ENVIRONMENTAL HEALTH

LECTURE NOTES FOR MEDICAL STUDENTS

Environment

The term environment implies all the external factors which surround man. These
surroundings could be living or non-living, material or non-material and man-made or
natural. The human environment consists of physical, biological and social environment.

 Physical (abiotic) environment comprises the non-living part of the environment, e.g.
water, soil, air, housing, chemicals, radiations, noise and atmospheric variations (heat,
cold, air pressure).
 Biological environment includes all living organisms; animals and plants.
 Social environment plays a prominent role in determining the mental health of man and
includes all the conditions affecting man as a member of the society, e.g. the culture,
including beliefs and attitude, educational system, religion, occupation, income, habits,
customs.

The human environment may exert an influence on man's health and it is necessary to
maintain a healthy environment in order to prevent or control a variety disease conditions that
may result from a poor environment. Many diseases result from an interaction between the
host and his environment. Changes in the environment upset the equilibrium between agent,
host and environment. The environment can change naturally (e.g. drought, desertification) or
man can alter the environment (e.g. irrigation schemes).

Health problems posed by environmental hazards vary from shortage of water supply, poor
sewage disposal and food hygiene in developing countries to accident prevention and air
pollution in developed countries. The purpose of environmental health is to create and
maintain ecological conditions that will promote health and thus prevent disease.

Environmental sanitation

Environmental sanitation is the process of taming the environment so that it does not
constitute a hazard to man.

Sanitation is defined as the control of all those factors in man’s physical environment which
exercise or may exercise a deleterious effect on his physical development, health and
survival.

Environmental health

The World Health Organization (WHO) defines environmental health as those aspects of
human health, including quality of life, that are determined by physical, biological, social and
psycho-social factors in the environment.

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It also refers to the theory and practice of assessing, correcting, controlling and preventing
those factors in the environment that potentially can adversely affect the health of present and
future generations.

The purpose of environmental health is to create and maintain ecological conditions that will
promote health and thus prevent disease.

It is targeted towards preventing disease, creating health-supporting environments and

encouraging positive human behaviours.

Environmental Health Hazards

A hazard is a potential source of danger OR a factor or exposure that may adversely affect
health. An environmental health hazard is the potential of an environmental agent to harm
particular individuals if the exposure is above a certain level.

Classification of hazards
• Physical
• Chemical
• Biological
• Socio-cultural

Physical hazards – are those substances or conditions that threaten our physical safety. They
result from excess or deficiency of physical components such as temperature, humidity,
pressure, radiation. Also, from trauma from man’s interaction with physical objects resulting
in traumatic injuries. Trauma arising from unsafe environments accounts for a large
proportion of preventable human illness. An example is noise in the workplace which is
responsible for the most prevalent occupational impairment: hearing loss or permanent
deafness.

Chemical hazards – results from human exposure to numerous chemicals. The sources may
be natural or man-made. It includes substances such as lead, arsenic, mercury, asbestos,
pesticides such as DDT. Diseases that can occur from exposure to chemicals include
• lung cancer and mesothelioma caused by asbestos
• liver cancer caused by vinyl chloride
• leukemia caused by benzene
• Minamata disease from food contaminated with mercury
• Yusho disease from food contaminated with chlorinated furans

The extent and frequency of illness are related to:

• dose of the toxin, in degrees depending on the toxin.
• length of exposure; chronic or delayed effects can result in cancer or adverse reproductive
effects; no “safe” dose threshold may exist below which disease is not produced.

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Biological hazards – Includes plants and animals. May be in the macro or micro forms.
Macro organisms include animals such as snakes, scorpions, fish, insects; for plants may
include pollen, contaminated grains. Micro may be viruses, bacteria, fungi (plant or animal
origin) and protozoa. Diseases result from contact or consumption of these biological
hazards. A variety of infectious diseases result from this hazard.

Socio-cultural hazards – Culture is the knowledge, belief, art, law, morals, customs and
habits that are acquired by people as members of society.

It is also the common way of life and set of thoughts and feelings shared by the members of a
society.

Socio-cultural hazards includes cultural beliefs, family situation, and social habits. These may
result in mental illness, drug addiction, bodily harm, transmission of infection, nutrient
deficiencies. Poverty and illiteracy is a social hazard – the poor and uneducated get sick more
frequently. Belief in evil spirits as the source of a disease will not allow medical help to be
sought early.

Control of Environmental hazards

To control the hazard there is a need to find the;
– Source of the hazard
– Type of hazard
– Pathway to the body
– Response of the body to the hazard

The principles for control of environmental hazards include;

• Elimination
– Substitution
– Change of process
• Containment/Isolation
– Partial
– Complete
• Good housekeeping
• Administrative control
• Personal protective equipment
• Health education

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Components of Environmental Health

1. Water Sanitation
2. Solid Waste Management
3. Sewage Disposal
4. Housing
5. Food Hygiene
6. Vector Control
7. Control of Air pollution
8. Control of Other Hazards – noise, radiation

Environmental pollution

Pollution is the introduction of contaminants into an environment causing harm, instability or

disorder to the ecosystem. It can be also defined as the presence of a substance in a medium
or environment that results in a change to its ‘natural’ state, potentially causing an adverse
effect.

Pollution is the harm that results because substances are present where they would not
normally be found, or because they are present in larger than normal quantities.

A contaminant is a minor substance, material or agent that is unwanted in the environment

and may or may not be harmful.

A pollutant is a contaminant which, due to its properties or amount or concentration, causes

harm e.g. gases (carbon monoxide, ozone, nitrogen dioxides), chemical vapours, dust
particles, fumes and liquid chemicals (pesticides, solvents, drugs, acids, etc.)

In nature, the environment has an inherent capacity to clean itself through self-cleaning
processes. Natural environmental processes have the ability to deal with many pollutants and
correct most imbalances if given enough time.

Types/classes of pollution

 Air pollution: the release of chemicals and particulates into the atmosphere.
 Water pollution: the release of wastes, chemicals and other contaminants into surface and
groundwater.
 Soil/land pollution: the release of wastes, chemicals and other contaminants into soil.
 Radioactive pollution: presence of radioactive substances in the environment.

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 Noise pollution: unacceptable levels of noise in work, residential and recreational places.
 Thermal pollution: the release of heat into the environment; for example heated water into
a river.

Water Sanitation

Most of the ill-health which affects humanity, especially in developing countries can be
traced to lack of safe and wholesome supply of water. Wholesome supply of water is one that
is easily accessible, adequate in quantity, free from contamination, safe and readily available
all year round.

Water can be harnessed at any point in its movement through the hydrological cycle. An
adequate source of water should have sufficient quantity to meet present and future
requirements and should be of acceptable quality.

Sources of Water

There are 3 main sources of water

 Rain water: This is the main source of water for other sources and for the water cycle. It
is the purest source of water in nature and is soft but may pick up impurities from the
atmosphere, roofs, roof guttering and storage tanks on its way to the ground.
 Surface water: rivers, streams, ponds, lakes, impounded reservoirs. It is the main source
of water especially in rural areas and is prone to contamination from human and animal
activities.
 Ground water: wells, boreholes and springs. Rain water percolates into the ground to
form it. It is the cheapest and most practical way of providing water to small populations.
It is purer than surface water since the ground acts as a filter for it. It may however
contain a higher chemical content which is picked up as the water percolates down.

