Naya Pakistan


Project Name: نیا پاکستان صاف اور صحت مند پاکستان
Project Management: Panacea Healthcare System, Partners & Sponsors

Brief Description of a Project
a)   Back Ground
Pakistan is the seventh worst country in terms of access to basic sanitation, as its 42 per cent of the population remains without access to basic sanitation
A report by WaterAid says 79 million people lack a decent toilet, while 37pc have no system for wastewater disposal, which leads to spread of diseases due to contamination of water and contact with human waste.
Despite the severity of the issue, sanitation remains a low priority area in the country. There is an immediate need to shift focus.
Diseases spread by waste water and lack of sanitation increase the financial burden on families. This disadvantages the poorest. There is already a vast disparity in the country in terms of rural-urban access to basic sanitation facilities. If not addressed urgently, this will continue to keep many below the poverty line.
Published in Dawn, November 23rd, 2017
b)   Campaign at Glance
The campaigns goal is to provide resources about health and hygiene, for example, cleaning and disinfection, and other easy-to-follow steps in an effort to develop and maintain successful hand hygiene and cleaning practices, and is aimed at educating a broad audience.
This year, the Panacea HealthCare System (PHCS) has selected a priority area of public health for this one year campaign and working on this area with the theme of Naya Pakistan, Saaf or Sehatmand Pakistan 2019.
As the world’s population ages and grows, unhygienic and unhealthy behavior, an unbalanced diet, a lack of physical activity, smoking, harmful use of alcohol, together with stressful lifestyles, all increase the chances of developing high risk diseases. All regions of the world are affected with high risk disorders but underdeveloped countries are more prone to such high risk disorders.
Increasing public awareness is the key. Pakistan needs systems and services in place to support healthy lifestyles. Access to medicines of good quality, which are effective and inexpensive, is also vital, particularly at primary care level.
This year’s campaign provides an opportunity to focus attention on the hygiene and cleanliness for the prevention and control of diseases, as a means of reducing the number of people affected, both now and in the future.
Public Health Context
A World Bank study has calculated an estimated cost of Rs343.7 billion which Pakistan loses due to poor hygiene practice and sanitation.

The amount comes to 3.94 per cent of the country’s GDP. The study titled ‘The Economic Impacts of Inadequate Sanitation in Pakistan’ further says that out of the total amount, Rs69.52 billion constitutes direct financial cost, which is equivalent to 0.8 per cent of GDP.
Keeping in view the sanitation situation, a two-day national workshop, co-hosted by Unicef and the Water and Sanitation Program (WSP) of the World Bank, began here on Monday.
It aims at assessing the prevailing situation of sanitation and deliberating upon the course of action up to 2015 and beyond.
The workshop will also discuss the agendas for the forthcoming major events on sanitation including the South Asian Conference on Sanitation and Pakistan Conference on Sanitation.
“Poor sanitation, hygiene and lack of safe drinking water trigger a downward slide into poverty,” said MNA Maryam Aurangzeb, who is also an environmentalist, and was the main speaker at the workshop. “Women and adolescent girls are disproportionately affected by lack of access to adequate sanitation,” she said. “While efforts made by Unicef, WSP and other partners in the sanitation sector are highly appreciable, I urge all partners to join hands and strive harder towards achieving the sanitation-related Millennium Development Goals (MDGs) in Pakistan,” Ms Aurangzeb emphasized.
Speaking at the workshop, Unicef Representative in Pakistan Dan Rohrmann called upon the government, and bilateral and multilateral donors to make further commitments to water and sanitation sector.
“In addition to necessary investments, coordination and harmonization is crucial both for sustainable development and humanitarian response. Improved sanitation for all in Pakistan is achievable. Let us make it a reality,” Mr Rohrmann said.
In collaboration with Unicef, WSP has supported the provincial governments in designing large-scale sanitation programs in Pakistan.
It has also contributed significantly to institutional capacity development of water and sanitation service providers in urban areas of the country.
The World Bank study which was based on the state of sanitation in 2006 was released last month.
It says the need for special treatment and attention are needed in areas where the poor population lives and in rural areas where children are more at risk from diarrhea and malnutrition.
Education and awareness campaigns are needed at all levels, particularly in schools, to promote personal hygiene, such as hand-washing and other inexpensive means to minimize the incidence of diseases and the impact of poor sanitation indirectly, the study said.
The major component of the total health-related costs was premature mortality which consumed Rs216.29 billion.
Productivity losses due to illness are estimated at Rs40.55 billion with total productivity losses contributing to 11.80 per cent of the total health costs.
Water-related economic cost of poor sanitation has been calculated at Rs15.98 billion, equivalent to 0.18 per cent of the GDP.
Key findings of the report further showed that the coverage level for sewage collection was estimated at 50 per cent nationally, with 20 per cent coverage in rural areas, and only 10 per cent of sewage being effectively treated.
Treatment plants existed in a few cities, with only a few fully functional. The national figures hide rural-urban disparities.
Ninety per cent of the urban population had access to improved sanitation, while the percentage of rural population having this facility was 40.
In the rural areas, 45 per cent of the population still practiced open defecation, the study says.

