Introduction

This module is divided into three units viz. Concepts of environmental health, occupational and
health safety and educational30% field visits. Concepts of environmental health will cover
introduction to environmental health, water and sanitation, proper methods of handling food,
housing, control of vectors and pests and pollution. Occupational and health safety will cover
introduction to occupational and health safety and occupational hazards. Educational field visits to
water and sewage treatment plant, refuse disposal site, slaughter house and food processing plant
will be made.

Topic 1: Introduction to Environmental Health

Objectives

By the end of this topic, the learner will be able to:

Define the term ‘Health’

Define the term environmental health

Outline the components that make up environment and how they affect our health

Definition of terminologies

Environment:

[Link] circumstances, objects, or conditions by which one is surrounded.

[Link] that which is external to the individual host. [It] can be divided into physical, biological, social-
cultural, economic and political factors, any or all of which can influence health status in populations.

Health: WHO: …“a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity”.

Environmental Health

Since the environment comprises all things that make up our surrounding, environmental health,
therefore, describes the aspects of health related or emanating from our interaction with the
environment.
Components of Environment and their Effects on our Health

The following components of environment can have a positive or negative effect on our health:
Biological, Physical, Socio-Cultural, Economic and Political.

Diagrammatic Illustration of Components of Environment Biological Environment:

Biological Environment

Biological Environment comprises all the living things. These may include; people, trees, crops,
domestic animals, pests, insects, bacteria, viruses, fungi, parasites etc.

People and the Environment

Human beings and their activities can be a big source of infection. For example, overcrowding and
slum settlements are as a result of urbanization. This may be a fertile environment for contracting
diseases that are spread through droplets like tuberculosis among many other diseases. Explosions
from quarries may create dust which can cause respiratory and eye problems. The artificial dams
created become water collection points and breading sites for mosquitoes. these "dams" are risky
places for kids.

Plants and Environment

Plants have many uses in the environment. They absorb gases that are dangerous to ozone layer.
They prevent soil erosion, protects water sources, act as wind breakers and as natural beauty ,
influence weather patterns, provide firewood, timber, charcoal, paper etc. They provide a variety of
food stuffs and herbal medicine e.g Neem tree, garlic, aloe Vera etc. Felling of trees destroys water
sources. Cultivation along river beds contaminates water supply through seepage of fertilizers and
pesticides used on crops. Overgrazing leads to soil erosion, water contamination and destruction of
vegetation. All these human activities have a direct or indirect effect on human health. However,
some plants may adversely affect our health: some people react to pollen –develop hey fever,
asthma etc; Ingesting or touching some plants may have devastating effects on ones health.

Animals: Usefulness to Environment

Animals provide meat, milk, eggs, hides, wool, manure and act tourist attraction thus improving the
economy. Cats and dogs are kept as pets by some people. However, some animals like snakes and
insects are fatal to human beings; some insects eg mosquitoes are vectors of malaria, yellow fever,
dengue fever, Chikugunya virus and filariasis. Houseflies are vectors of dysentery and other diarrheal
diseases. Bacteria, Viruses and fungi are also part of the environment and are disease causing
organisms to man.

Physical Environment

This can be divided into two: Geographical and Man-made environment. Some examples of
geographical environment are land, type of soil, climate, altitude and rivers. Man-made environment
comprises roads, houses, dams, industries, chemicals and toxic substances. All these have a direct of
indirect effect on human health.
Pollution:

Pollution is the term used to describe the spoiling of natural resources such as air, food and water by
harmful substances. Industrial wastes such as smoke can pollute the air and water. Similarly, poorly
disposed off human waste can pollute the environment and thus cause diseases. Other industrial
wastes can pollute the soil and vegetation In rural areas, pollution may result from use of
insecticides, pesticides and industrial waste from coffee, sugarcane etc

Environmental health problems are usually more prevalent in towns and slums than in rural areas. Its
noteworthy to point out that, as a health worker, you can make a difference in the community by
assisting individuals, families and the community to make their environment healthy.

Socio-cultural Environment

Human beings are social animals. different communities have different cultures which may positively
or negatively affect their health. Some cultural elements include: customs, beliefs, religion and
values. Some social elements may include family, kinship, housing, leadership and power structure.

Socio-cultural Practices that Affect Health:

- Tattoos performed for beautification/Circumcision - Spread of STIs & HIV/AIDS

- Wife cleansing ceremonies after the death of a husband- Spread of STIs & HIV/AIDS

- Female Genital Mutilation (FGM)– Difficult deliveries, HIV/AIDS

- Discouraging breast-feeding after child birth - malnutrition, retarded growth

- Failure to use prenatal and delivery services - perinatal death, high mortality rate

- Food habits and cooking practices…Give examples

-Pregnant women prohibited from taking certain parts of an animal meat - poor growth of the
foetus

- Wife inheritance and polygamy- Spread of STIs & HIV/AIDS

Economic and Political Components of the Environment

Economic Environment

These components include work, money and government. The economic factor relates to both rural
and urban economies as well as local community organizations. Rural and urban economies
determine to a great extend the quality of environment. People can change their environment either
positively or negatively. Some of these changes are described as development. Some development
projects may make the environment healthier while others make it a suitable habitat for diseases. An
example is an irrigation scheme for growing rice, which is a cash crop. It improves the peoples’
income, but at the same time, rice fields are breeding sites for mosquitoes and snails which are
vectors of malaria and schistosomiasis respectively.

Political Environment

The political establishment is instrumental in many development projects. Beyond Zero Campaign is
a good example. The Government develops policies which enforce environmental health. National
Environment and Management Authority (NEMA) is a government entity that regulates and
safeguards the environment. Political instability causes unrest, insecurity and psychological
problems. When there is political instability, management of disease outbreaks may be lacking as
health facilities may be destroyed

Summary

In this topic, you have learned about:

Definitions of ‘Health’, environment and environmental health

Components that make up the environment and their effects on our health

References / Recommended Reading

Blumenthal, DS & James R. (Eds). 2010. Introduction to Environmental Health, 2nd Ed. New York
City: Springer publishing company

Koren H,. & Michael, SB. 2002. Handbook of Environmental Health, Volume I, 4th Ed.
Philadelphia: Routledge Press.

Topic 2: Water and Sanitation

Part 1: Water

Specific Objectives

By the end of the topic, the learner will be able to:

State the sources and uses of water

State the sources of water contamination 30

Identify Water Related Diseases

Explain simple methods of water purification

Introduction
Water is essential for life. It is found in every cell of our body and is
necessary for most basic functions. Over 50% of human body weight
is made up of water. Water is thus vital to health and survival.
However, water may become the source of disease and should be
properly treated and made safe for domestic use

Sources of water
Th three main sources of water include: rain water, surface water and
underground water
Note that, the most important water for a community is underground
water. This is the water that is in the soil, by the roots of trees in the
forest. The community’s long-term underground water store…
educate the community on the need to preserve their forests.

Rain Water
Rain water is relatively pure and clean. The cleanliness depends on
the method of harvesting. The community health nurse should assist
the community to ensure collection of clean water.
Surface water: This includes shallow springs and shallow wells,
streams, rivers, dams, ponds and lakes. Shallow springs and wells are
liable to contamination by pit latrines and surface water after the
rains.
 Underground Water: Underground water lies between two
impenetrable layers of rock. It finds an outlet through a fissure or a
crack in the upper layer. Its obtained as a deep spring, a well or a
borehole. Its Plentiful and has less chances of contamination. It does
not usually dry up during dry seasons. This type of water needs to be
pumped into reservoirs before use.
Sea Water: This type of water is salty and requires expensive
purification processes to make it suitable for use.

Sources of water contamination

Rain water can absorb gasses like carbon dioxide from the
atmosphere and other impurities from the roofs. Surface water
absorbs minerals and dangerous chemicals from industrial wastes.
Water harvested from roofs is usually contaminated by leaves, dust,
birds’ droppings etc. Its also contaminated by human/animal excreta,
refuse, fertilizers or industrial waste. Excreta can contaminate
shallow wells too.
Wells: Wells may be contaminated by dirty containers, oils, bathing,
urinating, defecating in water, washing clothes and animal watering,
contaminates rivers etc
Piped water may be contaminated by leaking pipes
Water from any source may be contaminated if its drunk from dirty
or communal drinking vessels.
Note that, Its safer to prevent water from contamination than to
clean it.
Some ways in which water contributes to spread of disease
1. Water Washed Diseases
When water is scarce, and people cannot observe basic personal
hygiene, diseases like scabies, non-specific diarrhoea, dysentery and
trachoma spread. Such diseases whose spread is promoted by lack of
adequate water are called water-washed (water-scarce) diseases.
By simply improving the quantity of water, these diseases can easily
be prevented.
2. Water-Borne Diseases
Water can also contribute to the spread of disease when it carries
specific disease - causing organism. Examples of these diseases
include typhoid, cholera, amoebiasis, Hepatitis A, Poliomyelitis etc.
Diseases caused by contaminated water are called water-borne
diseases. The only way to prevent them is to improve the quality of
water i.e. the cleanliness of water.