Uses of Water
These include:

 Domestic uses = cooking, bathing, washing

 Industrial uses = processing, cooling, cleaning equipment

 Agricultural uses = irrigation, animal husbandry

 Power = hydro-electricity

 Public use = recreation, wash streets, fountains

Characteristics of Water

Water is said to be potable when it is free of impurities, including pathogenic organisms and
is aesthetically appealing, and safe and acceptable for drinking.

For water to be potable it must possess some basic characteristics.

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(i) Physical Characteristics

Appearance - must be clear and aesthetically appealing

Odour - must have no smell.
Taste - must be tasteless.
Turbidity - must contain no impurities or suspended particles
pH - WHO allows for 6.5 – 8.5

(ii) Biological (Bacteriological) Characteristics

Drinking water should not contain disease carrying organisms e.g. bacteria, protozoa, virus or
fungus. Coliform organisms e.g. E. coli, klebsiella, citrobacter are used as indicators of recent
faecal pollution. Coliform count is measured in cfu/ml or cfu/100ml, cfu referring to colony
forming units. Potable water should have a 0 cfu/ml count.

(iii) Chemical Characteristics

Potable water should be free from toxic chemicals, e.g. lead (not more than 0.1 mg/l), arsenic
(0.05mg/l), iron (0.05mg/l), cyanide (0.05mg/l), cadium (0.01mg/l), mercury (0.001mgll),
fluoride (1.0mg/l) and nitrate (4.5mg/1).

Water is said to be hard if it contains excessive amounts of calcium and magnesium

carbonates and bicarbonates (temporary hardness), and calcium and magnesium sulphates
and chlorides (permanent hardness). Water hardness is also referred as the soap destroying
power of water. Effects include changing the colour of food, destroying clothes, and forms
precipitates when boiled. Temporary hardness can be removed by boiling, addition of
lime/NaCO3 while permanent hardness can be removed by addition of NaCO3 or a base-
exchange process.

Qualities of a Sanitary Well (Protection of wells)

i. A well should be sited at least 30 meters and preferably uphill from any potential
source of pollution e.g. pit latrine, septic tank.
ii. There should be a water-tight lining of at least 30 feet from the surface.
iii. There should be a concrete platform (parapet) about 2 feet high.
iv. There should be a concrete apron to drain the waste water away.
v. There must be a water tight cover.
vi. Water should be drawn by a pump or at least a permanent bucket attached to the well.

Water Related Diseases

Water related diseases can be classified into five epidemiological groups based on their
transmission mechanism as follows:

1. Water-borne (feaco-oral): cholera, typhoid and paratyphoid, Hepatitis A,

poliomyelitis, dysenteries.

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 2. Water-based (water impounded): schistosomiasis, guinea worm, paragonimiasis
3. Water-washed (water shortage): skin and eye infections, conjunctivitis, trachoma.
4. Water-vector (water-related): malaria, onchocerciasis, filariasis, yellow fever,
trypanosomiasis.
5. Water chemical which may be due to:
(a) Shortage of a chemical e.g. iodine, endemic goitre, cretinism, dental caries
(b) Excess of a chemical e.g. fluorosis, methaemoglobinaemia, lead poisoning

Treatment of water

Pure, uncontaminated water does not exist in nature since most water sources are
contaminated by natural and man-made impurities.

 Natural impurities; dissolved gases (N,CO2, H2S) and minerals (salts)

 Human impurities; result from urbanization and industrialization and include sewage,
industrial waste, agricultural and physical pollutants.

The presence of these contaminants makes it necessary for water from all sources to go
through a process of treatment to make it potable and safe for human use

Purification of water at the home level can be achieved through the following stages

(a) Protection of source

Human beings and animals should be prevented from having contact with surface water.
Waste water, refuse and industrial waste should not be channeled or disposed into sources
of water supply. Farming and other human activities around such areas which form the
attachment area should be avoided.

(b) Storage

This will remove some human pathogens with short life spans in water, e.g. cercariae of
schistosoma which survive only 48 hours in water. Large solids will also settle during
storage.

(c) Sedimentation

When water is allowed to stand, heavy particles (sediments) settle at the bottom. A clearer
and purer form is then obtained which is decanted.

(d) Sedimentation and Coagulation

Addition of alum (aluminium sulphate) causes flocculation and sedimentation of much

finer sediments that cannot be removed by simple sedimentation. Such substances like
alum which can attract together colloidal substances to form larger particles to such a size
that become heavy and settle are known as coagulants and the process is known as
coagulation. Addition of alum therefore accelerates the rate of sedimentation.

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(e) Filtration

This process will remove pathogenic bacteria, protozoal cyst and large viruses. Smaller
viruses will however pass through the filter (filterable viruses). Various devices are used
for filtration, including thick white linen cloth which may remover large particles or
organisms such a cyclops - the intermediate host of guinea worm from the water. For
domestic filtration, a candle filter made of fine clay is also used.

(f) Boiling

This is also a reliable method of water purification used commonly during emergency
conditions and in special circumstances e.g. infant feeding.

(g) Disinfection with household chemicals

This is a process of water treatment which aims at complete destruction or pathogenic

organisms that may escape other processes of treatment. Disinfectants are usually
chlorine based household chemicals e.g. Watergaurd

Better results are obtained when combinations of these methods are used.

Municipal Water Treatment

This refers to purification of water on a large scale and comprises of;

1. Protection of source from contamination

2. Storage; will remove some pathogens with short life in water.

3. Coagulation and sedimentation; addition of alum causes flocculation (attraction of

colloidal substances) and these sediment.

4. Filtration; which removes some pathogens. Done using a rapid sand filter. A sand filter
consists of sand and stones of graded size, with fine sand at the top and large stones at the
bottom.

5. Disinfection; is a process of removal/killing microorganisms using heat, ultraviolet rays

or chemicals (halogens like chlorine, iodine, ozone). Chlorine addition is termed
chlorination and is added at 0.5-1ppm (parts per million).

Chlorination is the commonest method of disinfection of large municipal water supply. Other
chemicals that can be used include, iodine, ozone, Milton and potassium permanganate.
Chlorine may be used in the form of chlorine gas or as bleaching power (chlorine of lime),
liquid bleach or hypochlorite. Chlorine gas is given in a concentration of 1 ppm released from
a cylinder by means of a measuring device - the chlorinator. During emergencies, e.g.
epidemics of water-borne diseases super-chlorination is used and this is achieved by the
application of doses of chlorine which considerably exceed that normally required to disinfect

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the water e.g. 1.5 ppm. After a suitable contact time the water is dechlorinated using
chemicals such as sulphur dioxide sodium bisulphate and sodium thio-sulphate. Some
chlorine tablets are also available in the market for domestic purification of water and at the
time of emergency and they include' Halozone', 'Chlordechlor' and 'hydrochlorozone' among
others.

Solid Waste Management

Human waste can be sub-classified as solid waste (refuse) and liquid waste.

