Presented by Edith N. Ogbozor Walden University Potential Health Hazards associated with Consumption of locally brewed Beverage Drinks sold in Public Schools in Warri, Nigeria. Presented by Edith N. Ogbozor Walden University Good Day All. You are welcome to this discussion which is a very important public health issue. My name is Edith, a public health student of Walden University . The reason why we are gathered here today is to enlighten our students , on some public health issues that confront all of us as a community. I am glad to have the teachers consent to me being here and the parents of these students as well, for coming to be part of this talk. I have personally been observing these students for the past one month, especially during their break period, which is about mid day and noticed that as soon as its break time, a good number of them rush to the corners where some snacks , water ,juice and beverages of all sorts are sold. On keen observation, the beverages ( which are in various colors) hawked around the school premises happen to be locally made and brought to be sold by the hawkers. I have also watched some of these hawkers, and trailed some of them home to see where these drinks are produced and the things that go into their production. My finding was what initiated today’s presentation .

PRESENTATION OUTLINE Expected learning outcomes Background information Public Health Significance of the topic Data from WHO, CDC Water- borne diseases Intervention measures Conclusion Questions / Interacting session References Additional Resources The sequence of this presentation will flow as outlined on this slide. At the end of my presentation, I would be glad to take any questions or concerns that you might have. It is also an interacting session, as a result, we would all come up with ideas to share with one another concerning how our children ,here in Warri will go to school each day and return with sound health, both of the mind and body.

Learning Objectives Sources of locally prepared , non-alcoholic beverage drinks consumed in Nigerian Primary and Secondary Schools. Composition of the beverages. Sources of water used in preparing the drinks. Economic burden of water borne or water related diseases. WHO standards for drinking water quality This slide shows what we are expected to have learnt at the end of the presentation. It is my wish that this knowledge will impact on the students the importance of healthy living as well as make them understand that they can get sick if they are not careful about what goes into their mouth., especially the ones that they buy in school. So, come along with me as we explore the discuss.

Background Information Kunu-zaki drink -> a non-alcoholic fermented beverage ,widely consumed in the Northern parts of Nigeria (Amusa & Odunbakun, 2009). It has however gained popularity among the rest of the states in the country. Zobo drink-----> an aqueous extract of calyx of roselle, Hibiscus sabdariffa, which is an annual herb that is widely cultivated in India and Africa ( Nwachukwu et al., 2007) References Amusa, N. A. & Odunbaku, O. A. (2009). Microbiological and Nutritional Quality of Hawked Kunun ( A Sorghum Based Non-Alcoholic Beverage) Widely Consumed in Nigeria. Pakistan Journal of Nutrition. 8: Nwachukwu, E., Onovo, O. M. & Ezeama, C. F. (2007). Effect of Lime on the Bacterial Quality of Zobo Drinks Locally Produced in Nigeria. Research Journal of Microbiology. 2 (10); 787 – 791. School pupils and students in public schools in Warri, Delta State of Nigeria are interesting students. At the sound of the mid day bell each school day, they are happy to have this break and go back to class work after the recess. This time affords them an ample opportunity to play, socialize, munch and drink. Aside water and bottled drinks, juices and beverages are consumed in Nigeria and students are also not left out . Kunu and Zobo drinks are popular drinks sought after. Kunu is made from sorghum while Zobo is made from Hibiscus flower., from while it locally derived its name in Hausa language. On their own, and when hygienically prepared , researches have shown that these drinks are of very great nutritional values. The public health concern here is in the area of the source of water used in their preparation.There are other unbranded coloured drinks among the ones the students buy, which are also water dependent.