Overall goal
The overall goal of this campaign is to reduce high risk diseases by promoting healthy lifestyle and personal hygiene behaviors in the country.

Specific objectives of the campaign are:
·       To raise awareness of healthy lifestyle and the causes and consequences of high risk diseases due to unhygienic behaviors;
·       To provide information on how to prevent high risk disease and related complications;
·       To encourage adults for general and routine health checkups and to follow the advice of healthcare professionals;
·       To encourage self-care to prevent high risk diseases;
·       To make healthcare affordable to all;
·       To incite national and local authorities to create enabling environments for healthy behaviors.

Target audiences
We encourage individuals and organizations working at international, regional, national, and community levels, in the public and private sectors and civil society, to coordinate and engage in activities for this campaign.


"نیا پاکستان صاف اور صحت مند پاکستان"
Campaign Materials
Campaign materials use in this campaign is:
• Posters, brochures, handouts and fliers
• Banners and steamers 
• Technical resources on diseases
• Links to regional materials
• Photos
Additional materials will be available on the campaign site in the lead-up to and on the Day of event etc, including:
• A global brief on diseases, its consequences, and how this global health problem can be addressed;
• A 120-seconds video of participants available on social websites of PHCS.

Key Messages
The Problem
There are many sicknesses which can be caused by inadequate (poor) domestic or personal hygiene.
Signs Of Poor Domestic Hygiene Include:

·       Not cleaning the toilet
·       Not getting rid of rubbish
·       Not washing clothes and bedding frequently
·       Not storing food properly
Signs Of Poor Personal Hygiene Include:
·       Not washing hands
·       Not showering
·       Not washing hair

Diseases in Indigenous communities caused by germs and parasites resulting from inadequate domestic and personal hygiene
·       Food poisoning
·       Gastroenteritis
·       Diarrhea caused by campylobacter
·       Pneumonia
·       Trachoma
·       Skin infections
·       Hepatitis A
·       Gastroenteritis
·       Colds and flu
·       Giardiasis
·       Scabies infection
·       Pediculosis (head lice infection)
·       Hookworm infection
·       Threadworm infection
·       Roundworm infection (strongyloides)

Poor domestic and personal hygiene practices can help the transmission of disease-causing germs:
·       Directly by the faecal-oral route, or by person to person or pet to person contact
·       Indirectly by vectors coming into contact with people or their food, people breathing in airborne droplets of moisture which contain germs or eating contaminated food.
The Solution
House design and health
It is important that houses are pleasant and healthy places in which to live. There are many factors to be considered in a house design to make it a healthy place.
1.    Protection from the weather
A house should keep out the rain and strong winds. It should keep out as much heat as possible in hot weather and keep in the warmth during cold weather. If the house meets all these requirements it lowers the chances of people getting sick from too much heat, cold or dampness.

2.    Size of rooms
Each room in the house should be large enough to allow the people living there to have enough space to live comfortably.
Rooms that are too small can lead to overcrowding and this can make it easier for diseases to be spread from person to person. Overcrowding can make people annoyed and depressed (downhearted). Rooms that are too small can result in the people using them not getting enough air.
Even a large house can become overcrowded if too many people live in it.

3.    Ventilation
All rooms should be well ventilated. This means that air should be able to flow into and out of each of the rooms. This is important so that fresh air can get inside all the rooms and stale air can get out. Ventilation also allows heat, steam and odors (smells) to escape, particularly from the kitchen, bathroom, laundry and toilet. This is important for the good health of the people living there.

Open windows and doors allow the house to be well ventilated. Sometimes air vents are placed in the walls or the corners of the ceiling to provide ventilation when doors and windows are closed.
Toilets usually have a window with one part always fixed open, or have an air vent in the ceiling which opens to the outside air.
Cooking areas also should be well ventilated so that any cooking smells are blown or sucked out of the house.
Sometimes houses do have plenty of windows but the people living in the house rarely or never open them. These people should be encouraged to open their windows, especially on days when a breeze is blowing. Fly screens allow for windows to be open while protecting people inside from flying insects (flies and mosquitoes).

