Every year, World Toilet Day is observed to raise awareness about the global sanitation crisis and encourage action to solve it. The goal set by the United Nation is to achieve safe toilets for all by 2023, as a part of their Sustainable Development Goals.

The UN also states that 3.5 billion people live without proper sanitation and many children also lose their lives due to poor sanitation and unsafe water. This is why World Toilet Day is observed to raise awareness on this issue.

Theme

This year, the theme for World Toilet Day 2024 is "Toilets - A Place for Peace'. This focuses on the growing threat to sanitation that is caused by conflict, climate change, disaster and neglect. When there is a threat to using toilets, it can lead to many health risks.

Not using toilets for too long may lead to Urinary Tract Infection or UTI. For many who do not have access to clean toilets do not drink enough liquid or hold pee for too long. Doctors suggest that holding in pee for too long can cause bacteria to multiply and lead to UTI. By not drinking enough water, your bladder fails to tell the body to pee often, and can cause the bacteria to spread through the urinary tract, which can lead to infection.

Symptoms of UTI:

• Burning or stinging feeling while urinating
• Pain in pelvis or lower abdomen
• Constant urge to empty the bladder
• Strong or foul smelling urine
• Consistently dark urine
• Blood in urine

Holding in pee for too long can also cause your bladder to stretch, making it difficult or even impossible for the bladder to contract and release pee normally. It can also damage your pelvic floor muscles or could lead to kidney stones.

World Toilet Day History And Significance

To prevent such conditions, it is important that everyone has access to clean and safe toilets. In terms of history, the day was established in 2001, by the World Toilet Organization (WTO), which was founded by Jack Sim. However, it was officially recognised by the UN in 2013. The Government of Singapore worked with WTO to create the first UN resolution called Sanitation for All.

India too promotes safe and hygiene toilet through its Swachh Bharat Yojna.

Duloxetine, a widely prescribed antidepressant, has been recalled in the United States after the US Food and Drug Administration (FDA) found potentially cancer-causing impurities above federal safety limits.

According to the Cleveland Clinic, duloxetine is commonly used to treat depression, anxiety, fibromyalgia, and certain chronic pain conditions.

The FDA issued a notice stating the presence of N-nitroso-duloxetine, a nitrosamine impurity detected at levels exceeding the agency's recommended safety threshold. The recall affects nearly 370,000 bottles of prescription-only duloxetine delayed-release capsules USP, 30mg, 1000 Capsule bottles, distributed across the US.

The agency warned that exposure to nitrosamine impurities "may increase the risk of cancer if people are exposed to them above acceptable levels and over long periods of time."

The agency classified the action as a Class II recall, indicating that use of or exposure to the product may cause temporary or medically reversible adverse health consequences, while the likelihood of serious health effects remains low.

How Is Duloxetine Linked to Cancer?

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Notably, this is the second duloxetine recall linked to the same impurity. In October 2024, more than 7,000 bottles were recalled because of potential nitrosamine contamination.

According to the FDA, people who take medications containing nitrosamines—even daily for up to 70 years—are not expected to face an increased cancer risk if nitrosamine levels remain at or below the recommended limits.

There is currently no direct evidence linking N-nitroso-duloxetine itself to cancer. However, it belongs to a class of compounds known as nitrosamines, some of which are considered probable human carcinogens.

Moreover, health risks associated with nitrosamines generally depend on both the amount and duration of exposure. Higher levels over extended periods are considered more concerning.

The US National Library of Medicine describes N-nitroso-duloxetine as a compound that is "suspected of causing cancer" and notes that it is toxic if swallowed.

At the same time, the California State Board of Pharmacy emphasizes that exposure does not automatically result in cancer. The agency notes that nitrosamines are commonly found in water and foods, including cured and grilled meats, dairy products, and vegetables.

"Everyone is exposed to some level of nitrosamines," the board states. "These impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time."

What Are Antidepressants?

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Antidepressants are prescription medications used to treat depression, anxiety disorders, chronic pain, and other conditions by increasing levels of certain brain chemicals involved in mood regulation.

Common classes of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medications often take several weeks to achieve their full therapeutic effect. Common side effects may include dry mouth, dizziness, nausea, and weight changes. Emerging research also suggests that side effects can vary significantly depending on the specific medication.

What Is Duloxetine?

Duloxetine belongs to a class of antidepressants known as SNRIs.

Cleveland Clinic explained that duloxetine is used to treat depression, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, including nerve, bone, and joint pain.

The medication works by increasing levels of serotonin and norepinephrine in the brain—neurotransmitters that help regulate mood and pain perception.

The ongoing Ebola epidemic in the Democratic Republic of the Congo (DRC) could continue for more than a year, as the outbreak has yet to reach its peak, according to the International Federation of Red Cross and Red Crescent Societies (IFRC).

In a statement, the global aid organization also expressed concern that the Ebola crisis could divert attention and resources from ongoing humanitarian emergencies and conflicts across the region.

"We are afraid that this could last one year to end this disease," said Bruno Michon, Operations Manager for the IFRC.

The warning echoes concerns raised by the NGO Doctors Without Borders (MSF), which has said that the outbreak is currently spreading faster than response efforts can contain it.

The concerns come as both infections and deaths continue to rise. According to the DRC Ministry of Health, 29 new confirmed cases were recently reported, bringing the total number of infections to 837. Four additional deaths have pushed the death toll to 196, while the case fatality rate has increased to 23.4 per cent.

Meanwhile, 49 people have recovered from the disease, and approximately 376 patients remain in isolation.

The outbreak, caused by the Bundibugyo strain of the Ebola virus, is spreading rapidly in remote areas of the DRC and neighboring Uganda.

