Urban Services And Health

6.1. Solid waste management

Although private and public waste management systems exist in the Kathmandu valley, waste disposal practices of local residents are not suitable. Throwing household wastes into local streams has affected the quality of water in local streams as well as the aesthetics value of the cities of Kathmandu Valley (Pradhan, 1998). The solid waste pollutes the land and contaminates the ground water and wells. About three million urban residents in 1999 in Nepal generated an estimated amount of 426,500 tones of waste and 29% of it was produced by the Kathmandu Metropolitan City alone according to the Minority of Local Development.

Segregation of hospital infectious waste is not practiced in a systematic way. Considering the population growth rate of 4.8% per annum in Kathmandu, hospital waste in 1990 was estimated to be 679 tons/annum or 1.86 tons/day (National Review Committee, 1992). A total of 6251 hospital beds in Nepal generated approximately 500 tons of hazardous waste per year.

Most of the waste is mixed with other garbage and is either dumped or burned in ordinary kilns (Tuladhar, 1999). There has been little study on the health impact of poor waste management, although its health impact was likely substantial for the waste management workers, scavengers and river users.

6.2. Sanitation and Water Quality

About 33% of the urban population has no access to toilet facilities in Nepal. They use river banks, ponds and urban fringe land for ablution. Cities have inadequate number of toilets in public areas and people use public roads and park corners, which pollutes the city areas and contaminates ground and surface water. Only half of the total urban population is served by piped drinking water supplies (Nepal Demographic and Health Survey, 2001).

Drinking water in Kathmandu Valley is unsafe throughout the year. The samples of water supplied by the Nepal Water Supply Corporation have up to 180 plus coliform organism per 100 ml of water (Himalayan Times, 2004). In Kathmandu Valley only 29.4 % of households boil the government supplied water before its use according to government statistics (His Majesty's Government in Nepal, 2000).

The fecal and pathogen contamination of drinking water causes diarrhea, gastroenteritis, infectious hepatitis, typhoid, paratyphoid, cholera, bacillary dysentery, amoebic dysentery, and giardiasis. Hospital records of Kathmandu city in 2003 revealed that gastroenteritis was the number two cause of morbidity in Kanti Children hospital and number one in Sukraraj Tropical Infectious Disease (STID) Hospital. The second and third causes of morbidity in the STID hospital were enteric fever and hepatitis respectively. Likewise, Hepatitis was the leading cause of mortality in STID Hospital. A hospital record survey of 2002 revealed that diarrhea (1960), typhoid (322), and hepatitis (160) were the three major diagnoses among those admitted to the STID hospital (Figure 2). Similarly, diarrhea (2036) and typhoid (170) were the major diagnoses among those admitted in Kanti Children's hospital in 2002 (Department of Health Services, 2003).



Figure 2. Pattern of Disease Recorded in STID Hospital, Kathmandu City (Source: Hospital Record, 2003).

Typhoid(322) 13.19%

Diarrhea(1960) 80.26%

Total number of cases identified = 2442 in 2002

Sukraraj Tropical and Infectious Disease Hospital (STID) Hospital Record, 2003

Figure 2. Pattern of Disease Recorded in STID Hospital, Kathmandu City (Source: Hospital Record, 2003).

6.3. Ground Water Contamination

Ground water contains high concentrations of iron, manganese and ammonia in Kathmandu Valley (Tamrakar, 1995). A more serious issue is the arsenic poisoning in the ground water of Tarai (plain area) towns of Nepal. About 30,000 shallow tube wells have been tested for arsenic and 7% were found to contain arsenic exceeding the national guideline: 50 parts per billion (ppb) (Shrestha, et al., 2004). About 435 arsenicosis patients were identified by a study conducted in four districts of Tarai (plains): Nawalparasi, Parsa, Bara and Rautahat (Pradhan, et al., 2004).

6.4. River Water Pollution

Kathmandu Valley hosts more than 72% of the country's water polluting industries (Devkota and Neupane, 1994). Many of these discharge effluents to the rivers accounting for about 7% of the total effluents (domestic and industrial) in Kathmandu Valley. Rivers and ground waters are also polluted due to haphazard disposal of sewerage, waste water and solid wastes. The study by Devkota and Neupane in 1994 indicates that about 93% of the pollution load is from domestic sewage and the remaining 7% from the industrial effluent.

The health impact of this is on the residents of the nearby settlements; children who play with these water, women who wash their clothes and vegetable produce. The washed vegetables on these rivers would also eventually affect the health of the urban consumers.

About 10.6 % of the food samples inspected in 2003 by the Department of Food Technology and Quality Control in Kathmandu Valley were found to be substandard. There has been an increasing prevalence of zoonotic diseases in Nepalese cities in the past few years. Staphylococcus, tuberculosis and brucellalocis were found in meat products and salmonella in fish and prawns (Ministry of Population and Environment, 1999). Many food items including ice cubes, meat products,

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