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РАЗДЕЛ 2. ТЕОРЕТИЧЕСКИЕ ДИСЦИПЛИНЫ CHAPTER 2. THEORETICAL DISCIPLINES
ГИГИЕНА И ЭКОЛОГИЯ
HYGIENE AND ECOLOGY
UDC: 614
A.O. Omarova1, K.M. Tussupova2, R. Berndtsson2, M.G. Kalishev1
1Department of Food Hygiene, General Hygiene, and Ecology, Karaganda State Medical University, Karaganda, Kazakhstan 2Department of Water Resources Engineering & Center for Middle Eastern Studies, Lund University, Lund, Sweden
MEDICAL AND SOCIAL SIGNIFICANCE OF WATER SUPPLY, SANITATION AND HYGIENE IN HUMAN ACTIVITY
This article presents the analytical survey of scientific publications by native and foreign authors' in the field of studying the role of water supply, sanitation and hygiene in reduction of water-related diseases and rise in the living standards and quality of life of population. The reviewed sources revealed that measures in the field of water supply, sanitation and hygiene are the most cost-effective way to prevent most of the devastating burden of water-related diseases, as well as they play a direct role in ensuring the right to sufficient living standards and rising the quality of life of population.
Keywords: water supply, sanitation, hygiene, water-related diseases, living standards, quality of life
Introduction. Sustainable development of national economy depends on availability and condition of water resources [1]. Water supply, sanitation and hygiene are basic human needs that influence on health, the living standards and quality of life of population [2-4]. Unimproved hygiene and inferior sanitary conditions, as well as insufficient and unsafe drinking water are responsible for 7% of the total disease burden and 19% of child mortality worldwide [5-6]. According to the World Bank [7-8], low water supply, sanitation and hygiene lead to about 675,000 cases of premature death every year; annual economic losses of some countries are estimated in up to 7% of GDP (Gross Domestic Product).
In view of this, the objective was a review of literature that deals with study of the role of water supply, sanitation and hygiene in reduction of water-related diseases and rise in the living standards and quality of life of population.
Methods. The publications of findings of both foreign and domestic researchers were analyzed. Literature sources were searched in the PubMed, Scopus, GoogleScholar h eLibrary databases. Out of 123 literature sources, 48 were selected as the analytical material of the article. The depth of the search was from 1972 to 2017.
Criteria for the inclusion of publications in this review are the following: publications in Russian and English languages that are in open full-text access and bear statistically verified conclusions. Exclusion criteria are as follows: summary reports, newspaper articles and personal messages.
Results and Discussion.
1. Basic Concepts. Medical and Social Significance of Water.
Water is a key factor in human health [9-12]. Almost all of its sources are exposed to anthropogenic and technogenic influence of varying intensity [9]. Tap water is used for different purposes and the range of its application is expanding with increasing social standards of living. It is used for drinking, bathing, washing, watering plants or lawns, replenishment of swimming pools and many other activities that expand as the country develops. Alternative water use imply different requirements to water characteristics, in other words, when it comes to drinking water, its quality is important but it is of less importance when water is used for other purposes [13].
In terms of physical, chemical and bacteriological parameters, the water of acceptable quality, which is safe to drink and can be used in cooking, is defined as drinking water. According to common values, the rate of daily water consumption is 2 liters per person weighing 60 kg. [14]. However, the actual water consumption varies with climate, physical activity and culture. When the air temperature exceeds 25 ± C, water consumption rises sharply. As compared to the adult population, infants and children consume more water [15].