Solid wastes can be described as substances produced in our daily activities in homes,
agricultural and livestock activities and in industries. They include garbage or kitchen wastes,
paper, leaves, empty cans, broken bottles, glass, iron scraps, plastics, e.tc. It can be grouped
as combustible/non-combustible, degradable/non-degradable, dry/wet or liquid. Wastes, both
solid and liquid must be handled and disposed of with care so that they do not constitute a
danger to public health.

Problems of improper/insanitary disposal of solid waste include;

1. An eye-sore

2. Breeding of vectors/disease causing agents

3. Pollution of sources of water

4. Pollution of the air with a bad odour

5. Starting of fires

6. Littering of the environment

7. Increases in infective diseases.

The choice of a method for disposal of refuse will depend on the physical characteristics of
the locality, e.g. the topography of the area, the character, quality of the waste, and the
community. The consideration in choosing a method for waste disposal should however be
the public health safety aspect.

The refuse disposal process

 Generation - Refuse is usually from the street, markets, farms, industries or homes.
 Storage - It is usually stored while awaiting collection in all sorts of containers but the
ideal should be a galvanized steel container with a cover
 Collection & transportation - The method of refuse collection is best done house-to-
house in vehicles that enclose it and transport it to where it will be disposed of.
 Treatment - some waste may require treatment before final disposal to render it harmless
 Final disposal

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Unsanitary methods of waste disposal

(a) Open dumping:

Refuse is dumped in a patch of land and left there. With bacterial action the refuse
decreases in volume and the degradable one is converted to humus. It is termed the most
insanitary method that constitutes a public health nuisance.

(b) Open Burning:

It is an improvement over open dumping where the refuse is set on fire. The combustible
part of it burns, polluting the atmosphere with smoke and its stench. The ash is also blown
by the wind and dirties the environment.

Sanitary methods of waste disposal

(a) Burial:

This refers to deposition of waste in a dug piece of land and then covered with earth. It
requires adequate land space. It is a culturally accepted permanent method of disposal of
carcasses and human corpses. It does carry with it the risk of contamination of
underground water sources and of being dug up if not properly done.

(b) Controlled Tipping or Sanitary Landfill

This method is useful in land reclamation of gullies, excavation and low land areas and
requires technically trained personnel and heavy machinery to operate. Refuse is piled up
in 2m layers, compacted and covered intermittently with 2-2.5cm of soil or sand till the
gap is filled. The land can be reused for development usually after a period of 10years.

(c) Composting

A mixture of compostable degradable refuse and other nitrogen rich decomposable wastes
(e.g. night soil) is heaped for several months with periodic turning. The end product,
manure is used in gardening or farming. There could be odour and fly nuisance if not
properly managed.

(d) Incineration

Refuse is sorted and combustible matters are dried up and burned in a large incinerator
maintained at 900° C - 1200°C. The ash is then disposed of. It produces less smoke than
with open burning. It is expensive to build and needs technically trained people to
manage.

(e) Sea Disposal or Berging

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 This method is popular for coastal areas. Refuse which has been encapsulated is dumped
directly into the waters of a river or sea at a distance to prevent refuse beings carried back
to shore by tides and causing a nuisance. For toxic or radioactive wastes, these are sealed
in water-tight containers and buried in deep seas. Water pollution is the main
disadvantage of this method.

(f) Mechanical Destructor

This is a plant used for treating refuse. After sorting out all that could work against the
machine, what remains is fed into it for pulverization and the end product used as manure or
buried in a small area of land. This method is very useful in big cities where the volume of
refuse generated are daily and enormous. Running cost is very high.

(g) Plasma gasification

This is a relatively new method of waste disposal. Plasma is primarily an electrically charged
or a highly ionized gas. Lighting it with electricity produces temperatures that range from
4,000 – 25,000 °F (2,200 – 13,900 °C). At these temperatures the waste is vaporized into
synthetic gas (syngas) which can be transformed into electricity.

(h) Pyrolysis

Also new in the use for waste disposal. Pyrolysis is a process of thermo-chemically
decomposition of organic materials by heat in the absence of oxygen which produces various
hydrocarbon gases. Temperatures of up to 10,000 °C can easily be reached. Is useful in
disposal of bio-medical waste. Its by-products are fuel gases and fuel oils.

Recycling

In an effort to manage the waste that is being produced worldwide recycling is being
encouraged as a concept of the 5R’s (originally 3Rs) – refuse, reduce, re-use, repurpose and
recycle. Refuse refers to not buying or accepting items that you know will become waste
especially if it is not essential. Reduce refers to source reduction i.e. reducing as much as
possible the use of materials that will eventually become waste. Re-use involves taking items
that would ordinarily be regarded as waste and using them again for a similar or different
purpose. Re-purpose refers to taking something and using it for something else.

Recycling is the collecting, sorting & processing of materials that would otherwise be
considered waste into raw materials for manufacturing new products and the subsequent use
of those new products. The process involves.

 sorting the waste into groups

 collecting them in the groups
 recycling
Advantages of recycling
• Conserves natural resources
• Conserves energy

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• Preserves land space
• Reduces water pollution
• Reduces greenhouse emissions
Diseases associated with poor refuse disposal

Improper disposal of refuse will lead to mosquito breeding as well as breeding of other flies
and of rodents and the spread of the following infectious disease:

1. Fly transmitted infections e.g. miasis, diarrhoea, typhoid, cholera.

2. Rodent transmitted diseases e.g Lassa fever, plague, leptospirosis, murine typhus.

3. Mosquito-borne e.g. malaria, yellow fever, filariasis, dengue hemorrhagic fever.

Can also be classified as follows

 Viral Viral - Lassa fever, yellow fever, Dengue haemorrhagic fever, rota virus
 Bacterial - miasis, diarrhoeal diseases, typhoid and paratyphoid fevers, leptospirosis,
plague
 Helminthic - ascariasis, taeniaisis, trichuriaisis
 Protozoal – malaria, yellow fever, trypanosomisasis

Sewage Disposal

Sewage has been described as a collective name for liquid or wet refuse consisting of excreta
(faeces and urine) effluents from bath, kitchen, laundry, rain runoff waste water. The term
sullage is often used for waste water from bathroom, kitchen and laundry devoid of excreta.
An average human excretes about 135 - 270g of faeces and 1.5 litres of urine a day. Excreta
contains a variety of pathogenic organism, for example, bacteria, viruses, protozoa, fungi and
helminthes.

Methods of Sewage Disposal

The methods of disposal of sewage from a community depend on the type of sewage. A good
sewage disposal system must have the following characteristics:

1. It must not pollute the surface of the soil, the surface of water or the ground water.
2. It should not be unsightly or smelly.
3. It must not make sewage accessible to flies or animals.
4. There must be no handling of fresh sewage.
5. It should be simple, cheap and culturally acceptable in terms of cultural belief of the
community.
6. It should provide some privacy for the users.
7. It should be built using hygienic and easy to clean materials.
8. Should be safe; children should not fall into it.

