Nepal history

Nepal is located in South Asia and shares territorial borders with India and China with an area of 147,181 square kilometers and a population of approximately 30 million.   Kathmandu is the nation's capital and the country's largest metropolitan city.   Previously ruled as a kingdom, today it is a Federal Democratic Republic. Nepal is known for its exquisite natural beauty, with the iconic Himalayas running across the northern and western part of the country.   Nepal is a country of highly diverse and rich geography, culture, and religions,it offers a wide variety of adventure tourism packages.  Of the 14 peaks above 8,000 meters in the world eight are located in Nepal. It is the land of Mount Everest (8,848 meters) the highest peak in the World and other 240 mountain peaks over than 6,000 meters high.  For those who cannot withstand the rigorousness of mountain flights which fly around the himalaya including Mount Everest and provide a close look of the top of the world.  Trekking is the best way to get to interesting and remote mountain villages of Nepal and to enjoy views of the famous peaks together with local people, cultures and their lifestyle untouched with modern civilization.  The River rafting, which is known as “White Water Adventure” represents another major attractions in Nepal.

Nepal offers plenty of Wildlife as there are eight National Parks and four Wildlife Reserves and two conservation areas in Nepal.   Pokhara, the city of  lakes, provides plenty of opportunities for fishing , boating and sightseeing with the panoramic view of Annapurna range.   Kathmandu valley has several historical memorials, old palaces and temples. Nepal is the land of Lord Shiva (Pashupatinath), which is supposed to be the holiest Hindu temple in the world. Not only for the Hindus but also for the Buddhists Nepal offers a unique -place of pilgrimage as it happens to be the birthplace of Lord Buddha, the apostle of peace and compassion.

Nepal is a place of festivals with some part of the kingdom or the other celebrating some festival during everyday of the year. Festivals may be linked with the remembrance of the departed soul, to herald the different seasons, to mark the beginning or end of the agricultural cycle, to mark the national events, or just family celebrations.  On a festive day the Nepalese take their ritual bath, worship different gods and goddesses, visit temple, observe fasting and undertake feasting. The most important aspect of Nepali culture is the religious harmony and understanding prevailing among the Hindus and Buddhist.

Trekking in Nepal

Trekking has been a popular activity in the mountains of Nepal for a long time. Nepal is a major destination for trekkers and peak climbers alike, as it is generally considered a safe country for trekking and peak climbing in the mountain areas, and Nepal offers treks and climbs that range from easy and relaxing to extreme and physically challenging. We particularly recommend a more relaxing pace if it is your first time to Nepal to allow yourself time to explore and take in the beauty of the surroundings. Trekking in Nepal is not just about walking from one place to another on your way to a final destination; instead it is more about the experience of observing Nepal's diverse society, religions and geography. While you are trekking at the higher elevations, you must make sure to acclimatize appropriately, and you must keep in mind that you will be sharing the trail with many kinds of wildlife.

 Trekking in Nepal is primarily divided into two types: 1. Camping trekking and 2. Teahouse trekking. Camping trekking is suitable for the places where teahouses are not available. Teahouse trekking is possible in Everest, Annapurna and Lang tang, which are connected with a network of good teahouses.

Teahouse Trekking
We offer modest accommodations and a reasonable standard of food at country lodges along the trails. Our guides and porters lead the trek carrying all the luggage and equipment.

Camping Trekking
Camping trekking we offer all the necessary food and camping equipment. Our guides, cooks, and porters will take care of all the technical and logistical aspects of the trip. Everyday our staff will set up camp along the trail and our well-trained cooks will prepare the food according to your tastes.

Trekking Grades

Easy Trekking: Involves up to 6 hours of walking in a day on good trails with plenty of time for relaxing. The altitude on these treks generally does not exceed 3,500 meters above sea level. Anyone who enjoys regular exercise and is in relatively good physical condition can easily make these treks.

Moderate trekking: Involves 6-8hrs of walking in a day in more remote areas, reaching altitudes of approximately 4,500 meters above sea level. A reasonable level of fitness is required as you are required to follow routes that ascend and descend. Some experience hiking or trekking is advisable.

Strenuous trekking: Strenuous trekking is harder and is only suitable for regular hikers as the treks are generally more demanding and may involve 7-8 hours of walking in a day at altitudes up to 5,500 meters above sea level. You should be physically fit and appropriate preparation is imperative. Some days may involve crossing a pass with up to 10 hours walking.



Altitude & Acclimatization
Proper acclimatization is very important and our routes are planned specifically to allow for gradual gains in altitude. Many of our treks include extra days to allow time for acclimatization. By slowly gaining elevation we can gradually acclimatize, allowing us to be fit, healthy, and prepared for the journey. We offer advice about acclimatization and take a sensible approach on all of our treks. Anyone who is reasonably fit and healthy should have no trouble acclimatizing on our climbing and trekking trips.