3. Water Related Diseases

Water can contribute to the spread of disease when it’s necessary in
the life cycle of a disease vector. Some examples of these diseases
include: malaria, schistosomiasis, onchocerciasis (river blindness) and
drancunlosis (guinea worm).
Protection of water sources
Protecting a spring
All water sources should be protected. To protect a spring, Clear the
bush or long glass around the site of the spring; Put up a fence
around the spring to prevent animals from grazing and children from
playing around it; dig a drain 45 meters from the spring to divert
surface water; build steps to the spring as well as a platform on which
to place the containers when collecting water. Design an area for
washing and for watering the animals. Select a caretaker to maintain
the protected spring

Protecting a well
Select the site at least 100 meters from a pit latrine or other likely
sources of contamination. Wall sides of the well should be built with
concrete. The top should be constructed sloping with water proof
materials. Put a strong well cover in place

Purification of water sources

Safe water System
The safe water system is a household-based water quality
intervention. This is an intervention that can be used by many
households in the community.
The intervention has three components
- Water treatment in the home by chlorination
- Safe storage
- Behavior change technique

Safe water System

The goals of safe water systems are:
- To improve the microbial quality of water in the home by
means of sustainable technology;
- To reduce morbidity and mortality from diarrhoea diseases
related to contaminated water;
- To improve hygienic behaviour related to water use

Chlorination
Chlorine is added to water that has been filtered on a large scale for
supply in cities and towns. Chlorination is the final safeguard of the
quality of water. Amount of chlorine added should be proportioned
to the volume of flow and to the chlorine demand of water. After
chlorine is added, there should be a minimum contact of 30 minutes
for it to be effective against pathogenic organisms in water.
Instructions on the amount of chlorine to be added is usually given
by the manufacturer.

Part 2: Waste Disposal

Objectives
At the end of the Section, the learner will be able to:
State the two types of wastes
30%
State the diseases spread by human excreta and explain the ‘4F'
connection’
State the different sources of waste
Outline excreta disposal methods and types of latrines

Types of Waste
Man produces waste wherever he is and it is necessary to manage
this waste properly to prevent diseases
There are two types of waste: Solid waste and Liquid waste. Solid
waste is also known as refuse.

Liquid Waste
Liquid waste produced by human beings is called excreta i.e faeces
and urine. These are a source of pathogenic organisms.
Excreta are offensive to both sight and smell and can also lead to
contamination of water and food, Faecal organisms may infect
people directly or indirectly through an immediate host. Human
excreta may spread the following diseases: typhoid fever, cholera,
intestinal worms, poliomyelitis, infective hepatitis A, bacillary and
amoebic dysentery.
Urine Carries the infective ova of Schistosoma Haematobium while
faeces spread the haematobium mansoni. FAECES should not be
accessible to FINGERS, FLIES and FOOD (4Fs)
Fingers and Flies transfer faeces to food through the faecal-oral-
route transmission, known as the 4F connection.
Its necessary to help people understand the importance of proper
excreta disposal by use of simple and cheap facilities. As a nurse, you
should be able to identify possible customs and beliefs which hinder
proper excreta disposal in the community and educate the people
accordingly.

Solid Waste
Solid waste or refuse is defined as any unwanted discarded material,
the remains, residual or by-products of human activities which are no
longer required for further use by the initial producer.
This is normally in the process of preparation, manufacture, packing
and other human related activities. If solid waste is not disposed off
properly, it may create a number of problems. Problems caused by
indiscriminate waste disposal include: offensive smell,attracting
insects, vector/pests particularly flies, cockroaches and rats,
spreading diseases, causing pollution of air, water or food, causing
accidents.

Sources of Waste
There are various sources of waste. These include: domestic waste,
street waste, industrial waste, hospital waste and garden/agricultural
waste.

Domestic Waste
This usually consists of all the unwanted materials from the house
e.g food left-overs, potato and banana peelings, waste paper, worn
out clothes, shoes, broken utensils, bottles tins etc.
Street Waste
This type of refuse consists of paper, food and commercial refuse in
public places such as markets and hotels. Scrap metals may also be
included in this category.
Industrial Waste
This varies with the type of industry. Modern industries produce
chemical wastes, which are hazardous to man and other living
things. The waste may be toxic, caustic, acidic or inflammable. This
means that it needs special disposal. If the chemical waste is to be
discharged into a stream, it should be processed first. If it is solid, it
should not be dumped on land as it may eventually seep
underground and contaminate water sources.

Hospital Waste
This is the most familiar waste that nurses are aware of. It includes
the following: sharps e.g needles, surgical blades, gauze, cotton wool
swabs, vials and ampules, lotions, drugs, vaccines, tubings, gloves,
papers, foetuses etc.

Health workers have the responsibility of maintaining infection

prevention by proper decontamination and disposal of the above
waste.

Garden/Agricultural Waste

Agricultural waste from all types of crops and fertilizers may result in
pollution of natural resources such as air, food, and water.

Liquid Waste Disposal

The best method of excreta disposal in rural areas is a pit latrine,
while toilets are suitable for urban areas. As a health worker, it is
important for you to know how a pit latrine is constructed

General guidelines on construction of a pit latrine:

- Pit latrines and cesspools should be at least 2 -3 meters above the
water table;
- Latrines should be located at least 6 meters away from the
buildings;

- Wells should be located upstream to avoid contamination of water

passing through the pit latrine or cesspool.

Excreta disposal is divided into two categories i.e:

a. Water carriage System b. Non water carriage system
Water carriage system
In this system, excreta are disposed of by the use of a flash toilet,
which is also called a water closet. The flash toilet is the most
permanent and hygienic method of excreta disposal. This system is
used where there is a permanent water supply system. This is mainly
in cities and towns. Water closets are reliable and convenient for any
permanent building. The excreta are carried by water pressure into a
septic tank or sewage pit. The clear fluid effluent needs further
bacteriological treatment to become inactive. It is then led over
stones and sand in underground drains for completion of biological
decomposition. The solid part of the excreta (sludge) settles at the
bottom. The sludge relies on natural decomposition. It is reduced in
volume and is ultimately converted into inoffensive unstable product.
However, the water carriage system is very expensive, technical and
requires sewage treatment works

Non-Water Carriage System

In this method, excreta are disposed off by deposition in a pit latrine.
Pit latrine is the most important disposal method in the rural areas.
In its simplest form, the pit latrine consists of the following: a hole in
the ground; a squatting plate for sitting or standing; a hut or shelter
for privacy.
In this way, the excreta is safe from fingers, flies and food (4Fs).

Types of Latrines
Ventilated Improved Pit (VIP): These are more user friendly and the
features include a vent pipe for controlling flies.
Bore hole latrine: Its bored into the ground about 6 feet deep and 4
feet in diameter instead of digging a pit. It has a smaller volume and
fills up faster than a pit. It is faster to install, and is appropriate
following disasters where there is urgent need to install many
latrines.
Trench Latrine: A latrine where a trench is dug and a number of holes
with dividing partitions constructed over it. These types of latrines
are constructed in temporary work camps.
Bucket Latrines: These are also known as pail closets and are used
where the water tables are high. A squatting slab or seat is placed
above the bucket which is filled within a few days. Some of the
negative aspects of this type of latrine are the unpleasant job of
emptying it, and the spillage, which attracts flies.
Composting pit latrine: Suitable where the water table is too high for
a deep pit latrine to be dung.

Objectives of solid waste disposal

Solid waste should be disposed off properly to prevent breeding of
pests and vectors, foul smells, contamination of water sources,
accidents from sharp objects, overcrowding where space can be
created for better utilization.

Methods of refuse disposal

Dumping: This is deposition of waste in open areas, in the sea or in
the rivers.
Burning: This is done in a number of ways including simple open air
burning, burning in a trench or using a simple mud-brick incinerator.
Open burning of combustible refuse is frequently used but it is not
very effective.
Burning by Incinerators: An incinerator is an improved way of
burning combustible refuse. Incinerators can be simple and cheap, or
complex and expensive. Among the cheap ones is the bin incinerator
made out of drum with fire bars across it and air holes underneath. A
more expensive one is built out of brick and fitted with chimneys.

Composting
Composting is “a process in which, under suitable environmental
conditions aerobic micro-organisms break down organic matter to
fairly suitable humus’’. The decomposition process occurs naturally
on the ground when droppings from trees and animals are converted
by micro-organisms to humus. Aerobic composting is usually odour
free. This method is cheap, convenient and recommended especially
in rural areas
Controlled Tipping
This method involves depositing refuse into depressions or large
holes in the ground. These tips should be situated at least half a
kilometre away from settlements, preferably out of sight and down
wind. This is an effective method for hygienic disposal of refuse. It
can be used where sufficient land is available.

The method consists of three steps as shown below

Step 1

Step 2

Step 3

DEPOSIT REFUSE

SPREAD AND COMPACT REFUSE

COVER IT WITH EARTH AND
COMPACT EARTH COVER

Topic Two: Summary

In these sections, you have learned about:

Sources and uses of water

Sources of water contamination and water related diseases

Diseases spread by human excreta and the ‘4F connection’

Excreta disposal methods and types of latrines

Topic Two: References / Further Reading

Blumenthal, DS & James R. (Eds). 2010. Introduction to

Environmental Health, 2nd Ed. New York City: Springer publishing
company

Koren H,. & Michael, SB. 2002. Handbook of Environmental

Health, Volume I, 4th Ed. Philadelphia: Routledge Press.

