All sorts of disease-causing bugs- virus, bacteria, protozoa and parasitic worms- found in the faeces of infected people find their way into our bodies through contaminated soil and water and food handled by infected people.
Add to that mosquitoes breeding in stagnant water, algae and fungi in neglected surroundings, lack of safe running water and missing toilets and sewerage- we are juggling several triggers of outbreaks waiting to happen.
Diarrhoeal diseases alone kill 100,000 children under 11 months old in India each year, making this water and food-borne infection the second largest killer of children after pneumonia.
Here are the 15 diseases that India can stamp out with improved sanitation.
Anaemia, malnutrition: Nutritional deficiencies cause physical and mental stunting, fatigue, listlessness, muscle weakness.
Cause:Iron deficiency, poor nutrition and food- and water-borne infections that interfere with nutrient absorption, such as frequent diarrhoea and worm infestations.
Treatment:No vaccine, treated using oral rehydration solution (ORS).
Ascariasis: Infection of the small intestine caused by Ascaris lumbricoides, a large roundworm that causes stomach cramps from intestinal blockage. People may experience cough, wheezing and difficulty in breathing, or fever.
Cause:Eating uncooked food grown in soil contaminated by human faeces or irrigated with untreated wastewater.
Treatment:Tablets mebendazole or pyrantel pamoate.
Campylobacteriosis: Infection of the gastrointestinal tract that triggers severe diarrhoea (often with mucous and blood), stomach cramps, fever, nausea and vomiting.
Cause:Consuming bacterium Campylobacter jejuni or C. coli in contaminated water and undercooked meats or raw milk from infected animals such as poultry, pigs, goats and cattle.
Treatment:ORS therapy, with antibiotics for severe infection.
Cholera: Intestinal infection caused by the bacterium Vibrio cholera, which leads to painless watery diarrhoea, nausea and vomiting.
Cause:Eating food or drink contaminated with faeces of infected persons.
Treatment:ORS therapy, with intravenous fluids for the severely dehydrated. Antibiotics are not necessary to treat cholera.
Cyanobacteria toxins: Cyanobacteria or blue-green algae in fresh water cause a range of symptoms including skin irritation, stomach cramps, vomiting, nausea, diarrhoea, fever, sore throat, headache, muscle and joint pain, and liver damage. Swimmers may suffer allergic reactions, such as asthma, eye irritation, rashes, and blisters around the mouth and nose.
Cause:Drinking or bathing in contaminated water. Reducing nutrient build-up (eutrophication) in ponds, lakes and reservoirs using improved wastewater disposal systems and control of pollution by fertilizers (including manure).
Dengue: People get infected with the dengue viruses through the bite of an infective female Aedes mosquito. Symptoms include high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash.
Cause:Increased mosquito breeding in and around urban habitats- drinking water containers, discarded car tyres and flower pots.
Treatment:No vaccine, treated symptomatically.
Hepatitis: Two viruses that cause infectious hepatitis (hepatitis A and E) are transmitted through contaminated water and food. Symptoms include fever, body weakness, loss of appetite, nausea and abdominal discomfort, followed by jaundice (yellowing of the skin and whites of the eyes).
Cause: Hepatitis A and E viruses, while unrelated to one another, are both transmitted from person to person through contaminated water and food. Hepatitis A is also transmitted though injecting drug use and through food and water handled by infected food-handlers.
Treatment: Vaccine available against Hepatitis A, treatment symptomatic.
Japanese encephalitis (JE): Swelling in the membranes around the brain that usually causes mild fever and headache but 1 in 200 results in severe disease characterised by sudden high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death.
Cause:infection by a flavivirus transmitted through the bite of Culex tritaeniorhynchus and Culex vishnui mosquitoes found in paddy fields.
Treatment: Vaccine available, treatment symptomatic.
Leptospirosis: Leptospira bacterial infection that causes high fever, severe headache, muscle pain, chills, redness in the eyes, abdominal pain, jaundice, haemorrhages in skin and mucous membranes (including pulmonary bleeding), vomiting, diarrhoea and a rash.
Cause:Leptospires enter the body through cuts and abrasions in the skin and through mucous membranes of the eyes, nose and mouth through contact with fresh water (rainwater, lake, river, stream) or soil contaminated with urine of infected animals. Human-to-human transmission occurs very rarely.
Treatment:Antibiotics use as early as possible.
Malaria: Parasitic infection that causes fever, chills, headache, muscle aches, tiredness, nausea, vomiting, diarrhoea, anaemia, and jaundice (yellow colouring of the skin and eyes).
Cause:Malaria spreads through the bite of a female Anopheles mosquito, which has long, filament-thin legs and dappled wings.
Treatment:Artemisinin combination therapy (ACT) that uses artemisinin-based compounds in combination with other anti-malarial drugs. Four of the five combinations approved by the WHO are available in India.
Ringworm or Tinea: Ringworm is a contagious skin disease caused by dermatophytes fungi that cause red or pink circular sores on the scalp, nails, feet or body.
Cause:Infection spreads though direct contact with an infected person or animal (dogs, cats, cattle), or things and food handled by an infected person.
Treatment:Topical anti-fungal lotions or creams for rashes, oral anti-fungal medication for persistent infection. The clothing and linen of infected persons should be laundered in hot water to rid them of the fungus.
Scabies: Microscopic mite Sarcoptes scabei infestation that starts as a pimple-like rash most commonly found on the hands, especially the webbing between the fingers, the skin folds of the wrist, elbow or knee, the penis, breast or shoulder. Scratching results in sores that may become infected By bacteria.
Cause: Spreads principally by direct skin-to-skin contact and to a lesser extent through contact with infested garments and linen.
Treatment:Acaricide ointments preceded by a hot bath with liberal use of soap; oral dose of ivermectin. Bedding, mattresses, sheets and clothes may require dusting with acaricides.
Schistosomiasis: Flatworms infestation that initially causes rash followed two months later by fever, chills, cough and muscle ache. Untreated infections can result in blood in urine and stools, and enlarged liver and spleen and affect growth, nutritional status and brain development.
Cause: In Asia, cattle and water buffalo are reservoir hosts, with free-swimming larvae developing in freshwater snails and penetrating human skin.
Treatment:Praziquantel, taken for 1-2 days.
Trachoma: Eye infection by Chlamydia trachomatis that starts as mild itching and irritation and leads to blurred vision and eye pain. Repeated re-infections cause blindness.
Cause:Spreads through direct contact with the eyes, eyelids, and nose or throat secretions of infected people, or by flies that land on the face of an infected person.
Treatment:Antibiotic treatment (tetracycline eye ointment new antibiotic, azithromycin, face and hand hygiene.
Typhoid and paratyphoid enteric fevers: Infections of the intestinal tract and bloodstream caused by bacteria Salmonella typhi and Salmonella paratyphi respectively that cause mild to severe fever as high as 39°-40° C, loss of appetite, headache, constipation or diarrhoea, rose-coloured spots on the chest area and enlarged spleen and liver. Paratyphoid has similar, but milder, symptoms.
Cause:Food and water handled by an infected person or contaminated by sewage containing the bacteria Salmonella typhi and Salmonella paratyphi respectively. Even after recovery, some people (called carriers) carry the bacteria and continue infecting others.
Treatment:Vaccine available, but it does not give full protection. Antibiotic treatment.
Source: World Health Organisation, Union Ministry of Health & Family Welfare, India