a piped system, do you know whether your clinic/hospital/office gets its water from a river or lake or spring or from a tube well or dug well?

Prior to this workshop did you consider that water source to be safe for PLWHA?

15(Government of Nepal, Central Bureau of Statistics)

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Piped Water

Piped water may not be safe water for PLWHA

Intermittent flow and pressure loss can result in pathogens entering into drinking water pipes from contaminated groundwater or sewage pipes

Household water treatment is important for PLWHA even when piped water is available

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Kathmandu Valley Municipal Water Supply Systems

7 existing systems: Balaju, Bansbari, Sundarijal, Bhaktapur, Dudhpokhari, Shainbu and Chapagaon

“The water drawn from the water source is not suitable for drinking purpose without treatment.”

“The status of the existing water treatment plants has been studied in detail. The study showed that most of the water treatment plants are in poor condition and very poorly maintained. The treated water quality deteriorates in rainy season and does not appear to be suitable for drinking as per WHO guideline.”

(Kansakar, B., 2005. Performance of Existing Water Treatment Plants of Kathmandu Valley. Nepalese Journal of Engineering)

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Key Messages

Whether in Kathmandu or a rural area, drinking water in Nepal likely poses a health risk to PLWHA

Surface water poses a significant protozoa risk (e.g. Cryptosporidium, Giardia, Entamoeba histolyica), as well as bacteria and viral contamination

Tube wells and dug wells pose significant bacteria and viral contamination risks

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Any Questions?