Preventive, Family & Community Medicine: Sanitation

Comprehensive practice flashcards covering water sanitation, waterborne disease classifications, PNSDW 2027 standards, water treatment, food safety under RA 10611, foodborne intoxications, preservation techniques, and housing sanitation principles.

What four diseases compose the acronym "WILD Diseases" targeted in public health sanitation advisories?

Water-borne, Influenza-like illness, Leptospirosis, and Dengue

According to the WHO-WPRO, how many annual child deaths from diarrhea could be prevented through safer water supplies?

$$1.4\text{ million child deaths}$$

How many annual deaths from malaria could be prevented worldwide by safer water, according to WHO-WPRO?

$$500{,}000\text{ deaths}$$

According to WHO-WPRO, how many child deaths from malnutrition could be prevented each year by improving water?

$$860{,}000\text{ child deaths}$$

According to WHO-WPRO, how many annual deaths from drowning could be averted through safer water interventions?

$$280{,}000\text{ deaths}$$

What fraction of the total global disease burden could be prevented by improving water sanitation?

Almost $\frac{1}{10}$ of the global disease burden

What are the four primary classifications of water diseases detailed in the lecture outline?

Water-borne diseases, Water-washed diseases, Water-based diseases, and Water-related vector-borne diseases

What defines a water-borne disease?

Infections spread through contaminated drinking water or the ingestion of contaminated drinking water

What are three classic clinical examples of water-borne diseases?

Acute gastroenteritis, cholera, and typhoid

What is the defining characteristic of water-washed diseases?

Diseases that occur due to insufficient hygiene secondary to an insufficient water supply

What dermatologic condition is presented as an example of a water-washed disease because it is easily washed off with sufficient water?

Scabies

What is the defining characteristic of water-based diseases?

Infections transmitted by aquatic invertebrate organisms

What aquatic snail serves as the invertebrate vector for schistosomiasis?

Oncomelania quadrasi

How does schistosomiasis infect humans following release from its snail host?

The parasite grows inside the snail, exits into the water, and penetrates the human skin upon contact

What defines a water-related vector-borne disease?

A disease transmitted by insects (vectors) whose life cycle is partially dependent on water

Which specific vector transmits dengue and malaria?

Female mosquitoes

What are the "4 T's" under the DOH Dengue Prevention Program?

"Taob, Taktak, Tuyo, at Takip"

Besides malaria and dengue, what two other diseases are classified as water-related vector-borne diseases?

Japanese encephalitis and filariasis

What defines a water-dispersed disease?

Diseases spread by water (e.g., floods) whose pathogens proliferate in freshwater and enter the body through the respiratory tract

How does freshwater amoeba enter a host to cause disease along the olfactory tracts and meningitis?

It enters the body in large numbers via the respiratory and olfactory tracts when proliferating in freshwater

What bacterial pathogen causes leptospirosis, and how is it dispersed into floodwaters?

Leptospira spp., which is shed in the urine of rats and dispersed by floodwaters

What respiratory infection is classified as a water-dispersed disease alongside leptospirosis and freshwater amoeba?

Legionnaire's Disease

What is the ultimate source of all freshwater in the world?

Rainwater

How is rainwater traditionally captured and stored for domestic use?

Directly collected from roofs and artificial catchment systems and stored in cisterns and tanks

Why is rainwater considered an unreliable and vulnerable source of water supply?

Rainfall patterns are seldom constant, catchment areas are costly for large populations, and it carries risks of contamination from atmospheric gases, haze, and acid rain

What percentage of community water system users receive their water from a surface water source?

$$68\%$$

Through what natural processes is surface water replenished and lost?

Replenished through precipitation, and lost through evaporation and seepage into groundwater supplies

Where is groundwater located and how is it accessed?

Located below the ground surface in rock layers; accessed via drilled wells, springs, and infiltration galleries

Which mineral ions in groundwater solution cause water hardness?

Calcium ($\text{Ca}^{2+}$) and magnesium ($\text{Mg}^{2+}$) ions

What particulate forms do iron ($\text{Fe}$) and manganese ($\text{Mn}$) produce in groundwater?