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Methods of Sewage Disposal

The common methods of sewage disposal include:

1. The Non-water Carriage Systems.

(a) Bucket Latrine (Conservancy): The bucket latrine is a bad sewage disposal
method. It consists of a seat that has an opening in the centre below which a
bucket or container is placed. It is very cheap to start but difficult and expensive to
operate. In addition the bucket latrine allows fresh handling of faeces by the night
soil men, constitutes odour, and attracts flies and vermin.
(b) Pit Latrine: The pit latrine is ideal in rural areas and other communities where
there is scarcity of water. The conventional pit latrine consists of the pit, the floor
and the superstructure. The pit should be made as deep as possible so that it can be
dark inside and also last many years before it is filled up. It should be at least 2.4
meters deep. The floor should be made of reinforced concrete slab to ensure that it
is strong and safe. There are many modifications of the pit latrine aimed at
improving the sanitary features of this method of disposal. These include the
ventilated improved pit (VIP) latrine, the borehole latrine, the seal pit latrine, etc.
(c) Ventilated Improved Pit (VIP) Latrine: Is an improvement over the pit latrine
meant to overcome its limitations. The main difference is the ventilation pipe
which is placed outside the super structure. The top of pipe is fitted with a fly-
proof screen mesh or non-corrosive material. It allows hot, foul smelling air rise
up and out of the vent. Flies can’t get in, those in the hole are attracted to the light,
get trapped and die.
(d) Composting: This is a biological destruction process whereby excreta and refuse
are mixed and allowed to decompose in a corrosion-resistant container or a
shallow ditch. The content of the container is turned regularly until decomposition
is achieved. The process takes place at normal air temperature. Humus is produced
and carbon dioxide and other gases are allowed to escape.
(e) Trench Latrine: The trench latrine consists of shallow, long trenches. Trench
latrine is suitable for temporary sites such as work camps, picnic sites, and holiday
and festival camps. The excavated soil from the trenches is left close to the latrine
so that it can be used by each user to cover the excreta after defecation.

2. Water Carriage System

(a) Septic Tank and Soak-away Pit (ST & SP) Method: This method of sewage
disposal is ideal where there is some availability of water. It consists of the
flushing device known as the water closet, the inspection chamber and the short
sewer pipe which leads into the septic tank and the soak-away pit. The night soil
discharges from the house through the sewer to the septic tank where anaerobic

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 action takes place and from where a clear effluent leaves to the soak-away pit. In
the soak-away pit the effluent is absorbed by the surrounding soil. The sludge in
the septic tank is removed when the tank is filled.
(b) Aqua Privy: It consists of water-tight tank made up of concrete or any other
durable material and a floor which carries an inlet drop pipe. Faeces are stored in
the tank which is kept at a constant water level. A soak-away pit may be provided
for the effluent from the aqua privy tank. It is important that the top of the water
level is maintained constant to prevent the tip of the drop pipe from being
exposed. To this effect addition of about a litre of water each time the toilet is
used is recommended. Alternatively the aqua privy tank may be connected to the
bathroom, kitchen or laundry so that the water ensures that the correct top water
level is maintained.
(c) Chemical Toilet: This is suitable for mobile communities, caravans, boats, buses,
trains and aircrafts. It consists of a corrosion resistant container of about 400 - 500
litres of containing bactericidal liquid such as strong solution of sodium hydroxide
or formaldehyde. From time to time the contents of the toilet will have to be
discharged in such a way that it does not pollute the environment.
(d) Sewerage: Toilets/water closets, bathrooms, kitchens, etc. are connected to
sewers and the water used to flush them transports the wastewater through the
network of sewers (sewerage) to a collection point, treatment plant or to a final
discharging point.

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 Sewage treatment
Secondary Rx
Primary RX

Addition
of
chlorine

Sludge Effluent
Raw digester disposal
sewage
Sewage treatment

The primary purpose is to improve the quality to the point that it can be released into a body
of water or piece of land without seriously disrupting the aquatic environment, causing health
problems or causing nuisance conditions.

Other methods of sewage treatment include;

 Sea outfall
 River Outfall
 Land treatment
 Oxidation ponds
 Oxidation ditches

Diseases associated with inadequate sewage disposal (sewage-related diseases)

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Human excreta are an important source of pathogenic organisms. In most of the diseases
associated with inadequate sewage disposal, the infective agents, which are bacteria, viruses,
protozoa and helminths are often discharged from human faeces and seldom in the urine. The
diseases are transmissible by the pathogens passing from the faeces of an infected person and
subsequently infecting a new host. They are therefore referred to as sewage-related diseases
and can be transmitted directly through the water-borne route (e.g. typhoid, paratyphoid,
cholera, dysentery, infective hepatitis, poliomyelitis), or soil or food (e.g. Ascariasis,
trichuriaisis, giardiasis, balantidiasis, dysenteries), through skin penetration (e.g.
schistosomiasis, hookworm). In addition, sewage is attractive to flies and can lead to
proliferation of flies which can contaminate food.

The control of sewage-related diseases is mainly by adequate disposal of sewage or by rigid

prevention of unapparent faecal contamination of food, water and hands the three main items
which regularly make contact with the mouth. Other methods of control include provision of
good water, personal hygiene, food hygiene and f1y control among others.

Housing

A house is a man-made physical structure which is designed to offer shelter to human beings.
Housing refers to the physical structural accommodation, its immediate surrounding and the
related community services and facilities.

Qualities of a Good House

A good house must have the following basic facilities.

 Meet basic physiological needs

• Satisfactory lighting - adequate day light, admission of direct sunlight.
• Satisfactory Ventilation - free circulation of air; atmosphere of reasonable
chemical purity (pure air)
• Adequate protection against excessive noise.
 Meet basic psychological needs
• Separate rooms for sleeping and living with adequate lighting and spacing for
movement and free circulation of fresh air.
• Adequate privacy for the individual and possibly separate rooms for both children
of different sexes that are above 10 years of age
• Adequate open space for recreational activities and relaxation.
 Protect from contagion (disease)
• Adequate sanitary facilities such as toilet, bathroom and good sewage disposal
facilities
• Adequate kitchen and storage facilities safe from contamination
• Adequate potable water supply
 Protect from accidents
• Must be designed and built with proper materials as to prevent accidents, fire
electrical shocks, poisons and mechanical injuries due to collapse of any part of
the building.

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Aspects of housing considered when planning:

– Accessibility to potable water – Vegetative cover

– Security – suitable materials for construction
– Space – Ventilation
– Access – Cooking facilities
– Soil type – Storage
– Drainage – disposal of waste (solid and liquid)
– Availability of fuel

Building regulations and bye-laws

These are meant to ensure that the building does not endanger lives during and after
construction and that it promotes health and provides environmental aesthetics. While
regulations are of general application, the bye-laws are often restricted to the local
government or the planning authority.

SIZE: Building should occupy a maximum of 50% of the plot size for high density area, 45%
for medium density and 35% for low density.
ROOM SIZE: This should be as large as possible and at least 1.8 sq.metres (20 sq.ft). The
side of the room should not be less than 2.4 metres.
HEIGHT OF ROOM: The height of the ceiling should be at least 1.68 metres from the
ground level.
VENTILATION: Total area of window or ventilation opening must be at least 1/8th of the
total floor area. Room should be cross-ventilated. In cross-ventilation there are windows on at
least two opposing or adjoining walls.
Health hazards associated with bad housing
The striking features of poor housing are:

(a) Overcrowding and diseases associated with overcrowding, notably respiratory

infections (pneumonia, bronchitis, tuberculosis, cerebrospinal meningitis, measles,
etc.)
(b) Lack of basic sanitation leading to gastro-intestinal infections e.g. diarrhoea and
dysenteries, infective hepatitis.
(c) Filth which will attract flies, lice, fleas, bugs, mites, mosquitoes and rodents. All of
which transmit a variety of diseases.
(d) Behavioural disorders; nervous irritability, bad temper and mental unrest associated
with homes lacking basic psychological needs.
(e) Accidents and injuries from falls burns, electrical shock, as well as atmospheric
pollution from smokes, excessive noise and poor lighting resulting from bad designs
of homes.

