Assignments

Course Materials: No required text.
PowerPoint slides for most lectures will be posted on the class website/Blackboard prior to the lecture. The World Health Organization CD distributed in class contains many of the reading assignments for the course. Other material may be added; most readings will be listed in the syllabus below.
General reading by subject - updated Feb 10th
WHO Online Resource Listing

Course website: http://www.unc.edu/courses/2009spring/envr/890/002/

Course Objectives:
This course focuses on water, sanitation and hygiene in both developing and developed countries from an environmental health perspective. It emphasizes an appreciation and understanding of the need to develop effective, appropriate, accessible and affordable measures to reduce the global burden of disease from environmental exposures to biological and chemical agents of human health and environmental concern. The course content is based on the World Health Organization risk-based framework that uses risk assessments of health effects from exposures to pathogenic (disease-causing) microbes and toxic chemicals in environmental media to inform the development of holistic, integrated risk management policies and systems. Exposures to various agents of health concerns via water, wastes, air, vectors and other transmission routes will be considered, as will the various prevention and control measures of risk management systems intended to reduce these exposures.

Eligibility and prerequisites
Enrollment is limited to graduate students and upper level undergraduates who have core knowledge in chemistry, biology, epidemiology and statistics. This core knowledge would be satisfied by undergraduate or entry level graduate courses in chemistry though organic chemistry, biochemistry, microbiology or cell biology and epidemiology. Core knowledge in risk assessment is also recommended.

Tentative Course Schedule (May change to accommodate guest presenters & student needs)