Group Sizes
Small groups are better and help to reduce our impact on the environment while enabling us to provide more personalized services. The maximum group size on most of our treks/tours is 20 people and we are more than happy to offer tours to individuals travelling alone.

The Everest or Khumbu region trekking is not only famous because of Mount Everest the highest mountain in the world. It is also people by friendly Sherpas, the attractions of this area are the majestic mountains, the high mountain villages, the buddhist monasteries, and the local peoples. The easiest and shortest way to reach Everest region is by an exciting flight to Lukla (2886m) where the trek begins. Those who like to experience village life are best to start trekking from Jiri, an 8-hour drive from Kathmandu . This route is ideal for those who have more time and wish to acclimatize slowly. The major destinations of Everest trek include Kalapathar, Gokyo Lake (home of five holy lakes) and Everest Base Camp (EBC). Trekking in Kalapathar offers magnificent views of Everest & other unlimited snow caped mountains. Trekking in Everest base camp is also glorious; trekking in Gokyo valley is incredibly amazing. Gokyo region has various glacier lakes such as Gokyo Lake is third lake it is the biggest lake among the five lakes. Fist Lake , Second Lake , Third Lake , Fourth Lake & Fifth Lake . The views from fifth lake area are wonderful & hiking in Gokyo RI gives an experience of life time. Gokyo Ri is one of the most popular trekking peak for the best view of Everest range. It offers some classical trekking program such as Everest Base camp, Gokyo Ri/lake, Chola pass from Lukla & Jiri .

Also many of the world's (8,000m) peaks such as Cho Oyu, Lhotse and Makalu. First climbed in 1953, Everest still holds a fascination for many, however the Everest region boasts many more spectacular and beautiful mountains, as well as some of the most rewarding trekking anywhere in the world. Whilst for many a visit to the foot of Mount Everest is a personal goal, for some it is enough to visit the Everest or Khumbu region and experience the culture, the people, and the spectacular scenery. The Everest View trekking is famouse with the Tengboche monastery at (3,867m) being the high point. From here we get breathtaking views of Everest as it rises above the Lhotse-Nupse. It is designed for those who wish to experience Everest region without ascending to high altitude.

Jungle Safari

Visiting Nepal offers you the opportunity to enter the Nepalese jungle and see some of the most beautiful and endangered wildlife on earth. A Jungle Safari in Nepal is a very exciting experience. It is possible for any visitor to stay in Nepal’s national parks and take part in organized jungle safaris and other activity programs. It is a great way to relax while being exposed to the jungle environment. Bring your kids along and have the family holiday of a life time. In the jungle you can experience, elephant back safaris, bush walking, bird watching, boating, and a variety of recreational activities and cultural programs.
You can hike into the jungle by foot with an experienced tracker, or go on elephant back, by boat or by jeep. The jungle safari in Nepal is a fun filled package ideal for anyone. The national parks offer a wide range of options for accommodations, including lush resorts. Joyful Trekking can create a package for you that includes accommodations, meals, and activities.

One of the most exciting parts of Jungle safaris in Nepal are the nature walks. Nature walks give you the chance to observe and be immersed in the enthralling beauty of the Jungle. A jungle walk can bring you closer to nature and expose you to the tracks, signs, and sounds of Nepal’s unique wildlife. If you are lucky, you may even catch a glimpse of endangered species in their natural habitat. Come on a jungle safari with us and experience the scenery, fauna, wildlife of Nepal, as well as the traditions of the indigenous local people.

Paragliding in Nepal

Paragliding is a relatively new adventure sport in Nepal and it can be a truly wonderful and fulfilling experience for the adventure seeker. Paragliding is a weather dependent sport and you must keep weather conditions like fog, rain, and wind in mind for flights. The best time for paragliding in Nepal is between November and February. The take-off location for the majority of flights is Sarankot, which stands at 1,592 meters above sea level.



A paragliding flight can give you a panoramic view of the sunrise or sunset in the Himalayas, depending upon the time and weather conditions, and the landing zone is near the famous Fewa Lake. Paragliding is an amazing adventure and no previous experience is required to experience these flights. Qualified paragliding trainers or pilot  will provide instruction and training before your flight.

Mountaineering in Nepal

Mountaineering in Nepal is another prime tourism activity proving Nepal the cradle for mountaineers for ages. The great Himalayan range in Nepal has eight out of fourteen of the world's 8000 meter peaks with total number of 1310 snow peaks over 6000 meters and offers the best choices for Himalaya expedition and mountaineering in Nepal. Climbing Himalayas in Nepal has become a dream for most of the adventure enthusiasts and mountaineers in the world. We have the expertise to organize full scale Himalayan expedition as well as logistic support for climbing peaks in Nepal & Tibet under the expert management of famous mountaineers. Mountain climbing in Nepal, there are several trekking peaks open for alpine climbing under NMA (Nepal Mountaineering Association). The climbing of these peaks in Nepal are controlled under the rules & regulations conducted by the association. Being a member of the NMA helps you to organize peak climbing program in different regions of Nepal.

