应急时期与水和卫生关联的疾病 Introduction to WASH-related diseases in Emergencies 模块1-第2节 健康 Health

什么是健康 What is health? 世界卫生组织将健康定义为：  健康不仅是身体没有病或身体虚弱，还要有完整的生理、心理状态和 社会适应能力 World Health Organization defines health as: “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ” 世界卫生组织还提出：  获得高度健康的幸福感是每个人最基本的权利，这种权利不应因个人 种族、宗教信仰、政治信念、经济或社会地位的不同而不同 。 ” WHO constitution also mentions: “ The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition ”

应急时期的卫生 Health in Emergencyy.应急时期的公共卫生也可以成为一种自然灾难，其可以引起高概 率的人员伤亡。 “Public Health in Emergency ”, is a natural disaster that poses a high probability of a large number of deaths or harm to a population  -应急时期的卫生（处理灾难中与卫生有关的事宜） Health in Emergencies (deals with health in disasters)  -紧急卫生事件（流行病） Health Emergencies (epidemics)

灾难产生的后果 Consequences of Disasters  人员、牲畜伤亡Severe injuries, deaths  房屋损坏或损毁Loss/damage to shelters  财产损失Loss of properties  爆发疾病Disease outbreaks  食物短缺Food Shortages  大量人员转移Large population displacement  与健康有关的基础设施需求超负荷Load on health infrastructure  水、卫生设施需求超负荷Load on water sanitation  营养需求超负荷Load on nutrition

各种灾难对人类健康造成的后果 Health Impact of different disasters  受伤 Injuries  疾病传播（水生疾病、食物传播的疾病、虫媒传播的疾病）腹泻、霍乱 、伤寒、疟疾、结核病 Disease epidemics (water-borne, food-borne, vector-borne) – Diarrhea, Cholera, Typhoid Fever, Malaria, Tuberculosis …  应急时期，与特定人群有关的具体健康问题 Population specific health issues in emergencies  小于5岁的孩子、老年人、残疾人 < 5 y/o children; elderly; physically challenged  急性呼吸道感染、麻疹、缺乏维生素A、营养不良、生殖健康、艾滋病毒 /艾滋病 ARI, Measles, Vit.A deficiency, malnutrition, reproductive health, HIV/AIDS  精神压力 Psychological stress  其他 —— 蛇咬伤，狗咬伤、皮肤疾病 Others-snake-bites, dog bites, skin diseases

可增加疾病严重性的要素 Factors contributing to Disaster Severity  贫穷和社会不平等造成了人们的易受灾性 Human vulnerability due to poverty and social inequality  环境恶化 Environmental degradation  快速的人口增长，尤其是贫困家庭人口的快速增长 Rapid population growth especially among the poor  人口密度增加 Increasing population density  更多的人定居在高风险区域 Increased settlement in high-risks areas  增加的技术性灾害和依赖性 Increased technological hazards and dependency

可使疾病增多的要素 Factors that can increases to Diseases 水质差 Poor water  -用于卫生方面的水的数量非常有限 Limited quantity of water for hygiene purposes  -水质差 Poor quality water 卫生设施差 Poor sanitation  -排泄物处置设施的设立和维护不足或不当 Lack/absence of sufficient or appropriate and well-maintained excreta disposal facilities  -缺少垃圾收集体系，排水不畅，有死水 Lack of refuse collection, blocked drainage, standing water  -虫媒控制不足（如：蚊、蝇、跳蚤、虫、鼠） Inadequate control of vectors (e.g. mosquitoes, flies, fleas, insects & rodents

可使疾病增多的要素 Factors that can increases to Diseases 房屋质量和排水设施差 Poor Housing and Drainage  房屋条件差，拥挤-Poor, over-crowded housing  -排水设施不足 Inadequate drainage systems 缺少有关的知识、习惯差 Poor knowledge and practice  -卫生知识不足 Poor level of hygiene understanding  -卫生习惯差（脏手导致食物污染） Poor hygiene practice (food contamination from soiled hands)