National water consumption standard in rural areas is 30 liters per capita per day and 48%-44% access to safe water and sanitation [16]. Water supply means 30 liters of safe water per capita per day within 250 meters where one point serves about 250-500 people; safe water is water that meets national requirements for drinking water quality [17]. Water supply includes the delivery of water for domestic use, apart from irrigation or stockbreeding. Sanitation is used in a strict sense of sanitary disposal, except for other environmental health activities such as management of domestic solid waste and surface drainage [18]. Access to water is defined as "the presence of water, at least 20 liters per person per day from a source within a kilometer from the user" [19]. Improved drinking water sources are "a drinking water source or a delivery point, which protects the water source from outside contamination, particularly faeces, by virtue of its construction and design" [20]. According to the World Health Organization [9,21], water contains 13 thousand potentially toxic elements. Over the past few decades, the problem of contamination of water sources, such as lakes, rivers and ground water, has become very acute [22]. Harmful substances can accumulate in the body causing a variety of diseases up to malignant neoplasms [9,21,23-27]. The direct health benefits from the improvement of water supply and sanitary conditions in rural areas are well known. These activities involve the safe disposal of human waste, efficient use of water for sanitary purposes (washing, cleaning, etc.) and satisfaction of basic needs with quality drinking water [17,28]. High-quality water supply exerts a considerable impact on reduction of water-related diseases and rise in the living standards and quality of life of population (Figure 1) [1,9,21-23].
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Figure 1 - Medical and Social Implication of High-Quality Drinking Water Supply
When drinking water is not available in the home, the time required to collect the water is an important factor that determines whether a households can receive a sufficient amount of water for domestic use [29-31]. When the time required to collect drinking water is 5 to 30 minutes, the amount of water collected is fairly constant and is suitable to meet the basic needs of about 20 liters per person per day [31]. Early studies have shown that if the total time spent on water collection exceeds 30 minutes, people tend to collect less water to the detriment of their basic needs [29-30]. In terms of time or distance, access to water has influence on the risk of disease. A study conducted by Wang and Hunter [32] showed a significant increase in gastrointestinal diseases in people living far away from the water source (OR = 1.45; 95% CI = 1.04-1.68).
Millennium Development Goal No.7 (MDG 7) was "to halve the proportion of people without continuous access to safe drinking water and basic sanitation by 2015 (compared to 1990 level)" [20,33]. This was supposed to be achieved by increasing the coverage of population with access to safe and reliable water and sanitation services from 40% to 55% by 2009, and thereby to reduce the incidence of diseases transmitted through water and related to sanitation by about 50% [34].
While the global progress in achieving these objectives is different, 147 countries have reached the target on drinking water, 95 countries have solved the problem of providing people with sanitation facilities and 77 countries have implemented the one and the other [35].
The difference between rural and urban areas around the world has declined, but a significant gap still remains. Throughout the entire world the proportion of rural population without access to improved drinking water sources has fallen by more than half, from 38% in 1990 to 16% in 2015 [35]. At the present time, 96% of urban population and 84% of rural one use improved drinking water sources. In addition, four out of five people living in urban areas have access to the tap drinking water, while in rural areas only one in three people can use this service [35].
Water safety is also the integral element of achievement of Sustainable Development Goals (SDG). Sustainable Development Goal No.6 (SDG 6) aims to "ensure accessibility and sustainable management of water resources and sanitation for everyone" and includes six engineering purposes relating to drinking water, health affairs, wastewater management, water use efficiency, integrated water resources management and aquatic ecosystems protection [36].
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation has monitored drinking water and sanitation since 1990 and cooperated with partners of UN-Water to develop a basis for integrated monitoring of water and sanitation [36]. 2. The Role of Sanitation and Hygiene in Preventing Water-Related Diseases.
Since 1990, the worldwide share of rural population without access to improved sanitation facilities has decreased by nearly a quarter. In 2015, the proportion of people who resort to open defecation was reduced from 38% to 25% in rural areas [35]. And still, almost half of people living in rural areas do not have improved sanitation facilities, and one in four people resorts to open defecation as before. In contrast, in urban areas only 18% of people have no access to improved sanitation facilities. People in rural areas, as well as those who belong to poor and marginalized groups, much less often have access to improved water sources and sanitation facilities. They are also much less likely to use tap water in dwellings. The United Nations Organization [35] reports that the gradual elimination of inequalities in access to public services and their quality will remain an important area in the agenda for the period after 2015.
