1

Safe drinking water and Diarrheal Disease in India

Jessica Hernandez
May 3, 2018
California State University, Long Beach

Introduction
 2

Many developing countries suffer with various issues whether it’s through infrastructure,

economic, environmental or health. In India health issues is one big problem they are faced with.

There is a large amount of diseases that are being spread daily that impact many communities.

This has been a big problem in India which has been happening for a long time and is still faced

with today. Diseases such as Diarrhoeal disease is one of the top diseases that affects many

communities. A lot of people are not aware of the different diseases that are affecting others in

developing countries due to not being exposed to it in their country. This interested me in

focusing in a developing country such as India to see what is causing the disease to continue to

be spread in the community. Seeing what it the main cause of the spreading of the disease can

also help understand the issues and what can be done to help stop the spreading of the disease.

Understanding other contributing factors on the spread of disease can help us be aware and

provide a solution to it.

Research questions

With the help of the libraries database, research and government websites the sources will

assist me in identifying the population the disease is affecting the most as well as the reasons

why it continues affect the community. Understanding what the government has done in order to

help provide clean drinking water or clean water in general for the community. If the government

has done something to help this matter seeing if it has helped with the problem that is continuing.

Also, what has and has not helped with decreasing the number of individuals that are affected

due to diarrhoeal disease and what can be done in order to reduce the amount of individuals

affected by this disease and unclean water. These questions will help guide the paper in trying to

understand the problems that contribute in the reoccurring problem that is affecting many

communities in India.
 3

Literature review

There are several diseases that are impacting many developing countries like India today.

Diarrhoeal disease is just one of many diseases that is continuing to affect communities in India.

This can be “caused by a variety of bacterial, viral, and parasitic organisms” which the majority

are spread through contaminated water (Diarrhoeal disease, 2017). This can be the result of not

having adequate sanitation, hygiene and safe/clean water for cooking, drinking and cleaning

(Diarrhoeal disease, 2017). Rotavirus and Escherichia coli are two most common causing agents

of moderate to severe diarrhoea which is most common in low-income countries (Diarrhoeal

disease, 2017). Not having safe drinking water places a big role in the development of this

disease. This disease can be spread from person to person and consuming seafood and fish that

have been captured from polluted water can contribute in people developing the disease

(Diarrhoeal disease, 2017). Just 30% of India’s water waste in the city is treated before being

disposed and the rest of it flows into rivers, lakes, and groundwater (Mudur, 2003). This is a

major problem which contributes to the continuation of the diarrhoeal disease. Having a lack of

safe and clean water for people to use results in the illness and deaths that are caused by this

disease.

Diarrhoeal disease is affecting many people in developing countries today. This disease is

the second leading cause of death in low-income countries among children who are under five

years (Kumar & Subita, 2012). There are about 400,000-500,000 children who are under the age

of five die each year in due to diarrhoea (Mudur, 2003). This results in the continuation of the

problem since the country may not have any or enough resources to help people from getting the

disease. Having access to clean water plays a big role in this disease. Even with the investments

made in water and sanitation infrastructure there are many low-income communities in India as
 4

well as other developing countries that continue to need access to safe drinking water

(Combating Diarrhoeal disease, 2010). The communities where low-income people live are more

likely to live in poor conditions and have access to contaminated water. Having access to clean

drinking water, hygiene and sanitation can lower the occurrence of non-rotavirus in low and

middle-income countries (Nandi, Megiddo, Verma, & Laxminarayan, 2017). A survey conducted

found that having access to improved sanitation was connected with 13% reduced odds of

childhood diarrhea incidence and a 27% reduced likelihood of stunting (Nandi, Megiddo, Verma,

& Laxminarayan, 2017). In an analysis of 46 studies conducted in developing countries they

found that having access to a better water source and sanitation it reduced the risk of diarrhea

illness by 25% in an overall population and 32% correspondingly, though access to both water

and sanitation decreased the risk by 33% (Nandi et al,. 2017). Although they may say that they

have improved drinking water it may not be free from pathogens and contaminantes (Nandi et

al,. 2017). In a study conducted by urban India they found that those households that reported

using at least one method to purify their water at home showed that more than 55% had fecal

bacterial contamination in their water (Nandi et al,. 2017). Those in low-income communities

are the ones who are the most affected by not having access to clean water and live in poor

sanitary conditions.