Climbing trekking Peaks of Nepal gives hobby-climbers an opportunity to deal with a high Himalayan peak without having to organize a major expedition. Although these peaks are lower than their more famous cousins - the 8000-meter peaks - many of the climbs are no less demanding and adventurous in nature. By Himalayan standards these are considered minor peaks, but in fact some of them are relatively challenging snow and Ice climbing of high standard.
Our company provides you qualified & trained mountaineering guides, porters  and other staffs to take non-climbers for convenience, safety & expected successes with 100% guaranteed services to make your trekking together with peak climbing trip simple and take care. For more details Please check the peak climbing programs.

Sightseeing in Kathmandu

Since Long time, Nepal has been an extremely fascinating destination for travel among the tourists with all its varied language, tradition & unique hospitality of the people inhabited in the countryside. Hinduism & Buddhism are the two main religions of Nepal along with other several religions followed by the people from different ethnic groups. Nepal, therefore, known as one of the multi-religious country which holds temples, stupas & monasteries in uncountable number with variety of God and Goddess depicting the deep faith of the people. Apart from these, Nepal has more to offer for our clients.

The amazing and wonderful sight of the Himalayas, a diversity of beautiful landscape, all are beyond our imagination. Nepal's well-known fame in the world being the birthplace of Buddha - 'Light of Asia' is thing of splendor for every Nepalese people. For those who interested in local people and their culture, the Kathmandu valley is endowed with seven World Heritage sites. This valley was divided into three kingdoms less than a century ago. Its now contains countless architectural memorial, and vestiges of varied cultural and religious traditions. As such, numbers of tourists from different corners of the world have been enrolling towards Nepal with a view to visit this beautiful country.

Diaarrhea

What is diarrhea?

Diarrhea is loose, watery stools. Having diarrhea means passing loose stools three or more times a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4 weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be continual or they may come and go.
Diarrhea of any duration may cause dehydration, which means the body lacks enough fluid and electrolytes—chemicals in salts, including sodium, potassium, and chloride—to function properly. Loose stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the United States, adults average one bout of acute diarrhea each year,¹ and young children have an average of two episodes of acute diarrhea each year.²

¹DuPont HL, Practice Parameters Committee of the American College of Gastroenterology. Guidelines on acute infectious diarrhea in adults. The American Journal of Gastroenterology. 1997;92(11):1962–1975.

²Ramaswamy K, Jacobson K. Infectious diarrhea in children. Gastroenterology Clinics of North America. 2001;30(3):611–624.

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What causes diarrhea?

Acute diarrhea is usually caused by a bacterial, viral, or parasitic infection. Chronic diarrhea is usually related to a functional disorder such as irritable bowel syndrome or an intestinal disease such as Crohn’s disease.
The most common causes of diarrhea include the following:

• Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli).
• Viral infections. Many viruses cause diarrhea, including rotavirus, norovirus, cytomegalovirus, herpes simplex virus, and viral hepatitis. Infection with the rotavirus is the most common cause of acute diarrhea in children. Rotavirus diarrhea usually resolves in 3 to 7 days but can cause problems digesting lactose for up to a month or longer.
• Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome.
• Intestinal diseases. Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, and celiac disease often lead to diarrhea.
• Food intolerances and sensitivities. Some people have difficulty digesting certain ingredients, such as lactose, the sugar found in milk and milk products. Some people may have diarrhea if they eat certain types of sugar substitutes in excessive quantities.
• Reaction to medicines. Antibiotics, cancer drugs, and antacids containing magnesium can all cause diarrhea.

Some people develop diarrhea after stomach surgery, which may cause food to move through the digestive system more quickly.
People who visit certain foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Traveler’s diarrhea can be a problem for people traveling to developing countries in Africa, Asia, Latin America, and the Caribbean. Visitors to Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.
In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own within 1 to 2 days, finding the cause is not usually necessary.
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What other symptoms accompany diarrhea?

Diarrhea may be accompanied by cramping, abdominal pain, nausea, an urgent need to use the bathroom, or loss of bowel control. Some infections that cause diarrhea can also cause a fever and chills or bloody stools.

Dehydration

Diarrhea can cause dehydration. Loss of electrolytes through dehydration affects the amount of water in the body, muscle activity, and other important functions.
Dehydration is particularly dangerous in children, older adults, and people with weakened immune systems. Dehydration must be treated promptly to avoid serious health problems, such as organ damage, shock, or coma—a sleeplike state in which a person is not conscious.
Signs of dehydration in adults include

• thirst
• less frequent urination than usual
• dark-colored urine
• dry skin
• fatigue
• dizziness
• light-headedness

Signs of dehydration in infants and young children include

• dry mouth and tongue
• no tears when crying
• no wet diapers for 3 hours or more
• sunken eyes, cheeks, or soft spot in the skull
• high fever
• listlessness or irritability

Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released.
Anyone with signs of dehydration should see a health care provider immediately. Severe dehydration may require hospitalization.
Although drinking plenty of water is important in preventing dehydration, water does not contain electrolytes. Adults can prevent dehydration by also drinking liquids that contain electrolytes, such as fruit juices, sports drinks, caffeine-free soft drinks, and broths. Children with diarrhea should be given oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte to prevent dehydration.
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When should adults with diarrhea see a health care provider?

