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.

Kerala is battling a highly contagious bacterial disease called shigellosis (bacillary dysentery), caused by the bacteria Shigella. The southern state has recorded 85 cases of the intestinal infection called shigellosis since the beginning of this year.

All districts in the state have reported sporadic cases of the disease, which is primarily caused by contaminated food and water or poor hygiene practices.

Currently, cases have been reported from northern districts such as Wayanad, Kozhikode, Alappuzha, and Malappuram.

This week, two cases involving a four-and-a-half-year-old boy and a five-year-old girl were confirmed among children at Mar Baselios School in Wayanad.

About 25 students with suspected Shigella infection have been admitted to the Sultan Bathery Taluk Headquarters Hospital. However, Kerala Health Minister K. Muraleedharan said their conditions are stable, ANI reported.

Earlier, a four-year-old girl undergoing treatment at Kozhikode Medical College died after being infected with Shigella.

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According to health authorities, 339 people have reported symptoms associated with the infection. Of these, 21 are undergoing treatment at Sultan Bathery Taluk Headquarters Hospital, while 38 others are receiving treatment at private hospitals.

Officials said none of the patients is currently in serious condition. A total of 21 samples were sent for laboratory testing. Two samples have tested positive so far, while the results of the remaining samples are awaited.

Muraleedharan also asserted that the Shigella outbreak reported in parts of the state remains under control, even as health authorities continue monitoring cases in Wayanad and other districts.

The Health Minister noted that a special medical team from Kozhikode Medical College has been deployed to Wayanad, where several students were admitted to hospital following reports of shigellosis, a highly contagious bacterial intestinal infection.

Shigella: Why Are Young Children at High Risk?

Speaking to HealthandMe, Dr. Rajeev Jayadevan, Ex-President of IMA Cochin and Convener of the Research Cell, Kerala, explained that even a small number of bacteria—as few as 10—is enough to cause infection.

It is because the Shigella bacteria “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 said.

Shigella is most severe in children below the age of five, as their immune systems are less efficient at clearing the infection early.

“Adults also become ill, but acquired immunity from childhood keeps the infection mild in many instances,” the expert said.

How Does Shigella Spread?

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Shigella spreads through:

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

“Shigella outbreaks can occur in crowded places such as anganwadis, where children come into close physical contact with each other and share toys. Very young children also have the habit of putting their fingers in their mouths, which enables the bacteria to gain access to their gut,” Dr. Jayadevan said.

The expert noted that houseflies can also spread the bacteria. Flies transmit the bacteria from human feces to food, water, and surfaces, contributing to up to 37 percent of cases in some regions, according to a study published in PLOS Neglected Tropical Diseases.

Shigella: What Are the Symptoms?

The disease typically develops within one to three days after ingestion of the bacteria and may begin with:

• Fever
• Diarrhea
• Body aches
• Headache

Once the infection involves the large intestine, bloody diarrhea can occur along with severe abdominal cramps.

How to Prevent Shigella

Dr. Jayadevan stressed the need for early recognition and treatment with appropriate antibiotics. ORS can help prevent dehydration, while zinc tablets can enhance recovery.

Other measures to reduce the risk of spread include:

• Washing hands with soap and water, especially before touching food and after using the toilet
• Maintaining hygiene among food handlers
• Controlling flies.

From 130 maternal deaths per lakh live births during 2014–16, India has achieved a 43-point reduction in the Maternal Mortality Ratio (MMR) between 2022 and 2024, according to the government.

Currently, the MMR in the country stands at 87 maternal deaths per lakh live births.

In an official statement, the government credited the achievement to Pradhan Mantri Surakshit Matritva Abhiyaan (PMSMA), which today completed a decade.

Launched in June 2016, PMSMA provides free, comprehensive antenatal care to pregnant women at designated government health facilities on the 9th of every month.

More than 7.50 crore pregnant women have received antenatal services under PMSMA in addition to routine ANC check-up services in the last 10 years. The Extended PMSMA, launched in 2022, strengthens follow-up care and tracking for high-risk pregnancies.

"Over the past decade, the Pradhan Mantri Surakshit Matritva Abhiyaan has transformed the delivery of antenatal care in India. Quality maternal healthcare is now more accessible, systematic and responsive," the statement said.

“The remarkable decline in the Maternal Mortality Ratio from 130 to 87 over the past decade demonstrates how focused interventions can save thousands of lives,” it added.

How PMSMA Works

The government noted that PMSMA works through:

• Early identification of high-risk pregnancies
• Regular monitoring
• Timely medical intervention

"PMSMA has demonstrated that when quality healthcare reaches women at the right time, it saves lives, prevents complications and creates healthier beginnings for families and future generations," the govt said.

Services Offered Under PMSMA

The PMSMA service package includes clinical examinations, laboratory investigations (blood and urine tests), ultrasonography, medicines, and counselling on nutrition, birth planning, and safe pregnancy practices.