水 传 疾病 Water-borne diseases- 通过饮用含有病原体的水而进行传播：如：霍乱、伤寒、腹泻、 痢疾、传染性肝炎 transmitted through drinking water which contains pathogen e.g. cholera, typhoid, diarrheas, dysenteries and infectious hepatitis

用水带来的疾病 Water-washed diseases  其由病原体引起，可以通过改善个人卫生（主要指水的数量而非 水的质量）来预防其传播 caused by pathogens whose transmission can be prevented by improving personal hygiene-water quantity rather than water quality 类型:-该疾病与某些媒介物引起的皮肤或眼睛传染病的粪便至口感 染路径有关 Types diseases associated with the faecal-oral route-infections of the skin or eyes-infections caused by some vectors

水媒疾病 Water-based diseases  病原体部分生命周期在水中完成 pathogen spends parts of its lifecycle in the water  通常在蜗牛或其他水生动物中，都是由寄生虫引起的。病原体通 常从感染者的尿液和粪便进入水中 usually in a snail or other aquatic animal. -all caused by parasitic worms-pathogens usually enter the water from faeces and urine of infected persons

食物引发的疾病 Food-borne illnesses  当可导致疾病发生的介质通过食物进入身体时则会引发 有关的疾病 result when disease-causing agents enter the body through food;

水媒昆虫疾病 Vector Borne  由昆虫传播的疾病。虫类在脏水中或其附近繁殖，通过载体（如 蚊子，苍蝇，虱子）传播疾病 diseases carried by insects that breed in or near dirty water-transmitted through vectors (e.g. mosquito, fly, lice)

腹泻 Diarrhea  通常出现肠胃感染的症状 It is usually a symptom of gastrointestinal infection.  严重腹泻会导致体内液体流失，并可能危及生命，尤其是对儿童和营 养不良或免疫功能受损的人更是如此。 Severe diarrhea leads to fluid loss, and may be life-threatening, particularly in young children and people who are malnourished or have impaired immunity. 1. 感染：大多数细菌、病毒和寄生生物的寄主散布在被粪便污染的水 中。一旦缺乏洁净的水饮用、烹饪、清洗，感染腹泻的病例则更多 Infection:a host of bacterial, viral and parasitic organisms, most of which are spread by feces- contaminated water. Infection is more common when there is a shortage of clean water for drinking, cooking and cleaning. 在发展中国家，轮状病毒和大肠杆菌是引起腹泻最常见的原因。 Rotavirus and Escherichia coli-two most common causes of diarrhea in developing countries. 2..营养不良：那些死于腹泻的孩子常常存在营养不良的问题。营养不 良使得他们更容易感染腹泻 Malnutrition:Children who die from diarrhea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhea

腹泻 Diarrhea 传播模式 Mode of transmission  摄入了受污染的食物或水，或由于不良卫生习惯导致的人与人之 间的疾病传播 Ingestion of contaminated food and water, or from person to person as a result of poor hygiene. 症状 Signs and symptoms .腹泻至少每天3次，或根据个人情况超过正常范围的次数 Passage of loose or liquid stools at least 3x a day, or more frequently than is normal for the individua l  过度口渴 Excessive thirst  囟门凹陷 Sunken fontanels

腹泻 Diarrhea  即时处置 Immediate Treatment  口服补液、米汤，以补充流失的水分 Give Oral Rehydration Solution (ORESOL), rice soup (am) to replace lost body fluid  继续进食 Continue feeding  咨询健康员有关脱水的迹 象 Consult a health worker for signs of dehydration  预防和控制 Prevention and control  改善饮用水质量 Improve access to safe drinking water  改善卫生设施的条件 Improve sanitary conditions  养成个人良好的卫生习惯和食品卫生习惯 Good personal and food hygiene  开展有关疾病传播的健康教育 Health Education on how infections spread

减少腹泻发病率（ % ） Reduction in diarrhoea morbidity (%)