There are a lot of factors that has caused the continuation of Diarrhoeal disease. Some of

these factors consist of unclean water sources, sanitation and lack of education. But what has the

government done to help decrease the amount of individuals affected by this ongoing problem in

low-income communities. The World Health Organization (WHO) works with state members

and other partners to “promote national policies and investments that support case management

of diarrhoea and its complications as well as increasing access to safe drinking-water and
 5

sanitation in developing countries” (Diarrhoeal disease, 2017). Results from a study suggest that

“poverty alleviation efforts occurring in concert with programs to educate women and girls will

be more effective for improving children’s health than either approach alone” (Kumar & Subita,

2012). Programs to educate them about the importance of sanitation and how it reduces the risk

of becoming sick is important. They also work on developing “new health interventions such as

the rotavirus immunization (Diarrhoeal disease, 2017). Rotavirus is the only one that is currently

vaccine preventable in India of pathogen causing diarrhoeal disease (Nandi et al,. 2017). A

vaccine against rotavirus has been introduced in India but non-rotavirus diarrhea will continue to

be an important motive of death and illness (Nandi et al,. 2017). All the organized studies

showed that rotavirus immunization is cost-effective, but the developing world may not be able

to afford it (Kumar & Subita, 2012). The Strategic Advisory Group of Experts (SAGE)

recommend incorporating the rotavirus vaccines in all national immunization programs of infants

(Kumar & Subita, 2012). Organizations such as the World Health Organization has tried to help

the government with the health problems they are facing such as Diarrhoeal disease. The World

Health Organization, Centers of Disease and Control (CDC), and the Pan American Health

Organization (PAHO) have created the Safe Water System (SWS) to reduce the number by

around 50% of diarrhoeal incidents (Combating Diarrhoeal disease, 2010). The Safe Water

System is an intervention to improve the water quality which uses simple, low-cost and strong

technologies suitable for the developing world to avoid deaths and illness connected to

diarrhoeal disease (Combating Diarrhoeal disease, 2010). The way the Safe Water System works

is by having a “bottle of 0.5 to 1% sodium hypochlorite (chlorine) solution to disinfect water at

the point-of-use, the household level, along with a home water storage vessel to prevent water

recontamination (Combating Diarrhoeal disease, 2010). This was a way to help with the
 6

sanitation of water to be able to have clean water for the community to use. The “Total

Sanitation Campaign” began in India to improve sanitation which increased sanitation coverage

significantly over a decade by building more than 64.3 million toilets by 2010 (Nandi et al,.

2017). This campaign focused on implementing more access to toilets and encouraging the

community to use them in which later was expanded into a bigger sanitation and public health

program called the Swachh Bharat (Clean India) (Nandi et al,. 2017). Their goal in 2014 was to

provide universal access to sanitation by 2019 and during 2014-2015 Swachh Bharat has built

5.58 million new toilets in rural India (Nandi et al,. 2017). This campaign has helped increase the

amount of toilets for people in the community to have access to which helps in the sanitation of

the community and environment.

In 2005 the Indian government created a National Health Mission and presented

structural reforms to reinforce sanitation and health care (Health, Water and Sanitation, n.d). A

big challenge for India has been providing everyone with clean water, good hygiene and decent

toilets (India, n.d). The Clean India campaign created by the Indian government has goal by the

end of 2019 no one will use the restroom out in the open (India, n.d). About half of the

population in India today has no choice but to use the restroom outside in rivers, fields, next to

train tracks or down alleyways (India, n.d). This poor sanitation results in water being

contaminated by feces causing many to become ill due to the only water source they have being

a lake or river. About 166 children under five years die everyday because of diarrhoea that is

caused by dirty water and poor sanitation (India, n.d). In India “163 million people don’t have

clean water, 732 million people don’t have a decent toilet, and over 60,000 children under 5 die

each year from diarrhoea” (India, n.d). There is a severe inequality with individuals having

access to sanitation facilities with more than 90% of urban residents having access to sanitation
 7

facilities as to rural India only having 39% of access and 44% of the population continues to use

the restroom out in the open (Health, Water and Sanitation, n.d). A survey conducted found that

having improved sanitations lowers the risk by 2.2% from contracting diarrhoea (Kumar &

Subita, 2012). Sanitation and having access to toilets plays an important role in lowering the

number of people being affected by diarrhoeal disease. Having more toilets and better sanitation

lowers the risk of water from lakes and rivers of being contaminated.

