There is a myth in our country that only the uneducated and poor people in our country lack simple hygiene knowledge which is the cause of 80 per cent of their total disease incidence -- with diarrhea, cholera, jaundice, dysentery, and typhoid being the five most common water borne diseases. But the recent outbreak of jaundice among the students living at Dhaka University indicates that our educated people are not immune to the problem either. It is unclear whether the recent outbreak of jaundice can be ascribed to the lack of hygiene knowledge among the students or the DU canteen staff, but there is a high probability that lack of hygiene knowledge is why jaundice has taken the endemic shape in DU halls to claim the life of one student and strike another 400.
Let me make it clear why I am saying this. As per the reports of the newspapers, the students of DU have been struck by the Hepatitis A Virus (HAV). There are also some other hepatitis viruses like B, C, D, E, and G. These are called non-A. The non-A spreads through needle-sharing, blood, and sex. There are no positive reports of the non-A hepatitis in the dorms.
But the HAV gets into the host through the fecal-oral route with water and food when the hosts lack the knowledge of whether their food and water have come into contact with fecal matter. Although there are two other routes like parenteral route (transmitting by blood and blood products or by skin penetration) and homosexuality among men that creates oral-anal contact and gets the HAV into the host -- this is quite rare and unusual in our country and highly unlikely to be the cause of the DU outbreak.
The possibility of spreading this disease through water is very low because the DU halls are not supplied with the DWASA water that has the serious risk of being contaminated with HAV as the water pipelines of the DWASA often come into contact with the sewerage lines through leakage. The DU students are supplied with ground water considered as the best quality water in our country. Besides, the DU halls have a sufficient supply of water round the clock. Therefore, I think the other factors of fecal-oral contamination like food, hand washing, the hygiene practices are causing the endemic situation of jaundice in DU halls, not the water.
Living almost seven years in a DU hall I have understood that there is the high possibility of transmitting the HAV through the food. The resident students of DU halls eat in the hall canteens and some other shops located inside the campus. The staff that operates the canteen has a serious lack of knowledge of hygienic practices. As the students have the same level of ignorance, they cannot create pressure on the canteen staff and are unable to advise the shopkeepers and canteen staffs for the maintenance of food hygiene.
I have observed that the students lack the knowledge of the importance of hand washing with soap during the critical times like after defecation, before having meal, and at the time of preparing or handling the food.
The students wash their hands normally only with water before having meal, but use soap for washing the hands after.
The staffs of the canteens have not any practices of washing hand with soap at any of those critical times. So the risk of bringing the HAV remains high while they serve and prepare food and touch utensils. The students are habituated to touch and eat the dry food without washing the hands at all or taking any precaution for safety.
The food that is served in the DU canteens is simply substandard. The students are often supplied with rotten and substandard vegetables purchased as remnants from the kitchen markets. The fish supplied in the canteen also has the possibility of bearing HAV as the canteen owners always bought the carps cultivated in sewerage polluted water around the city. The canteen operators prefer those fish to feed the students because the price is lower than the other fish in the market.
All of the latrines and urinals in the DU campus are also the potential sources of water and excreta borne disease because these latrines often remain filthy with excreta and urine that spreads bad odour and attracts other carriers like cockroach, flies, etc.
Perhaps it is the common scenario for the student dormitories belonging to other college and universities of this country. And consequently, we often get the news of outbreak of food poisoning, diarrhea, cholera, dysentery, and typhoid among the students.
In conclusion, I must say that jaundice and other water borne disease is a big problem for our country. Every year these diseases cause the loss of Tk 500 crore and inflict other social and economic harm on our population like labour loss, disruption of mental peace, etc. These are the diseases for all of the people who do not maintain the sanitation rules and hygiene practices. And almost all of the people of this country fall under this criteria. The incidents of DU are enough to understand this reality.
However, the point for hope is the transmission routes of these diseases are identical and identified all over the country. An effective sanitation barrier can dismantle these transmission routes and save thousands of lives from these diseases. But generation of the critical awareness on the hygiene practices among the people is the primary and crucial task for the concerned stakeholders.
Author: Md. Firoj alam, Published in The Daily Star, November 27, 2004.
Link:http://www.thedailystar.net/2004/11/27/d41127150198.htm
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