he substantial rise in India’s urban population
and the concurrent growth of slums has resulted in overstraining of
infrastructure, and deterioration in public health. Access to safe water
and sanitation is a basic human right essential for health and life.
Safe water and sanitation reduces child mortality, and positively
influences health and development of the Nation. As pediatricians,
all of us have the responsibility of making our environment healthy and
friendly in order to safeguard health of future generations. It is high
time that we alert the public and the authorities for a sanitary
awakening.
Diarrhea is a leading cause of death among children,
accounting for one-tenth of all deaths among children under age of five
years. In 2013, 1600 under- five deaths occurred each day; majority
being children aged less than 2 years [1]. Many of these lives could
have been saved through interventions to improve drinking water,
sanitation and hygiene (WASH). Recurrent episodes of diarrhea leads to,
and accentuate malnutrition resulting in a negative impact on overall
development of the country. Simple interventions like hand-washing are
well-known to substantially reduce the incidence of diarrhea and acute
respiratory tract infections [2,3].
Access to drinking water in India has increased over
the past few years; however, the negative impact of unsafe water on
health still exists. The World Bank estimates that one-fifth of
communicable diseases in India are water-related. Waterborne diseases
affect around 37 million people in our country, 1.5 million children are
estimated to die of diarrhea, and 73 million working days are lost due
to waterborne disease annually [4]. Census data reports that the
proportion of houses with television and telephones in rural India
exceeds the proportion of households with access to toilet facilities
[5]. Half of the billion people in the world, who defecate in the open,
live in our country. Only half of the population in India wash hands
with soap after defecation, and only 11 per cent of the Indian families
dispose child’s excreta safely. The proportion of schools having
facilities for safe drinking water and adequate usable toilets is also
abysmally low. For adolescent girls, the problems are even more complex
if the toilet facilities are not safe, private or not available.
Girl-friendly toilets established in a few schools, with facilities to
change and dispose sanitary napkins are good initiatives. However, much
more needs to be done about providing the facilities for good menstrual
hygiene in all schools. Indian Academy of Pediatrics (IAP) – under
Action Plan 2011, had initiated ‘Child Friendly School Initiative
Program’ where provision for one urinal for 60 students and one
latrine for 100 students, with provision for daily cleaning, was one of
the conditions for a school to be declared as Child-friendly
The seventh goal of Millennium Development Goals has
one of the objectives as: to halve (by 2015) the proportion of the
population without sustainable access to safe drinking water. It is
essential to understand the mechanisms by which water gets contaminated,
and formulate interventions at critical points to decrease and prevent
contamination of drinking water. Regardless of the initial water
quality, unhygienic practices during water collection and storage, poor
hand washing, and inaccess to sanitation facilities accelerates the
transmission of germs through the fecal-oral route. ‘WASH at Schools’
program launched by UNICEF shows its commitment to ensure that all
children have access to high quality water and sanitation services at
school [6]. Hygiene education to children at schools helps to creates
demand for safe water and sanitation facilities in future, and will
transform the children into agents of change for the whole community.
Political and administrative commitment is evident at
National level by Central Government’s National Bal Swachhata Mission
and Swachh Bharat campaign. Government is committed to improve
the general quality of life of people, by promoting cleanliness,
hygiene, and by eliminating open defecation. Now it is the time for the
citizens to act with civic sense. Intersectoral coordination with
departments of education, health, water and local self-governments are
essential. Water-safety planning and water-quality monitoring are the
need of the hour. Establishment of an efficient water quality
surveillance system and a model guideline regarding proper planning and
execution of water supply and drainage systems are needed. IAP is
committed to, and will promote WASH in schools. IAP will raise the voice
for children for safe drinking water – to reduce child deaths, and to
improve health and education of children.
References
1. United Nations Children’s Fund. Levels & Trends in
Child Mortality. Report 2014. New York. Available from:
http://www.unicef.org/media/files/Levels_and_Trends_
in_Child_Mortality_2014.pdf Accessed August 15, 2015.
2. Rabie T, Curtis V. Handwashing and risk of
respiratory infections: A quantitative systematic review. Trop Med Int
Health. 2006;11:258-67.
3. Curtis V, Cairncross S. Effect of washing hands
with soap on diarrhoea risk in the community: A systematic review.
Lancet Infect Dis. 2003;3:275-81.
4. Reddy V. Economic Impact Analysis. Encyclopedia of
Environmental Health. 2010.
5. Government of India. Census 2011. Data sheet.
Availability and Type of Latrine Facility. New Delhi. Available from:
http://censusindia.gov.in/2011census/hlo/Data_sheet/India/Latrine.pdf
Accessed August 15, 2015.
6. UNICEF. Water, Sanitation and Hygiene (WASH) in Schools. A
Companion to the Child Friendly Schools Manual. New York. Available
from: http://www.unicef.org/publications/files/CFS_WASH_E_web. pdf.
Accessed August 15, 2015.