Research Issue

Diarrhoeal disease is one of the diseases in India that affects many children under five

years old. Their body is growing and developing which is becoming stronger as they grow.

Although there is a retrovirus vaccine that was created to help protect children from becoming ill

some developing countries may not be able to afford the vaccine to vaccinate people in the

community. The amount of people who live in the communities in India and received the

vaccines should be looked over to see if the vaccines were effective if a child had the virus

before and got cured and then got the vaccine. By looking at the collected data it can help us

understand how the vaccine works on those individuals who had the virus before receiving the

vaccine. Looking more in depth into the vaccines and the amount of people who actually got the

vaccine can help us understand who was able to receive the vaccine and who wasn’t. If there

weren’t many individuals who received the vaccine this can assist in finding a way the

government can provide the vaccine to make it available for people to get. Whether its free or at

a low cost it is important to vaccinate children in order to prevent them from being ill from

diarrhoea which can cause death. It can also avoid any medical expenses due to the illness and

the treatment they may need in order to recover from the illness.
 8

Having access to a bathroom is important in order for the waste to be disposed property.

This is something that many people in India don’t have access too. Not having access to a toilet

results in people using the outdoors which becomes unsanitary and unhealthy for people to be

around resulting in many people being sick. The Clean India campaign has helped many

communities by providing them with toilets for them to use. They have increased the number of

toilets throughout the years which looking at the conditions and how many communities they

have help would help us see how effective the campaign is in the communities. Also seeing if

there is a need of modifying it to be able to give access too everyone and not just some people in

the community since a few may be added in communities and difficult or to far for others to

access them. Looking into how many people do use it or don’t is important to see if they don’t

what are the reasons why they do not use it and find ways to encourage the use of toilets. If it

because they don’t have easy access to it, it will show us where there is a need in the community

and provide them with it for them to use. This also leads to accessing clean water. Although they

have created campaigns to provide more toilets for people to use having more research done of

the Safe Water System (SWS) and looking at the continuation problem. However, this system

may provide cleaner water but may still be contaminated. Looking at what can be modified to be

able to provide the cleanest water possible for the community to use. Going more into depth in

the study can help find a way to lessen the water contamination. Observing if there is a

connection between the clean India campaign and the Safe Water System (SWS) to improve the

sanitation of water as well as reducing the risk of having diarrhoeal disease. Also, conducting

more research on the success of both and what can be done to improve them to be more effective

for the community.

 9

Sanitation is another significant part of diarrhoeal disease. Educating the community

about the importance of sanitation and things they can do to avoid spreading of germs is

important. Looking more into the programs they have to educate the community of the

importance of washing their hands and storing their water properly to avoid any water

contamination is necessary. Seeing if the programs were effective in the community and if it

helped on lowering the risk of having a diarrhoeal disease. This can demonstrate the

effectiveness of the programs and what needs to be changed in the program to become more

effective. If it has been effective provide more programs for different communities who don’t

have access to these programs to help lower the risk of them becoming ill. Not only provide

educational programs for women but also for men so they can also understand the importance of

sanitation. More study should look into the programs created to help the communities with

sanitation. Seeing the results of the study can help how much the programs helped and what the

community thought about these programs that were provided for them to benefit them and help

them.

Discussion

Diarrhoeal disease has been affecting many children throughout the years. Water

sanitation is part of the problem causing many to become ill and causing death for some. Water

sanitation is connected to diarrhoeal disease since people can develop this disease through

bacteria that comes from contaminated water. Beginning with water sanitation may be a good

start in avoiding people in the community especially children who are more vulnerable and more

likely to catch this disease. People become ill from this disease due to the contaminated water

they use daily. As stated before 163 million people don’t have access to clean water (India, n.d).