Adults with any of the following symptoms should see a health care provider:

• signs of dehydration
• diarrhea for more than 2 days
• severe pain in the abdomen or rectum
• a fever of 102 degrees or higher
• stools containing blood or pus
• stools that are black and tarry

Diarrhea is not usually harmful, but it can become dangerous or signal a more serious problem.
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When should children with diarrhea see a health care provider?

Children with any of the following symptoms should see a health care provider:

• signs of dehydration
• diarrhea for more than 24 hours
• a fever of 102 degrees or higher
• stools containing blood or pus
• stools that are black and tarry

If children have diarrhea, parents or caregivers should not hesitate to call a health care provider for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. Children can die from dehydration within a day.
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How is the cause of diarrhea diagnosed?

If acute diarrhea lasts 2 days or less, diagnostic tests are usually not necessary. If diarrhea lasts longer or is accompanied by symptoms such as fever or bloody stools, a doctor may perform tests to determine the cause.
Diagnostic tests to find the cause of diarrhea may include the following:

• Medical history and physical examination. The doctor will ask about eating habits and medication use and will perform a physical examination to look for signs of illness.
• Stool culture. A sample of stool is analyzed in a laboratory to check for bacteria, parasites, or other signs of disease and infection.
• Blood tests. Blood tests can be helpful in ruling out certain diseases.
• Fasting tests. To find out if a food intolerance or allergy is causing the diarrhea, the doctor may ask a person to avoid foods with lactose, carbohydrates, wheat, or other ingredients to see whether the diarrhea responds to a change in diet.
• Sigmoidoscopy or colonoscopy. These tests may be used to look for signs of intestinal diseases that cause chronic diarrhea. For sigmoidoscopy, the doctor uses a thin, flexible, lighted tube with a lens on the end to look at the inside of the rectum and lower part of the colon. Colonoscopy is similar to sigmoidoscopy, but it allows the doctor to view the entire colon.

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How is diarrhea treated?

In most cases of diarrhea, the only treatment necessary is replacing lost fluids and electrolytes to prevent dehydration.
Over-the-counter medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate) may help stop diarrhea in adults. However, people with bloody diarrhea—a sign of bacterial or parasitic infection—should not use these medicines. If diarrhea is caused by bacteria or parasites, over-the-counter medicines may prolong the problem, so doctors usually prescribe antibiotics instead.
Medications to treat diarrhea in adults can be dangerous for infants and children and should only be given with a doctor’s guidance.
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Eating, Diet, and Nutrition

Until diarrhea subsides, avoiding caffeine and foods that are greasy, high in fiber, or sweet may lessen symptoms. These foods can aggravate diarrhea. Some people also have problems digesting lactose during or after a bout of diarrhea. Yogurt, which has less lactose than milk, is often better tolerated. Yogurt with active, live bacterial cultures may even help people recover from diarrhea more quickly.
As symptoms improve, soft, bland foods can be added to the diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. For children, the health care provider may also recommend a bland diet. Once the diarrhea stops, the health care provider will likely encourage children to return to a normal and healthy diet if it can be tolerated. Infants with diarrhea should be given breast milk or full-strength formula as usual, along with oral rehydration solutions. Some children recovering from viral diarrheas have problems digesting lactose for up to a month or more.
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Can diarrhea be prevented?

Two types of diarrhea can be prevented—rotavirus diarrhea and traveler’s diarrhea.

Rotavirus Diarrhea

Two oral vaccines have been approved by the U.S. Food and Drug Administration to protect children from rotavirus infections: rotavirus vaccine, live, oral, pentavalent (RotaTeq); and rotavirus vaccine, live, oral (Rotarix). RotaTeq is given to infants in three doses at 2, 4, and 6 months of age. Rotarix is given in two doses. The first dose is given when infants are 6 weeks old, and the second is given at least 4 weeks later but before infants are 24 weeks old.
Parents of infants should discuss rotavirus vaccination with a health care provider. For more information, parents can visit the Centers for Disease Control and Prevention rotavirus vaccination webpage at www.cdc.gov/vaccines/vpd-vac/rotavirus.