Key features include:

• Minimum one comprehensive and quality antenatal check-up by an Obstetrician and Gynecologist or a Comprehensive Emergency Obstetric and Newborn Care (CEmONC) trained doctor during the second or third trimester.
• Mobilizing pregnant women for specialist antenatal care services at designated public health facilities.
• High-risk pregnancy identification by screening for 25 high-risk factors and management at an early stage.
• Linking high-risk pregnancies to the nearest First Referral Unit (FRU) for safe delivery.
• Empanelment of private service providers for PMSMA service provision.
• Essential blood and urine investigations and ultrasonography.
• Counselling on nutrition, appropriate birth planning, and complication readiness for every pregnant woman.

Who Can Access PMSMA Services?

The program is available to:

• Pregnant women in their second trimester (13–27 weeks) or third trimester (28 weeks until delivery).
• Indian citizens residing in India who are willing to visit designated government health facilities on the 9th of every month.
• High-risk pregnancy cases, which receive priority attention and follow-up care.
• Women who are dropouts from regular antenatal care and are actively encouraged to participate.

What Is Maternal Mortality Ratio?

MMR is defined as the number of maternal deaths per one lakh live births during a given period.

A maternal death refers to the death of a woman during pregnancy or within 42 days of termination of pregnancy due to causes related to or aggravated by the pregnancy or its management, excluding accidental or incidental causes.

Maternal health remains one of the clearest indicators of the strength and inclusiveness of a country's healthcare system.

"As India marches towards Viksit Bharat@2047, PMSMA will continue to transform the maternal healthcare landscape by ensuring that every pregnancy is safer and every mother receives the care she deserves. With continued commitment and collective action, PMSMA can help usher in an era where no woman loses her life while giving life, strengthening the foundations of a healthier and more prosperous India," the statement said.

Health officials in Kerala have reported two deaths caused by West Nile fever in Ernakulam district.

The deceased was identified as Muraleedharan, a 70-year-old man from Kadangalloor near Aluva. The elderly man died while undergoing treatment on Monday at Kalamassery Medical College, officials said.

Muraleedharan, who was suffering from cancer and had respiratory problems, was admitted to the Medical College Hospital a few days ago with symptoms of West Nile fever. This is the second death from West Nile fever in the Ernakulam district in a week.

Saraswathiyamma, a native of Paravur, died of West Nile fever the other day. Many people have reportedly sought treatment at various hospitals in Ernakulam district with West Nile fever and dengue fever symptoms.

Health Department Issues Advisory

Following the incident, the state health department urged people to remain cautious and also issued an advisory urging the public to take precautions against the mosquito-borne disease.

The West Nile Fever "is caused by a flavivirus commonly found in migratory birds and is transmitted to humans through the bite of infected mosquitoes," the department said, in a statement.

It clarified that "the disease does not spread from person to person and that preventing mosquito bites is the most effective way to avoid infection".

According to health authorities, symptoms may include fever, high body temperature, stiffness of the neck, behavioral changes, confusion, semi-consciousness, or loss of consciousness, PTI reported.

The statement warned that severe infection could affect the nervous system and lead to conditions such as encephalitis and meningitis.

"Elderly persons, those with low immunity, individuals with underlying illnesses, pregnant women, and children have been identified as high-risk groups requiring special attention. Culex mosquitoes, which breed in stagnant and polluted water bodies, drainage channels, septic tanks, marshy areas, paddy fields, and overgrown vegetation, are the primary carriers of the disease," the statement said.

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What Is West Nile Fever?

The disease is spread through mosquito bites, and most who get infected do not have any symptoms. However, one in every five infected people has a fever, headache, body aches, and other flu-like symptoms.

The West Nile virus also infects the nervous system and is capable of causing serious brain or spinal cord inflammation.

According to the WHO, West Nile Virus is a member of the flavivirus genus and belongs to the Japanese encephalitis antigenic complex of the family Flaviviridae.

The mosquitoes become infected when they feed on birds that carry the virus in their blood, and then bite humans and infect them.

West Nile Fever: The Symptoms

The symptoms include fever, headache, muscle aches, nausea and vomiting, diarrhoea, rash around the chest and back, swollen lymph nodes, sore throats, and pain behind the eyes.

In severe cases, individuals may have an intense headache, high fever, stiff neck, making you unable to move your chin towards your chest, confusion, muscle weakness, loss of control over your muscle movements, seizures, paralysis, and coma.

West Nile Fever: How Does It Spread?

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While the mosquitoes that feed on infected birds are the carriers, there is still a lack of evidence to determine whether it comes directly from the birds. The incubation period for symptoms to show up is two to six days, but it can extend to 14 days, too.

It can be transmitted from a pregnant person to their fetus, through human milk, blood transfusion, and organ transplant. People who are over the age of 60, have cancer, diabetes, or high blood pressure are more prone to the virus.

West Nile Fever: Treatment

There are no treatments or antiviral medications available for it. However, one can treat the mild symptoms at home with over-the-counter medications that you take for a cold or the flu. The best way to prevent is to protect yourself from mosquito bites.