4.    Lighting
As well as providing ventilation, windows also let natural light into the house. There should be enough windows to let in plenty of light. It is difficult for germs and insects to live and breed in light, airy rooms. When plenty of light can get into the house, it helps to make the home a cheery place to live in.

When electric power is supplied to the house, each room usually has electric light. Electric light is one kind of artificial light (not supplied naturally by the sun or moon). Gas, kerosene and candle lights are also artificial.

Where possible, electric lights also should be positioned outside to light up areas such as verandahs and outside toilet blocks at night.

5.    Power
If it is available in the house, electric power can be used for many purposes. For example, it can be used for lighting, heating water, cooking and for running many appliances such as refrigerators, TV sets, radios, kettles, toasters, and vacuum cleaners.

6.    Water supply
Every house should have clean drinking water supplied to it. Plumbing carries the water to taps in different parts of the house.
The kitchen, laundry and bathroom should each have water supplied. Water must also be supplied to the toilet if it has a flushing mechanism. Outside the house, water can be used on gardens and trees. Care should be taken to avoid wasting water.

7.    Kitchen
·       If possible, the kitchen should have:
·       a window or vent to let in fresh air and to allow cooking odours to escape. Sometimes a mechanical fan will ventilate the room
·       screens covering the windows to stop flies from coming in
·       a sink with water supplied to wash food and dishes
·       if possible, hot as well as cold water should be available to the sink
·       a workbench area which can be used to prepare food
·       a ventilated storage cupboard in which to keep dry and canned foods
·       storage areas for crockery (cups, saucers, plates, glasses), cutlery (knives and forks), kitchen utensils (saucepans, frying pans, billies) and cleaning equipment
·       a stove for cooking
·       a refrigerator for keeping foods cold to stop them from going bad too quickly

8.    Bathroom
Every house should have an area where people can clean their bodies. The bathroom should have a basin and a shower or bath with water supplied directly to each of them. If possible, hot as well as cold water should be available at these places.

Many families have small children or babies who need to be bathed regularly. If there is no bath in the bathroom, the shower recess may be deep enough to plug and use as a bath. If the shower recess is to be used in this way, the water must be drained out immediately after use and the floor of the shower kept very clean.
The bathroom should also have towel rails, hooks to hang clothes on, a mirror and a cabinet for storing toiletry items such as soaps, deodorants, toothpaste, and toothbrushes.

9.    Laundry
This is the room or area in which clothes, bedding, towels and other linen are washed.

The laundry should have a deep tub. Cold and hot water should be supplied to it. There may be a washing machine. The tub can be used for soaking and washing clothes and linen when there is no washing machine. A large tub can also be used as a baby bath if there is no proper bath in the house. However, the water must be drained out immediately after use and the tub kept very clean.

Every house or other type of dwelling (place in which people live) must have some type of toilet provided or at least there should be one close to the house. Modern houses have toilets under the main roof, while older houses may have them in a small separate building located nearby. In some Indigenous communities, several families share toilets in an toilet block.
The toilet may be a full flush water type, a dry septic tank type or a borehole toilet. The toilet is important as it removes faeces and urine, and their disease-causing germs and parasites, from the environment in which people live.
It is important that water and soap are nearby so that people can wash their hands after going to the toilet. This water may be provided by a tap connected to a house water supply or a sealed container with a tap.

11.Sewage disposal
There must be a way of removing the sewage produced in a house. The sewage comes from the toilet, bathroom, kitchen and laundry.
There are two main disposal systems. These are:
 (a) Septic tanks
(b) Community effluent system.

12.Rubbish disposal
Each house should have a way of properly disposing of the solid waste produced by the people living in the house. This solid waste is called rubbish and includes things such as food scraps, tin cans, plastic containers, glass bottles and jars, papers, cardboard and disposable nappies. If this rubbish is not properly disposed of it will quickly attract pests and germs.
Solid waste disposal for a house should include:
·       a small bin inside the house for daily use
·       a large bin in the yard into which all the household rubbish is placed. This rubbish should be collected and taken away at least once a week by a rubbish truck
13.Protection from pests
There are many pests which carry disease-causing germs and parasites and are therefore a danger to health. Such pests include flies, mosquitoes, cockroaches and rodents.
Houses can be made safe from these pests by:
·       putting flyscreens on all windows and vents, and fitting doorways with flywire doors or hanging strip barriers
·       sealing (closing) all gaps where pipes pass through walls
·       sealing all gaps, such as cracks and crevices, around food storage cupboards which allow entry to the cupboard
4 House hygiene—cleaning
 Page last updated: November 2010

If a house is to be a healthy place it must have all the design features already listed. However, it is also important that everything in the house is kept clean. If the house is not regularly cleaned then rubbish and dirt will build up. Germs and parasites will multiply and grow in the dirt and people living in the house may get sick.