Traveler’s Diarrhea

To prevent traveler’s diarrhea, people traveling from the United States to developing countries should avoid

• drinking tap water, using tap water to brush their teeth, or using ice made from tap water
• drinking unpasteurized milk or milk products
• eating raw fruits and vegetables, including lettuce and fruit salads, unless they peel the fruits or vegetables themselves
• eating raw or rare meat and fish
• eating meat or shellfish that is not hot when served
• eating food from street vendors

Travelers can drink bottled water, soft drinks, and hot drinks such as coffee or tea.
People concerned about traveler’s diarrhea should talk with a health care provider before traveling. The health care provider may recommend that travelers bring medicine with them in case they develop diarrhea during their trip. Health care providers may advise some people—especially people with weakened immune systems—to take antibiotics before and during a trip to help prevent traveler’s diarrhea. Early treatment with antibiotics can shorten a bout of traveler’s diarrhea.
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Points to Remember

• Diarrhea is loose, watery stools. Having diarrhea means passing loose stools three or more times a day.
• Diarrhea is a common problem that usually goes away on its own.
• The most common causes of diarrhea include bacterial, viral, and parasitic infections; functional bowel disorders; intestinal diseases; food intolerances and sensitivities; and reactions to medicines.
• Diarrhea can cause dehydration, which is particularly dangerous in children, older adults, and people with weakened immune systems.
• Treatment involves replacing lost fluids and electrolytes. Depending on the cause of the problem, medication may also be needed to stop the diarrhea or treat an infection.
• Children with diarrhea should be given oral rehydration solutions to replace lost fluids and electrolytes.
• Adults with any of the following symptoms should see a health care provider: signs of dehydration, diarrhea for more than 2 days, severe pain in the abdomen or rectum, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.
• Children with any of the following symptoms should see a health care provider: signs of dehydration, diarrhea for more than 24 hours, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.
• People can take steps to prevent two types of diarrhea—rotavirus diarrhea and traveler’s diarrhea.

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Hope through Research

The Division of Digestive Diseases and Nutrition at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports basic and clinical research into gastrointestinal diseases, including diarrhea. Among other areas, researchers are studying

• vaccines to prevent diarrhea caused by viruses
• new treatments for diarrhea, such as zinc supplements and probiotics
• medicines to prevent and treat traveler’s diarrhea

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

santation lead problems n solution

What could have prevented the family's illness? The spread of illness could have been prevented: f the man had used a toilet. if the pig was kept in a fenced area. if the child had washed his hands, rather than used his mother's skirt. if the mother had not touched her soiled skirt and then touched the food. if the mother had washed her hands with soap and water.

Important: washing hands © The Hesparian Sanitation

Ways to prevent spread of germs and worms

© The Hesparian Sanitation

  

Bladder and kidney infections

Infections of the bladder and kidney are caused by germs. These infections are much more common in women than in men because germs can easily get into the body through the urinary opening near the vagina. Infections of the urinary system can be mild or severe and even life-threatening.

Causes of bladder infections Germs can enter the urinary opening and cause infection when a woman: goes a long time without urinating. Try to urinate every 3 or 4 hours. goes a long time without drinking liquids. Try to drink at least 8 glasses or cups of clean water a day. Drink even more when working in the hot sun. does not keep her genitals clean. Try to wash the genitals every day, and always wipe from front to back after using the toilet. has sex. This is one of the most common causes of bladder infection in women. To prevent infection, urinate after having sex. This washes the germs that cause bladder infections out of the urine tube.

A girl or woman of any age - even a small baby - can get an infection of her urine system. © The Hesparian Sanitation

Signs and treatment Signs of bladder or urinary tract infection include: Need to urinate often and urgently Pain in the lower belly just after urinating Burning feeling when urinating Urinating without control Reddish or cloudy urine Foul-smelling urine If you have signs of a bladder infection, start drinking plenty of water to help flush out germs. If a bladder infection goes untreated, it can worsen and infect your kidneys. If the signs last more than 2 days, you may need medicines.

© The Hesparian Sanitation

Signs of kidney infection include: Any bladder infection signs Pain in the lower back Fever and chills Nausea and vomiting Diarrhea Feeling very weak and ill Kidney infections are more serious than bladder infections because the kidney can get so sick that it stops working. While plenty of water, herbal remedies, or sulfa drugs usually cure a urinary tract infection, a kidney infection often needs more treatment. If you have the signs of a kidney infection, see a health worker right away.

© The Hesparian Sanitation

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Diarrhea and dehydration

Many people die from diarrhea diseases, especially children. These diseases are often caused when germs get into drinking water or food. Most children who die from diarrhea die because they do not have enough water left in their bodies. This lack of water is called dehydration. People of any age can become dehydrated, but dehydration can happen very quickly to small children and is most dangerous for them. Any child with watery diarrhea is in danger of dehydration.

© The Hesparian Sanitation

Note for the health worker

To teach the signs of dehydration, you can use a "body mapping" activity. Bring parents together and show them a picture of a healthy baby. Have them point or draw arrows to where they would see signs of dehydration. Discuss all the signs. Then discuss the ways they can help their children when these signs appear - and what they can do to prevent dehydration and diarrhea in the first place.

To stop dehydration

When a child has watery diarrhea or diarrhea and vomiting, do not wait for signs of dehydration. Act quickly.

Give lots of liquids to drink, such as a thin cereal porridge or gruel, soup, water, or rehydration drink (see below).

