Peran Perguruan Tinggi Dalam Pembangunan Sektor Kesehatan Yang Berwawasan Lingkungan Kualitas Air Dengan QMRA – Mengurangi Dampak Kesehatan Waterborne Diseases dr. Henry M.F. Palandeng, M.Sc Bagian Ilmu Kedokteran Komunitas FK - UNSRAT

Outline Introduction Environmental Health Quantitative Microbial Risk Assessment Waterborne disease (case study) Take home messages

Introduction Facts: In 2015, 91% of the world’s population had access to an improved drinking-water source, compared with 76% in 1990. 2.6 billion people have gained access to an improved drinking-water source since 1990.

Introduction Facts: 4.2 billion people now get water through a piped connection; 2.4 billion access water through other improved sources including public taps, protected wells and boreholes. 663 million people rely on unimproved sources, including 159 million dependent on surface water.

Introduction Facts: Proporsi RT yang memiliki akses terhadap sumber air minum improved di Indonesia adalah sebesar 66,8 persen (perkotaan: 64,3%; perdesaan: 69,4%);

Source: Riskesdas 2013

Introduction Facts: Proporsi RT yang memiliki akses terhadap sumber air minum improved di provinsi Sulawesi Utara adalah sebesar 61,0 persen (perkotaan: 52,8%; perdesaan:68,0%);

Source: Riskesdas Sulawesi Utara 2013

Global Situaition Globally, at least 1.8 billion people use a drinking-water source contaminated with feces. Contaminated water can transmit diseases such diarrhea, cholera, dysentery, typhoid and polio. Contaminated drinking-water is estimated to cause 502 000 diarrheal deaths each year.

Problems 38% of health care facilities lack any water source, By 2025, half of the world’s population will be living in water-stressed areas. In low- and middle-income countries, 38% of health care facilities lack any water source, 19% do not have improved sanitation and 35% lack water and soap for hand washing.

Environmental Health What do we know? What environments are doing?

Stage of susceptibility Relations for host, agent, & environment which can result as Risk Factor host environment agent Tingkat kepekaan

What environments are doing? Recycle Pollutions Garbage Faeces Pharmaceuticals Waste water

Quantitative microbial risk assessment Used to calculate risk of developing illness in each exposures uses information on the distribution and concentration of specific pathogens in the water supply and the infectivity of those pathogens in humans. QMRA uses information on the distribution and concentration of specific pathogens in the water supply and the infectivity of thoese pathogens in humans.

Quantitative Microbial Risk Assessment What are the facts? Water quality is one of the main issues in the water sector in Manado City and its improvement is a major concern; 30 – 40% of the total population have access to a water supply from the water company.

E. coli concentration in taps and vendors

E. coli concentration Water treatment plant

*WHO reference level 10-6 pppy WHO Level for the risk Samples DALY’s Comparison with WHO Water taps 1,5 * 10-4 155 Water vendors 1 * 10-5 12 *WHO reference level 10-6 pppy Weighing each health affects for its severity

Water borne diseases What are the risks? 842,000 deaths from diarrhoeal diseases each year could be prevented by improved water, sanitation and hygiene Poor water, sanitation and hygiene are major contributors to neglected tropical diseases like schistosomiasis, trachoma and intestinal worms, which affect more than 1.5 billion people every year.

Hygiene What are the risks? Basic hygienic practices by birth attendants can reduce the risk of infections, sepsis and death for infants and mothers by up to 25%, Many health facilities lack even basic water and sanitation facilities.

What is our Role What do we see our potentials Tridharma PT What do we see what they have done Environmental Impact Assessment What is our commitment Helping Community

Take Home Messages The SDG targets will call for universal access to drinking water, sanitation and hygiene WASH monitoring must move from access to quality, and in addition to families, also encompass schools, health care facilities and work places. Role of our institution: Health for All