RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. ANUSHA MERIN MATHEW
1st Year MSC Nursing, Koshys College of Nursing,No.31/1, Hennur Bagalur Road, Kadusonnappanahalli, Kannur Post, Bangalore- 562149
2 / NAME OF THE INSTITUTION / Koshys College Of Nursing
Bangalore
3 / COURSE OF THE STUDY AND SUBJECT / 1st year MSC Nursing
Community Health Nursing
4 / DATE OF ADMISSION TO THE COURSE / 09-03-2011
5 / TITLE OF THE TOPIC / A descriptive study to assess the knowledge regarding hardness of water and its effects among adults in selected rural areas of Bangalore with a view to prepare a self instructional module

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Water is the prime necessity of life, without which, terrestrial animals and vegetable life must cease to exist. Water helps the man in many ways that is it replaces loss of fluid from tissues; maintain fluidity of blood and lymph; helps in excretion of waste products ; acts as a vehicle of dissolving food; helps in digestion and regulates body temperature.1

Mans life in this universe or on the moon will be impossible without water, which is a prime necessity of life. Even the vegetable and animal kingdom will not thrive without water. Without clothes, shelter, sometimes even without food man can live but without water he soon dies.2

Next to oxygen, water is the most important factor for survival of man and animals. A person can do without food for five weeks or more, but without water he can survive only for a few days. The ten basic kinds of water by John R Christopher as hard water, boiled water, raw water, rain water, snow water, filtered water, soft water, reverse osmosis, de-ionized water and distilled water.3

The various uses of water include domestic use, public purposes, industrial purposes, agricultural purposes, power production from hydropower and steam power and carrying away waste from all manner of establishments and institutions. On domestic front water is required for drinking, cooking, washing and bathing, flushing of toilets, gardening etc. Cleaning streets, recreational purposes and public parks are included in public purposes. In industries water is used for processing and cooling. Water is thus an essential factor in the economic, social and cultural development of a community. It can eliminate diseases, promote rural development and improve quality of life.4

The basic physiological requirements for drinking water have been estimate at about 2 liters per head per day. This is just for survival. The consumption of water, however depends upon the climate conditions, standard of living and habits of people. A daily supply of 150-200 liters per capita is considered as an adequate supply to meet the needs for all urban domestic purposes. In India 40 liters of water supply per capita per day was the set target to be achieved in rural areas.4

Much of ill health which affects humanity especially in the developing countries can be traced to lack of safe and wholesome water supply. Water is not only a vital resource to all forms of life, but it has also a great role to play in socioeconomic development of human population.4

Hardness may be defined as the soap- destroying power of water. The hardness in water is caused mainly by four dissolved compounds. These are calcium bicarbonate, magnesium bicarbonate, calcium sulphate and magnesium sulphate. Chlorides and nitrates of calcium and magnesium, iron, manganese and aluminium compounds can also cause hardness but they occur generally in small amounts .4

Water from any source including ground water, water from aquifers etc. that contain more than 1 GPG (Grains Per Gallon) of dissolved hard minerals is called hard water. This hard mineral could be calcium, magnesium, carbonate, manganese etc. In general water with 0 to 3.5 GPG is considered safe and soft. Anything above this is considered hard water.5

Hardness is not a specific constituent of water. It is primarily due to the presence of calcium and magnesium in water. Hardness is expressed in terms of calcium carbonate (CaCO3). Water with less than 75 milligrams per liter is considered soft, 76-150 mg/l is moderately hard and above 150 mg/l is hard water.6

Hard water can cause many problems. While bathing if one is using shampoo and soap he will have to rinse more thoroughly. Sometimes the soap remains on the skin even after bathing that can clog skin pores and can cause rashes and other skin problems. Hard water with minerals such as iron and manganese has undesirable odor and

taste. Other health problems include calcium and magnesium in hard water reacts with soap and detergent and

diminishes their lathering and cleaning capability and form a scum, scales and lime deposits can damage the home **Note: GPG: Grains Per Gallon

appliances and add to their repair cost, in the kitchen hard water can leave spots on dishes and cookwares and the most common problem is in home plumbing. When hard water is heated, the dissolved hard water minerals re-crystallize and form scale that can clog plumbing system and reduce flow of water through pipes.5

6.1 NEED FOR THE STUDY

One of the important public health care element is safe drinking water sanitation. More than a billion people in developing countries lack access to safe drinking water.1

Water is a good solvent and picks up impurities easily. As water moves through soil and rocks, it dissolves very small amount of minerals and holds them in solution. Dissolved calcium and magnesium are the two most common minerals that makes water hard. The degree of hardness become greater as the calcium and magnesium content increases.7

Hard water scum will not rinse from clothing and bed linen properly so that there is a disadvantage of these residuals being in contact with delicate skin 24 hrs a day. Thus hard water can cause high levels of discomfort.8

Water hardness is associated with higher incidence of urolithiasis among the population supplied with such water. Urolithiasis is the formation of urinary calculi or stones in the bladder or urinary tract. It involves multiple factors such as intake of liquids, genetic predisposition, eating habits, climatic and social conditions, gender etc. Since the high magnesium content coupled with a high sulphate content can cause diarrhea, there is higher incidence rates of cholelithiasis, urolithiasis, arthrosis and arthropathies with hardness of water.9