Topic Three: Appropriate Methods of Handling Food

Objectives
By the end of this topic, the learner should be able to:
State the source of food
Explain methods of food storage
Explain preparation and preservation of food
State Causes of Common Food Borne Diseases

Introduction
Food is essential for growth, development and in the provision of
energy. However, food can also be responsible for the spread of some
disease. The aim of food hygiene is to prevent the contamination of
food at any stage. These stages are production, collection, storage,
sale, preparation and consumption.

Sources of Food

Sources of food vary widely. They include: crop production, animals,

markets etc. Foods that are of animal origin should only be derived
from animals that are legally allowed for human consumption, for
example, some countries ban game meat.

Crop production should follow rules in agricultural practice, which

involve spraying crops against pests. Farmers are advised on safe use
of pesticides. During food processing, certain standards of food
hygiene are applied, for example, in milk treatment, drinks and
tinned foods. The chemicals used as preservatives are also regulated
for safety of the consumers.
The slaughter of animals is governed by several rules and Acts, for
example, the Meat Control Act, the Veterinary and The Public Health
Act.

Food can be contaminated by excreta, dirty fingers, fries, poisonous

insecticides or pesticides on vegetables or chemical preservation of
food. It can also be contaminated if it is derived from infected
animals, for example, animals with tapeworms or brucellosis.

Recommended Conditions for Storing Different Types of Food

Storage

Storage depends on the type and packaging of the food.

Dry foods

These include foods like maize, beans, wheat (cereals). Such foods
should be stored in dry, airy conditions in improved granaries.

Bagged foods

These foods should be stored on raised shelves at least 18 inches

above the floor or ground level. This enables the store to be swept
and washed easily. It also allows for ease of inspection.
Perishable foods

These are foods that go bad within a short time. Such foods include
dairy products, meat and fish. They should be refrigerated to inhibit
the multiplication of bacteria.

Preservation

This is defined as any method used to treat food for the purpose of
prolonging its life, without appreciated loss of its quality and appeal.
Most human food is of biological origin and there is continuous
metabolism to produce the end product. This applies to food of both
animal and plant origin, for example, meat, milk, fish, leaves, tubers
and seeds. When an animal or plant dies, they lose the mechanism of
protection from bacteria, fungi and moulds.

We preserve food in order to:

Increase the shelf life, for example, highly perishable foods like milk;

Conserve the food for use during the periods of scarcity, for instance
dried cereals and vegetables;

Avail seasonal foods like fruits throughout the year

Principles of food preservation

There are two principles of food preservation.

The first principle is to destroy organisms responsible for spoilage

through heat treatment.

The second principle is inhibiting micro-organisms through cold

treatment.

Organism Involved in Food Spoilage

Molds, which affect the surfaces of foods containing high sugar and
salt. They also affect dry foods that may become damp due to poor
storage;

Yeast, which affect foods that have acid or high sugar concentration,
for example, dried fruits, and concentrated fruit juices.

Bacteria, which affect foods under various conditions apart from dry
food.

The principle of destroying organism involved in food spoilage

through heat treatment.
Heat Treatment of Foods

To destroy microorganisms, cooking, blanching, pasteurization,

sterilization and canning methods of food preservation are used.

Heat Treatment of Foods

Cooking: This is heating process, which aims to produce more

palatable food. Cooked food generally keeps longer than raw foods as
long as re-contamination is minimized. Cooking destroys or reduces
micro-organism and potential toxins in food. Cooking also inactivates
undesirable enzymes in food. On the other hand, cooking may cause
degradation of food nutrients, for example, over cooking vegetables
destroys vitamin C.

Blanching: This is the process where most vegetable foods are heat
treated at 70-100˚C for 2-10 minutes. This is done by immersing food
in boiling water or exposing it to steam. Blanching is used before
freezing, canning or drying. This process inactivates enzymes, drives
out air bubbles trapped in food, enhances retention of green colors
and reduces micro-organisms.

Pasteurization: This is relatively a slow method of heat treatment.

Pasteurization is generally carried out at a temperature of below
100˚C. This method is used to increase the life span of the product.
The method reduces organisms that cause spoilage and eliminates
pathogens.
Sterilization: In this method, heat is used to kill all micro-organisms
and their spores at a temperature of 100˚C. The sterilized food must
be stored in an airtight container to prevent the entry of, and
decontamination by, micro-organisms.

Canning: In this method, food is first heated at a temperature that

kills all bacteria and it is then sealed up in sterile cans or bottles. This
prevents bacteria from getting into it and enables it to remain safe
for a long time at a room temperature.

Inhibiting microorganisms’ multiplication

Method A: Cold treatment- Freezing and refrigeration

Method B: Others- salting, smoking, drying

Freezing

This is the most satisfactory method currently available for the long-
term preservation of food. When properly done, freezing is effective
for retaining the color, texture, flavor and nutritive value. Food must
be deep-frozen at 0-4 degrees Celsius to remain palatable. This keeps
food fresh for weeks or months.

Salting
This is saturation of food with salt or sugar, for example, ham, jam
and jelly. The added solute reduces microbial activity due to its
dehydrating effect; salt and sugar solutions are more concentrated
than the cytoplasm inside the cell. Therefore, the water passes out of
the cell into the concentrate, dehydrating the cell.

Smoking and drying

Drying and smoking makes food unsuitable for bacteria to grow and
multiply. Fish or meat may be preserved by these methods. A wood
rack is made and fish or meat is placed on it. A wood fire, which
generates heat and thick smoke, is made under the rack. The heat
will dry the fish or meat, and the smoke gets inside the food to act as
preservative. Green vegetables, cereals and legumes can be
preserved by drying them in the sun. If food is preserved by drying It
must be stored in a dry place until it is used.

Food Preparation
Adequate personal hygiene must be observed when preparing food
to prevent a number of diseases. Below are some important factors
to consider.
Health
Individuals suffering from respiratory infections such as colds or sore
throat should not work with food until they get well. This also applies
to people with infected cuts, skin eruption and diarrheal diseases like
dysentery and typhoid.

Clothing
Individuals working with food should wear clean washable outer
garments. Every worker in the kitchen or washing dishes should wear
a clean uniform or apron. These clothes should be worn when the
worker is in the premises where food preparation is taking [Link]
avoids cross food contamination.

Head covering

To avoid hair from getting into food, hair bands, caps or nets should
be used to cover the head when handling food.
Personal hygiene
A daily bath is necessary for every individual. Wash hands before
handling the food, use clean utensils and avoid bad habits such as
nose picking. Nails should be kept short and clean.
Food
Raw food should be separated from cooked food. All vegetables
should be cleaned thoroughly before preparation for cooking. Fruits
should be washed before eating. Food should be hygienically
prepared and cooked adequately. All food utensils should be cleaned
properly after use and left to dry before being stored in a clean place.

Environment
The environment pertaining to the preparation of food should be
clean throughout. The area should be dust free. This includes the
floors and all the surfaces used for food preparation. The facility itself
should be clean and with adequate ventilation and lighting.
Causes of Common Food-Borne Diseases:
Disease
Cause

Illness affecting the mental function

Some naturally poisonous plants

Poisoning

Chemicals such as lead, arsenic

Ascariasis

Taeniasis

Amoebiasis

Parasites e.g

Askaris
Taenia

Entamoeba histolytica

Typhoid fever

Paratyphoid fever

Food poisoning

Bacillary dysentery

Milliary tuberculosis

Brucellosis

Cholera

Salmonella typhi

Salmonella paratyphi

Salmonella typhiniurium
Shigella

Bovine tuberculosis

Brucella

Vibrio cholera

Food safety regulations

Introduction

The safety of food is so important that our government has passed

laws to protect the public. These laws cover many aspects of food
handling and health officers are generally responsible for enforcing
these laws. Agricultural personnel assist them, where necessary. We
shall look at some of factors that should be considered when
preparing or handling food and some of the food borne diseases.

The public health Act Cap 242:

This is an Act of Parliament to make provision for securing and

maintaining health.

This is divided into 15 parts.

Each part deals with specific aspect of public health. Part 10 of the
act deals with “ protection of foodstuffs”.

This part regulates the construction of buildings used for storage of

foodstuffs. Secondly, it prohibits residing or sleeping in kitchens or
food stores. Part (ii) deals with “milk, meat and other articles of
food.” This part prohibits the sale of unwholesome foods. It gives
powers to authorized officers to inspect and examine food, seize and
recommend disposal at any time.

These laws aim at protecting the public and the public health officers
are responsible for enforcing them.

As a community health nurse, you need to work closely with public

health officers to apply the food safety regulations.

The following are some of the areas that need close supervision:

Meat: Meat is one of the commonest foods that cause problems to

the public. Therefore, it is important that inspection of
slaughterhouses, cows, sheep, goats and pigs be done. The same
case applies to butcheries where meat is sold.

Milk: Milk is one of the foods that are easily contaminate and cause
problems to the public. Inspection of shops where milk is sold is of
paramount importance. Milk should be safe and clean. It should be
obtained from healthy cows as it can transmit bovine tuberculosis
among other diseases. The room for handling milk should be clean,
dustless and separate from the barn. The pails, cans, bottles, coolers
and other equipment, which comes into contact with the milk,
should be thoroughly cleaned.

Homes: It is the responsibility of the community health nurse to

share health messages with community members on food hygiene.
These include maintenance of personal hygiene as discussed earlier
that is cleaning the utensils, handling them with clean hands, and
storing them in clean and dry cupboards or containers.