4.1 Cleaning equipment and materials
Equipment and materials which help to make housecleaning tasks easier and more effective include:
cleaning products for floors
cleaning products for wet areas (baths, handbasins, laundry tubs, kitchen sinks)
cleaning products for food preparation and meal areas (tables and benchtops)
dish washing detergent for cleaning kitchen utensils (pots, pans, plates and cutlery)
laundry detergent for washing household linen (towels, sheets, blankets) and clothes
oven cleaner
disinfectant (kills germs)
cleaning cloths and sponges. These should be replaced regularly and there should be different ones for different cleaning areas (for example, never use the same cloth or sponge to clean the bathroom and the kitchen, as this can spread germs from one place to another)
scrubbing brush
stainless steel pot scourer
broom, dust pan and brush
mop or squeegee
It is important to remember that some household cleaning liquids and powders contain dangerous ingredients and can be poisonous. Always follow the instructions on the label and keep these products out of reach of children.

4.2 House cleaning tasks
Each room in the house has its own particular cleaning requirements, which are outlined below.

The Kitchen
The cleaning tasks (jobs) which should be done in the kitchen include:
washing the dishes
cleaning down the kitchen bench and table top
emptying and washing the kitchen rubbish bin
sweeping and/or washing (mopping) the floor
wiping the shelves and cleaning the cupboards, inside and out
cleaning the stove and oven
cleaning out the refrigerator
cleaning the walls, windows and brushing flyscreens
removing cobwebs
Fig. 3.9: Cleaning kitchen cupboards and benches gets rid of unwanted germs and parasites.
Fig. 3.9: Cleaning kitchen cupboards and benches gets rid of unwanted germs and parasites.

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The Bathroom
The cleaning jobs which should be done in the bathroom include:
cleaning the hand basin, shower recess and/or bath
sweeping and washing (mopping) the floor
cleaning the mirror, cupboards and/or shelves
changing or washing the towels and the bath mat
cleaning the walls and windows and brushing flyscreens
removing cobwebs
Fig. 3.10: Cleaning the bathroom.
Fig. 3.10: Cleaning the bathroom.

The Laundry and Toilet
The cleaning jobs which should be done in the laundry and toilet include:
washing clothes, linen (for example, towels, sheets) and blankets
sweeping and washing (mopping) the floor
cleaning the tub and washing machine
cleaning the cupboards, walls and windows and brushing flyscreens
cleaning the toilet
removing cobwebs
Fig. 3.11: Cleaning the laundry and toilet.
Fig. 3.11: Cleaning the laundry and toilet.

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The cleaning jobs which should be done in bedrooms include:
sweeping and/or washing the floors
dusting the shelves and cleaning out cupboards
cleaning walls and windows and brushing flyscreens
removing cobwebs
changing the sheets on the bed and airing (putting in the sun for a few hours) the blankets and mattresses
Fig. 3.12: Airing bedding in the sun
Fig. 3.12: Airing bedding in the sun.

Living Rooms and Verandah
The cleaning jobs which should be done in living rooms and verandahs include:
sweeping and/or washing (mopping) the floors, including the verandah
dusting the shelves and cleaning out cupboards
cleaning the walls and windows and brushing flyscreens
removing cobwebs
Fig. 3.13: Keeping the bedroom and living room clean.
Fig. 3.13: Keeping the bedroom and living room clean.

