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close this bookSpecial Public Works Programmes - SPWP - Community Water Supply - A Community Participation Training Element for SPWP User Beneficiaries (ILO - UNDP, 1987, 100 p.)
close this folderSESSION 2: The Relationship of Water, Sanitation and Disease - Faecal-Oral Transmission
View the documentGUIDELINES
View the documentREADING SECTION




At the end of this learning/discussion session, the participants should be able to:

1. Explain the faecal-oral route of disease transmission.
2. Give three examples of water-borne diseases.
3. Describe two ways that water can be contaminated by disease-causing micro-organisms.


one to two hours


chalkboard and chalk, or flipchart and pen microscope (optional)


1. The USEFUL WORDS at the beginning of this session material are very important. If the participants do not understand these words, they will not understand the information that is presented later.

DO NOT just ask them if they understand the definitions. Simplify and translate the words into the local language. Discuss and give examples of each word.

The subject matter of this session and of the vocabulary is very personal. If you think that participants will feel shy or embarrassed by such a discussion, you should arrange separate sessions for males and females.

2. The ideas presented in this session are difficult for some people to understand and accept. If you know that their beliefs about disease transmission are based on religious or cultural ideas which are contrary to the germ theory presented in this session, you will have to prepare the session very carefully.

You may want to ask a medical doctor or other respected medical person to reinforce and discuss these ideas with the group.

You may want to make and use posters or other visual aids to graphically illustrate the transmission of disease.

You may want to obtain a microscope and let the participants see for themselves the micro-organisms in a drop of contaminated water.

Other publications that will give you more information are:

Community Health (Rural Health Series No. 12)
Communicable Diseases (Rural Health Series No. 7)

Both of the above books are available from:

African Medical and Research Foundation
P.O. Box 30125
Nairobi, Kenya

3. Four ways in which excreta can get into water are presented in this session. Each will need a careful explanation.

Number 1 (If people or animals defecate or urinate in the bush, rain running over the bush may wash the excreta into springs and rivers. If people or animals bathe, urinate or defecate in a river, lake or dam, that water will also be contaminated.) Help participants understand that even a small amount of excreta from an infected person could cause illness in a large number of people who drink the water. Women who care for children may mistakenly believe that baby’s excreta are not as harmful as those of adults. You should help participants understand that risk of contamination is just as great, and that since babies often put dirty hands and objects in their mouths, the risk of contamination may be even greater.

Number 2 (If latrines are located uphill from or very close to a water source such as a spring, a stream, a pond or a well, liquids carrying the micro-organisms may seep from the latrines into soil and then into the water supply.) This is illustrated with a picture. Make sure that the participants understand how pollution can seep into the water supply. Do not allow participants to get the mistaken idea that sanitary latrines are bad! Use this opportunity to encourage not only the use of sanitary latrines, but also the proper siting of latrines (downstream and at least 25 m from the nearest source of water). They should always be at a lower elevation than the water source.

Number 3 (If wells are not covered or protected, the well water can become polluted when germs wash into the well with surface mud. Wells can also be polluted by using dirty buckets or containers to take out the water. This often happens when buckets are left lying on the ground.) If wells are improperly protected in this community, take the opportunity to help the participants make a commitment to improve the situation immediately. Discuss each well.

Number 4 (If containers used to store water are contaminated, then the fresh water may also become contaminated after it has been collected.) Pollution after collection is a very common problem. Help participants understand that dirty storage containers, dirty dippers or dirty hands can contaminate water.

4. DISCUSSION OPPORTUNITY: REMEMBER that the purpose of the discussion opportunity is to give people a chance to understand and talk about common water-related problems. It is essential that you LISTEN and encourage people to ask questions and discuss their different points of view.

Do not criticise any answers, but do help people understand the point of view put forth in the session material.

Possible answers are suggested below.


Question 1: Accept all answers and list them on the chalkboard or flipchart. All answers are worthy of discussion. If there are cultural or religious explanations for disease, it is important to bring these out. The objective of this session, however, is to inform the participants of the relation of water, sanitation and disease. An understanding of how diseases (micro-organisms) are spread by the faecal-oral route is important. Help the participants conclude that the babies probably died from a water-borne disease transmitted through the faecal-oral route.