Date	Lecture topic / Readings (citation format - inconsistent, possibly wrong)
01/13	Course details, introduction and overview
01/15	Global burden of disease and Water/Sanitation/Hygiene (WSH) Prüss A, Kay D, Fewtrell L, and Jamie Bartram. 2002. Estimating the Burden of Disease from Water, Sanitation, and Hygiene at a Global Level. Environ Health Perspect 110 (5): 537-42. Prüss-Üstün, A and C Corvalán. 2006. How Much Disease Burden can be Prevented by Environmental Interventions? Epidemiology 18 (1): 167-78.
01/20	Infectious Diseases and WSH Pathogens Hunter PR, Payment P, Ashbolt N and J Bartram. Assessment of Risk. In Assessing microbial safety of drinking water: Improving approaches and methods. 2003. Edited by A. Dufour, M. Snozzi, W. Koster, J. Bartram, E. Ronchi and L. Fewtrell. Published on behalf of the World Health Organization and the Organisation for Economic Co-operation and Development by IWA Publishing, London Risenbro H and PR Hunter. Estimating health impacts of interventions with a focus on small scale drinking water interventions. In Press, World Health Organization, Geneva.
01/22	Epidemiology and WSH Blumenthal UJ, Fleisher JM, Esrey SA, and A Peasey. 2001. Epidemiology: a tool for the assessment of risk. In Water quality - Guidelines, standards and health: Assessment of risk and risk management for water-related infectious disease. Lorna Fewtrell and Jamie Bartram, Eds. Published on behalf of the WHO by IWA Publishing, London. Hunter PR and H Risenbro. Defining the current situation - epidemiology. In WHO Guide to Understanding Costs and Benefits of Water Interventions. In Press, World Health Organization, Geneva.
01/27	Quantitative Risk Assessment Fuller T. 2009. "Spread of Malaria Feared as Drug Loses Potency." New York Times 27 January 2009. Haas C and J Eisenberg. 2001. Risk Assessment. In: Water quality - Guidelines, standards and health: Assessment of risk and risk management for water-related infectious disease, L. Fewtrell and J. Bartram, World Health Organization-Geneva and Intl. Water Assoc.-London. "Karaoke Videos Teach Safe Water Techniques." Narr. Jon Hamilton. Morning Edition. NPR; 27 January 2009. ISLI. 2000. Revised Framework for Microbial Risk Assessment. An ISLI Risk Science Institute Workshop Report.
01/29	Quantitative Microbial Risk Assessment
02/03	Excreta and Sanitation*
02/05	Excreta and Sanitation
02/10	Excreta and Sanitation (revised 2/17) Cairncross S and V Valdmanis. 2006. Water Supply, Sanitation, and Hygiene Promotion. In Disease Control Priorities in Developing Countries (2nd Edition), 771-792. New York: Oxford University Press. Carr R. 2001. Excreta-related infections and the role of sanitation in the control of transmission. In Water Quality: Guidelines, Standards and Health. L. Fewtrell and J. Bartram (eds.) IWA Publishing, London, UK, for WHO-Geneva. Feachem R, Bradley D, Garelick H and D Mara. 1983. Sanitation and Disease: Health Aspects of Excreta and Wastewater Management. Chichester: John Wiley and Sons for the World Bank. PDFs: Chapter One | Chapter Two | Chapter Three Mackenbach, Johann P. 2007. Sanitation: pragmatism works. British Medical Journal 334:s17. Should ecological sanitation carry a health warning?: Assessing the health risks of ecological latrines. Smith RS. 2003. Sanitation: Controlling problems at source. Prepared for Water, Sanitation and Health. Reviewed by the Water and Sanitation Programme, World Bank and the Water, Sanitation and Health Unit (WSH), World Health Organization (WHO). UN-Water. 10 Things You Need to Know About Sanitation.
02/12	Excreta and Sanitation Azurin JC and M Alvero. 1974. Field evaluation of environmental sanitation measures against cholera. Bull World Health Organ 51(1):19-26. Barreto ML, Genser B, Strina A et. al. 2007. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet 370:1622–28. Daniels DL, Cousens SN, Makoae LN and RG Feachem. 1990. A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho. Bull World Health Organ 68(4):455-463. Fewtrell L and JM Colford, Jr. 2004. Water, Sanitation and Hygiene: Interventions and Diarrhoea. A Systematic Review and Meta-analysis. World Bank, Washington. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L and JM Colford Jr. 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005 Jan;5(1):42-52. Genser B, Strina A, dos Santos LA, Teles CA, Prado MS, Cairncross S and ML Barreto. 2008. Impact of a city-wide sanitation intervention in a large urban centre on social, environmental and behavioural determinants of childhood diarrhoea: analysis of two cohort studies. Int J Epidemiol. 37(4):831-40. Langergraber G, Muellegger E. 2005. Ecological Sanitation--a way to solve global sanitation problems? Environ Int. 2005 Apr;31(3):433-44.
02/17	Water and Health