Farms: The community should follow the regulations on the use of

insecticides and pesticides in form of sprays and fertilizers. This will
help them to use each of them correctly depending on the age of the
crop. Your role as a community health nurse is to encourage the
community to adhere to the instructions from the agricultural field
educators. Moreover, instructions are given on the respective
containers of theses pesticides.

You should teach the community about regulations of food storage

and preservation of different types of food. Harvest should be
carried out when the crops are completely ripe or ready to facilitate
longer preservation. The cereals and legumes should be dried
properly before storage to avoid spoilage. All perishable foods should
be consumed at the right time.

Markets: All types of foodstuffs are sold in markets. Markets should

be designed in a manner that considers stations where similar types
of foods should be stored sold, for example vegetables of all kinds,
dry foods like cereals, fruits and cooked foods. Market should be
kept clean and proper refuse disposal maintained. The food sold
should be clean and fit for human consumption. This, therefore,
explains the importance of inspecting markets by public health
officers. These officers have the powers to close markets and
condemn foods to prevent disease outbreaks.

Hotels: Hotels, restaurants and food shops should also be inspected

under hygiene regulations. They require inspection by the public
health officers. All the food handlers should be supervised and a
regular medical examination is mandatory for them to prevent
spread of diseases through food handling. Licenses should only be
given to hotel owners who have met the requirements. Laboratory
examinations may be necessary for food such as precooked meat.
The use of uniforms, aprons, head covering, as described earlier,
should be observed in the hotels. Proper personnel and environment
hygiene in the hotel premises should be maintained. The hotel
should store, preserve, prepare, cook and serve the food according to
the public health regulations. The law also empowers closure of
hotels, which do not meet the regulations.

Topic Three: Summary

In this topic, you have learned about:

Source of food

Methods of food storage

Preparation and preservation of food

Causes of Common Food Borne Diseases

Topic Three: References / Further Reading

Blumenthal, DS & James R. (Eds). 2010. Introduction to

Environmental Health, 2nd Ed. New York City: Springer
publishing company

Koren H,. & Michael, SB. 2002. Handbook of Environmental

Health, Volume I, 4th Ed. Philadelphia: Routledge Press.

Njeru, S. 2004. Environmental Health, 3rd Ed. Nairobi: Amref and

Nursing Council of Kenya

Topic Four: Housing

Objectives

By the end of this topic, the learner will be able to:

Describe the three types of houses;

List the criteria for an adequate house;

Explain suitable building sites;

Explain the characteristics of poor housing;

Explain community involvement in improving housing.

Introduction
A combination of dampness, lack of light, poor ventilation and
overcrowding contribute to the spread of airborne and droplet
infections. Earth floors and walls permit the entry and breeding of
flies and bedbugs, while un-screened windows permit entry of
mosquitoes. Cooking fires on the floor are hazards to small children.
For these reasons it is important to improve the quality of housing.

The provision of good housing is an essential aspect of environmental

health. Good housing is a requirement for every human being
because it provides shelter and protection from the environmental
hazards.
Types of Houses
A house can be permanent, Semi-permanent or temporary.
Permanent house
This type of house has a stone foundation, a cemented floor and
plastered walls. The roof is covered with iron sheets, tiles or stones in
the case of flats or marionettes. This type of house has advantages in
that it is easy to keep the floor and the walls clean. However, the
floor should be kept dry to avoid accidental falls. Permanent houses
are not cheap to construct and it is necessary to budget for the
activity.

Semi-permanent houses

This is a type of house whereby the floor is usually cemented but

does not necessarily have a stone foundation. The walls are made of
iron sheets or sometimes timber. The house is iron roofed. It is
satisfactory and easy to keep clean. However, appropriate
preservatives for timbers have to be used or else termites destroy it.
In many places mud bricks are used and they are an appropriate
method of improving houses.

Temporary Houses

These types of houses may be found in rural and slums areas. The
floor is earthen, the walls are made of cardboard, polythene paper,
grass or mud. The roof is thatched with the same material as the
walls. This type of a house does not provide for privacy and can easily
catch fire. Temporary houses are a health hazard and do not meet
the requirements for good housing. Temporary houses should be
discouraged as much as possible

Criteria for an Adequate House

A good house should meet:

i. Biological,

ii. Physical and

iii. Social Criteria.

Biological Criteria

Good housing minimizes the risk of transmission of diseases. For

example: The spread of gastro-intestinal infections is minimized by
some important factors. These include:

- Good water supply

- Good food storage, preservation and preparation

- equate facilities for washing utensils and well-designed
kitchens

- Adequate and good methods of refuse disposal.

Physical Criteria
The house should be safe for every occupant. This means that home
accidents should be controlled. It is, therefore, necessary that
appropriate safety devices be provided for. The house should also be
free from air pollution.
Social Criteria
Good housing should be designed to enable the family function
effectively in regard to its cultural background. This means that the
required privacy for adults should be catered for. It should have a
suitable setting for bringing up children.

Adequate Housing

Characteristics of Adequate Housing

A good house should have:

- A suitable design for the climate and variations of weather of

the region;

- Adequate light, both artificial and natural.

Natural Light

The sun provides natural light, which is essential for physical growth,
especially in young children.

Lighting is also essential for proper vision. The presence of sunlight

into the house kills some microorganisms. This underscores the need
for sunlight in the house. Some insects are also driven away by
adequate lighting.

Artificial Lighting

This type of lighting is needed at night. The sources are electricity, oil
lamps and gas. The type of lighting used should correspond to the
purpose for which it is needed in the house.

Ventilation

Fresh air is necessary for our health. Ventilation of a house is the

removal of impure air and pouring in pure air. This is achieved
through windows and door ventilators. Good ventilation in the house
is important, because it keeps the air on continuous movement
without creating draught, cools the housing and maintains the room
temperature at a constant.

Room Separation
 The house should have adequate rooms to provide separate
accommodation for adults and children. The shelter for animals
should be separate from the main house. There should also be
separate rooms for food storage and preparation.

Others
The house should have, where possible, cemented floor and
plastered walls to protect against insects and should be rodent-proof.
It should also have water supply in adequate and reliable quantity
and quality. It should have a good latrine and a clean compound. It
should be equipped with proper methods of refuse disposal, for
example, composting, burning or burying waste. The house should be
dry. The cooking arrangements should be satisfactory to avoid home
accidents. Generally, there should be an effort to protect against all
types of home accidents, for instance, those caused by fire, tools and
chemicals.

From the above list, you will notice that it may not always be possible
to meet all the necessary requirements for adequate housing.
However, we can improve housing in a number of simple and
practical ways.

Suitable Building Sites

The following factors should be considered when selecting a Suitable
site for a house:

- The soil should be suitable for construction;

- The site should be dry, sunny and exposed to free air;

- The surroundings should be hygienic and healthy;

- The site should be away from noisy factories, cinema halls and
heavy traffic;

- It should be on high ground to avoid water from standing and

stagnating. This will prevent breeding of mosquitoes.

Characteristics of Poor Housing

A poor house does not protect its inhabitants from environmental
hazards. It may have some or all the following negative
characteristics:

- Dampness due to poor drainage;

- Overcrowding is a common feature in poor housing. This is due to

an insufficient number of rooms. Dampness and overcrowding
enhance the spread of common respiratory diseases such as colds,
influenza, tuberculosis and pneumonia;

- Earthen floors and walls encourage breeding of fleas and bed bugs
while un-screened windows encourage entry of mosquitoes;
- Unprotected fire places with poor cooking arrangements cause
home accidents to children. Working tools can cause accidents if not
properly stored;

- Water supply and storage, which lacks hygiene, poses a health

hazard for the transmission of water- borne diseases;

Community Involvement in Improving Housing

How We Can Make People Value Improved Housing

Everybody would like to enjoy living in a good house. A little effort is

needed to improve the type of a house one is living by using locally
available resources.

Sensitization

Sensitization is the process of creating awareness. As community

health nurses, we come in contact with the communities and we
should make use of these opportunities to share health messages
with them.
We should start at the health facility then extend our efforts to their
homes. The health team will have conducted a community diagnosis
so as to have valid information on the problem.

Steps that Can be Followed when Trying to Involve the Community:

- Meeting and discussing the problem with the health team

members;

- Sharing health messages daily (regularly) at the health facility

about improving housing;

- Meeting and discussing the problem with the community

leaders.

First Step:

Plan to meet and discuss the need for community involvement with
the health team members. Ensure that the relevant consultants and
government officers dealing with housing are invited so that they can
give pertinent information on housing matters according to the
Housing Act.

In this discussion, the health team members will deliberate on

community sensitization and identify ways of improving housing in
the community. All the health team members should be committed
to carrying out their plans for solving the housing problem.
Second Step

Start sensitizing the community at the primary health care facility.

This will be accomplished by sharing health messages on improved
housing. In this way, the patients and clients will get pertinent
information on types of houses, criteria for adequate housing, effects
of housing on health, characteristics of poor housing and diseases
associated with poor housing. This will make the community aware
of the problem and the need to improve housing for the family.

Third Step

Organize to meet and discuss the subject with the community

leaders of the area. These leaders include formal leaders in
government offices, for example, the Sub County Commissioner,
Chief and Assistant Chief. The informal leaders, such as opinion
leaders, community own resource persons, leaders of women, men
and youth groups should also be involved.

Moreover, you should target community-based health workers,

traditional birth attendants and community-based distributors of
family planning.