A trace amount of fluorine in drinking water is essential for healthy teeth and bones; lack of fluorine causes dental caries, while excess fluorine causes fluorine toxicity or fluorosis. Mild forms of fluorosis is manifested by mottled teeth and the more severe forms are manifested by enlarged bones thus weakening the teeth and bones.10

Excess fluorosis can lead to skeletal fluorosis and dental fluorosis. In skeletal fluorosis the muscles become stiff and the person cannot do his normal work due to deformity. In dental fluorosis the enamel loses its shine, the teeth become tough and tinted. Thus the enamel becomes weak and ultimately it is lost.11

It is also important that pregnant women imbibe no fluoride because it damages several brain functions or hormones in fetus. It also alters behaviour of babies. There is an average IQ of eight points in children showing fluorosis of teeth.12

Hard water cannot be used in industries for it interferes with the manufacturing process and causes decrease in the quality of the product. If used it may produce explosion of boilers when its deposit produce scales of unequal thickness of their inner surface.13

Hard water can also sometimes leads to dermatitis. Dermatitis is an inflammation of skin, and it is more common in persons suffering from dry skin. It can irritate the condition or even initiate a flare-up. Thus the skin will become unable to absorb moisture. The combination of hard water with a co-existing dermatitis condition can lead to more frequent and severe outbreaks.14

Availability of safe water in adequate amount in India is still a major problem even after 62 years of independence. There is scope for research in engineering and chemistry to convert available resources of water to deliver safe water. This supply and maintenance of safe drinking water is the basic requirement of public water.15

Unsafe water is the largest contributor of illness and death in developing countries. Eighty percent of death and diseases is related to water supply. Worldwide more than three million people die each year from water related diseases.16

Water is mankinds most precious resource and one of the most important necessities for existence of human life. Without good water supplies people can succumb to all types of illnesses, the majority of which can take lives. Thus the need of studying about drinking water is so important.17

By these informations the investigator is motivated and took this opportunity to access the knowledge and to provide some guidelines to adults regarding hardness of water and its effects.

6.2 REVIEW OF LITERATURE

Review of literature is an integral component of research process. It enhances the depth of the knowledge and inspires a clear insight into crux of the problem. It helps the researcher to know what data are available to narrow the problem itself as well as the technique might be used.

Review of literature for this study is divided under following headings:

·  Studies and literature related to safe drinking water

·  Studies and literature related to knowledge of hardness of water

·  Studies and literature related to effects of hardness of water

Studies and literature related to safe drinking water:

According to Peter H Gleick, the failure to provide safe drinking water and adequate sanitation services to all people is perhaps the greatest development failure of the 20th century. The most egregious consequence of this failure is the high rate of mortality among young children from preventable water related diseases. He examined different scenarios of activities in the international water arena and provided three estimates of the overall water related mortality likely to occur over the next two decades. He found that as the total population grows, total water related deaths will grow annually.18

Safe water is essential for life. Sadly 1.2 billion people around the world lack access to safe drinking water and twice that many lack adequate sanitation. As a result the World Health Organisation estimates that 3.4 million people die every year from water related diseases. Many of these diseases can be prevented with appropriate water treatment and proper sanitation and hygiene practices. The WSSD (World Summit on Sustainable Development) adopted a comparable goal for improving the access to basic sanitation.19

Studies and literature related to knowledge of hardness of water:

In United States, peoples’s consciousness about water quality was raised recently due to several widely reported incidents of public drinking water endangering health and even, causing death. Thus realizing major emerging health threat, federal agencies, The Center for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) issued warnings last summer that immune-compromised people are at great risk- drinking tap water. Such people are advised to boil their water, or drink well-tested bottled water. Because of all the publicity, even people in good health, who are unlikely to suffer infection from tap water, now are more concerned about their water quality. Many are considering bottle water and have treatment options.20

A prospective cohort study was conducted using 235 households (647 individuals) randomly selected from four rural hamlets. Data were collected by means of a self administered questionnaire, a self report diary of symptoms and two drinking water samples. Twenty percent of household sampled and had found bacteria Escherichia Coli (E coli) in drinking water. The people were unaware of the contamination of drinking water from private wells. This study confirms of relatively high prevalence of bacterial contamination of private wells in rural settings.21

Studies and literature related to effects of hardness of water:

A descriptive study was conducted for the analysis of protective effect of calcium and magnesium concentration in drinking water in 538 municipalities of Comunidad Valenciana (Spain) from 1991 to 1998.This study provides statistical evidence of relationship between mortality from cardiovascular diseases and hardness of drinking water. This relationship is stronger in cerebrovascular diseases than in ischemic heart disease, is more pronounced for women than for men, and is more apparent with magnesium than with calcium concentration levels. The weak effects of these two covariates make it difficult to separate them from the influence of socioeconomic and environmental factors.22

Mortality from CHD during the period 1961 – 1995 in 365 rural areas of Finland was linked with 2131 drinking water fluoride determinations performed in 1958 using negative binomial regression, adjustments made for sex, age, mean income of the resident commune and drinking water magnesium and calcium.: An inverse J- shaped relationship was found between drinking water fluoride and CHD, the association being most pronounced in the 1960s and leveling off consistently as a function of time. In 1961 – 1970 the adjusted mortality from CHD was 22% lower in the fourth quintile of fluoride than in the first quintile but this deficit reduced to 13% in 1991 – 1995. The more widespread use of fluoridated tooth pastes, soft drinks, and certain food items since the 1960s may have reduced the significance of drinking water as a source of fluoride.23