Adequate sanitation facilities, along with proper hygiene and safe water, are central to good health, and social and economic development [37].
Gastrointestinal diseases transmitted through water bring great economic losses, such as the billions of hours of disability among adults, as well as economic and healthcare costs [38-39].
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The main factors that reduce the relevance and impact of gastrointestinal diseases in the field of public health are good sanitation conditions, abundant availability of good quality water, adequate disposal of human and animal excrements and education in sanitation and hygiene. Some literature assumes
[40] that the good quality of drinking water is a necessary but not sufficient condition for elimination of gastrointestinal diseases as a public health issue. Furthermore, the amount of water used for personal and household hygiene is more important than the quality of drinking water during diarrhea
[41]. This means more frequent bathing and hand washing, more thorough washing of food products, as well as the inner cleanliness [15]. For example, washing one's hands with soap reduces the risk of endemic diarrhea, as well as respiratory and skin infections, while face washing prevents trachoma and other eye infections. A systematic review of the literature [42] confirmed that the hygiene, especially hand washing in childbirth and postpartum period, also contributed to reducing newborn mortality. Dr. Haldan Mahler said: "The number of water taps per 1,000 people is a better indicator of health than the number of hospital beds" [15].
The diseases associated with poor sanitation particularly correlate with poverty and infancy [6]. Human feces are the most dangerous to health. One gram of fresh feces from an infected person can contain about 106 viral pathogens, 106-108 bacterial pathogens, 104 protozoan cysts and oocysts and 10-104
helminth eggs [43]. Systematic reviews [44-46] show that improvement of sanitation may reduce the level of diarrheal disease by 32% -37%.
Unfortunately, the current policies in most areas of the world focus on drug treatment. In contrast to good sanitation, it is not the preferred solution because it is much more expensive [37]. Improvement of sanitation also brings some social and economic benefits. The latter include lower healthcare costs, fewer days lost from work or school due to illness or caring for a sick relative, time-saving and convenience [47]. In total, the prevention of diseases related to water and sanitation can save about $7 billion a year as health system costs; the cost of avoided deaths also adds to this amount 3.6 billion dollars per year [48]. Conclusion.
Measures in the field of water supply, sanitation and hygiene are the most cost-effective way to prevent most of the devastating burden of water-related diseases, as well as they play a direct role in ensuring the right to sufficient living standards and rising the quality of life of population.
Based on the above, solving problems in the field of sustainable development in the 21st century, such as human development, creating livable cities, counteraction to climate change, and ensuring food and energy security, is impossible without improvement of the control system of water resources and ensuring the access to reliable services of water supply and sewage system.
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А.О. Омарова1, К.М. Тусупова2, Р. Берндтссон2, М.Г. Калишев1
1 Тамацтану гигиенасы, жалп ы гигиена жэне экология кафедрасы, Караганды мемлекетт!кмедицина университетi, Караганды,
К,азацстан
2Су ресурстар инженериясы кафедрасы жэне Таяу Шыгыс зерmmеулерi отралыгы, Лундуниверситету Лунд, Швеция
АДАМ Т1РШ1Л1К ЭРЕКЕТ1НДЕГ1 СУМЕН ЦАМТАМАСЫЗДАНДЫРУ, САНИТАРИЯ МЕН ГИГИЕНАНЫН МЕДИКО- ЭЛЕУМЕТТ1К
МАН,ЫЗДЫЛЬИЫ
tywh: Ма;алада сумен ;амтамасыздандыру, санитария мен гигиенаныц сумен байланысты сыр;аттарды азайту, тургындардыц 0Mip дейгей мен сапасын жогарлатудагы релш мецгеру саласындагы отанды; жэне шетелдш авторлардыц гылыми басылымдарына жасалган аналитикалы; шолу усынылган. Эдебиет талдау керсеткендей, бул саладагы шаралар сумен байланысты сыр;аттардыц тал;андаушы ауыртпалыгыныц кеп белМнщ алдын алудыц экономикалы; тургындан ец тшмд эдга болып табылады. Сонымен ;атар, олар жетюлшт емiр децгешне деген кукыщты ;амтамасыз етуде жэне тургындардыц емiр сапасын жогарлатуда тшелей рел ат;арады.