Topic Four: Summary

 In this topic, we have learned about the three types of houses, the
criteria for an adequate house, suitable building, characteristics of
poor housing and community involvement in improving housing

Topic Four: References / Further Reading

International Code Council. Fact sheet. Falls Church, VA: International
Code Council; no date. Available from URL:
[Link] [PDF – 93 KB].

Koren H,. & Michael, SB. 2002. Handbook of Environmental

Health, Volume I, 4th Ed. Philadelphia: Routledge Press

Topic Five: Control of Vectors and Pests

30%

Specific Objectives

By the end the topic, the student will be able to:

Discuss diseases associated with vectors and pests

Describe methods of control of vectors and pests

Explain how you will community involvement in control of vectors

and pests
Ways in which a vector may transmit pathogens

There are two ways in which a vector may transmit pathogens:

1. Mechanical transmission

In this mode of transmission, the vector carries the infective

pathogen or agent on its body or limbs. Alternatively, the inefective
agent may be ingested by the vector and excreted unchanged in its
faeces;

2. Biological transmission

In this mode of transmission, the vector acquires the infective agent

from the blood or skin tissue of the infected host and the infective
organism undergoes some development in the vector.

The infective vector may also inoculate the infective agent from its
salivary secretion into a new host to cause disease, for example, in
the transmission of malaria.

The host may be infected through contamination of skin or mucous

membranes by the infective faeces of the vector, for example, louse
borne relapsing fever.
The host may acquire infection by ingesting the vector, for example,
guinea worm.

Diseases associated with vectors

VECTOR

DISEASE TRANSMITTED

Houseflies

1. Amoebic and bacillary dysentery

2. Typhoid

Tsetse flies

1. Sleeping sickness in man! Trypanosomiases

2. Nagana in animals

Mosquitoes
1. Malaria by female Anopheles mosquito
2. Filariasis by culex mosquito

3. Yellow fever by aedes aegypti mosquito

4. Dengue fever by aedes aegypti mosquito; Chikugunya

Fleas

1. Bubonic plague
2. Murine typhus fever. It is less severe than the louse borne
Bed bugs
Mites
Ticks
Cockroaches
1. Insomnia
2. Severe nuisance
Scabies

Tick borne relapsing fever

No specific disease known but like flies it is a mechanical vector of

pathogenic organisms
Pests Related Diseases
A pest is an organism, which in a given circumstance adversely affects
human health or the economy. Rats and mice are pests and they
belong to a group of animals called rodents. Insects such as white
ants, weevils, aphids are also pests. Pests have to be numerous in
order to cause a serious problem. Insecticides and pesticides are
used to eliminate pest infestations. The safest and the most
economical methods available are used.

RODENTS

DISEASE TRANSMITTED

Rats and Mice

1. Bubonic plague, (refer to fleas)

2. Marine endemic typhus fever

3. Salmonellosis. This is transmitted through food, which is
contaminated with the infected faeces or urine of an infected rodent.

4. Haemorrhagic jaundice (Weil’s disease). This is transmitted to

humans through eating food contaminated with faeces or urine from
an infected rodent, bathing in contaminated water or handling
infected rats or excreta from rodents.

5. A bite from an infected rodent causes a rat bite fever.

Their noise is a nuisance in the houses.

Insects and rodents also cause property destruction.
How do Rodents Destroy Property?

Rodents destroy all types of dry grains in our houses, granaries and in
the fields. In food processing regulations, the evidence of rodent
droppings and urine stains causes condemnation and disposal of
large quantities. They can destroy buildings by gnawing wood, water
pipes, electric cables and they can cause fire outbreaks.

Methods of Control

The following methods may be used to control pest infestations:

Personal hygiene, Environmental hygiene, Improved housing and Use

of pesticides and insecticides.
Personal Hygiene

This includes thorough hand washing, which should be practiced

before preparing or eating food and after visiting the toilet. Short and
clean nails should be kept and a daily bath should be taken. Wearing
of shoes will prevent infestation by jiggers and hookworms. The hair
should be kept short and clean. The use of shampoo, which has a
suitable insecticide, is helpful for cases of head lice. Clothing should
be washed at least once a week and ironed.

Bedding

Bedding should be cleaned thoroughly at least weekly and dried well

in the sun. If infested with mites and lice, it should be boiled and
ironed, in order to kill them.

Food

Food stores, cupboards and tables should be kept clean. All

foodstuffs should be covered to prevent flies gaining access to them.
All food utensils should be kept clean and dry. Make use of the
improved methods of preservation of food we have previously
discussed.

Environmental Hygiene
Drainage of water

The aim of proper water drainage is to destroy all mosquito-breeding

sites. Drain any stagnant water or slow-moving water around the
house. All holes and ditches should be filled to avoid standing water.
All receptacles likely to retain water, for example, used cans and tins,
bottles, coconut husks, vehicle tyres and so on should be collected
and properly disposed of. Slow moving streams should be canalized
to facilitate faster water flow.

Roof gutters should be cleared regularly to prevent blockage of water

flow by leaves and other materials. Clearing of the vegetation around
the buildings, and water banks removes damp areas where
mosquitoes breed.

Cleanliness

The home or village environment should be kept clean. Animal

shelters should be a reasonable distance away from the main house.

Waste and excreta disposal

This should follow the proper methods of waste disposal as described

earlier

Improved Housing
Floors and walls

These should be cemented so that they can easily be swept and

washed. The floors should be cleaned after meals to clear all the food
on the floor. All the crevices and cracks in the walls and floors should
be plastered.

Beds and Other Furniture

People should not sleep on the floor but on raised beds. Beds and
mattresses should be regularly taken outside in the sun to kill any
lice, mites and bed bugs. Boiling water can be poured on the bed
stands for the same purpose. Joineries of furniture with tracks and
crevices should be filled up with plastic wood filler.

Buildings and Food Stores

Rat proof buildings and food stores should be constructed. In malaria

areas, buildings should be mosquito proof, with wire gauze to cover
all ventilation openings, doors and windows. Buildings should be
inspected regularly for pests.

Use of Chemical Substances such as Pesticides and Insecticides

Chemicals used to kill the pests are in the form of insecticide sprays,
dusting powders, miticides, rodenticides, emulsions, oils and
molluscides.

Remember, as earlier said, crop production should follow the rules of

agricultural practice, which involves spraying crops against pests.

After harvesting, the cereals and legumes are dried in the sun and
then treated with pesticides in the form of dust or powder. This
protects the grains against pests for at least six months.

For cats, dogs and cows the appropriate insecticide is used to dust or
wash them regularly to kill any fleas and ticks. Rodents are controlled
by the use of rodenticides, which are available in most shops, for
example, Rat & Rat, Rat Rid, Fuko Kill and so on.

The floors and walls of houses may also be treated with insecticides
regularly.

Mattresses and bedsteads can be treated in the same way.

Heavily infested buildings should be treated with residual insecticidal

sprays. Kerosene is also used to kill bed bugs and white ants when
worked into cracks and crevices by use of an applicator like a feather.

Insecticides and larvicides in the form of oils and emulsion are

sprayed on the water surface to kill insects in water.
Molluscides may be applied in water to kill the snails, which spread
schistosomiasis.

Topic Five: Summary

In this topic, learned about diseases associated with vectors and
pests, control of vectors/pests and community involvement in the
control process.

Topic Five: References /Further reading

Koren H,. & Michael, SB. 2002. Handbook of Environmental
Health, Volume I, 4th Ed. Philadelphia: Routledge Press.

NASPHV Compendium of Animal Rabies Prevention and Control -

[Link] ndium_2005.pdf

World Health Organization: Equipment for Vector Control- A Guide

to Major items, Specifications, Use, Descriptions - Field Tests.
WHO-Geneva 1964.

Topic Six: Pollution

Objectives

By the end of this topic, the student will be able to:

Define pollution
30%

Identify major types of pollution

Explain pollution prevention and control

Pollution is the term used to describe the spoiling of natural

resources such as air, food and water by harmful substances.
Industrial wastes such as smoke can pollute the air and water. Other
industrial wastes can pollute the soil and vegetation.

Air pollution is the introduction of particulates, biological molecules,

or other harmful materials into the Earth's atmosphere, causing
disease, death to humans, damage to other living organisms such as
food crops, or the natural or built environment

Air Pollutants: Air can be polluted by different types of pollutants.

