1. 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

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

3. 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.

4. 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.

5. 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%);

6. Source: Riskesdas 2013

7. 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%);

8. Source: Riskesdas Sulawesi Utara 2013

9. 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 diarrheal deaths each year.

10. 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.

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

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

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

14. 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.

15. 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.

16. E. coli concentration in taps and vendors

17. E. coli concentration
Water treatment plant

18. *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

19. 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.

20. 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.

21. 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

22. 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