It is important when washing or mopping floors anywhere in the house to make sure that:
no water gets into any power outlets or electrical appliance, such as a radio or video recorder
pools of water are removed immediately
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4.3 House cleaning timetable
How often the various parts of a house need to be cleaned depends upon:
how many people live in the house
how many other people use the house
how tidy people are, such as whether or not people clean up after meals
how many pets belong to the household
whether or not there is sickness in the house, such as when someone has scabies or diarrhoea
whether there has been a plumbing problem, such as water from an overflowing handbasin
any other environmental factors, such as wind blowing dust into the house or wet soil being walked into the house when it is raining
Household cleaning tasks are usually done according to the following timetable:
Several times each day
Wipe down kitchen benches after food preparation.
Wash dishes and cooking utensils after each meal.
Once each day
Sweep the floors.
Empty the kitchen rubbish bin.
Once or twice each week
Wash the floors.
Clean the toilet.
Clean the laundry tubs.
Clean the shower recess/bath and handbasin.
Dust surfaces
Wash clothes and bed linen
Once each month
Clean the stove/oven and refrigerator
Clean cupboards, windows and walls
Brush the flyscreens
Get rid of cobwebs
It is important to remember that it may be necessary to do some cleaning tasks more often than is suggested in the timetable. This is because there are times when parts of the house get much dirtier than usual. For example, the toilet may get very dirty when a lot of children or visitors are using it or when someone in the house has diarrhoea.
Some people may not know about the importance of keeping a house clean or what needs to be done. The EHP can help community members by:
explaining why it is important to clean the house
showing them what needs to be cleaned and what equipment and materials are needed
telling them how often the cleaning needs to be done
demonstrating the cleaning method
5 House cleaning—tidying and maintaining the yard
 Page last updated: November 2010

The outside of the house is also an area where disease-causing germs can grow and multiply or where vectors can live and breed. For example, germs can live in rubbish and faeces, and mosquitoes can breed in water in old washing machines and tyres.

Grass is effective at reducing dust levels in the yard. Long grass is attractive to snakes so, where grass grows, it should be kept short.

5.1 Equipment
The equipment needed to tidy and maintain the yard includes:
a rake
a shovel
a hose
an axe
There are some other items which may be needed to help tidy or maintain the yard and garden. These include wheelbarrows, lawn mowers, pruning saws, or brush cutters. Because these items can be very expensive, it may be a good idea for the Community Council to purchase them for people to borrow. A loan system can be organised.

This could be a job for the EHP who would need to:
work out the arrangements with the community and the Council
organise the ordering, storing, and lending of the equipment
be responsible for ensuring the return of the equipment after use
The rules of the loan system would make the person who borrows the equipment responsible for paying for any lost or damaged items. However, the equipment will eventually break down or wear out with normal use. The cost of maintaining and repairing worn out equipment will always be the responsibility of the Council.

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5.2 Yard tidying and maintenance tasks
The jobs which should be done to keep the yard tidy and well maintained include:
raking up and disposing of rubbish (for example, cans, papers, plastic containers, bottles, broken glass), faeces and leaves
mowing lawns, trimming edges and removing weeds
pruning shrubs and trees
cleaning out gutters if necessary
removing bulky rubbish (for example, old tyres, refrigerators, car bodies)
watering lawn, shrubs or trees. This particular job maintains the garden. Lawns and shrubs help keep dust under control. Lawns need only be watered twice a week
Fig. 3.15: Cleaning the yard.
Fig. 3.15: Cleaning the yard.

5.3 Yard tidying timetable
Most yard tidying tasks are usually done once a week or less often. What needs to be done and how often depends upon one or more of the following:
How many people use the yard and what they do there. For example, one or two people having a barbecue will probably not make as much mess as thirty people
The number and kind of pets that use the yard. For example, dogs are dirtier and more destructive than cats
Weather factors. For example, rain collecting in containers can allow mosquitoes to breed and very strong winds blow objects, such as pieces of tin, around the community
Other environmental factors such as the vegetation in the yard. For example, shrub types may differ as to how often they need to be cut back
How tidy people are who used the yard. For example, some people will usually put their rubbish in a bin, while others do not.
6 Communal facilities
 Page last updated: November 2010

In some communities the houses have no bathrooms, toilets or laundries. Instead there are communal toilet blocks for everyone to use. A toilet block usually contains separate toilets and showers for males and females, handbasins, and sometimes a communal laundry facility.

Toilet blocks need to be cleaned regularly just as if they were part of a house. Since they are used by all of the people in the community the toilet blocks should be cleaned daily. If they are allowed to get dirty and surfaces become contaminated with germs, many people in the community could get sick.

Plumbing problems, such as blockages and leaking taps, pipes or cisterns need to be repaired as soon as possible. Regular (daily) cleaning allows for problems to be identified and reported to the community office or organisation responsible for repairs and maintenance.