Question 2: This question provides an opportunity for participants to think about the responsibility of the entire community.

List all the answers. They will probably range from the babies’ mothers to medical personnel, to village authorities.

Try to guide the discussion to include the need for health education and the need for both personal and community hygiene.

6. READING ASSIGNMENT: If this group does study assignments before each learning/discussion session, ask them to read the material in Session 3 before the next group meeting.



Read the definitions of the USEFUL WORDS. Discuss the meanings with your group and your discussion leader. What do the words mean in your own language?

Read about the faecal-oral transmission of disease. Your group discussion leader will answer any questions you have.

Use the DISCUSSION OPPORTUNITY to talk with the other group members about diseases in your community.


URINE - the liquid waste matter excreted from the body.

URINATE - to let urine come out from the body.

FAECES - waste matter which comes from the bowels.

DEFECATE - to empty the bowels of faeces. People should defecate in a latrine.

EXCRETA - the waste matter from the body; either urine or faeces.

ORAL - used or taken in through the mouth, e.g. some medecine is taken orally. It is taken by mouth.

CONTAMINATION - the state of being impure because of contact with something harmful. (Similar to POLLUTION).

CONTAMINATE - to make unclean by adding something harmful.

POLLUTION - the contamination of soil or water by something.

MICRO-ORGANISM - an animal or plant or germ of microscopic size.

TRANSMIT - to spread; to pass on. The sickness spread to all the family members. It was transmitted to all the family. Transmission was through contaminated water.


Many diseases and infections in your community are caused by unclean water and/or poor sanitation. It is important to understand the relation of water, sanitation and disease.

WATER-BORNE diseases are passed from one person to another through the faecal-oral route. This means that diseases are spread when the faeces of a sick person contaminate water. This water is unclean because of the faeces. The faeces from a person who has a stomach sickness contain germs (micro-organisms) which can make other people sick. When the faeces contaminate water, all the people who drink the water may also get sick.

Diseases which may be transmitted this way are: typhoid, cholera, diarrhoea, amoebic dysentry, polio and hepatitis A.


There are several ways that excreta can get into the water.

1. When people or animals defecate or urinate in the bush, rain may wash the excreta into streams or rivers. Also, if people or animals bathe, urinate or defecate in a river, lake or dam, that water will also be contaminated. The urine and faeces of babies are just as dangerous as those of adults.

2. If latrines are located uphill from or very close to a water source such as a spring, a stream, a pond or a well, liquids carrying the micro-organisms may seep from the latrines into soil and then into the water supply.


3. If wells are not covered or protected, the well water can become polluted when germs wash into the well with mud on the rope or bucket.

4. If water containers are contaminated (for example, by dirty hands or dirty water) then the clean water put into those containers may also become contaminated.


The FAECAL-ORAL ROUTE OF DISEASE TRANSMISSION can also occur without water. In the home, for example, if a mother does not wash her hands after caring for a baby with diarrhoea, and if the mother then prepares food for the family, germs from the sick baby that are on the mother’s hands may contaminate the food she is preparing. People who eat the food may then get the same sickness as the baby.

Disease can also be spread by flies. A fly (or other insect) which has landed on excreta and then walks on food may bring disease-causing micro-organisms onto the food. The person who eats the food may become sick with the same illness as the person who left faeces in the bush.


Last year at the beginning of the rainy season, four babies in a nearby village died in one month. Many other children and adults were also sick. They all suffered from diarrhoeal diseases. All the people who got sick used water from the same stream.

It is the custom in this village to defecate in the bush. Many people prefer to use the area near the stream because it is private and because water for cleansing is available.

1. WHAT do you think was responsible for the babies’ deaths and the other illnesses?

2. WHO do you think was responsible for the babies’ deaths?

3. Water is pure when it falls as rain. How can it become contaminated with germs (micro-organisms)?

4. If your friend did not understand the relation between sanitation and health, could you explain to him or her the faecal-oral route of disease transmission? What would you say?

5. Can you name some diseases that are spread by contaminated water?