Tiny particles of iron rust and oxides of manganese

What four demineralization processes are used to produce desalinated water?

Distillation, ion exchange, electrodialysis, and reverse osmosis

What are the two major disadvantages of desalination?

It is costly and requires complicated equipment and highly trained personnel

What is reclaimed wastewater?

The reuse of treated wastewater, such as sewage effluents, following treatment processes and disinfection

What two additional treatment steps are performed on reclaimed wastewater before use?

Rapid filtration and the use of activated carbon to reduce fine suspended/dissolved solids, followed by chlorine disinfection

What are the primary applications of reclaimed wastewater?

Industrial processes, industrial cooling water, and toilet flushing

What is a Level I (Point Source) water facility?

A protected well or a developed spring with an outlet but without a distribution system (e.g., "Poso")

What is the household coverage and maximum outreach distance for a Level I water source?

Serves $15\text{ to }25\text{ households}$, with an outreach distance of no more than $250\,\text{meters}$ from the farthest user

What is the standard discharge rate of a Level I point source?

Generally $40\text{ to }140\,\text{liters per minute}$

What is a Level II (Communal Faucet System or Standpost) water facility?

A system composed of a source, a reservoir, a piped distribution network, and communal faucets or standposts

What is the household coverage and operating radius for a Level II communal faucet?

Serves an average of $4\text{ to }6\text{ households}$ per public faucet within a $25\text{-meter}$ radius

What is a Level III (Waterworks System) water facility?

A system with a source, a reservoir, a piped distribution network, and direct, individual household taps

What is the recommended daily rate of water usage for individuals in urban areas?

$$180\,\text{liters/person/day}$$

In rural areas, what are the recommended water usage rates for public taps versus piped household connections?

$25\,\text{liters/person/day}$ from public taps; $150\,\text{liters/person/day}$ for households with piped connections

What is the recommended daily water tank capacity for residential versus industrial areas?

Residential: $10\text{–}15\,\text{gal/day}$; Industrial: $100\text{–}150\,\text{gal/day}$

What three factors determine the quantity of water required for domestic purposes?

Availability of water, water pressure in the distribution system, and the number of plumbing fixtures in the house

What are the standard freezing and boiling points defining the physical qualities of pure water?

Freezing point at $0^\circ\text{C}$; Boiling point at $100^\circ\text{C}$

What regulatory document prescribes drinking-water quality standards in the lecture notes?

PNSDW 2027 (Philippine National Standards for Drinking Water 2027)

What are Mandatory Parameters under PNSDW 2027?

Legally enforceable parameters for all drinking-water providers that directly affect health, indicate contaminants, exceed tolerable values, have wide spatial distribution, or indicate general supply stability

What are Primary Parameters under PNSDW 2027?

Site-specific chemical impurities in water that directly affect health through acute or chronic exposure

What are Secondary Parameters under PNSDW 2027?

Operational parameters that affect the efficiency of treatment processes and render water unacceptable for drinking aesthetically

What is the target year established by the Sustainable Development Goals (SDG) for universal access to safe water?

Year $2030$

Under PNSDW 2027, what are the maximum permissible limits for Color and Turbidity?

Color: $10\,\text{CU}$; Turbidity: $5\,\text{NTU}$

Under PNSDW 2027, what are the maximum permissible levels for Total Hardness and Total Dissolved Solids (TDS)?

Total Hardness: $300\,\text{mg/L}$; Total Dissolved Solids: $600\,\text{mg/L}$

What are the acceptable standards for pH and Hydrogen Sulfide under PNSDW 2027?

$\text{pH } 6.5\text{–}8.5$; Hydrogen Sulfide: $0.05\,\text{mg/L}$

What is the PNSDW 2027 limit for Heterotrophic Plate Count (HPC)?

$$< 500\,\text{CFU/mL}$$

Under PNSDW 2027, what is the standard limit for Total Coliform and E. coli tested via Multiple Tube Fermentation Technique (MTFT)?

$$< 1.1\,\text{MPN/100 mL}$$

Under PNSDW 2027, what are the maximum allowable limits for Arsenic ($\text{As}$) and Lead ($\text{Pb}$)?