For communal toilet blocks to be healthy places the cleaner must:

make sure there is always toilet paper in the toilets
clean the toilets, showers, basins and tubs once a day, and more often if they get very dirty
hose or sweep the floors regularly
report any faults or damage immediately to the community office
It should be the EHPs job to check that communal toilet blocks are being properly cleaned and maintained
Fig. 3.16: Communal toilet blocks need to be cleaned often.
Fig. 3.16: Communal toilet blocks need to be cleaned often.
Personal hygiene
 Page last updated: November 2010

The human body can provide places for disease-causing germs and parasites to grow and multiply. These places include the skin and in and around the openings to the body. It is less likely that germs and parasites will get inside the body if people have good personal hygiene habits.

7.1 Good personal hygiene
Good personal hygiene habits include:
washing the body often. If possible, everybody should have a shower or a bath every day. However, there may be times when this is not possible, for example, when people are out camping or there is a shortage of water
If this happens, a swim or a wash all over the body with a wet sponge or cloth will do
cleaning the teeth at least once a day. Brushing the teeth after each meal is the best way of making sure that gum disease and tooth decay are avoided. It is very important to clean teeth after breakfast and immediately before going to bed
washing the hair with soap or shampoo at least once a week
washing hands with soap after going to the toilet
washing hands with soap before preparing and/or eating food. During normal daily activities, such as working and playing, disease causing germs may get onto the hands and under the nails. If the germs are not washed off before preparing food or eating, they may get onto the food
changing into clean clothes. Dirty clothes should be washed with laundry soap before wearing them again
hanging clothes in the sun to dry. The suns rays will kill some disease-causing germs and parasites
turning away from other people and covering the nose and mouth with a tissue or the hand when coughing or sneezing. If this is not done, droplets of liquid containing germs from the nose and mouth will be spread in the air and other people can breathe them in, or the droplets can get onto food
Fig. 3.17: Washing the body helps keep it free of disease-causing germs
Fig. 3.17: Washing the body helps keep it free of disease-causing germs
Fig. 3.18: Cleaning teeth helps keep gums and teeth healthy.
Fig. 3.18: Cleaning teeth helps keep gums and teeth healthy.
Fig. 3.19: Washing hands after going to the toilet helps stop the spread of germs.
Fig. 3.19: Washing hands after going to the toilet helps stop the spread of germs.
 Fig. 3.20: Washing hands before preparing food helps keep germs out of our bodies.

Fig. 3.20: Washing hands before preparing food helps keep germs out of our bodies.
Fig. 3.21: Washing hands before eating food helps stop germs getting into our bodies
Fig. 3.21: Washing hands before eating food helps stop germs getting into our bodies
Fig. 3.22: Washing clothes helps keep them free of disease-causing germs.
Fig. 3.22: Washing clothes helps keep them free of disease-causing germs.
Fig. 3.23: Hanging clothes in the sun helps to kill some disease-causing germs and parasites. 
Fig. 3.23: Hanging clothes in the sun helps to kill some disease-causing germs and parasites.
Fig. 3.24: Covering the nose and mouth when sneezing helps stop the spread of germs.
Fig. 3.24: Covering the nose and mouth when sneezing helps stop the spread of germs.

7.2 Overcrowding
When there are too many people in any house, the likelihood of them getting disease is greater than if the house is not overcrowded. This is because people in an overcrowded house will be much closer to each other and it is therefore easier for any germs to spread from one to another. For example:
sneezing and coughing in crowded rooms makes it easier to spread cold and flu germs
sharing towels can spread trachoma germs and other germs which cause eye infections (runny or sore eyes)
several children sleeping in the same bed makes it easier to spread a scabies infection
Fig. 3.25: Overcrowding helps spread germs and parasites such as scabies
Fig. 3.25: Overcrowding helps spread germs and parasites such as scabies.

Each house is designed to allow a particular number of people to live there comfortably. This number will depend upon the number and size of the rooms, especially bedrooms, and the size of other facilities such as the sewage system and washing and cooking areas.

If the number of people living in the house is greater than the number it was designed for, these facilities will not be able to cope properly. For example, large numbers of people using the toilet may mean that the septic tank will not be big enough to take and treat the additional load of sewage.

For good health and comfort, the number of people who should live in a house depends upon the factors outlined below.

The number and size of bedrooms
While most people who live permanently in a house will have a bedroom to themselves or share one with one or two other people, other rooms are often used as bedrooms. The number of people who should sleep in a room will depend upon the amount of air which is available to each person. The law requires that each adult person has at least 13 cubic metres of air and each child has at least 10 cubic metres of air in a sleeping area.

The type and size of the sewage system
Usually, a household septic tank system with 2 round tanks caters for a maximum of ten people.