Food Hygiene

This refers to the prevention of contamination of food-stuff at all stages of their production;
from its production, handling, distribution, serving and consumption.

17
WHO defines it as “all conditions and measures that are necessary during the production,
processing, storage, distribution and preparation of food to ensure that it is safe, sound,
wholesome and fit for human consumption”.

Food hygiene deals with the prevention of contamination of foodstuffs at all stages of their
production e.g. from the time the foods are produced to the time they are served for
consumption. It covers proper handling and storage of food stuffs and drinks, all the utensils
and equipment used in food preparation, service and consumption, as well as the care and
treatment of foods known to be contaminated with poison or pathogenic micro-organisms
which have originated from the material.

In developing countries, the normal atmospheric temperature is ideal for the multiplication of
micro-organisms which cause food to spoil and lead to food poisoning. Sometimes the food
may look attractive and may be normal in smell and taste, and yet cause acute illness almost
immediately after consumption or after a period of time due to toxins produced by bacteria.

Steps that are taken to ensure food hygiene can be looked at in terms of the different stages of
food production.

Food establishments

A food establishment is any building or area in which food is handled and the surroundings
under the control of the same management.

Location: A food establishment should not be located in:

• environmentally polluted areas and industrial activities which pose a serious threat of
contaminating food
• areas subject to flooding unless sufficient safeguards are provided;
• areas prone to infestations of pests
• areas where wastes, either solid or liquid, cannot be removed effectively

Equipment and structures: Should be made of easy to clean material and facilitate hygienic
operations and designed to protect food from cross-contamination.

There should be provision of:

• Safe potable water

• Proper waste disposal system
• Properly designed sewerage system
• Personal hygiene facilities and toilets
• Adequate facilities for temperature control (heating, cooling, refrigeration)
• Adequate ventilation and lighting
• Adequate storage facilities

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Food handlers

These are personnel working in food establishments. Their personal hygiene and working
habits directly hinge on food sanitation. Pre-employment and periodic medical examinations
are required for them. They are capable of transmitting diseases such as diarrhoeas,
dysenteries, typhoid and paratyphoid fevers, entero-viruses, viral hepatitis, protozoal cysts,
helminths, streptococcal and staph infections, salmenollosis. Do not employ those with a
history of chronic dysentery, typhoid fever, diptheria, TB, other communicable diseases.
Food should not be handled by those with wounds, discharges from ear, eye or nose, skin
infections, jaundice, diarrhoea and fever. In this environment food handlers tend to be mostly
uneducated hence need education/training in food handling. Emphasis must be laid on care of
the hands, hair, overalls and habits.

Methods of Food Preservation

The following methods of food preservation are available: refrigeration, drying, smoking,
salting, and pickling with brine, addition of sugar, addition of chemical pesticides,
sterilization and pasteurization.

Roles of governments, industry and consumers in food hygiene

Governments

• protect consumers adequately from illness or injury caused by food

• formulate policies that consider the vulnerability of the population, or specific groups
within the population
• provide assurance that food is suitable for human consumption
• maintain confidence in internationally traded food
• provide health education programmes which effectively communicate the principles
of food hygiene to industry and consumers
Industry

• provide food which is safe and suitable for consumption

• ensure that consumers have clear and easily understood information, by way of
labelling and other appropriate means, to enable them to protect their food from
contamination and growth/survival of food-borne pathogens by storing, handling and
preparing it correctly
• maintain confidence in internationally traded food

Consumers

• following relevant instructions and applying appropriate food hygiene measures

• seeking appropriate knowledge

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Food Poisoning/Food borne diseases

Food poisoning is loosely used to cover both infections and intoxications caused by eating
contaminated food. It is defined as a disease which is either infections or toxic in nature,
caused by agents that enter the body through ingestion of food. The symptoms include
diarrhoea, vomiting, abdominal pains chills, prostration and gastroenteritis. Food poisoning in
the tropics is commonly due to the following organisms: salmonella organisms,
staphylococcus and clostridium organisms, especially Clostridium welchii (perfringens).

Most of the organisms causing food poisoning have variable incubation periods, e.g.
salmonella organisms 12-24 hours staphylococcus 1-6 hours, Clostridium Welchii 10-24
hours. Moreover while salmonella and staphylococcus food poisoning typically present with
diarrhoea and vomiting, vomiting is not very common in Clostridium welchii food poisoning.
Other bacteria causing food poisoning include Clostridium botulinum, Vibro parahaemolytica
and bacillus cereus.

Apart from contamination by bacteria, food poisoning can be caused by a variety of

chemicals (Cassava - cyanide; mushroom-alkaloid, etc.).

When contamination is directly from the food materials, e.g. animal suffering from
salmonellosis or other disease, or vegetables contaminated with salmonella typhi or
helminthes, this is known as primary contamination. Secondary contamination arises
from workers with respiratory infections or skin infection and diarrhoea or persons with bad
habits and poor personal hygiene contaminating the food. Contamination can also occur
during transportation, transportation contamination, or in the markets or homes.

Food may also be the vehicle of transmission for many other infectious diseases. These
include typhoid and paratyphoid fever, shigellosis, streptococcal pharyngitis, brucellosis,
infective hepatitis, amoebiasis, cholera, bovine tuberculosis, trichinosis and other helminthic
infections.

In summary, the causes can be classified as below:

Foodborne intoxications

1. Due to naturally occurring toxins in food

• Neurolathyrism, beta oxalyl amino-alanine
• Endemic ascitis (pyrrolizidine alkaloids in millet, weeds)
2. Due to toxins produced by bacteria
• Botulism (clostridium botulinum)
• Staphyloccocal poisons
3. Due to toxins produced by some fungi
• Aflatoxin, aspergillus
• Ergot
• Fusarium toxins, sorghum, rice
4. Foodborne chemical poisoning
• Heavy metals e.g. Mercury, cadmium, lead

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 • Oils, petroleum products
• Migrant chemicals from packaged materials
• Asbestos
• Pesticide residues e.g. DDT
Foodborne infections
1. Bacterial
• Salmonella spp, Staphylococcus aureaus, streptococcus, Clostridium spp
especially C.welchi/perfringes, Clostridium botulinum, bacillus cereus, vibro
parahaemolytica, shigellosis, brucellosis
• Viral
• Viral hepatitis, ROTA viruses.
• Parasitic
• Taeniasis, hydatidosis, trichinosis, ascariasis, amoebiasis, oxyuriasis

Control of Food Poisoning

This involves the adoption of stringent food safety measures at sources till the eating place.

i. Individual Measures

• Health education of individual and food handlers on personal hygiene and proper
handling of food.
• Prompt and thorough refrigeration of food, especially meat and dairy products to
avoid multiplication of bacteria.
• Medical examination of food handlers and temporary exclusion of diseases carriers
and those suffering from diarrhoea and pyogenic skin, nails, eye and respiratory
infections.
ii. Community Measures

• Veterinary inspection of abattoirs and proper ante and post mortem inspection of
animals used for food. Sick animals should not be used for food.
• Proper cleaning and maintenance of utensils and equipment used.
• Provision of good sanitary facilities, including potable water in food premises and
eating houses.
• Potable water in food premises and eating houses
• Pasteurization of milk
• Discourage use of chemicals for meat preservation.