The major air pollutants include;

- Carbon Dioxide (Co2)

- Sulphur Oxides (Sox)

- Nitrogen Oxides (Nox)

- Carbon Monoxide (Co)

- Particulate Matter (Pm)

Sources of Air Pollution: These include: emissions from power

stations, emissions from industrial processes, vehicular emissions,
emissions from burning of solid waste, emissions from natural
sources such as volcanic eruptions & forest fires.
Control of air pollution: For air to be made safe from pollutants,
stringent measures must be put in place by the government to
ensure that the above emissions are at the lowest tolerable levels.
These measures include: setting standard for air cleanliness,
laboratory equipment (ambient air monitoring station, portable gas
analyser) and smoke control action plan. This would ensure that the
environmental air is free from disease causing pollutants.
Water pollution refers to the contamination of water bodies. These
may include lakes, rivers, oceans, aquifers and groundwater.
The major water pollutants are: organic contaminants (detergents,
herbicides, etc), inorganic contaminants (heavy metals, ammonia,
etc), solid waste (plastics, paper food waste) and thermal pollution
(discharge of warm water into water bodies by factories).
The major sources of water pollution are:
sewage, runoff of pesticides and fertilizers, solid waste disposal,
untreated effluents from industrial and other activities and chemical
and oil spills.
Land pollution refers to the deposition of solid or liquid waste
materials on land or underground in a manner that can contaminate
the soil and groundwater, threaten public health, and cause unsightly
conditions and nuisances.
Major sources of Land Pollution:(see topic 2 - types of waste)

Noise Pollution
Noise is generally defined as unwanted sound. Sound affects man
physically, psychologically and socially. Noise may be continuous or
intermittent and may be of high frequency or a low frequency.
There are are many sources of noise pollution. The common ones
include:
- Industrial (power plants, stone crushing, metal workshops, cabinet
making);
- Multipurpose halls including wedding halls;
- Bungalows along the coast;
- Places of entertainment, including night clubs;
- Road traffic e.g. moving trucks, automobiles, buses, especially those
with modified silencer system;
- Community noise e.g. radio/TV, loudspeakers, pool houses and
alarms;
- Animals e.g. dogs, cats, crows;

- Use of loud speaker, amplifier, musical instrument, electrical or

mechanical device for religious activities
- Aircrafts and speed boats;
- Neighbourhood;
- Machinery (generator sets, compressors, air conditioning units,
boilers, pumps, motors);
- Others, including construction works, road infrastructural works,
public gathering, vibration, ice cream sellers, vendor shouts.

Health Effects of Noise Pollution

 Noise can be a source of health problems. Some may be
immediate and others long term. they include:
 Hearing Loss (including occupational hearing loss)
 Stress
 High Blood pressure
 Sleep Loss
 Distraction
 Productivity Loss
 Irritability,
 headache
 Annoyance and interference with communications.
Noise Control Measures
Control measures should be instituted to minimize the above health
effects. These include:
Mass sensitization;
Enforcement of the existing Noise Regulations;
Use of noise abatement technologies (e.g installation of noise
barriers between the noise and the receiver)
Research in novel technologies;

Summary
In this topic, we have learned about:
Definition of pollution
Major types of pollution

Pollution prevention and control

References / Recommended Reading

United Nations Environment Programme (2017e). The Partnership

for Clean Fuels and Vehicles (PCFV). [[Link]
transport/pcfv.

UN-Water (2016). Water and Sanitation Interlinkages across the 2030

Agenda for Sustainable Development. [Link]
org/app/uploads/2016/08/Water-andSanitation-Interlinkag United
Nations Environment Programme (2017e). The Partnership for Clean
Fuels and Vehicles (PCFV). [[Link]
transport/[Link]

World Health Organization (2016a). Ambient Air Pollution: A Global

Assessment of Exposure and Burden of Disease
[Link]
bitstream/10665/250141/1/9789241511353- [Link].

UNIT 2: OCCUPATIONAL HEALTH AND SAFETY

Topic 1: Occupational Health and Safety
Objectives
At the end of this topic , the learner shall be able to:

Define occupational health

Explain the aims and objectives of occupational health services

30%

Introduction

As earlier stated, health is a basic human right. We should therefore

endeavour to provide health services - promotive, preventive and
curative - to all people, of all ages, wherever they live and work.

There are groups, however, who for various reasons need special
health services.
At independence, our government identified health as one of the
basic needs and an essential precondition for the overall economic
development and social progress in the country. But, as we well
know, some groups of people are at a higher risk than others of
becoming ill. That is why we talk about health services for special
groups, such as occupational health.
Reasons why Workers Require Special Health Services
At work, healthy people can be exposed to health risks. They may
work in very isolated areas where no other health services are
available. When an employment group is considered as a unit,
sickness caused by certain occupations can be identified and
prevented. Illness among workers creates a loss to both individual
and national productivity. Thus, every effort should be made to
decrease the chances of workers becoming sick.
Occupational health concerns
It is clear, then, that the objective of occupational health services is
prevention. Occupational health is also concerned with the effect
that work may have on health i.e. in causing injury or disease, the
effect that injury or disease may have on ability to work, the effects
of hazardous industrial fumes or toxic wastes which pollute the air,
sewers and rivers.

Historical Perspective
The first occupational health services were started by large
companies for workers in dangerous jobs such as mining, or in large
tea factories. Then it was referred to as industrial medical services
because it was concerned with the treatment and prevention of
injuries and special diseases, such as lung diseases due to dust
inhalation, for workers in these mines and factories.

How work affects one’s health

There are a number of ways in which people’s work may affect their
health. The use of new tools and machines e.g. a wood maker may
lose a finger in a circular saw if not well trained. Risk of poisoning
from chemicals e.g. pesticides, infections e.g. anthrax due to poor
handling of animals or animal products.
Hospital workers may contract diseases from the hospital
environment. E.g. the novel corona virus infection
Actors in occupational health programmes
In Kenya, the community health nurse carries out the responsibility
of organizing practical occupational health programmes. These
activities are carried out at different levels of our health system –
from the highest to the lowest level including industries, factories
and farms.
Actors in occupational health programmes
These include, the health team, employers, the employees, the
community’s formal and informal leaders.
Aims of Occupational Health as defined by ILO/WHO
- The promotion and maintenance of the highest degree of
physical, mental and social well being in all occupations;

- The prevention among workers of departure from health

caused by their working conditions;
- The protection of workers in their employment from risk
resulting from factors adverse to health;
- The placing and maintenance of the worker in an occupational
environment adapted to his physiological equipment
The aims of occupational health look at adaptation of work to man
and each man to his job.

Objectives of Occupational Health Services

The objectives of occupational health are primary prevention,

secondary prevention and tertiary prevention
Prevention: Prevention includes a wide range of activities — known
as “interventions” — aimed at reducing risks or threats to health.

Primary Prevention

Primary prevention aims to prevent disease or injury before it ever

occurs. This is done by preventing exposures to hazards that cause
disease or injury, altering unhealthy or unsafe behaviours that can
lead to disease or injury, and increasing resistance to disease or
injury should exposure occur.
Examples of primary prevention include legislation and enforcement
to ban or control the use of hazardous products (e.g. asbestos) or to
mandate safe and healthy practices (e.g. use of seatbelts and bike
helmets), education about healthy and safe habits (e.g. eating well,
exercising regularly, not smoking) and immunization against
infectious diseases. In the context of occupational health, primary
prevention anticipates diseases before they occur problems and tries
to avoid them.

This anticipation involves:

- Good construction of machines
- Training of the workforce on how to work with machines
- proper utilization of protective clothing
- Good personal hygiene
- Adequate rest when working with machines etc
…it also involves dealing with the following:
- Wounds/cuts caused by machines and tools
- People falling over things and vice versa
- Toxic effects (on eyes, skin, lungs, etc) of substances contacted
or inhaled
- Increased risk of any of the above because of the employees
own poor personal habits, attitudes or physical condition
- Putting fire- extinguishers, first aid boxes at strategic places

- Pre-placement examination- medical examination that is done

before a person is employed

Secondary prevention
Secondary prevention aims to reduce the impact of a disease or
injury that has already occurred. This is done by detecting and
treating disease or injury as soon as possible to halt or slow its
progress, encouraging personal strategies to prevent re-injury or
recurrence, and implementing programs to return people to their
original health and function to prevent long-term problems.
Examples include:
Regular exams and screening tests to detect disease in its earliest
stages (e.g. mammograms to detect breast cancer)
Daily, low-dose aspirins and/or diet and exercise programs to prevent
further heart attacks or strokes
Suitably modified work so injured or ill workers can return safely to
their jobs.

Three types of screening

1. Screening employees at risk of a particular hazard
2. Regular screening for non-occupational illnesses during
employment
3. Screening of the environment to check that recommended
preventive measures are put in place by employers to be used by
employees
Tertiary Prevention
Tertiary prevention aims to soften the impact of an ongoing illness or
injury that has lasting effects. This is done by helping people manage
long-term, often-complex health problems and injuries (e.g. chronic
diseases, permanent impairments) in order to improve as much as
possible their ability to function, their quality of life and their life
expectancy.
Examples include:
- Cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis, depression, etc.)
- Support groups that allow members to share strategies for
living well
- Vocational rehabilitation programs to retrain workers for new
jobs when they have recovered as much as possible.
- Retraining somebody using crutches / wheelchair after a
debilitating accident

Topic 1: Summary
In this topic, you learned about:
Definition of occupational health
Aims and objectives of occupational health services

Topic 1: References / Further Reading

Afubwa, SO,. & Mwathi, MA. 2014. Environmental Health and
Occupational Health & [Link]: Acrodile Publishing Ltd.
Koren H,. & Michael, SB. 2002. Handbook of Environmental Health,
Volume I, 4th Ed. Philadelphia: Routledge Press

Topic 2: Occupational Hazards

At the end of the lesson, the learner will be able to:

1. Identify occupational health hazards and their management
2, Explain the function, duties and role of an occupational health
nurse 30%
Introduction
Occupational diseases have a long latent period. Once they occur,
most of these diseases cannot be treated. The beauty about
occupational health is that all occupational diseases can be
prevented.