Uganda has not reported any new cases. So far, the country has recorded 19 confirmed infections and two deaths.

Could It Become the Deadliest Ebola Outbreak?

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The Ebola outbreak in the DRC could surpass the deadliest Ebola epidemic on record—which claimed more than 11,000 lives in West Africa between 2014 and 2016—if it is not brought under control soon, according to Africa's Centers for Disease Control and Prevention (Africa CDC).

"If we don't stop the outbreak very soon, it will be worse than what we had in West Africa and eastern DRC," Africa CDC Director-General Jean Kaseya said during a virtual meeting of African leaders and international donors in Burundi.

Speaking to Al Jazeera, Kaseya said that tens of thousands of people who may have been exposed to the virus have not yet been traced.

"Contact tracing is a major indicator and a major issue. We are missing more than 26,000 people, and we don't know where they are, and we don't know if they are contaminating other people," he said.

Testing and Contact Tracing Challenges

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There is currently no approved vaccine or treatment specifically for the Bundibugyo strain of Ebola. The World Health Organization (WHO) estimates that it could take up to nine months before a vaccine candidate is ready.

Testing remains one of the biggest weaknesses in the outbreak response. WHO Director-General Tedros Adhanom Ghebreyesus also voiced concern after visiting the DRC.

"I'm really worried," Tedros said, according to Stat News.

He explained that in North Kivu, South Kivu, and Ituri provinces—where the outbreak is concentrated—many residents view Ebola as a lesser threat compared with armed conflict, hunger, and other common deadly diseases.

"When the community is not taking it as its priority, it's very hard," Tedros said.

Many communities, particularly those affected by ongoing violence, still lack access to testing facilities and diagnostic kits. Treatment centers are also experiencing significant delays in receiving laboratory results, slowing efforts to identify and isolate infections quickly.

What Is Ebola?

Ebola is a severe and often fatal viral hemorrhagic fever first identified in 1976. Since then, more than 30 outbreaks have been recorded, primarily in Central and West Africa.

Common symptoms include:

• Fever
• Headache
• Weakness and fatigue
• Vomiting
• Diarrhea
• Muscle pain
• Sore throat
• Unexplained bleeding or bruising

In severe cases, the disease can lead to organ failure, internal bleeding, shock, and death. Aid organizations warn that without stronger surveillance, expanded testing, faster laboratory turnaround times, and more effective contact tracing, the outbreak could continue to grow in the coming weeks and months.

Kerala has reported 70 cases and four deaths due to shigellosis (bacillary dysentery), a highly contagious bacterial disease caused by Shigella bacteria, during June alone.

The southern state has recorded a total of 146 cases and five deaths from the intestinal infection since the beginning of the year, according to state Health Minister K. Muraleedharan. While one death was reported in March, the remaining four occurred in June.

Out of the 146 cases, 74 were reported in Kozhikode district, followed by 25 cases in Malappuram, including two deaths. Thiruvananthapuram also reported 25 cases, according to figures released by the minister.

No Shigella cases have been reported this year from Pathanamthitta, Palakkad, or Kasaragod districts.

A one-year-old child undergoing treatment for Shigella infection in the intensive care unit of Kozhikode Medical College Hospital remains in critical condition.

Why Children Are Most Vulnerable

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Young children are particularly vulnerable to the disease, which is primarily spread through contaminated food, contaminated water, and poor hygiene practices.

Of the five deaths reported in Kerala this year, four occurred in children under the age of 10. Shigella infections tend to be most severe in children below five years because their immune systems are less efficient at clearing the infection.

Dr. Rajeev Jayadevan, former President of the Indian Medical Association (IMA) Cochin and Convener of the Research Cell, Kerala, explained that the bacteria's resilience contributes to its spread.

“Shigella is able to withstand the hostile acidic environment of the human stomach. Outside the human body, it can stay alive in water for weeks together,” he told HealthandMe.

He added that even a very small number of bacteria—as few as 10 organisms—can cause infection.

Drug-Resistant Shigella Rising In The US

In April, the US Centers for Disease Control and Prevention (CDC) highlighted growing concerns about drug-resistant Shigella strains in its Morbidity and Mortality Weekly Report.

The report noted that changes in epidemiology and antibiotic resistance are transforming Shigella from a largely self-limiting infection into an emerging public health threat with limited treatment options.

According to the CDC, oral carbapenems, pivmecillinam, and fosfomycin may be effective against some resistant strains. However, none have been approved by the US Food and Drug Administration for treating shigellosis.

“Treatment of XDR shigellosis remains challenging because no optimal therapy has been established,” the report stated.

While Kerala's cases have largely been reported among young children, outbreaks in the United States have been more commonly reported among adult men, highlighting sexual activity as a potential route of transmission.

The CDC estimates that approximately 450,000 Americans develop shigellosis each year. Although most patients recover with rest and hydration, severe cases may require hospitalization.

Read More: One Month Into DR Congo Ebola Outbreak, Cases Cross 800 As Crisis Deepens

Shigella: Symptoms And Mode Of Transmission?

Shigella can spread through:

• Touching contaminated surfaces or objects
• Physical contact with an infected person
• Drinking contaminated water
• Consuming ice made from contaminated water

Symptoms usually develop within one to three days after exposure and may initially include:

• Fever
• Diarrhea
• Body aches
• Headache
• Bloody diarrhea
• Severe abdominal cramps

How to Prevent Shigella Infection

Oral Rehydration Solution (ORS) can help prevent dehydration, while zinc supplementation may aid recovery.

Other preventive measures include:

• Washing hands thoroughly with soap and water, especially before handling food and after using the toilet
• Maintaining strict hygiene among food handlers
• Controlling flies and preventing food contamination.