Federal Democratic Republic of Ethiopia Ministry of Health Hygiene and Environmental Health, Part 1 Blended Learning Module for the Health Extension Programme HEAT Health Education and Training HEAT in Africa Federal Democratic Republic of Ethiopia Ministry of Health The Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs) have developed this innovative Blended Learning Programme in partnership with the HEAT Team from The Open University UK and a range of medical experts and health science specialists within Ethiopia. Together, we are producing 13 Modules to upgrade the theoretical knowledge of the country’s 33,000 rural Health Extension Workers to that of Health Extension Practitioners and to train new entrants to the service. Every student learning from these Modules is supported by a Tutor and a series of Practical Training Mentors who deliver the parallel Practical Skills Training Programme. This blended approach to work-place learning ensures that students achieve all the required theoretical and practical competencies while they continue to provide health services for their communities. These Blended Learning Modules cover the full range of health promotion, disease prevention, basic management and essential treatment protocols to improve and protect the health of rural communities in Ethiopia. A strong focus is on enabling Ethiopia to meet the Millennium Development Goals to reduce maternal mortality by three-quarters and under-5 child mortality by two-thirds by the year 2015. The Modules cover antenatal care, labour and delivery, postnatal care, the integrated management of newborn and childhood illness, communicable diseases (including HIV/AIDS, malaria, TB, leprosy and other common infectious diseases), family planning, adolescent and youth reproductive health, nutrition and food safety, hygiene and environmental health, non-communicable diseases, health education and community mobilisation, and health planning and professional ethics. In time, all the Modules will be accessible from the Ethiopian Federal Ministry of Health website at www.moh.gov.et; online versions will also be available to download from the HEAT (Health Education and Training) website at www.open.ac.uk/africa/heat as open educational resources, free to other countries across Africa and anywhere in the world to download and adapt for their own training programmes. Dr Kesetebirhan Admasu State Minister of Health Ethiopian Federal Ministry of Health i Acknowledgements Hygiene and Environmental Health is one of the 13 Blended Learning Modules for the Ethiopian Health Extension Programme. Together with the practical skills training sessions that accompany each of the supported self-study texts, this programme will upgrade the Health Extension Workers who complete the curriculum to Health Extension Practitioners at Level- IV of the Ethiopian Occupational Standards. The upgrading programme is sponsored by the Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs). The FMOH gratefully acknowledges the receipt of funding for this programme from the Ethiopian Office of UNICEF (the United Nations Children’s Emergency Fund), The Open University UK, the Alan and Nesta Ferguson Foundation Trust UK, and AMREF (the African Medical and Research Foundation). Hygiene and Environmental Health is in two separate Parts and was produced by a team of Ethiopian experts, who were trained and supported by experts in blended learning pedagogy from the HEAT (Health Education and Training) Team for Africa at The Open University UK. The contributors of original material are: Ato Kassahun Alemu, Gondar University, School of Public Health Dr Zegeye Hailemariam, Ethiopian Health and Nutrition Research Institute Dr Abera Kumie (Module Academic Coordinator), Addis Ababa University, School of Public Health Ato Worku Tefera, Addis Ababa University, School of Public Health The Academic Editors of Hygiene and Environmental Health are Pam Furniss, Senior Lecturer in Environmental Systems in the Faculty of Mathematics, Computing and Technology, and Dr Sarah-Jane Davies, Lecturer in Environmental Sciences in the Faculty of Science, with contributions from Dr Hilary MacQueen, Dr Basiro Davey, Dr Stephen Burnley and Dr Suresh Nesaratnam, all at The Open University UK. The other members of the HEAT Team are: Lesley-Anne Long, HEAT Programme Director Dr Basiro Davey, HEAT Deputy Director (Ethiopia) Alison Robinson, HEAT Programme Coordinator Dawn Partner, HEAT Senior Production Assistant Jessica Aumann, HEAT Programme Assistant Ali Wyllie, HEAT Lead eLearning Adviser We acknowledge the vital contributions of the Programme Coordinators within Ethiopia: Ato Mohammed Hussein Abeseko, UNICEF Ethiopia and the Federal Ministry of Health Ato Tedla Mulatu, AMREF