Occupational Hazards
Types of occupational hazards are categorized according to the
agents which cause the hazard or disease. Therefore, occupational
hazards can be classified into five categories. These include physical
hazards, chemical hazards, biological hazards, mechanical hazards
and psycho-social hazards.
Physical Hazards
This category includes exposure to heat, cold, light, noise, vibration,
ultra violet light etc.
Examples of some damages caused by the above:

Heat and cold: The effects of exposure to heat range from burns,
heat stroke, and heat cramps, while the effects of exposure to the
cold include immersion foot, frost bite, vasoconstriction and
hypothermia.

Light: effects of poor illumination result in eye strain, headache, eye

pain, eye fatigue, and blurring of vision.
Noise pollution: auditory effects leading to temporary or permanent
loss of hearing;
Vibration: it has been proved that continuous vibration hinders the
proper function of blood vessels and may produce injuries to joints,
elbows and shoulders.
Ultraviolet radiation: This occurs mainly in welding works causing
intense conjunctivitis and keratitis (welder flash).
Chemical Hazards

Frequent skin contact with chemical substances can lead to

occupational dermatitis, eczema, ulcer, cancer, etc.

Inhalation: Inhalation of dust in various environments is responsible

for dust allergy, silicosis, anthracosis, asbestosis, cancer of the lungs
etc. Inhalation of gases may cause asphyxia due to carbon monoxide
and cyanide gas.
Presence of metal (lead, mercury, zinc, tin, silver, etc) and other
components may cause toxic effects to body organs.

Biological Hazards
Workers may be exposed to biologic agents and parasitic agents at
the place of work. This can result to infection with diseases such as
brucellosis, anthrax, hydatidosis, tetanus, encephalitis, fungal
infection, Hepatitis B, Rabies, HIV and AIDS etc.

Mechanical Hazards:
These include conditions due to strain in places of work.

Psycho-social Hazards: These are stress related conditions that

people may get as a result of prolonged exposure to stress at places
of work.

Common Methods of Dealing with Hazards

When a hazard has been detected, the preventive measures to be

adopted depend on the nature of the hazard or harmful substance
and its routes of absorption into the body.

The common methods of dealing with hazards are as follows:

i. Removing the hazard or toxic substance from the work place

The best preventive measure is to get rid of the substance or
chemical or machine altogether and replace it with a less dangerous
one.
ii Reducing exposure to the hazard
There are a variety of methods which are used to reduce exposure to
hazards.

Methods used to reduce exposure to hazards

Sucking or blowing away the dust or fumes from the place where
they are produced. This can be achieved in many ways…e.g. vacuum
suckers.
Wetting a substance that gives off dust when cut or worked on dry,
this is common in wood industries where there is a lot of drilling and
grinding.

iii General Ventilation

The ventilation of work rooms is improved so that the atmospheric
contaminants and heat are removed or reduced. This is mainly
achieved by installing wide windows and ventilators in areas of work
and ensuring that there is enough operating space for the workers.
iv General Cleanliness

General cleanliness is a very important method of dealing with a

hazard and harmful substance. Thus, good factory cleanliness
reduces exposure, encourages tidiness and safer methods of working.

v Personal hygiene
It has been documented that good washing habits can greatly protect
workers from hazardous substances. Thus, good washing facilities
should be available so that workers may wash dirt and chemicals off
their hands after handling them before eating. Where the work is
very dirty, or irritant chemicals are used, showers should be provided
in changing rooms.
Provision of washing facilities is even more important in horticultural
firms and chemical industries.

vi Protective and safety equipment

As health workers, this method of dealing with hazards is very
familiar to us since we wear protective clothing all the time to
protect ourselves from health hazards.
Clothing and protective equipment commonly used in health
facilities:
- Rubber gloves especially when handling dangerous substances;
- Goggles to protect our eyes and face during surgical
procedures

- Respirator or masks.
Accident Prevention and Promotion of Safety in Working Places
Accident: an unexpected and unplanned occurrence which can lead
to bodily injury
Although it is an unexpected and unplanned occurrence, situations in
which accidents occur generally can be foreseen. For example, a
sharp bend or curve on a road can be identified so that motorists can
avoid overtaking and over speeding at that point. Thus, by identifying
these situations, many accidents can be prevented, before they
occur.

Functions and Responsibilities of Occupational Health Nurse

Earlier on in this section we mentioned that occupational health is
one of the responsibilities of a community health nurse. In the
communities where we work (where we are likely to work at some
point during our career), there are small-scale industries using
machinery and toxic substances such as insecticides. You therefore
need to be aware of these hazards and harmful substances and be
prepared to advice workers, managers and development committees
on health matters.

Functions of the Occupational Health Nurse

The occupational health nurse looks at the health of a worker from

two angles: health in relation to their occupation and the health care
of non-occupational illness and injuries. Therefore, the functions of
an occupational nurse include the following:
- Physical and psychological assessment of workers to facilitate
proper selection and placement;
- Prevention of occupational and non-occupational illness;
- Provisions of treatment
- Fostering a high level of well-being of the workers.
Responsibilities of an Occupational Heath:
Participating in the health assessment program i.e. both pre-
placement and routine medical examination of workers;
Keeping a continuous watch on working conditions, equipment’s and
materials for safety precautions and possible dangers. Counseling
workers regarding personnel and family health problem;
Co-operating with management in the application, enforcement and
training on the use of protective measures;
Giving advice on environmental sanitation and safety education
activities;
Carrying out nursing administrative duties, which assure the efficient
management of the occupation health services;
Maintaining simple records on which to base surveillance, prevention
and control of occupational illness or accidents;
Evaluating health programmes and activities
Therefore, keeping the above responsibilities in mind, the
occupational health nurse has to play four major roles in
occupational health programmers.
These are: professional role, environmental role, managerial role and
educational role

professional Role
The role of an occupational health nurse (OHN) is to assess workers
for evidence of both occupational and non-occupational injuries and
illness. They therefore must have knowledge of occupational
processes and their toxic effects as well as the acute and chronic
diseases and injuries affecting the work group. The nurse should plan
a programme for periodic physical examination and follow-up of
exposed workers.
The nurse should also give emergency care and refer for appropriate
care. They should also be able to use epidemiologic concepts to view
illness or injury as it relates to the worker and the environment to
determine how it can be prevented; it is also the role of the OHN to
work closely and teaching foremen on how to prevent diseases and
injuries.

Environmental Role
An occupational environment is the sum of external conditions and
influences which prevail at the place of work and which have a
bearing on the health of the working population.
For example, in industry, the worker interacts with three different
types of agents:
Physical, chemical and biological agents, e.g.
- Physical - heat, cold, radiation etc
- Chemical - toxic dust, gases etc
- Biological - viral, fungal, bacteriological, Rickettsia etc

Managerial Role

Occupational health nurses work closely with management. Their

role is to report and give recommendations on unsafe and hazardous
conditions as well as the health condition of employees.
There is close interaction between an industry and the community
where it is located. Workers bring their knowledge, skills, attitude
and personal problems to the work setting and these may influence
work productivity.
Educational Role
Occupational health nurses are expected to play a vital role as
advisors, counselors, educators, environmentalist, hygienists,
rehabilitators, researchers, safety experts and supervisors.
Health education is essential for the promotion of optimal health for
workers and their community. The OHN should plan, organize, and
implement health education programme for the workers and their
community members.

Topic 2: Summary
In this topic, you have learned about:

Health hazards and their management

Function, duties and role of an occupational health nurse

Topic 2: References / Further Reading

Afubwa, SO,. & Mwathi, MA. 2014. Environmental Health and
Occupational Health & [Link]: Acrodile Publishing Ltd.
Koren H,. & Michael, SB. 2002. Handbook of Environmental Health,
Volume I, 4th Ed. Philadelphia: Routledge Press

Unit 3: Educational Field Visits

1st Visit: Water and sewerage Treatment Works
Learning Objectives
The following learning objectives should be met once the student
visits the plants:

Discuss the importance of water treatment

Understand how the water gets dirty
Outline the basics of how water is cleaned
2nd Visit: Refuse Disposal Site

Learning Objectives
The following learning objectives should be met once the student
visits the refuse disposal site
Describe the types of waste at the site
Understand the concept and steps of waste management
Describe diseases that may be caused by poor waste management

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Module Preliminaries
Module OverviewModule Competency

This module is designed to enable the learner promote

environmental health, so as to prevent illnesses.

Module Description
This is a first year module design to introduce learners to the course
of environmental health. It includes Introduction to environmental
health - definitions and concept of environmental health;
occupational health and safety - occupational hazard, Public Health
act, occupational health and safety act; Educational field visits t
water and sewage treatment plant, refuse disposal site, slaughter
house, food processing plant.
Learning
Outcomes
By the end of this module, you will have gained sufficient skills to:
1. Apply basic knowledge to promote environmental health

2. Prevent occupational related illnesses and hazards in work related

environment

3. Observe environmental health activities that promote health

Learning Support
This module will be taught by lecturers in the department of Nursing.
Performance Tasks
Within the various units and topics in the module, there are tasks
that you are supposed to attempt and submit for marking. Some of
them are not meant for submission. For those that are meant for
submission, you are encouraged to be very keen to observe due date
because once the date lapses, you will not be able to submit the
same. Calling support line will not help you on this. If you are not
able to upload an assignment, seek help well in advance before the
due date. Otherwise, this will not be used as an acceptable reason
for not submitting on time.
These tasks are divided into two as follows:
(i) Main Tasks that comprise of quizzes and written assignment
(ii) Sub tasks that comprise group discussion and clinical logs.