The size and availability of other facilities
The facilities within the house may not be able to handle all of the demands placed on them by the occupants. For example, the hot water system may not be able to produce enough hot water, or the amount of food to be chilled is too great for the refrigerator to hold.

In Indigenous communities, overcrowding in houses occurs for a number of reasons, such as:
there not being enough houses for the number of people who live in the community
families not being able to afford to pay rent on a house of their own and needing to live with relatives to share the cost
people visiting relatives and staying for a long time
visitors coming to stay so that they can attend special events such as funerals
It is important that EHPs remember that overcrowding is a significant environmental health problem in many communities.
8 Food poisoning and contamination
 Page last updated: November 2010
8.1 Food poisoning
Everybody at one time or another has had the experience of eating food and some time later becoming sick. This is called food poisoning. The symptoms may include:
stomach pains
feeling weak
fever or chills/sweating
Description: Fig.  3.26: Food poisoning comes from harmful bacteria on food.
Fig. 3.26: Food poisoning comes from harmful bacteria on food. 

Food poisoning can be caused by eating food contaminated with bacteria, viruses, chemicals or poisonous metals such as lead or cadmium. Most food poisoning, however, is caused by bacteria and because of this, only bacteria will be discussed in this section.

Food which has become contaminated with harmful bacteria does not always taste bad. Most of the time it looks, smells and tastes like it normally does.

Some food poisoning diseases are more common than others. For example, disease caused by Staphylococcus aureus occurs a lot more often than disease caused by Clostridium botulinum.

Some foods cause food poisoning more than others and need to be cooked properly and/or kept in the refrigerator. These include chicken, meat, seafood, eggs, cooked rice, ham, salami, milk and all dairy foods. It is important chicken is cooked properly to the bone and then kept in the fridge for no more than 2 days. If reheating chicken, or left-overs, make sure it is steaming hot and only reheat it once.

It is important to remember that the same food handling practices are used to prevent all food poisoning diseases. Washing your hands with soap and drying them on a paper towel or with a clean cloth is the best way to stop the spread of bad bacteria.

The four most common types of food poisoning bacteria are discussed below.

These bacteria are found on the skin, in sores, infected eyes and in the nose, throat, saliva and bowel of humans. There may be many of these bacteria in the yellow mucus (slimy substance) which comes from the nose or is coughed up when a person has a cold or a lung infection.

Staphylococci do not cause illness until they get onto food and grow and multiply. While they are doing this they produce a toxin (poison). It is the toxin which causes the illness. The toxin is not destroyed by cooking the food.

Symptoms of staphylococcus food poisoning usually appear between 1 and 8 hours after eating the infected food.

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There are hundreds of different types of salmonella bacteria but not all are harmful to humans. They are found mainly in the intestines, bowels and faeces of humans and other animals. It is the salmonella bacteria themselves which can cause salmonella food poisoning.
Description: Fig.  3.27: Bacteria on food.
Fig. 3.27: Bacteria on food. 

People can get salmonella food poisoning from:
poor food handling practices in the home or in food outlets
seafood caught in polluted water or eggs with dirty shells
meat or poultry which has been contaminated by poor food handling before it gets to the food outlet, such as at the abattoir
Salmonella food poisoning takes up to 48 hours to develop after the food is eaten. Symptoms include nausea, stomach cramps, diarrhoea, fever and headache, and may last between 3 and 21 days. It can cause death in very young, weak or very old people. People who have cancer or are taking medication for serious health conditions such as heart, kidney or liver problems need to also be particularly careful that they eat safe food.

These bacteria are found in the soil and in the intestines of animals, including cattle, poultry, fish and humans. Food poisoning caused by clostridium bacteria is important to know about because these bacteria are common in the environment.

People can get clostridium food poisoning from poor food handling practices in the home, in the factory or in a food outlet, especially relating to cooking and storage/refrigeration temperatures.

Clostridium food poisoning symptoms occur about 12 hours after eating the contaminated food and are similar but usually less severe than the other types.

Symptoms include stomach pains, diarrhoea and sometimes nausea and vomiting. Symptoms last about 24 hours.

One type of clostridium bacteria produces a very serious food poisoning disease called botulism. This disease is caused by eating food which is contaminated with an extremely poisonous toxin produced by the bacteria Clostridium botulinum. Unless properly treated about one-third of people who get this disease die within 3-7 days.

These bacteria are found in many animals including dogs, cats, cattle and poultry. The sources of infection from these bacteria are usually contaminated food and water.