Vector control

A vector is an invertebrate or an arthropod which harbours/carries an infectious disease and is

capable of transmitting it from one person to another. Transmission by a vector is mechanical

21
when the vector carries the infectious agent on its body or limbs or by passage of the
organisms unmodified through its gastrointestinal tract. In many cases there is biological
transmission by vectors, in which case the agent completes some or all of it's life cycle in the
vector, i.e there is multiplication or cyclic development of the organisms in the vector before
it can transmit the ineffective form of the agent to man.

An extrinsic incubation period is the phase within the vector during which the organism
develops into an infective form the vector becomes infective only after this periods. Pests,
unlike vectors may not transmit disease but can be a considerable nuisance to man and may
affect his health indirectly.

Examples of vector borne diseases include;

• Mosquito; malaria, filariasis, viral fevers

• Houseflies; typhoid, paratyphoid, gastroenteritis, trachoma, conjunctivitis
• Chrysops; loa-loa
• Sandfly; kala-azar, oriental sore, sandfly fever
• Tsetse fly; sleeping sickness
• Black fly; onchocerciasis
• Rat flea; bubonic plague, endemic typhus
• Reduviid bug; Chagas disease
• Itch-mite; scabies
• Cyclops; Guinea-worm
• Cockcroaches; enteric pathogens
• Crab; Paragonimiasis
• Snail; schistosomiasis: Bulinus(S. Haematobium), Biomfilaria(S. Mansoni),
Oncomelina(S. Japonicum)

Vector Control Methods

These can be classified into physical, biological, chemical and genetic methods

(a) Physical control

This involves;

- Trapping or collection and destruction of vectors using various mechanical devices, e.g.
sticky strips, insectocutor

- Contact barriers; use of bed nets, protective clothing or screening of the house with nets
to reduce man-vector contact

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 - Environmental control; this involves the elimination of breeding places such as filling
and drainage of impounded water, clearing of vegetation and bushes around houses,
provision of pipe-borne water, proper disposal of refuse

(b) Biological control

This involves the either the use of other living things or alteration in natural processes of
vectors to alter their life cycle. Use of natural predators e.g. larvivorous fish such as
Gambusia, or bacteria e.g. Bacillus thuringiensis or fungi e.g. coelomomomyces or other
biological agents to compete with the vectors and by so doing reduce the vector
population.

(c) Genetic control

These methods are mostly in the experimental phase. They include sterilization of males
using UV/X-rays, chromosomal translocations, insect growth regulators, chemosterilants,
sex attractants.

(d) Chemical control

This involves the use of chemicals on vectors. These are generally regarded as
pesticides. Pesticides are natural or synthetic chemicals that have been developed and
manufactured for the purpose of killing pests [any organism (plant, animal, or
microbe) that has adverse effect on human interest]. Types of pesticides include
insecticides, larvicides, herbicides, etc. The use of insecticides or larvicides is now an
accepted means of control of insect borne diseases throughout the world. It involves
the use of chemicals to kill the insect vectors or their larvae.

Insecticides in current use

Two types of insecticides are used in the field of public health.

(a) Non-residual Insecticides

These are insecticides which do not possess a lasting effect because they are unstable in light
and air. An example of non-residual insecticides is Pyrethrum derived from pyrethrum
flower. The insecticidal constituent consist of pyrethrum, is quick acting and will have a
knock-down effect or kill most insect pests which are in that room at the time of spraying.
Pyrethrum can be used as dusting powder or atomized space spray or incorporated in slow-
burning, joss-stick-type coils which produce an insecticidal smoke both toxic and repellant to
insects.

(b) Residual Insecticides

These are stable, organic chemicals which when applied to a surface; remain toxic for some
time, usually several months to insects resting on that surface. The following residual
insecticides are commonly in use:

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(a) Chlorinated Hydrocarbons (Organochlorines) e.g. DDT (dichloro-diphenyl-
trichoroethane), Gamma BHC (Gamaxane, Lindane), Chlordane (Octachlor), Dieldrin,
Aldrin.
(b) Organophosphates, e.g. Abate (Temephos), Ronnel (Fenchlorphos), Malathion
(Cyinthion), Dichlorvos (Nuvan), Fenthion (Baytex), Fenithrothion (Sumithion)
(c) Carbamates e.g. Carbaryl (Sevin), Propoxure (Baygon)

Methods of application

Depending on the objective to be achieved, insecticides can be applied in many ways, using
the following formulations.

i. Water-dispersible powder (WDP)

These are used for residual spraying of buildings and wall surfaces. Most DDT and dieldrin
wettable powders contain 50% of the commercial insecticides. But 75% wettable powders are
also available.

ii. Emulsion Concentration (EC)

Most organophosphates are also formulated as emulsion concentrates and percentage of

active ingredient vary from compound to compound, for example Abate (Temephos) are
available in 50% and 100% E.C.

iii. Dusts

These are commonly used in the control of agricultural pests and against cockroaches, flies,
fly maggots and lice, the precise location of which is known. Dusts are finely ground
mixtures of insecticides and inert diluents (e.g. talc) and usually contain different percentages
of active insecticide.

iv. Aerosols, Fogs, Vapours, Smokes, Fine Sprays

These are fine suspensions in the air of solid or liquid particles of insecticides. They are
usually less than 50 micron in size. They can remain suspended in the air for some
considerable time allowing penetration where required. They can be applied by use of
fogging machine, smoke generator aircrafts or by atomizers and aerosol containers in which
the insecticide is dissolved in liquefied gas under pressure.

v. Pellets or Granules

These are used mainly as larvicides for use in shallow water breeding places with much
vegetation. The granules are impregnated with insecticide which disintegrate slowly in water
and release the insecticide.

INSECTICIDE POISONING

Insecticide poisoning can occur through inhalation, skin contact and ingestion. There is
probably little risk to the occupants of treated houses, but as a safety measure all foodstuffs

24
should be removed or properly covered by spraying. Operators (Sprayers) should also be
carefully instructed in handling, and should be aware of the dangers in swallowing
insecticide, excessive inhalation or contact of the substance with the skin.

Air Pollution

Air pollution, also referred to as atmospheric pollution, is the presence in the atmosphere of
substance in the form, concentration or for such duration that they cause a nuisance to man,
animals or plants. It is the contamination of the air by harmful substances in amounts great
enough to result in damage to the environment, human health and quality of life.
Contaminants can be in the form of solids, liquids or gases. Normal air consist of about the
78% nitrogen, 21% of oxygen, 0.03% carbon dioxide and the remaining include argon, neon,
helium, methane and others.