Learning Requirements
For effective and smooth learning, it is expected of you to be
computer proficient. Additionally, to satisfactorily complete this
module, it is required of you to;
Submit assignment and required tasks on time
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Sit for CAT’s when scheduled, and
Sit in Exam at the end of the session.

Topic 2
Unit One: Concepts of environmental health
a) Introduction
This unit gives an overview the concept of environmental health

b) Unit Objectives
By the end of this unit, you will have achieved the following
objectives;

Explain the components of environmental and how they affect our

health
Explain the role of a nurse in promotion of good health
Understand the concept of disease prevention

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements
Lessons: 4
Progress: 0 / 4
Unit One Activities

a) Review Questions/Unit Activity

Discuss the professional requirements of a Nutritionist and Dietician
State roles and Functions of KNDI
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab
Assignments: 4 Forums: 4 Chats: 4
Progress: 0 / 12
Unit Two: Occupational Health and Safety
a) Introduction
This unit gives an overview of occupational health and safety and the
the functions and responsibilities of an occupational health nurse in
the workplace and the community.

b) Unit Objectives

By the end of this unit, the learner shall be able to:

Explain the aims and objectives of occupational health services
Identify occupational health hazards and their management
Explain the function, duties and role of an occupational health nurse

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements
Lessons: 4
Progress: 0 / 4
Unit Two Activities
a) Review Questions

Highlight the 10 steps to successful breastfeeding according to WHO

Discuss the relationship between nutrition and other careers
Outline roles of a community nutritionist
fab fa-twitter-square
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab
Assignments: 4 Forums: 4 Chats: 4 Files: 4
Progress: 0 / 16
Unit Three: Unit One: Enter Unit Three Name Here
a) Introduction
As a nutritionist or dietitian, you will be translating scientific
information about nutrition into practical advice at the same time
assessing and diagnosing as well as treat diet related problems; you
therefore need some essential skills and competence to enhance
your work.

b) Unit Objectives
By the end of this unit, you will have achieved the following
objectives;

Explain the skills required in dietetics

Explain the competencies required in nutrition and dietetics

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements
Lessons: 4
Progress: 0 / 4
Unit Three Activities
a) Review Questions

Explain skills needed in dietetics

Explain the importance of essential skills in day to day practice of
dietitian
review questions
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab
Assignments: 4 Forums: 4 Chats: 4 Files: 4
Progress: 0 / 16
Unit Four: Unit One: Enter Unit Four Name Here
a) Introduction
When providing services the nutrition and dietetics practitioners
adheres to the core values customer focus, integrity innovation social
responsibility and diversity. They are guided by standards and ethics
as discussed below.

b) Unit Objectives
By the end of this unit, you shall be able to;

Discuss the standards in nutrition and dietetics

Explain the ethics in nutrition and dietetics and disciplinary action
against unethical behavior
Describe the disciplinary action for unethical behavior in nutrition
and dietetics

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements
Lessons: 4
Progress: 0 / 4
Unit Four Activities
a) Review Questions

Describe Standards in nutrition and dietetic profession

State International Code of Good Practice
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab
Assignments: 4 Forums: 4 Chats: 4 Files: 4
Progress: 0 / 16
Unit Five: Unit One: Enter Unit Five Name Here
a) Introduction
The food we eat has a significant impact on our health. Changes in
diet can help prevent or control many health problems, including
diabetes, cancer and heart disease. There new knowledge that has
helped improve lifestyle.

b) Unit Objectives
By the end of this unit, the learner shall be able to;

Explain modern and contemporary issues in Nutrition and Dietetics

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements

Lessons: 4
Progress: 0 / 4
Unit Five Activities
a) Review Questions

Explain reasons for recommending parenteral nutrition

Describe briefly management of obesity
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Forums: 4 Chats: 4 Files: 4

Progress: 0 / 16
Unit Six: Unit One: Enter Unit Six Name Here
a) Introduction
Nutritional requirements need to be known in order to assess or
monitor the adequacy of nutrient intake and provision of nutritional
support. Dietary reference values provide guidance on the nutritional
needs of a particular group of healthy population but have limited
applications to individuals. Also important to note that diet reference
values provide a yard stick as to level of energy and nutrients
required but additional means of estimating the needs of a particular
individual are likely to be needed.
b) Unit Objectives

By the end of this unit, you will have achieved the following
objectives;

Explain in details the terms used in this unit

Describe how these terms can be applied in nutrition and dietetics

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.

Lessons: 4
Progress: 0 / 4
Unit Six Activities
a) Review Questions
Explain Importance of RDA

review questions
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Forums: 4 Chats: 4 Files: 4

Progress: 0 / 16
Unit Seven: Unit One: Enter Unit Seven Name Here
a) Introduction
Nutrient requirements are influenced by a combination of
performance potential and feed intake. The nutrient concentration in
the diet is adjusted according to feed intake to meet the
requirements during each stage of production. Providing diets with
nutrient levels below the requirements results in sub-optimal
performance, whereas feeding nutrients above the requirements
increases feed cost and nutrient excretion. Thus, in order to ensure
optimal production at an economical cost, it is important to
understand the factors involved in nutrient requirement estimates
and adjust the diet accordingly.

b) Unit Objectives

By the end of this unit, the learner shall be able to;

Explain the factors influencing nutrient intake

Explain factors that influence nutrient availability
Explain factors influencing nutrient utilization

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements
Lessons: 4
Progress: 0 / 4
Unit Seven Activities
a) Review Questions
Elaborate the factors that influence nutrient intake and utilization of
food
Explain the factors that affect the nutritional status of rural women in
Kenya

review questions
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Chats: 4 Files: 4 Forums: 4

Progress: 0 / 16
Unit Eight: Unit One: Enter Unit Eight Name Here
a) Introduction
Nutrient requirements are influenced by a combination of
performance potential and feed intake. The nutrient concentration in
the diet is adjusted according to feed intake to meet the
requirements during each stage of production. Providing diets with
nutrient levels below the requirements results in sub-optimal
performance, whereas feeding nutrients above the requirements
increases feed cost and nutrient excretion. Thus, in order to ensure
optimal production at an economical cost, it is important to
understand the factors involved in nutrient requirement estimates
and adjust the diet accordingly.

b) Unit Objectives

By the end of this unit, the learner shall be able to;

Explain the factors influencing nutrient intake

Explain factors that influence nutrient availability
Explain factors influencing nutrient utilization

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements

Lessons: 4
Progress: 0 / 4
Unit Eight Activities
a) Review Questions
Elaborate the factors that influence nutrient intake and utilization of
food
Explain the factors that affect the nutritional status of rural women in
Kenya

review questions
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks
[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Forums: 4 Chats: 4 Files: 4

Progress: 0 / 16
Unit Nine: Unit One: Enter Unit Nine Name Here
a) Introduction
Nutrient requirements are influenced by a combination of
performance potential and feed intake. The nutrient concentration in
the diet is adjusted according to feed intake to meet the
requirements during each stage of production. Providing diets with
nutrient levels below the requirements results in sub-optimal
performance, whereas feeding nutrients above the requirements
increases feed cost and nutrient excretion. Thus, in order to ensure
optimal production at an economical cost, it is important to
understand the factors involved in nutrient requirement estimates
and adjust the diet accordingly.

b) Unit Objectives

By the end of this unit, the learner shall be able to;

Explain the factors influencing nutrient intake

Explain factors that influence nutrient availability
Explain factors influencing nutrient utilization

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements

Lessons: 4
Progress: 0 / 4
Unit Nine Activities
a) Review Questions
Elaborate the factors that influence nutrient intake and utilization of
food
Explain the factors that affect the nutritional status of rural women in
Kenya

review questions
b) Performance Tasks
(i) Main Tasks
[The lecturer will provided further instructions on this in addition to
the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Forums: 4 Chats: 4 Files: 4

Progress: 0 / 16
Unit Ten: Unit One: Enter Unit Ten Name Here
a) Introduction
Nutrient requirements are influenced by a combination of
performance potential and feed intake. The nutrient concentration in
the diet is adjusted according to feed intake to meet the
requirements during each stage of production. Providing diets with
nutrient levels below the requirements results in sub-optimal
performance, whereas feeding nutrients above the requirements
increases feed cost and nutrient excretion. Thus, in order to ensure
optimal production at an economical cost, it is important to
understand the factors involved in nutrient requirement estimates
and adjust the diet accordingly.

b) Unit Objectives
By the end of this unit, the learner shall be able to;

Explain the factors influencing nutrient intake

Explain factors that influence nutrient availability
Explain factors influencing nutrient utilization

c) Unit Learning Requirements

To proficiently complete this unit, you ought to make sure you spend
quality time and purpose to;
Carry out all tasks within the sections and subsections
Participate in discussion forums as and when they are scheduled.
Participate in chat sessions as and when they are scheduled.
Learning requirements

Lessons: 4
Progress: 0 / 4
Unit Ten Activities
a) Review Questions
Elaborate the factors that influence nutrient intake and utilization of
food
Explain the factors that affect the nutritional status of rural women in
Kenya
review questions
b) Performance Tasks
(i) Main Tasks

[The lecturer will provided further instructions on this in addition to

the provided tools below...]
(ii) Sub -Tasks

[Discussion forum tool and chat tool below will be used for carrying
out group work..] lab

Assignments: 4 Forums: 4 Chats: 4 Files: 4

Progress: 0 / 16
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