$0.01\,\text{mg/L}$ for both Arsenic and Lead

Under PNSDW 2027, what are the maximum allowable limits for Cadmium ($\text{Cd}$) and Nitrate ($\text{NO}_3^-$)?

Cadmium: $0.003\,\text{mg/L}$; Nitrate: $50\,\text{mg/L}$

What three specific pesticides are listed under PNSDW 2027 chemical parameters?

DDT, Aldrin, and Dieldrin

What is the mechanism of coagulation in water treatment sanitation?

Chemical coagulants with a positive charge (aluminum sulfate or synthetic polymers) are added to destabilize and neutralize the negative charges of suspended and colloidal matter

What occurs during the flocculation step of water treatment?

Gentle mixing of water with coagulated matter encourages particles to bind together and form larger, heavier aggregates called flocs

What is the physical principle of sedimentation in water treatment?

Gravity pulls suspended floc particles down to the bottom of the tank, forming a settled sludge layer

What filter media compositions are used in water treatment filtration to remove fine particulates and microbes?

Beds of sand, gravel, and charcoal

What is the standard household recipe for chlorine water disinfection using unscented bleach?

$1.25\,\text{mL}$ of unscented household bleach per $1\,\text{gallon}$ of water

How much Vitamin C is needed to neutralize $1\,\text{ppm}$ of chlorine residual per $100\,\text{gallons}$ of water?

$1000\,\text{mg}$ of Vitamin C

What is the dosage and standing time required for water disinfection using $2\%$ Iodine?

$4\text{ to }8\text{ drops}$ of $2\%$ Iodine per $1\,\text{liter}$ of water; let stand for $30\,\text{minutes}$ before neutralizing with Vitamin C

What is the required boiling duration to ensure pathogen destruction at sea level versus high altitudes above $6{,}500\,\text{feet}$ ($2{,}000\,\text{m}$)?

A rolling boil for $1\,\text{minute}$ at sea level, or $3\,\text{minutes}$ at altitudes above $6{,}500\,\text{feet}$

Why is standard backcountry filtration ($0.3\,\mu\text{m}$) inadequate for complete water purification on its own?

It successfully removes bacteria and protozoan parasites but cannot remove enteric viruses unless specially designed

How effective are chemical disinfectants such as chlorine and iodine against Cryptosporidium oocysts?

Not effective

What sequence of treatment plant steps is shown in this CDC water treatment flow diagram?

Coagulation, Flocculation, Sedimentation, Filtration, and Disinfection

What official law is known as the Food Safety Act of 2013 in the Philippines?

RA 10611

According to global statistics, how many people fall ill and how many die each year from eating contaminated food?

$600\text{ million}$ fall ill (almost $1\text{ in }10$ people) and $420{,}000$ die every year

How many healthy life years are lost globally each year due to foodborne illnesses?

$$33\text{ million healthy life years}$$

What proportion of the global foodborne disease burden is carried by children under $5\,\text{years}$ of age?

$40\%$ of the disease burden, with $125{,}000\text{ deaths}$ each year

How many people fall ill and how many die each year specifically from foodborne diarrheal diseases?

$550\text{ million}$ fall ill and $230{,}000$ die every year

What are the five chronological stages of the food chain defined in RA 10611?

Production, Transport and processing, Retail and storage, Preparation, and Consumption

What is the key pathologic difference between food poisoning and a food-borne infection?

Food poisoning is the ingestion of preformed toxins from microbial growth or contamination; food-borne infection is the ingestion of living microorganisms that multiply inside the host and produce toxins

What are the five primary objectives of food sanitation?

Educate individuals/families on proper handling; provide protective measures against agents; ensure safe, wholesome food; prevent sale of poor/offensive food; and protect consumers from adulteration and misrepresentation

What are the five primary risk factors contributing to food-borne illness in food handling?

Improper hot/cold holding temperatures, improper cooking temperatures, contaminated utensils/equipment, poor employee health and hygiene, and food from unsafe sources

What boundary shown in this geological diagram separates the unsaturated zone from the saturated groundwater zone below?