TYrnH4i сездер: сумен ;амтамасыздандыру, санитария, гигиена, сумен байланысты сыр;аттар, емiр децгеш, емiр сапасы
А.О. Омарова1, К.М. Тусупова2, Р. Берндтссон2, М.Г. Калишев1
1Кафедра гигиены питания, общей гигиены и экологии, Карагандинский государственный медицинский университет, Караганда,
Казахстан
2Кафедра инженерии водных ресурсов и Центр Ближневосточных исследований, Лундскийуниверситет, Лунд, Швеция
МЕДИКО-СОЦИАЛЬНОЕ ЗНАЧЕНИЕ ВОДОСНАБЖЕНИЯ, САНИТАРИИ И ГИГИЕНЫ В ЖИЗНЕДЕЯТЕЛЬНОСТИ ЧЕЛОВЕКА
Резюме: В статье представлен аналитический обзор научных публикаций отечественных и зарубежных авторов в области изучения роли водоснабжения, санитарии и гигиены в сокращении заболеваний, связанных с водой, повышении уровня и качества
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жизни населения. Анализ источников показал, что меры в данной области являются самым экономически-эффективным способным предотвратить большую часть разрушительного бремени болезней, связанных с водой. А также они играют непосредственную роль в обеспечении права на достаточный уровень жизни и повышении качества жизни населения. Ключевые слова: водоснабжение, санитария, гигиена, болезни, связанные с водой, уровень жизни, качество жизни
УДК 614.2 -007:65.012.21
Д.К. Астаева1, Н.Ж. Кусайнова1, Ж.В. Романова2, К.С.Абсатарова2, А.Н. Нурбакыт 3
1РГП на ПХВ «Научно-практический центр санитарно-эпидемиологической экспертизы и мониторинга» КOOЗ МP РК,
2Казахский Национальный университет им.Аль-Фараби 3Казахский Национальный медицинский университет им.С.Д.Асфендиярова
АНАЛИЗ КАЧЕСТВА И БЕЗОПАСНОСТИ ДЕТСКИХ ИГРУШЕК, РЕАЛИЗУЕМЫХ НА РЫНКЕ КАЗАХСТАНА
В статье говорится о гигиенических требованиях к безопасности детских игрушек и лабораторный контроль за их качеством. В настоящее момент из всех видов продукции, изучаемых лабораторией токсикологии полимеров, они являются наиболее неблагополучными по гигиеническим показателям, что требует усиление контроля за их производством, ввозом и применением. Большое значение в гигиеническом отношении имеют материалы, из которых изготовлены игрушки, так как они могут быть источниками выделения небезопасных для детского организма химических веществ. Целью настоящих исследований явилось изучение органолептических показателей (запах), количественной миграции химических веществ (дибутилфталат, диэтилфталат, фенол, цинк) и токсикологических показателей (раздражающее действие на слизистые, индекс токсичности) в детских игрушках.
Ключевые слова: поливинилхлорид, резина, запах, дибутилфталат, диэтилфталат, фенол, цинк, раздражающее действие на слизистые, индекс токсичности, среднесмертельная доза.