Kunun processing is mostly done by women using simple household equipment and utensils (Essien et al., 2011).Some times , these beverages are fortified with sugar, coloring agents and some undisclosed additives (trade secret). The reason for the fortifying the drinks is,” so that the nutrients loss during processing would be replaced”(Abulude et al., 2006). References Abulude, F. O., Ogunkoya, M. O., & Oni, V. A. (2006). Mineral Composition, Shelf- life, and Sensory Attributes of Fortified ‘Kunuzaki’ Beverage. Acta Sci. Pol., Technol. Aliment. 5 (1), 155-162. Essien, E. B. Monago, C. C. & Edor, E. A. (2011). Evaluation of the Nutritional and Microbiological Quality of Kunlun (A Cereal Based Non- Alcoholic Beverage) in Rivers State, Nigeria. The Internet Journal of Nutrition and Wellness. 10(2) Aside water, some other additives are included in the preparation of these non-alcoholic drinks. At times sweeteners can be added from sugar cane juice as well as juice from other fruits such as pineapple and oranges according to the hawkers preference. During this process of fortifying the drinks, both chemical and microbial contaminants could be introduced, especially when prepared under unhygienic environment. These additives and water quality are a source of concern and it through these that the consumption of these drinks in school setting present potential health hazards.

Public Health implication of consuming locally made Beverage Drinks. Sources of contamination of the drinks ; Poor drinking water quality Utensils used in preparation and in packaging Poor environmental conditions Hygienic practice of the beverage maker Due to the nature of the preparation processes, these drinks are prone to being microbially contaminated at any stage of the preparation. The health hazard associated with the locally produced beverages are mainly that of water borne diseases such as gastroenteritis, diarrhea, salmonellosis, shigellosis, typhoid fever. Bearing in mind that most people resident in Warri rely on private drinking water supplies, where there is no standard or any form of water quality monitoring, It is therefore evident that these locally made drinks are also not under form of scrutiny or control. As a result, the students in this community are vulnerable to the risk of having waterborne diseases which have lots of undesirable outcomes.

Global Statistics on Water Related Diseases Diarrheal disease represents 4.2%of the global burden of disease. (WHO,2004). Dehydration resulting from diarrhea causes approximately 1.8 million deaths every year. WHO estimates that up to 80% of ill health in developing countries is water and sanitation related. Reference WHO (2004) Statistical annex. In WHO Health Report 2004: Changing History. World Health Organization, Geneva, Switzerland. WHO (2008). The global burden of disease , 2004 update. Geneva. Unsafe drinking water causes water borne diseases which are the most common cause of death in developing nations. World health organization had reported in 2004, that diarrheal diseases kill an estimated 1.8 million people each. A large percentage of this figure is found among the developing nations, of which we are belong. Statistics are numbers, but these numbers represent human beings and great effort should be made not to be captured among undesirable figures or statistics.

Water- borne diseases Etiologic agents include; Cryptosporidium Campylobacter spp. Gardia Entamoeba histolytica Yersinia spp. Rotavirus Shigella spp. Vibrio cholera Escherichia coli Salmonella spp. Diarrhea disease , which constitutes a major burden of disease globally, is most often a symptom of gastrointestinal infection .This can be caused by bacteria, viruses or parasites and some of the examples of these microbes associated with diarrhea are listed on this slide. It is possible to have water borne outbreaks that involve multiple pathogens. It is worth mentioning that the presence of enteric organism in portable water signifies fecal contamination and represents a public health threat.

Intervention Measures Educational Interventions Parents / guardians’ support Provision for school operated snacks stand Improve environmental sanitation Involve policy makers Some of the things we can do to prevent students fro getting water related diseases is to have occasional forum like this one. This way they are constantly reminded on the need to stay healthy and the consequences consuming contaminated drinks. Parents and guardians can also assist in making arrangement for home made launch packs ,including drinks, preferably water, for the students to take to school. This will reduce their reliance on external provision to take care of their appetite. Alternatively, the school should ban food and drink vendors from entering the school premises while they make provision for a snacks store that will be completely under the care and supervision o the school authority. Let us also not forget that the need for improved sanitation cannot be over emphasized.