Keep giving food. As soon as the sick child (or adult) can eat food, give frequent feedings of foods he likes. To babies, keep giving breast milk often - and before other drinks.

Rehydration drink helps to prevent or to treat dehydration. It does not cure diarrhea, but may give enough time for the diarrhea to cure itself.

© The Hesparian Sanitation

WARNING: If dehydration gets worse or other danger signs appear, get medical help.

How does poor sanitation lead to health problems ?

Illnesses caused by germs and worms in feces are a constant source of discomfort for millions of people. These illnesses can cause many years of sickness and can lead to other health problems such as dehydration, anemia, and malnutrition. Severe sanitation-related illnesses like cholera can spread rapidly, bringing sudden death to many people.

        How germs spread disease

Sometimes it is easier to remember the ways germs travel by showing that they are all words beginning with the letter "F": fingers, flies, fields, foods, and fluids (water).

© The Hesperian Foundation

Many illnesses are spread from person to person by germs. Germs are tiny living things that cause sickness. Sometimes it is easy to know where germs are - in feces, rotting foods, and other dirty places. But sometimes, germs are in places that look and smell clean. Germs can pass directly from person to person through touch, and sometimes through the air with dust or when people cough or sneeze. They can spread through food and drinking water. Or they can be carried by flies and animals. Germs that cause diarrhea travel on these paths:

sanitation

sanitation

           
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes as well as the treatment and proper disposal of sewage wastewater. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems include human and animal feces, solid wastes, domestic wastewater (sewage, sullage, greywater), industrial wastes and agricultural wastes. Hygienic means of prevention can be by using engineering solutions (e.g. sewage and wastewater treatment), simple technologies (e.g. latrines, septic tanks), or even by personal hygiene practices (e.g. simple handwashing with soap).
The World Health Organization states that:

"Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. The word 'sanitation' also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal.^[1]

The term sanitation is applied to a wide range of subjects such as:

• Improved sanitation - refers to the management of human faeces at the household level. This terminology is the indicator used to describe the target of the Millennium Development Goal on sanitation, by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation.
• On-site sanitation - the collection and treatment of waste is done where it is deposited. Examples are the use of pit latrines, septic tanks, and Imhoff tanks.
• Food sanitation - refers to the hygienic measures for ensuring food safety.
• Environmental sanitation - the control of environmental factors that form links in disease transmission. Subsets of this category are solid waste management, water and wastewater treatment, industrial waste treatment and noise and pollution control.
• Ecological sanitation - an approach that tries to emulate nature through the recycling of nutrients and water from human and animal wastes in a hygienically safe manner.

History

Further information: History of water supply and sanitation

The earliest evidence of urban sanitation was seen in Harappa, Mohenjo-daro and the recently discovered Rakhigarhi of Indus Valley civilization. This urban plan included the world's first urban sanitation systems. Within the city, individual homes or groups of homes obtained water from wells. From a room that appears to have been set aside for bathing, waste water was directed to covered drains, which lined the major streets.
Roman cities and Roman villas had elements of sanitation systems, delivering water in the streets of towns such as Pompeii, and building stone and wooden drains to collect and remove wastewater from populated areas - see for instance the Cloaca Maxima into the River Tiber in Rome. But there is little record of other sanitation in most of Europe until the High Middle Ages. Unsanitary conditions and overcrowding were widespread throughout Europe and Asia during the Middle Ages, resulting periodically in cataclysmic pandemics such as the Plague of Justinian (541-42) and the Black Death (1347–1351), which killed tens of millions of people and radically altered societies.^[2]
Very high infant and child mortality prevailed in Europe throughout medieval times, due not only to deficiencies in sanitation but to an insufficient food supply for a population which had expanded faster than agriculture.^[3] This was further complicated by frequent warfare and exploitation of civilians by autocratic rulers.
Sanitation refers to the safe disposal of human excreta (Mara, Lane and Scott and Trouba,1). This entails the hygienic disposal and treatment of human waste to avoid affecting the health of people. Sanitation is an essential part of the Millennium Development Goals. The most affected countries are in the developing world (Zawahri, Sowers, and Weinthal 1153). Population increase in the developing world has posed challenges in the improvement of sanitation (Konteh 69). According to Zawari, Sowers, and Weinthal (1154), lack of provisions of basic sanitation is estimated to have contributed to the deaths of approximately 3.5 million people annually from water borne diseases.

Wastewater

Wastewater collection

For more details on this topic, see Wastewater.

The standard sanitation technology in urban areas is the collection of wastewater in sewers, its treatment in wastewater treatment plants for reuse or disposal in rivers, lakes or the sea. Sewers are either combined with storm drains or separated from them as sanitary sewers. Combined sewers are usually found in the central, older parts or urban areas. Heavy rainfall and inadequate maintenance can lead to combined sewer overflows or sanitary sewer overflows, i.e. more or less diluted raw sewage being discharged into the environment. Industries often discharge wastewater into municipal sewers, which can complicate wastewater treatment unless industries pre-treat their discharges.^[4]
The high investment cost of conventional wastewater collection systems are difficult to afford for many developing countries. Some countries have therefore promoted alternative wastewater collection systems such as condominial sewerage, which uses smaller diameter pipes at lower depth with different network layouts from conventional sewerage.