The water table

What is the most common causative agent and typical incubation period of Salmonellosis?

Salmonella typhimurium (incubation: $6\text{–}48\,\text{hours}$, often $12\text{–}24\,\text{hours}$)

What are the clinical features and prognosis of Salmonellosis?

Sudden abdominal pain, diarrhea, frequent vomiting, fever, anorexia, and loose stools for several days; death is uncommon

What is the causative agent and incubation period of Staphylococcal food poisoning?

Enterotoxins of Staphylococcus; incubation is $1\text{–}6\,\text{hours}$ (often $2\text{–}4\,\text{hours}$)

What unique clinical signs accompany the violent nausea, vomiting, and diarrhea in Staphylococcal food poisoning?

Subnormal body temperature and lowered blood pressure (prostration); death is exceedingly rare

What is the causative agent, incubation, and characteristic clinical presentation of Clostridium perfringens food poisoning?

Clostridium perfringens (C. welchii); incubation $8\text{–}22\,\text{hours}$ (often $10\text{–}22\,\text{hours}$); causes abdominal colic and diarrhea with uncommon nausea and vomiting; lasts $1\,\text{day}$ or less

What is the incubation period and mortality rate of Botulism?

Incubation is $12\text{–}36\,\text{hours}$ (ranging $2\,\text{hours to } 6\,\text{days}$); $\frac{2}{3}$ die of respiratory or cardiac failure within $1\text{–}7\,\text{days}$

What cranial nerve and neuromuscular symptoms characterize Botulism?

Weakness, dizziness, headache, constipation, oculomotor paralysis, double vision, difficulty swallowing, and respiratory paralysis

What health hazards are caused by low-dose versus high-dose ingestion of Aflatoxin from moldy grains or peanuts?

Low doses induce liver cancer; high doses cause general liver damage

What foods are classically involved in Bacillus cereus intoxication, and what is its onset time?

Custard, cereals, and starchy foods; onset is $8\text{–}16\,\text{hours}$ and duration is less than $1\,\text{day}$

What causes Ciguatera poisoning, and what are its clinical features?

Ingesting carnivorous tropical reef fish with concentrated dinoflagellate toxin; causes tingling, rash, fever, and breathing discomfort lasting up to $2\,\text{weeks}$

What is Ergotism, and what clinical manifestations does it produce?

Intoxication caused by eating moldy grains contaminated with ergot alkaloids; causes burning abdominal pains and hallucinations lasting months

What are the clinical features and typical onset time of Methyl mercury poisoning from contaminated fish?

Onset is $1\,\text{week}$ (often chronic); features include blurred vision, numbness, apathy, and coma

What mushroom genus causes severe food intoxication with liver necrosis?

Amanita species (causes vomiting, liver necrosis, and neurotic effects)

What causes Paralytic Mollusk Poisoning, and what are its symptoms?

Bivalve mollusks harvested during red tide (dinoflagellate blooms); causes tingling, rash, fever, and respiratory paralysis within $1\,\text{hour}$

What causes Scombroid poisoning, and how can it be prevented?

Histamine-like substance produced by Proteus growing on fish such as tuna; prevented by prompt refrigeration of fish

What are the time and temperature requirements for Low Temperature Long Time (LTLT) pasteurization?

$$63^\circ\text{C}\text{ for } 30\,\text{mins}$$

What are the time and temperature standards for HTST and UHT pasteurization?

High Temperature Short Time (HTST): $72^\circ\text{C}\text{ for } 15\,\text{secs}$; Ultrahigh Temperature (UHT): $138^\circ\text{C}\text{ for } 2\,\text{secs}$

What thermal processing standard is required to destroy Clostridium botulinum in commercial canning?

$$121^\circ\text{C}\text{ for } 3\,\text{minutes}$$

Which three bacterial pathogens can grow or survive at low temperatures?

Listeria monocytogenes, Yersinia enterocolitica, and non-proteolytic Clostridium botulinum

What is the maximum recommended refrigeration temperature for cold food storage?

$$< 4.4^\circ\text{C}$$