02/19	Water and Health Brookes JD, Antenucci J, Hipsey M, et al. 2004. Fate and transport of pathogens in lakes and reservoirs. Environ Int. 30:741–759.
02/24	Water and Health Mahmud SG, Shamsuddin SA, Ahmed MF, et al. 2007. Development and implementation of water safety plans for small water supplies in Bangladesh: benefits and lessons learned. Journal of Water and Health 5(4):585–597
02/26	Water and Health
03/03	Water Reclamation and Reuse Carr R. 2005. WHO Guidelines for Safe Wastewater Use—More than Just Numbers. Irrig. and Drain. 54: S103–S111
03/05	Tools for QMRA and WSPs Howard G. 2008. Water safety frameworks in developing countries: science science-policy linkages. Presented at "Sustainable and Safe Drinking Water in Developing and Developed Countries: Where Science Meets Policy." UNC-CH, November 5-6, 2008. Blumenthal UJ, Mara DD, Peasey A, Ruiz-Palacios G, Stott R. Table 2 from Guidelines for the microbiological quality of treated wastewater used in agriculture: recommendations for revising WHO guidelines. Bull World Health Organ. 2000;78(9):1104-16.
03/10	SPRING BREAK
03/12	SPRING BREAK
03/17	Exam 1 Old exams: 133 | 176 | 421 | 890 Exam Answers Grade Summary
03/19	Hygiene Curtis V, Biran A, Deverell K, et. al. 2003. Hygiene in the home: relating bugs and behaviour. Soc Sci Med 57: 657–672. Curtis V and S Cairncross. 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3:275-281. Curtis VA, Danquah LO, and RV Aunger. 2009. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res epub March 13, 2009. Ejemot RJ, Ehiri JE, Meremikwu MM, and JA Critchley. 2008. Hand washing for preventing Diarrhoea. Int J Epidemiol 37:470–473. Ejemot RJ, Ehiri JE, Meremikwu MM, and JA Critchley. 2009. Hand washing for preventing Diarrhoea. The Cochrane Library Issue 1.
03/24	Hygiene Bloomfield SF, Stanwell-Smith R, Crevel RWR and J Pickup. 2006. Too clean, or not too clean: the Hygiene Hypothesis and home hygiene. Clinical and Experimental Allergy 36:402–425. Cozad A and RD Jones. 2003. Disinfection and the prevention of infectious disease. AJIC 31(4): 243-254. Hadley C. 2004. Should auld acquaintance be forgot… EMBO Reports 5(12): 1122-1124.
03/26	Hygiene Supplemental Lecture Bloomfield S, Exner M, Fara1 GM and EA Scott. 2008. Prevention of the spread of infection – the need for a family-centred approach to hygiene promotion. Eurosurveillance 13(4-6): 1-4
03/31	Solid Waste
04/02	Solid Waste Domingo JL and M Nadal. 2009. Domestic waste composting facilities: A review of human health risks. Environ Int 35: 382–389 Sharholy M, Kafeel A, Mahmood G, and RC Trivedi. 2008. Municipal solid waste management in Indian cities – A review. Waste Management 28: 459–467
04/07	Air Pollution
04/09	Food Safety and Foodborne Diseases
04/14	Vectors and Vector-borne Diseases 'Double whammy' malaria drug hope. BBC News. 10 April 2009.
04/16	Problem Set Christen A, Navarro CM, Mäusezahl D. 2009. Safe drinking water and clean air: An experimental study evaluating the concept of combining household water treatment and indoor air improvement using the Water Disinfection Stove (WADIS). Int.J.Hyg.Environ.Health doi:10.1016/j.ijheh.2009.01.001. Gupta SK, Islam MS, Johnston R, et.al. 2008. The Chulli Water Purifier: Acceptability and Effectiveness of an Innovative Strategy for Household Water Treatment in Bangladesh. Am. J. Trop. Med. Hyg., 78(6): 979–984 Howard G, Pedley S and S Tibatemwa. 2006. Quantitative microbial risk assessment to estimate health risks attributable to water supply: Can the technique be applied in developing countries with limited data? Journal of Water and Health 4(1): 49-65. Luby SP, Agboatwalla M, Painter J, et.al. 2006. Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Tropical Medicine and International Health 11(4): 479–489. Schmidt WP and S Cairncross. 2009. Household Water Treatment in Poor Populations: Is There Enough Evidence for Scaling up Now? Environ. Sci. Technol. 43(4): 986-992
04/21	Climate Change and Health: International Perspective Campbell-Lendrum D and C Corvalán. 2007. Climate Change and Developing-Country Cities: Implications For Environmental Health and Equity. Journal of Urban Health 84(1): i109-i117. Campbell-Lendrum D, Corvalán C, and M Neira. 2007. Global climate change: implications for international public health policy. Bull WHO 85(3): 235-237. WHO. 2008. Protecting Health from Climate Change. Geneva: WHO Press. WHO. 2007. Climate and Health. Fact Sheet No. 266.
04/23	Take-Home Final Exam *DOOM
04/29	Final Exam due
*Each main topic will be divided into the following units: 1) Health Risk 2) Exposure Pathways 3) Prevention and control measures/strategies 4) Social, cultural and political context; policies and regulations

Grading:
Individual assignments (1) 20%
Group assignment (1) 20%
Mid-term exam (in-class) 20%
Term paper (1) 20%
Final exam (in-class or take-home) 20%