Wastewater treatment

For more details on this topic, see Sewage treatment.

Sewage treatment plant, Australia.

In developed countries treatment of municipal wastewater is now widespread,^[5] but not yet universal (for an overview of technologies see wastewater treatment). In developing countries most wastewater is still discharged untreated into the environment. For example, in Latin America only about 15% of collected sewerage is being treated (see water and sanitation in Latin America)

Health Impacts of Sanitation

For any social and economic development, adequate sanitation in conjunction with good hygiene and safe water are essential to good health (Mara, Lane and Scott and Trouba 1). Lack of proper sanitation causes diseases. Most of the diseases resulting from sanitation have a direct relation to poverty. The lack of clean water and poor sanitation has caused many diseases and the spread of diseases. Sanitation is very important in order to keep good health.One of the most significant diseases that arise from poor sanitation is diarrhea. Deaths resulting from diarrhea are estimated to be between 1.6 and 2.5 million deaths every year (Mara, Lane and Scott and Trouba 2). Most of the affected are young children below the ages of five. Other diseases that are caused by poor sanitation include schistosomiasis, trachoma, and soil transmitted Helminthiases.
Poor sanitation accounts for almost 50 percent of underweight child since it has a direct link to diarrhea. Children suffering for diarrhea are more vulnerable to become underweight. According to Mara, Lane, and Scott and Trouba (3), about 26 percent acute respiratory infections occur in children who are malnourished, which has a direct link to diarrhea. Sanitation is a serious issue that is affecting most parts of the world especially the developing countries. On a global scale, the most affected are children who in most cases lose their lives due to diseases caused by poor sanitation. Major initiatives need to be set up if the MDG goal on sanitation is to be achieved by 2015.

On-site treatment

Main article: Septic tank

In many suburban and rural areas households are not connected to sewers. They discharge their wastewater into septic tanks or other types of on-site sanitation. On-site systems include drain fields, which require significant area of land. This makes septic systems unsuitable for most cities.

Reuse of wastewater

The reuse of untreated wastewater in irrigated agriculture is common in developing countries. The reuse of treated wastewater in landscaping, especially on golf courses, irrigated agriculture and for industrial use is becoming increasingly widespread.

Ecological sanitation

For more details on this topic, see Ecological sanitation.

Ecological sanitation is sometimes presented as a radical alternative to conventional sanitation systems. Ecological sanitation is based on composting or vermicomposting toilets where an extra separation of urine and feces at the source for sanitization and recycling has been done. It thus eliminates the creation of blackwater and eliminates fecal pathogens. If ecological sanitation is practiced municipal wastewater consists only of greywater, which can be recycled for gardening. However, in most cases greywater continues to be discharged to sewers.

Sanitation and public health

The importance of the isolation of waste lies in an effort to prevent diseases which can be transmitted through human waste, which afflict both developed countries as well as developing countries to differing degrees. It is estimated that up to 5 million people die each year from preventable water-borne diseases,^[6] as a result of inadequate sanitation and hygiene practices.The effects of sanitation has impacted the society of people throughout history.^[7] Sanitation is a necessity for a heathly life.^[8] The results of studies published in Griffins Public Sanitation show that better sanitation produces an enhanced feeling of wellbeing.^[citation needed]
Relevant disease include:

• Waterborne diseases, which can contaminate drinking water
• Diseases transmitted by the fecal-oral route
• Hookworm, where eggs can survive in the soil

There continues to be many countries that are struggling with diseases due to unhealthy living conditions and unfiltered water all in the name of bad sanitation.^[9][10][11]

Global access to improved sanitation

The Joint Monitoring Programme for Water Supply and Sanitation of WHO and UNICEF has defined improved sanitation as follows:

• Flush toilet^[12]
• Connection to a piped sewer system^[13]
• Connection to a septic system^[14]
• Flush / pour-flush to a pit latrine^[15]
• Ventilated improved pit (VIP) latrine^[16]
• Pit latrine with slab^[17]
• Composting toilet^[18]
• Some special cases^[19]

