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PUBLIC HEALTH IMPLICATIONS OF INDISCRIMINATE URINATION AND

DEFEACATION
Oludoyinmola Ojifinni
Community Medicine Department, University College Hospital, Ibadan, Nigeria
oludoyinmola@yahoo.com

Introduction
Indiscriminate urination and defeacation occurs when people go against safe sanitary practices
in excreting these normal human wastes. According to some experts, it is advisable for every
human being to bring out excreta or defeacate at least once every day. Freeing of ones bowel
is a good habit, and is good for health. However, disposing of it carefully and responsibly is the
central idea. Some factors found to be responsible for this practice include indiscipline, poverty,
nonexistent or poor enforcement of laws regulating building standards, inaccessibility of toilet
facilities in public places.
Indiscriminate urination/ defeacation are particularly significant when it occurs where there is a
high likelihood of contaminating water supplies or the food chain. Such areas include;

Banks of rivers, streams, or ponds which may be used as a water source

Agricultural land planted with crops, particularly if the crops are soon to be handled or
harvested for human consumption. This also involves fields where livestock regularly
graze.

Areas where children play

Areas where food is prepared

These issues are of particular concern in low- and medium-income countries, contributing to
disease transmission; this is due to a lack of adequate and appropriate sanitation and hygiene
access. An estimated 2.6 billion people lack access to adequate sanitation globally. If the
current trend continues, by 2015 there will be 2.7 billion people without access to basic
sanitation. The regions with lowest coverage are sub-Saharan Africa (31%), southern Asia (36%),

and Oceania (53%). Underlying issues that add to the challenge in many countries include a
weak infrastructure, an inadequate human resource base and scarce resources to improve the
situation. Nigeria falls amongst the worst performing nations with millions of its population
without access to basic sanitation and drinking water. Thirty four million Nigerians- more than
the size of any of the nations six Geopolitical zones - are without toilets, and still practice
open defeacation.
Also indiscriminate defeacation/ urination usually increase significantly in emergency situations
and in refugee camps and constitute the main health hazard in such situations. People affected
by a disaster still need to defeacate, they will attempt to follow traditional practices, but if that
is not possible, they will defeacate wherever they can.
The public health implication of indiscriminate urination/ defeacation stems from the role these
human wastes play in the transmission of a whole range of diseases of public health
importance. According to some experts, human excreta contain 400 different species of
bacteria and viruses. With the presence of these pathogens in the environment, surely there
will be no doubt that foods and drinks would be contaminated either directly or indirectly. The
end results of contaminated foods and drinks are usually associated with diseases such as
typhoid fever, cholera and diarrhoea.

Diseases of Public Health Importance in which Indiscriminate Urination/


Defeacation have been implicated.
Indiscriminate urination/ defeacation due to the fact that it exposes humans to undesirable
contact with these human wastes, and their contained pathogens facilitate the transmission of
a number of diseases of public health importance. These diseases are particularly of public
health importance because of their geographical spread, number of individuals involved, and
burden of disease in the general population. These diseases can be classified in a number of
ways depending on type of causative organism (viral, bacterial, protozoal, helminthic), and
route of transmission (most follow the faeco-oral route, but then some others are transmitted

through the skin and mucous membranes). For the purpose of this brief, a combination of both
will be employed;

1) Viral

Gastro-enteritis/ meningitis (coxsackie, echo, reo, rotaviruses)

Poliomyelitis (poliovirus)

Viral hepatitis (hepatitis A & E viruses)

2) Bacterial

Enteric fevers ( Salmonella typhi, S. paratyphi)

Gastro-enteritis (Escherichia coli, Campylobacter spp.)

Bacillary dysentery (Shigella spp.)

Cholera (Vibrio cholera)

Brucellosis (Brucella spp.)

Trachoma ( Chlamydia trachomatis, serotypes A-C)

Food poisoning (Salmonella typhimurium, Staphylococcus aureus, Clostridium


welchii)

3) Protozoal

Amoebiasis (Entamoeba histolytica)

Giardiasis (Giardia lamblia)

Balantidiasis (Balantidium coli)

Toxoplasmosis (Toxoplasma gondii)

Cryptosporidiosis (Cryptosporidium)

4) Helminthic

Nematodes (roundworms) Ascariasis (Ascaris lumbricoides), Hookworm


(Ankylostoma duodenale, Necator americanus), Strongyloidiasis (Strongyloides
stercoralis),

Trichuriasis

(Trichuris

trichuria),

vermicularis).