霍乱 Cholera 病原体 Causativeagent  细菌（霍乱弧菌 ） Bacteria(VibrioCholera) 传播模式 Modeoftransmission  摄入了被粪便污染的食物或水 Eatingoffoodordrinkingwatercontaminatedbyfeacalwastes 症状 Signsandsymptoms  突然发起的频繁的无痛性腹泻，一天至少3次 Sudden on set of frequent painless watery stool at least 3xaday  呕吐 Vomiting  快速脱水（眼球凹陷，皮肤干燥、皱巴巴的） Rapid dehydration (sunken eyeballs, wrinkled dry skin)

霍乱 Cholera 即时治疗 Immediate Treatment:  通过口服补液补充水分 Replace lost body fluid by giving Oral Rehydration Solution (ORESOL)  如果症状持续，应送病人就近医治 If symptoms persist, bring the patient to a nearest health facility 预防和控制 Prevention and control-  改善饮用水，如果在水源或水处理方面没有保障，应将水煮沸后使用 Improve access to safe drinking water. Practice boiling of water if unsure of the source and handling  水加氯 Do water chlorination  剩余食物加盖保存 Practice food safety by covering left over foods for future consumption  正确的清洗和烹饪食物 Wash and cook food properly  卫生处理人类排泄物 Sanitary disposal of human wastes  -正确使用厕所Use toilet properly  保持周围环境卫生，防止垃圾成堆，蚊蝇虫鼠繁殖 Keep surroundings free from rubbish to prevent flies and other insects and rodents from breeding  多洗手 Practice Hand-Washing

伤寒 Typhoid fever 病原体 Causative Agent  细菌（伤寒沙门氏菌 ） Bacteria (Salmonella Typhi) 传播模式 Mode of transmission  摄入了受污染的食物或水 Ingesting contaminated food and/or water 症状 Signs and symptoms  持续高烧 Sustained high fever  头痛 Headache  精神萎靡不振 Malaise  厌食 Anorexia  腹泻或便秘，腹部不适 Diarrhea or constipation and abdominal discomfort

伤寒 Typhoid 预防和控制 Prevention and Control  改善饮用水。如果在水源或水处理方面没有保障，应将水煮沸饮 用 Improve access to safe drinking water. Practice boiling of water if unsure of the source and handling  水加氯处理 Do water chlorination  注意食品安全。剩下的食物应加盖保存，以便再次食用 Practice food safety by covering left over foods for future consumption  正确的清洗和烹饪食物 Wash and cook food properly

螺旋体病 Leptospirosis 病原体 Causative Agent  -细菌（钩端螺旋体 ） Bacteria (Leptospira interogans) 传播模式 Mode of transmission  -接触了被携带传染源的尿液污染的水 Contact with water contaminated with bacteria-infected urine 症状 Signs and symptoms 早期 Early Stages  - 严重头疼Severe headache  -发高烧High Fever  -眼红Redness in the eyes  -肌肉痛（腿部肌肉和背部肌肉痛）Muscle Pains (calf and back muscles)  -易疲劳Fatigue  -恶心-Nausea  -腹痛Abdominal pain  -黄疸高Jaundice

螺旋体病 Leptospirosis 管理和治疗 Management and treatment  大量抗生素，如青霉素、盘尼西林、链霉素，应由医生合理开处方 Wide range of antibiotic e.g. doxycycline, penicillin or streptomycin duly prescribed by a physician  早期识别和治疗前两天的病情，可防止出现钩端螺旋体病的病发 症 Early recognition and treatment within last 2 days of illness to prevent complications of leptospirosis 预防和控制 Prevention and Control  避免直接或间接接触动物尿液（如：发洪水时，避免从水中趟过）Avoidance to direct and indirect contact with animal urine (e.g. wading in flood water)  使用橡胶防水鞋和手套Use of rubber boots and gloves  下肢受刀伤或擦伤时，应在伤口使用抗菌软膏或聚合碘In cases of cuts and abrasions on lower extremities, antiseptic ointment or betadine should be applied before and after exposure  正确排放污水Drain potentially contaminated water  控制啮齿动物 Control of rodents  保持环境卫生 Maintain cleanliness of surroundings