Sources of Air pollution

1. Natural sources: this can contribute to atmospheric pollution through pollen grains dust,
mold spores, vegetable fibers, micro-organisms carried up and transported by the wind.
Natural occurrences also result in air pollution; volcanic emissions whirl winds,
tornadoes, carbon monoxide discharged from coal mines.
2. Man-made (Anthropogenic) sources: these result from man-made activities that pollute
the atmosphere.
a. Combustion; giving rise to:
• Carbon monoxide discharged from automobile exhausts
• Carcinogenic hydrocarbons from automobile exhausts
• Organic lead discharged from automobile exhaust
• Sulphur dioxide discharge from burning oils.
b. Specific Industrial Processes; giving rise to:
• Hydrogen sulphide discharged from rayon industries, canning, dye making
and oil refining
• Hydrogen fluoride discharge from fertilizer, chemical and aluminium
industries
• Carcinogenic hydrocarbons discharged from organic chemical industries
c. Personal habits
• Personal habits, e.g. smoking can lead to discharge of carbon monoxide and
hydrocarbons.

Health Effects of Air Pollution

Air pollution is a major environmental health problem with increasing amounts of potentially
harmful gases and particles being emitted into the atmosphere on a daily bases.

• Primary effects; chronic bronchitis, asthma, emphysema, lung cancer, eye irritation,
heart disease.

25
 • Secondary effects; global warming, chemical/acid rain, depletion of the ozone layer.

Control of Air Pollution

Atmospheric pollution cannot be completely prevented but can be controlled in the following
ways:

(a) Site Selection; careful planning of residential areas, industrial zones and highways to
ensure that air pollution is minimized.
(b) Process Redesign and Equipment Modification; use of tall chimneys; reduction at source
through substitution of raw materials, wet methods to reduce dust, and use of electrostatic
precipitators.
(c) Legislation and Health Education; effective legislation backed up by health education
(d) Regular monitoring of industrial gases, fumes and vapours

OTHER HAZARDS

Control of noise pollution

Noise is defined as unwanted sound. Noise level or intensity is measured in decibel (db),
which represents the weakest sound which can be heard (0.0002 dynae/c 2). A whisper
produces 20 - 30 db, a normal conversation produces 60 - 65 db, a heavy diesel propelled
vehicle produces 90 - 100 db.

Threshold limit value (TLV) of noise, i.e. the daily exposure limit about which people can
tolerate without adverse effect is 80-90 db.

Sources of Noise

(I) Industrial sources

(II) Household sources

(III) Human noice

Health Effects of Noise

(i) Auditory effects - auditory fatigue, hearing loss, and noise induced deafness

(ii) Non Auditory effects - Loss of concentration, irritation, annoyance, normal

communication difficulty, increased accident risk. Physiological changes such as blood
pressure, heart rate, sweating, breathing, etc.

Physiologic Change Associated With Noise

26
(i) Increased Intracranial Pressure (resulting in headaches)

(ii) Increased blood pressure

(iii) Sweating

(iv) Increased respiratory rate

(v) Increased heart rate

Control of Noise

(a) Process Redesign: Designing of less noisy equipment

(b) Personal protection: Use of protective devices, e.g. ear plugs, ear muffs, etc.
(c) Health Education: Education on health hazards of noise.
(d) Pre-employment Medical Examination: Persons with ear defects should not be engaged
in noisy work places.

Radiation

Energy emitted in the form of particles by substances such as uranium and plutonium, whose
atoms are not stable and are spontaneously decaying. This energy can be converted into
electric power, but it can also cause severe or fatal health problems to people who are
exposed to it.

Types of radiation are ionizing and non-ionizing

• Ionizing - Comprises those forms of radiation that penetrate materials and deposit their
energy in the form of opposite electrically charged ions e.g. X-rays, radioisotopes, nuclear
energy

• Non-ionizing – refers to several forms of electromagnetic radiation of wavelengths longer

than those of ionizing radiation thereby have less energy e.g. Ultraviolet rays, radio
waves, electric and magnetic fields, microwaves, infrared. They are generally considered
as safe and have minimal health hazards.

IONIZING RADIATION

(a) Alpha Particles; These are positively charged particles and can penetrate 4cm in air and
0.05-0.1 mm in tissues. Alpha rays are biologically very destructive although irradiation
is confined to the immediate vicinity of the source of radiation.
(b) Beta Particles; These are negatively charged particles (electrons), and can penetrate 6 -
300cm in air and up to 4mm in tissues.

27
(c) Neutrons; These are uncharged with a wide range of energy and power penetration.

(d) Gamma rays; electromagnetic radiation.

(e) X-rays; electromagnetic, usually produced artificially, high penetration

Alpha, beta particles, neutrons ad protons, etc. are referred to as corpuscular radiations while
X-rays and Gamma rays are referred to as electromagnetic radiations.

Sources of ionizing radiation

Ionizing radiation can be obtained in nature or from man-made sources.

Natural sources include;

A. Cosmic rays
B. Environmental sources which could terrestrial or atmospheric. Examples of terrestrial
elements that emit radiation are thorium, uranium and radium. Atmospheric ones include
radon and thoron
C. Internally occurring in plants, animals, humans and natural resources include K40 and C14

Man-made sources include;

A. Medical and dental equipment e.g. X-rays, radioisotopes

B. Occupational exposure
C. Nuclear energy from radioactive fallouts
D. Miscellaneous sources such as television sets, radioactive dial watches, isotope tagged
products, luminous markers

Sources of exposure to ionizing radiation

• Occupational = miners, workers at nuclear reactors and atomic energy plants,

radiographers/radiologists, high voltage tv makers, pilots

• Non-occupational=nuclear fallouts, atomic bombs, TV, watches and phones.

Radiation units

• Roentgen: Is the unit of exposure. The amount of radiation absorbed in air at a given
point i.e. Number of ions produced in 1 ml of air

• RAD (Radiation Absorbed Dose): Is the unit of absorbed dose. Is the amount of
radioactive energy absorbed per gram of tissue or any material

• REM (Radiation Equivalent Man): product of the absorbed dose and the modifying
factors. It indicates the degree of potential danger to health

The radiation units are being replaced by the new SI units:

28
 Coulomb per kilogram (C/kg) for Roentgen

 Gray (Gy) for RAD

 Sievert (Sv) for REM

 Dose equivalent (H) has been introduced to provide a similar basis for assessing the
biological effect per unit of energy absorbed

Control of Radiation

This involves the use of strategies such as:

– Legislation on use in industries and hospitals

– Health education
– Periodic medical examination
– Regular working hours
– Recreation/holidays
– Avoid use if not necessary e.g. Pregnant women
– Shielding e.g. lead shields and lead rubber aprons
– Complete enclosure of radiation sources
– Safe distance from sources of radiation
– Reduce exposure time
– Environmental monitoring (dosimeter/film badge)
– Good hygiene