Cestodes (tapeworms) Taeniasis (Taenia spp.)

Enterobiasis

(Enterobius

Trematodes (flukes) Paragonimiasis (Paragonimus spp.), Clonorchiasis


(Clonorchis sinensis), Fasciolopsiasis (Fasciolopsis buski), Schistosomiasis
(Schistosoma spp.)

Rotaviruses
Diarrhoeal diseases, as a group, remain a major cause of death in developing countries,
especially preschool children. Children under 3 years of age may experience as many as 10
episodes of diarrhoea per year. Rotaviruses are the most common cause of diarrhoea
worldwide, accounting for 134 million episodes yearly. Virtually all children have been infected
by the age of 4 years.

Cholera
This is a highly infectious disease of rapid onset characterized by vomiting; profuse
dehydrating diarrhoea with rice water stools and marked toxaemia. It is caused by bacteria
named Vibrio cholerae. These bacteria cause not only epidemics, but are responsible for
several pandemics. It is strongly related to the use of polluted water for irrigation or to unsafe
disposal of sludge and excreta. Major risks occur where there are large concentrations of
people and hygiene is poor (as in refugee camps and urban slums).

Amoebiasis
Amoebiasis is caused by the protozoan Entamoeba histolytica. The parasite lives in the large
intestine causing ulceration of the mucosa with consequent diarrhoea. It has a worldwide
distribution, but clinical disease occurs more frequently in tropical and subtropical countries.
In certain areas of Africa, Asia and Latin America, the prevalence of asymptomatic infections
ranges from 5% to more than 80%. Recent estimates suggest that 500 million people per year
are infected with E. histolytica and approximately 8% will develop overt disease. Also, 40,000

100,000 deaths per year are attributable to invasive amoebiasis. Globally, amoebiasis is the
third most common parasitic cause of death after malaria and schistosomiasis.

Soil Transmitted Helminths/ Geo - Helminths


These are soil transmitted parasites where immature stages (eggs) require a period of
development or incubation in the soil before they become infective. The commonest and well
known of such parasites are A. lumbricoides, T. trichuria, Hookworm, and Strongyloides
stercoralis. It is estimated that over one billion people are infected with Ascaris, 800 million
with hookworm and 770 million with Trichuris. School children are the most heavily infected
group. In Nigeria, a 68.2% prevalence rate of intestinal helminths from stool samples of
children 0 17years was reported from Ibadan. Geohelminth is the second leading cause of
mortality in children < 6 years of age in Africa. The infection is promoted by poor hygienic
habits such as indiscriminate disposal of human and animal faeces. This habit permits contact
of faeces and its accompanying microbial load including Geohelminth eggs with soil. Infection
may be direct or indirect through secondary sources such as food, water, vegetables and fruits
since most Geohelminth infections are acquired through the faeco-oral route. Observations in
Zaria, Northern Nigeria showed that 70% of the soil samples collected in a school compound
was contaminated with Geohelminth eggs showing the level to which the soil can be
contaminated with faeces.

Schistosomiasis/ Bilharziasis
This is caused by a water-based trematode. It affects approximately 246 million people
worldwide, causing tens of thousands of death every year, mainly in sub-Saharan Africa. It is
strongly related to unsanitary excreta disposal and the absence of nearby sources of safe
water. It is the most widespread of human parasitic worm infection, ranking second only to
malaria in terms of its socio-economic and public health importance in tropical and subtropical
areas. Direct mortality is relatively low; but the disease burden is high in terms of chronic

pathology and disability. The distribution is particularly related to large-scale water


development and water impoundment. Despite control efforts in a number of countries, still
an estimated 200 million people are infected, of which 120 million are symptomatic and 20
million have severe disease. An estimated 80% of all the cases, and all of the most severely
affected is now concentrated in Africa. Being mainly an occupational disease, Schistosomiasis
is principally a disease of people engaged in agriculture or fishing, but in this country, a large
proportion of children are affected by the age of 15 years.

Conclusion
Indiscriminate urination and defeacation is clearly a public health issue of significant
proportions considering its prevalence globally and especially in developing countries like ours.
The significant contribution it thus makes to the transmission of quite a number of infectious
diseases of public health importance cannot be overlooked.
It can then be inferred that any measures capable of reducing indiscriminate urination and
defeacation will significantly improve health status and thus reduce mortality and morbidity
globally especially in low- and medium- income countries.

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