People can get campylobacter from:
ingestion of contaminated food or water (especially undercooked chicken & creek or river water)
contact with infected animals (especially puppies or kittens with diarrhoea)
poor food handling (especially by using the same chopping boards, knives and plates for raw and cooked chicken)
Campylobacter food poisoning symptoms usually last from 2 to 5 days. These include diarrhoea, severe abdominal pain, vomiting and fever. It is a serious disease in Indigenous communities because of the possibility of dehydration from diarrhoea.

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8.2 How bacteria grow and multiply
Bacteria reproduce (breed) by splitting in half. When they do this they are said to multiply. In the right conditions, bacteria multiply at a very fast rate.
Description: Fig.  3.28: Bacteria can multiply very quickly.
Fig. 3.28: Bacteria can multiply very quickly. 

Disease causing bacteria grow best when there is:
warmth (37°C-38°C) (Note: human body temperature is 37°C)
food supply
In ideal conditions, bacteria double their numbers every 20 minutes. For example, if a piece of kangaroo meat infected with 100 food poisoning bacteria is left lying on a kitchen bench on a warm day, the bacteria will double their number every 20 minutes, and in 3 hours, the 100 bacteria will multiply to over 50,000 bacteria.
The following table shows how the bacteria will multiply on the meat over 3 hours:
Number of bacteria
20 minutes
40 minutes
1 hour
1 hour 20 minutes
1 hour 40 minutes
2 hours
2 hours 20 minutes
2 hours 40 minutes
3 hours
It is important to note that once inside a person’s intestine the bacteria can continue to multiply. This means that a person may eat contaminated food having only a few bacteria on it, but eventually suffer from food poisoning.

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8.3 Ways food can become contaminated through incorrect food handling
Food can become contaminated with disease-causing bacteria anywhere the food is handled or stored. These places include:
in a factory where it is processed ready for sale
in a truck in which it is taken from the factory to the shop
in a shop
in a food outlet such as a school canteen or take-away shop
between the shop and home
in a home
Most food has to be prepared in some way before it is eaten. During this preparation the food is handled by people. There are many ways in which unhygienic practices can cause food poisoning bacteria to be deposited on the food while it is being handled. Some examples are:
Leaving food uncovered. Pets, flies, cockroaches and other insects carry germs, including food poisoning bacteria, which contaminate the food
Touching parts of the body while handling food. While preparing food a food handler might scratch a pimple, touch a sore, push back hair, scratch an ear or rub or pick the nose. Every one of these activities contaminates the fingers with bacteria. If the persons hands are not washed before handling food again, these bacteria will be passed to the food.
Description: Fig.  3.29: Rubbing the nose while preparing food helps spread germs
Fig. 3.29: Rubbing the nose while preparing food helps spread germs. 

Sneezing or coughing near food. If a food handler, or anyone else, sneezes or coughs near uncovered food, then the food almost will certainly be sprayed with bacteria laden droplets.
Description: Fig.  3.30: Sneezing over food spreads germs.
Fig. 3.30: Sneezing over food spreads germs. 

Licking fingers while handling food. Human saliva carries staphylococcus bacteria and licking the fingers could result in these bacteria being passed to the food.
Description: Fig.  3.31: Licking fingers while handling food spreads germs
Fig. 3.31: Licking fingers while handling food spreads germs. 

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Not washing hands after going to the toilet during food handling. If a person goes to the toilet during food handling activities and does not wash his/her hands afterwards food poisoning bacteria may be passed onto the food.
Description: Fig.  3.32: Washing hands after going to the toilet helps stop the spread of germs.
Fig. 3.32: Washing hands after going to the toilet helps stop the spread of germs.

Poor handling of high risk foods. High risk foods are those which generally need refrigeration and have a high moisture content. Poor handling of high risk foods is a common cause of food poisoning. High risk foods include:
chicken, duck and other poultry
fish and shellfish
raw meat products
dairy products (milk, cheese, cream)
unpasteurized cow or goats milk
eggs and egg products
Cross contamination. Certain foods will always contain some bacteria. Poor handling of these foods may result in cross contamination. Cross contamination is the passing of bacteria from contaminated food to uncontaminated food. Cross contamination can occur when storing or handling food.

An example of cross contamination during storage is:
A high risk food, such as a raw chicken thawing in a refrigerator, is placed in contact with cooked meat. The bacteria from the raw chicken contaminates the cooked meat. Since the cooked meat is not heated again before eating, the bacteria from the chicken pass to the person who eats the meat.