Conclusion Protection of public health by ensuring the safety of drinking water is the primary objective of drinking –water quality management ( Riza and Hrudey, 2008). In Nigeria,non-alcoholic drinks contribute to the dietary habits of the people. Since most of these beverages are made up of about 90% water ( Osuntogun and Aboaba, 2004), it therefore becomes imperative that the community is well kept abreast of the heath risks associated with water of poor quality standard. References Rizak, S. &Hrudey, S. E. (2008). Drinking –Water Safety-Challenges for Community managed Systems. Journal of Water and Health. Doi:10.2166/wh.2008.033 Osuntogun, B., & Aboaba, O. O. (2004). Microbiological and Physico- chemical Evaluation of some Non-alcoholic beverage. Parkistan Journal of Nutrition. 3 (3): 188- 192. A lot of diarrheal diseases, which could lead to death in severe cases, are attributable to consumption of unsafe water . Along with inadequate sanitation and hygiene, especially in the preparation of the beverages students consume at break periods, on daily basis. The information being passed at discussions such as these is necessary to alert the students, parents and guardians on the issues they are up against. Now that we know, what are going to do about it? Since one cannot ascertain the integrity of source of portable water used in preparing these beverages, it is recommended that students desist from patronizing hawkers of these locally made drinks. This will be a safe measure to adopt, especially when there are no monitoring standards guiding their production. Thank you all for your attention.

Question and Answer Session Thank you for your time.

REFERENCES Ahs, J. W., Tao, W., Löfgren, J. & Forsberg, B.C. (2010). Diarrheal Diseases in Low- and Middle-Income Countries: Incidence, Prevention and Management. The Open Infectious Diseases Journal. 4: 113-124. Abulude, F. O., Ogunkoya, M. O., & Oni, V. A. (2006). Mineral Composition, Shelf- life, and Sensory Attributes of Fortified ‘Kunuzaki’ Beverage. Acta Sci. Pol., Technol. Aliment. 5 (1), 155-162. Adeleke, R. O. & Abiodun, O. A. (2010). Physico-chemical Properties of Commercial Local Beverages in Osun State, Nigeria. Pakistan Journal of Nutrition. 9 (9); 853- 855 Amusa, N. A. & Odunbaku, O. A. (2009). Microbiological and Nutritional Quality of Hawked Kunun ( A Sorghum Based Non-Alcoholic Beverage) Widely Consumed in Nigeria. Pakistan Journal of Nutrition. 8: 20 -25.

References (contd) Chen, K-T, Chen, C-J, & Chiu, J-P. (2001). A School Water Outbreak involving both Shigella sonnei and Entamoeba histolytica. Journal of Environmental Health. 64 (4),9-13. Essien, E. B. Monago, C. C. & Edor, E. A. (2011). Evaluation of the Nutritional and Microbiological Quality of Kunlun (A Cereal Based Non- Alcoholic Beverage) in Rivers State, Nigeria. The Internet Journal of Nutrition and Wellness. 10(2) Osuntogun, B., & Aboaba, O. O. (2004). Microbiological and Physico- chemical Evaluation of some Non-alcoholic beverage. Parkistan Journal of Nutrition. 3 (3): 188- 192.

References (contd) Nwachukwu, E., Onovo, O. M. & Ezeama, C. F. (2007). Effect of Lime on the Bacterial Quality of Zobo Drinks Locally Produced in Nigeria. Research Journal of Microbiology. 2 (10); 787 – 791. Rizak, S. &Hrudey, S. E. (2008). Drinking –Water Safety-Challenges for Community managed Systems. Journal of Water and Health. Doi:10.2166/wh.2008.033 WHO (2004) Statistical annex. In WHO Health Report 2004:Changing History. World Health Organization, Geneva, Switzerland.

Additional Resources. Centers for Disease Control and Prevention [CDC]. www.mmwr.com World Health Organization (2000).Global Water Supply and Sanitation Assessment 2000 Report Session.