ACCIDENTS

Accidents are the 5th leading cause of unintentional injury deaths worldwide with Road
Traffic Accidents (RTAs) accounting for the highest cause (40%), followed by poisoning
(18%) and falls (17%).
Definition: An accident is an undesirable or unfortunate happening that occurs
unintentionally and usually results in harm, injury, damage, or loss.
Types: include RTAs, poisonings (drugs, insecticides, rat poisoning) and falls. Others are
burns, drowning, other transport-related accidents (railway, airway), industrial accidents,
bites and injuries from sharp or pointed instruments.
Epidemiology
• Age – leading cause of death after 1 st year of life, up to 44 years of age, 3 rd leading cause
in 45-54 year age group
• Sex – males>females
• Place – home, work, on the road, recreation. More injuries at home but more at deaths on
the road
• Time – night, holidays
Causes
The causes can be looked at in terms of host (human), agent and environmental factors
Host factors

29
These are factors that are inherent in the person that predispose them to these accidents e.g.
alcoholism, drug abuse, youthful exuberance, ignorance, carelessness, disregard for
instructions, psychological/emotional state and medical conditions such as poor vision,
seizure disorders, medication, cardiac disorders.
Agent factors
These are factors that relate to the object by which the injury occurs. These include nature of
the object/agent (e.g. sharp, heavy, slippery), manufacture/design errors, faulty equipment
(e.g. badly maintained vehicles), poorly labelled items.
Environmental factors
These concern the area or circumstance under which the accident occurs. Examples are poor
lighting, weather problems, topography, poor or absent road signs, stray animals or wrongly
placed items, poor housing.

Control of accidents
 Primordial
- Legislation and enforcement of laws and standards
 Primary
- Health education
- Change in attitude
- Law enforcement
- Well maintained equipment
- Adherence to instructions, speed limits
- Safety gadgets
- Properly built and maintained environments e.g. good road designs and road layouts,
road signs/speed limits
- Adequate treatment of medical conditions e.g. visual aids, hearing aid
 Secondary
- First aid skills
- Access to health care
- Ease of access or exits
- Easy access to disaster control equipment e.g. fire extinguishers
- Rescue facilities
 Tertiary
- Limitation of disability through medical, vocational, psychosocial rehabilitation
 Surveillance

Environmental Health Services in Nigeria

30
Historical Perspective
Environmental Sanitation has for a long time remained consistently poor in Nigeria.
Consequently, there is high morbidity and mortality from sanitation related diseases. Various
governments have made albeit piecemeal and uncoordinated attempts at various times/levels
to complement the socio-cultural norms of sanitation practices in the communities.

Culturally, certain norms guide the maintenance of adequate sanitation in the communities.
For instance, women and children, particularly the girls, sweep the homes/surroundings and
empty refuse bins. There are also cultural festivals that emphasize cleanliness in various
communities and many such festivals still persist till today.

During the pre-independence era (1900 – 1960), several legislative controls were put in place
to address the problem of Environmental Sanitation. Among these were:
i) Cantonment Proclamation of 1904 on the Layout and Sanitation of GRA;
ii) Public Health Act of 1909 on Environmental Sanitation;
iii) Township Ordinance No. 29 of 1917 on Sanitation and Environmental Management;
iv) Lagos Colony Ordinance of 1928 – Outbreak of Bubonic Plague;
v) Mineral Act of 1945 – Trench and Drainage Pollution, etc;
vi) Town and Country Planning Ordinance of 1946 – cap 123 (West), cap 130 (North)
and cap 155 (East);
vii) Building Lines Regulation of 1948;
viii) Local Government Ordinance 1950/54-58;
ix) Public Health Laws of 1957 – to Combat Overcrowding, Diseases and Squalor

In the current dispensation (1981 – date), all tiers of Government have developed
legislative/regulatory instruments to further address the issue of sanitation. These include:
i) Harmful (Toxic) Waste Criminal Provision Decree 42 of 1988;
ii) Federal Environmental Protection Agency (FEPA) Decree No. 58 of 1988 and No. 59
of 1992 as amended;
iii) National Policy on Environment (1989) & 1999 as amended;
iv) National Environmental Protection (Effluent Limitations) Regulations S.1.8 of 1991 –
mandatory for industries to install anti-pollution equipment and for effluent treatment;
v) National Environmental Protection (Pollution Abatement in Industries and Facilities
Generating Wastes) Regulations S.1.9 of 1991;
vi) National Environmental Protection (Management of Solid and Hazardous Wastes)
Regulations S.1.15 of 1991;
vii) Environmental Impact Assessment (EIA) Decree No. 86 of 1992;
viii) Nigerian Urban and Regional Planning Decree No. 88 of 1992;
ix) National Urban Development Policy, 1992;
x) Guidelines on Hazardous Chemical Management 2001;
xi) Guidelines on Pesticides Management and Handbook on Safe and Effective Use of
Pesticides 2001;
xii) Blueprint on Municipal Solid Waste Management in Nigeria 2001;
xiii) The Blueprint on Handbook on Waste Management 2001;

31
 xiv) The Blueprint on Environmental Enforcement 2001;
xv) Promulgation of State Edicts/Laws and Local Government Bye-laws.

Ministries/Agencies/ Organizations involved in Environmental Sanitation

Various roles and contributions are played by the Federal Ministries of Health, Housing and
Urban Development, Water Resources, Information, Agriculture and Rural Development,
Culture and Tourism; as well as External Support Agencies; the Academia; Organised Private
Sector; Civil Society Organisations and Communities in the nation’s drive towards achieving
sound Environmental Sanitation for sustainable development. The Federal Ministry of
Environment (created in 1999) is the overseeing body for environmental issues in Nigeria
while NESREA (National Environmental Standards and Regulation Enforcement Agency) is
the law enforcement arm of the Ministry. At various times several State and Local
Government Agencies have been created and saddled with the responsibility of sanitation.

Activities that these agencies engage in include;

i) Solid waste management;
ii) Medical waste management;
iii) Excreta and sewage management;
iv) Food sanitation;
v) Sanitary inspection of premises;
vi) Market and abattoir sanitation;
vii) Adequate potable water supply;
viii) School sanitation;
ix) Pest and vector control;
x) Management of urban drainage;
xi) Control of reared and stray animals;
xii) Disposal of the dead (man and animals);
xiii) Weed and Vegetation Control;
xiv) Hygiene education and promotion.

Many constraints and problems, ranging from socio-cultural, economic and management
problems hinder effective Environmental Sanitation practices in Nigeria. Some of these
constraints include:
1) Lack of clear policy assigning responsibilities for Environmental Sanitation within the
levels of Government;
2) Poor perception of Environmental Sanitation as an essential service and a major
determinant of health and good standard of living;
3) Inappropriate institutional framework;
4) Duplication of responsibility by many Stakeholders in the sector;
5) Weak and poorly enforced Public Health Laws, State Laws and Bye-laws;
6) Lack of adequate professional manpower especially at the State and LGA levels;
7) Inadequate research activities;
8) Inadequate Environmental Sanitation education and awareness;

32
9) Inadequate allocation of resources for Environmental Sanitation services;
10) Inadequate sensitization and mobilization of communities in planning, designing and
decision-making on Environmental Sanitation matters;
11) Inadequate sensitization and mobilization of the private sector in the delivery of
Environmental Sanitation services;
12) Inadequate participation of Stakeholders in project planning and implementation;
13) Low literacy level

ACKNOWLEDGEMENTS
Dr. S.O. Adah (late)
Dr (Mrs) M.E. Banwat

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