Введение. Современные игрушки характеризуются значительным многообразием по совокупности характеристик: по виду материалов, из которых они изготовлены; по возрастной группе детей, для которой они предназначены; по функциональному назначению; по конструкции игрушек. Большое значение в гигиеническом отношении имеют материалы, которые используются для изготовления игрушек: полимерные материалы (полиэтилентерефталат, полиэтилен, полипропилен и др.), стекло, текстиль, резины, силикон, пластизоль, бумага, картон, дерево, металл [1]. Данные материалы могут быть источником выделения небезопасных для детского организма химических веществ: формальдегид, фенол, соли тяжелых металлов, эфиры фталевой кислоты и т.д. Особого внимания заслуживают игрушки, по функциональному назначению предназначенные для контакта с полостью рта ребенка. Токсичные вещества, попадая в организм ребенка, могут не оказать сиюминутного воздействия, но накапливаясь в организме, могут привести к нарушениям состояния здоровья и психики детей. При гигиенической экспертизе игрушек следует уделять внимание органолептическим показателям - внешний вид игрушки, ее запах, привкус водной вытяжки из игрушки. Посторонний неприятный запах любого материала может служит косвенным признаком выделения из него летучих химических веществ. Именно по этой причине органолептические показатели являются лимитирующими при проведении санитарно-химических исследований, т.е. при несоответствии образца нормативным требования по одному из них, возможно выдача заключения о несоответствии без проведения последующий лабораторных испытаний. Основным нормативным документов, содержащим требования к детским игрушкам является Технический регламент Таможенного союза 008/2011 «О безопасности игрушек», утвержденный Решением Комиссии Таможенного союза от 23 сентября 2011г. № 798 (далее - ТР ТС) [2]. Требования ТР ТС распространяются на выпускаемые в обращение на территории Таможенного союза игрушки, ранее не находившиеся в эксплуатации. При этом игрушки должны пройти подтверждение соответствия и быть маркированы единым знаком обращения на рынке государств-членов Таможенного союза.
В соответствии с ТР ТС требования гигиенической безопасности игрушек включают [2]: органолептические показатели (запах, привкус водной вытяжки из изделия); физические факторы (уровень звука, уровень напряженности электростатического поля, уровень напряженности электромагнитного поля радиочастотного диапазона, уровень напряженности электрического поля, уровень интенсивности интегрального
потока инфракрасного излучения, уровень локальной вибрации, удельная эффективная активность естественных радионуклидов); санитарно-химические показатели (миграция в модельные среды вредных химических веществ, перечень которых определяется в зависимости от химического состава материала, и нормы выделения вредных химических веществ из игрушек); токсиколого-гигиенические показатели
(раздражающее действие на слизистые, индекс токсичности); микробиологические показатели.
Если при подтверждении гигиенической безопасности выявляется несоответствие игрушки любому из контролируемых показателей, она признается
несоответствующей, и дальнейшие исследования прекращаются (ТР ТС).
Материалы и методы исследования. Материалами исследования послужило 2172 проб детских игрушек взятые центрами санитарно-эпидемиологической экспертизы. Нами были проведены исследования 5 образцов детских игрушек:
Образец 1 - игрушка для купания осьминог «Lubby», изготовлен из поливинилхлорида;
Образец 2 - уточка розовая для купания, изготовлена из поливинилхлорида;
Образец 3 - набор разноцветных животных «Djeco», изготовлен из резины;
Образец 4 - игровой набор «Baby Веселая компания», изготовлен из резины;
Образец 5 - игровой мячик маленький, изготовлен из резины. Все образцы игрушек согласно маркировке изготовлены в Китайской Народной Республике.
Результаты исследования. Всего по республике в 2016 году детских игрушек Центрами санитарно-эпидемиологической экспертизы было исследовано 2172 проб, что на 53% выше аналогичного показателя 2015 г. (1027), что связано с действовавшим в 2015 году мораторием на проверки объектов малого и среднего бизнеса. При этом удельный вес запрещенных детских игрушек составил 33,7% [3]. Однако такой высокий показатель запрещенных игрушек связан не столько с неудовлетворительным качеством, сколько с неправильным оформлением маркировки. Наиболее высокий процент некачественных игрушек выявлен в Западно-Казахстанской (76,2%), Акмолинской (59%), Павлодарской (56,1%), Атырауской (50,9%), Северно-Казахстанской (49%) областях. Наиболее низкий процент некачественных игрушек по республике составил в Южно-Казахстанской (4%) области (рисунок 1).