Ethiopia The cover design for Hygiene and Environmental Health is by Chris Hough, Learning and Teaching Solutions, The Open University UK. The cover illustration (large circle) and some other illustrations in this Module were produced by Terefe Wondimagegnehu from the Federal Ministry of Health. The small cover photo is reproduced with the permission of UNICEF Ethiopia. We particularly wish to acknowledge our use in this Module of photographs supplied by WaterAid in Ethiopia and adapted extracts and illustrations from the following sources: Bassett W.H. (ed.) (2004) Clay’s Handbook of Environmental Health 19th ed, London, Spon Press. ii Eawag: Swiss Federal Institute of Aquatic Science and Technology http://www.eawag.ch/index_EN International Federation of Red Cross and Red Crescent Societies (2008) Household water treatment and safe storage in emergencies. A field manual for Red Cross/Red Crescent personnel and volunteers. http://www.wsscc.org/sites/default/files/publications/ifrc_hwts_in_emergencies_2008.pdf Stockholm Environment Institute (2007) Toilets that make compost: Low-cost, sanitary toilets that produce valuable compost for crops in an African context, by Peter Morgan, Stockholm Environment Institute, EcoDSanRes programme. http://www.ecosanres.org/pdf_files/ToiletsThatMakeCompost.pdf Sustainable Sanitation Alliance (SuSanA) (2007) Fura kebele declared open defecation free environment. http://www.susana.org/docs_ccbk/susana_download/2-297-open-defecation-free- environment-ethiopia-en.pdf UNICEF (2009) Community Approaches to Total Sanitation, Field Notes. http://www.unicef.org/evaluation/files/CATS_field_note.pdf University of California Regents, Dermatology Glossary. http://missinglink.ucsf.edu/lm/DermatologyGlossary/index.html USAID/HIP (2007) Preparing for Community-led Total Behaviour Change in Hygiene and Sanitation. http://www.aed.org/Publications/upload/Health-Extension-Worker-Handbook.pdf WaterAid in Ethiopia (2007) The colour of change. http://www.wateraid.org/documents/plugin_documents/the_colour_of_changeweb.pdf WHO (1994) Health Laboratory Facilities in Emergency and Disaster Situations. http://helid.digicollection.org/en/d/Jh0193e/16.7.html WHO (1996) Participatory hygiene and sanitation transformation: A new approach to working with communities. http://www.who.int/water_sanitation_health/hygiene/envsan/phast/en/ WHO (1997) Vector control: Methods for use by individuals and communities. http://www.who.int/water_sanitation_health/resources/vectorcontrol/en/index.html WHO (1997) Guidelines for drinking water quality, Volume 3 Surveillance and control of community supplies. http://www.who.int/water_sanitation_health/dwq/gdwq2v1/en/index2.html WHO (1998) Participatory Hygiene and Sanitation Transformation (PHAST) Step-by-step Guide: A Participatory Approach for the Control of Diarrhoeal Diseases. http://www.who.int/water_sanitation_health/hygiene/envsan/phastep/en/ WHO (2003) Malaria entomology and vector control. http://whqlibdoc.who.int/hq/2003/WHO_CDS_CPE_SMT_2002.18_Rev.1_PartI.pdf WHO and IRC Water and Sanitation Centre (2003) Linking technology choice with operation and maintenance in the context of community water supply and sanitation: A reference document for planners and project staff, by F.Brikke and M.Brodero. http://www.bvsde.paho.org/bvsacd/cd41/agua.pdf The opinions expressed in this Module are those of the authors and do not necessarily reflect the views of any of the donor organisations whose generous support made the production of Hygiene and Environmental Health possible. iii Contents Study Session Part 1 1 Introduction to the Principles and Concepts of Hygiene and Environmental Health 2 Environmental Health Hazards 3 Personal Hygiene 4 Healthful Housing 5 Institutional Hygiene and Sanitation 6 Important Vectors in Public Health 7 Introduction to the Principles of Food Hygiene and Safety 8 Food Contamination and Spoilage 9 Foodborne Diseases and the Investigation of Disease Outbreaks 10 Food Protection and Preservation Methods 11 Hygienic Requirements of Foods and Drink Service Establishments 12 Hygienic and Safety Requirements for Food of Animal Origin Notes on the Self-Assessment Questions (SAQs) for Hygiene and Environmental Health Part 1 Continued in Part 2 iv Introduction to the Hygiene and Environmental Health Module Drinking, eating, washing, excreting – these are things we do every day of our lives. But the way we do them can have a major impact on our health. Good hygiene practices are an essential part of daily life and we all need to understand what hygiene means, why it’s important for our health and wellbeing, and how we can change our behaviour to safeguard our health. Promoting good hygiene in your community and educating people