The JMP publishes a report of updated estimates every two years on the use of various types of drinking-water sources and sanitation facilities at the national, regional and global levels. In March 2012, the JMP released its latest updates.^[20] According to the definition above, 1.8 billion more people used improved sanitation in 2010 than in 1990, bringing the percentage of people using improved sanitation to 63% globally. However, the world remains off track for the sanitation target of the Millennium Development Goals. 2.5 billion lack improved sanitation.^[21] According to the JMP, if current trends continue, in 2015 2.4 billion people will lack access to improved sanitation facilities. 15 per cent of the population still practise open defecation, defined as defecation in fields, forests, bushes, bodies of water or other open spaces. This represents 1.1 billion people. Though the proportion of people practising open defecation is decreasing, the absolute number has remained at over one billion for several years, due to population growth.^[22] In 2011 the Bill & Melinda Gates Foundation launched the Reinvent the Toilet Challenge to promote safer, more effective ways to treat human waste. The program is aimed at developing technologies that might help bridge the global sanitation gap.
This outcome presents substantial public health risks as the waste could contaminate drinking water and cause life threatening forms of diarrhea to infants. Most cities can neither afford a sewage drainage system, nor a sewage treatment system, as Sunita Narain spelled out in the magazine D+C Development and Cooperation. Improved sanitation, including hand washing and water purification, could save the lives of 1.5 million children who die from diarrheal diseases each year.^[23]

Solid waste disposal

For more details on this topic, see Waste management.

Hiriya Landfill, Israel.

Disposal of solid waste is most commonly conducted in landfills, but incineration, recycling, composting and conversion to biofuels are also avenues. In the case of landfills, advanced countries typically have rigid protocols for daily cover with topsoil, where underdeveloped countries customarily rely upon less stringent protocols.^[24] The importance of daily cover lies in the reduction of vector contact and spreading of pathogens. Daily cover also minimises odor emissions and reduces windblown litter. Likewise, developed countries typically have requirements for perimeter sealing of the landfill with clay-type soils to minimize migration of leachate that could contaminate groundwater (and hence jeopardize some drinking water supplies).
For incineration options, the release of air pollutants, including certain toxic components is an attendant adverse outcome. Recycling and biofuel conversion are the sustainable options that generally have superior life cycle costs, particularly when total ecological consequences are considered.^[25] Composting value will ultimately be limited by the market demand for compost product.

Food preparation

Modern restaurant food preparation area.

Sanitation within the food industry means the adequate treatment of food-contact surfaces by a process that is effective in destroying vegetative cells of microorganisms of public health significance, and in substantially reducing numbers of other undesirable microorganisms, but without adversely affecting the food or its safety for the consumer (U.S. Food and Drug Administration, Code of Federal Regulations, 21CFR110, USA). Sanitation Standard Operating Procedures are mandatory for food industries in United States, which are regulated by 9 CFR part 416 in conjunction with 21 CFR part 178.1010. Similarly, in Japan, food hygiene has to be achieved through compliance with food sanitation law.^[26]
Additionally, in the food and biopharmaceutical industries, the term sanitary equipment means equipment that is fully cleanable using clean-in-place (CIP) and sterilization-in-place (SIP) procedures: that is fully drainable from cleaning solutions and other liquids. The design should have a minimum amount of deadleg^[27] or areas where the turbulence during cleaning is insufficient to remove product deposits. In general, to improve cleanability, this equipment is made from Stainless Steel 316L, (an alloy containing small amounts of molybdenum). The surface is usually electropolished to an effective surface roughness of less than 0.5 micrometre to reduce the possibility of bacterial adhesion.

Improving access

The United Nations Millennium Development Goals (MDGs) include a target to reduce by half the proportion of people without access to basic sanitation by 2015. In December 2006, the United Nations General Assembly declared 2008 'The International Year of Sanitation', in recognition of the slow progress being made towards the MDGs sanitation target.^[28] The year aims to develop awareness and action to meet the target. Particular concerns are:

• Removing the stigma around sanitation, so that the importance of sanitation can be more easily and publicly discussed.
• Highlighting the poverty reduction, health and other benefits that flow from better hygiene, household sanitation arrangements and wastewater treatment.

Research from the Overseas Development Institute suggests that sanitation and hygiene promotion needs to be better 'mainstreamed' in development, if the MDG on sanitation is to be met. At present, promotion of sanitation and hygiene is mainly carried out through water institutions. The research argues that there are, in fact, many institutions that should carry out activities to develop better sanitation and hygiene in developing countries. For example, educational institutions can teach on hygiene, and health institutions can dedicate resources to preventative works (to avoid, for example, outbreaks of cholera).^[29] There are also civil society organisations providing the necessary infrastructure where national governments cannot do that on their own. In Ghana, there is an umbrella organisation for those programmes, called CONIWAS (Coalition of NGOs in Water and Sanitation) as reported in the magazine D+C Development and Cooperation.
The Institute of Development Studies (IDS) coordinated research programme on Community-led Total Sanitation (CLTS) is a radically different approach to rural sanitation in developing countries and has shown promising successes where traditional rural sanitation programmes have failed. CLTS is an unsubsidized approach to rural sanitation that facilitates communities to recognize the problem of open defecation and take collective action to clean up and become ‘open defecation free’. It uses community-led methods such as participatory mapping and analysing pathways between feces and mouth as a means of galvanizing communities into action. An IDS 'In Focus' Policy Brief suggests that in many countries the Millennium development goal for sanitation is off track and asks how CLTS can be adopted and spread on a large scale in the many countries and regions where open defecation still prevails