Although people don’t have access to clean water they are still using the contaminated water
 10

because it’s the only water source they have. With the help of programs such as the Safe Water

System (SWS) they are trying to find ways to provide clean water for the community. Many

people’s daily water source may be using lakes or rivers that are in their community and not be

aware of how contaminated the water they use is. The water may be contaminated by human or

animal feces, chemicals from factories or by other things that are being dumped in them. By

providing clean water to the community it will decrease the amount of people affected by

diarrhoeal disease. This is one step in finding a solution to having a clean water system and

reducing diarrhoeal disease.

Providing the community with latrines for them to use is another great way to lower the

amount of people being affected. Having to use the restroom outside due to not having access to

a restroom as a result of not having money or living in a poor community they may not be able to

afford having a toilet for them to use. The clean Indian program is also another great way to help

the community by providing them with toilets for them to use since they may have not been able

to get themselves one. This can also have less contamination added to what may be many water

source. This also goes hand in hand with water sanitation and diarrhoeal disease. By providing

the community with toilets they won’t have to go use the restroom out in the open and

contaminating the community and water. This will help the decrease the amount of bacteria

being spread and less people becoming ill of diarrhoea.

Some recommendations would be to create a health program that can help the community

and those who become ill of this disease. The program can help the people be educating then

about ways they can reduce their risk of becoming ill and help them receive the vaccine to have

less people become sick due to diarrhoea. This along with the other programs such as the safe

water system and clean India program can work together to help the community since they all
 11

have the same goal of helping the community. This can help spread more awareness of the

importance of having a clean water source and sanitation facilities to help decrease the spread of

diarrhoeal disease. Also asking the participant their thoughts on the program and ask if they have

any recommendations to be able to help them. This can help adjust the programs to be more

effective.

Conclusion

Throughout the years India has been affected with unclean water and diarrhoeal disease.

Many people aren’t aware of how much this affects people in developing countries and low-

income communities. Till this day many people don’t have access to a clean water source or

sanitary facilities which results in them becoming ill. Diarrhoeal disease affects several

individuals especially children since they are growing and developing their immunity. Although

there is a vaccine to lower the amount of individuals affected by this disease not everyone is able

to have access to it. Programs have been created to help provide a cleaner water source for

people in the communities such as the Safe Water System (SWS) but doesn’t fully clean the

water meaning that it may still be contaminated. The Clean India campaign also helps out the

community by providing them with restroom for them to use and not go out in the open and

contaminate the communities water source whether it’s a lake or river. These are a good start to

help the communities and lower the amount affected by diarrhoeal disease since it is caused by

bacteria that comes from contaminated water. Having programs form a connection with other

programs and campaigns may be more effective in helping the community. They all have the

goal to help the community and by doing so it may be more successful.

Reference
 12

Combating diarrhoeal disease in India through safe drinking water. (2010, November 23).

Retrieved from http://www.who.int/mediacentre/multimedia/2002/ind_sanitation/en/

Diarrhoeal disease. (2017, May 02). Retrieved from http://www.who.int/en/news-room/fact-

sheets/detail/diarrhoeal-disease

Health, Water and Sanitation - UN India. (n.d.). Retrieved from http://in.one.un.org/health-water-

and-sanitation/

India. (n.d.). Retrieved from https://www.wateraid.org/where-we-work/india

Kumar S G, Subita L. (2012) Diarrhoeal Diseases in Developing Countries: A Situational

Analysis. Kathmandu Univ Med J 2012;38(2):83-88.

Mudur, G. (2003, June 14). India's burden of waterborne diseases is underestimated. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1151007/

Nandi, A., Megiddo, I., Ashok, A., Verma, A., & Laxminarayan, R. (2017). Reduced burden of

childhood diarrheal diseases through increased access to water and sanitation in India: A

modeling analysis. Social Science & Medicine, 180, 181-192.

doi:10.1016/j.socscimed.2016.08.049