planning

Health Impacts of Climate Variability and Climate Change in Nepal

Bandana PradhanKeshav ShresthaFang Jing

Han Heijnen

Workshop on Climate Change and Healthin South- East and East Asian Countries

Kuala Lumpur, Malaysia2-5 July 2007

Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007

26 22' N - 30 27' N Lat.80 4'E - 88 12'E Long.

0 200 400100 Kilometers

India

China

Iran Pakistan

Myanmar

Thailand

Afghanistan

Laos

Cambodia

Bangladesh

Oman

Bhutan

Sri Lanka

Turkmenistan

Malaysia

0 130 26065 Kilometers

Country Description

Nepal


Physiographic (Ecological) Regions, Nepal

Population growth in Nepal

Pop/km15712610279Density

100.2623.1518.4915.0211.56Country

157.7011.218.636.564.35Tarai

68.8610.258.427.166.07Hill

48.251.691.441.301.14Mountain

2001199119811971

% change 1971- 01

Population (million) by Census YearRegions

Area: 147,181 kmPop growth rate: >2% per annum since 1971 - rapid


Mean

Temperature

Summer: 0 to 30C

Winter: -3 to 18C

Annual Precipitation

Range: from 4500mm

C

Relative

Humidity

Summer: 70 -100%

Winter: 55 90%


All Nepal Temperature Trend y = 0.039x + 19.335R2 = 0.5973

18.0

18.5

19.0

19.5

20.0

20.5

21.0

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

Year

Tem

pera

ture

(C

)

All Nepal annual rainfall trend (1971-2005)y = 3.73x + 1516.56

R2 = 0.08

1000

1200

1400

1600

1800

2000

1971

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

Year

Rai

nfal

l (m

m)


Ngojum

pa Gla

cier

Ngojum

pa Gla

cier

Settlement

Khumbu - largest glacier in Nepal

Economic and industrial development: features

Agriculture: Employs 66% (2001 census) of total economically active population & Contributes 41% to GDP

Manufacturing (primary production based, cement, carpet, garment, etc.): 9%

Commerce: 10%

Hydropower potential = 126,000 MW & shares 2.27% of the world water resources

Tourism: most potential/flourishing industry contributes 2.5% to GDP

Rural areas: 86% rural population & density = 139persons/km & Urban density = 985 persons/km

Rural poverty: 34.6%; Urban poverty: 9.6% (per capita $286)


3.023.31.924,1691004,446Nepal

4.422.71.345,74133.811,503Tarai

3.793.12.273,64252.252,323Hill

1.205.73.672,33613.95620Mountain

HSU/100 km

Area/HSU

HSU/10,000 Pop

Pop/HSU

%Units

Health ServiceUnit and Area (km)

Health ServiceUnit (HSU) and Population

Distribution of Health Services Physio

graphic Regions

Accessibility of Health Services


Household Access to Drinking Water Sources

1.81.56.428.49.052.94,174,457Nepal

2.50.61.158.66.530.81,938,895Terai

1.22.010.12.412.072.21,950,345Hill

1.03.417.10.06.272.2285,217Mountain

OtherRivers/ Stream

Stone Spout

Tube Well

WellTap/Pipe

Percent of Total Households

TotalHouseholds

Ecological Region

Note that all water sources depend on monsoon rainfall for replenishment and sustainability .


05848-2003-2010-131E. coli cfu/100 ml

-+Coliform bacteria (consumption point)

-++++/-Coliform bacteria (source)

0.4-5.00.10.10.10.1PO4 P (mg/l)

0.04-0.40.20.20.2ND-0.2N-NH4 (mg/l)

25023-4526-2722-4510-30Chloride mg/l

0.2NDNDNDNDChlorine mg/l

0.3 -30.30.20.2ND-0.2Iron (mg/l)

6.5-8.57.57.56.5-7.56.5-8.2pH

WHO GVS. spoutWellPu TapPr Tap

Water sourcesParameter

Water Quality Analysis


Temperature increased by 0 to 0.5 C per decade and will increase by 1 to 3.5C over the coming century

Monsoon rainfall - less predictable and less dependable in terms of distribution and amount

Glacier retreat reduction in area and volume Over the past 50 years, 21 recorded GLOFs20 potentially dangerous glacial lakes (GLOF)Weather change fog persist until late morning in Tarai (south)winter mornings are much colder than previous years

Climate Change in Nepal


0

1

2

3

4

5

6Skin

ARI

Diarrhoeal

Intestinal

Worm

s

Pyrexia

Gastritis

Ear

Eye

Bronchitis

Teeth

Disease Types

% of disease

Top Ten OPD Diseases in 2005 (n=9,552,307)


Trend of Vector Borne Diseases in Nepal

0

200

400

600

800

1000

1200

1400

1600

1800

2001 2002 2003 2004 2005

Num

ber o

f cas

es

Viral Encephalitis Filariasis Dengue Fever

Kala-azar Clinical Malaria


Monthly Trends in OPD Visits

0

400

800

1200

J F M A M J J A S O N D

Month

Pat

ient

s vi

sits

('0

00)

2003 2004 2005


1. Vector Borne diseases

2. Water borne diseases

3. Natural hazards induced diseases

Diseases Burden

Malaria endemic in 65 districts Malaria eradication program in 1958 Malaria control program in 1978 Most common species is Plasmodium vivax

Malaria parasite incidence and P.falciparum.

0

0.2

0.4

0.6

0.8

2000 2001 2002 2003 2004 2005

Ann

ual P

aras

ite

inci

denc

e (A

PI/

1000

)

0

4

8

12

16

P.fa

lcip

arum

(%

)

API /1000 P. falciparum (%)

Increasing trend of P. falciparum Anopheles minimus is common vector


Poor drainage conditions

favorable environment for mosquito breeding

Tarai

0.911.12004

0.824.62003

1.419.92002

CFR/100

Incidence/100,000

Year 2. Trend of Kala-azar (VECTOR-BORNE DISEASE)

Kala-Azar(Visceral Leishmaniasis) Endemic in 12 districts(10 Terai + 2 Hill districts)

11.750.362005

7.050.552003

3.600.462000

P. falciparum (%)API/1000Year 1. Malariometric Indicators

17,000 Kg 0.025600,000 Cypermethrin

Insecticide consumption (kg)

Dose /M2 (gm)

Target population

Insecticide used

3. Population Protected by Insecticide Spraying


Kala-azar


Japanese Encephalitis Endemic Districts


Lymphatic Filariasis Elimination Activity


Drinking Water versus Diarrhoeal Diseases


Typhoid fever indirect effect of climate

Occurs where water supply and sanitation is substandard

Precipitation and Typhoid cases from Patan hospital

0

20

40

60

80

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Typ

hoid

cas

es

0

200

400

600

Pre

cipi

tatio

n (m

m)

Typhoid cases Precipitation


0

2000

4000

6000

8000

10000

12000

2001 2002 2003 2004 2005

Tot

al C

ases

0

0.4

0.8

1.2

1.6

2

Cas

e F

atal

ity R

ate

(CF

R) %

Typhoid Average CFR Typhoid CFR

Trend of total inpatient cases of Typhoid disease and comparison of average case fatality rate and Typhoid disease


840

1207

141 154 151

273

193

173 196441

0

200

400

600

800

1000

1200

1400

1600

1998 1999 2000 2001 2002

Number of deaths

Epidemics Avalanches Fires Flood/land slides

Earthquakes Thunderbolts Wind and hailstorm

Human Deaths due to Natural Hazards

Floods = valleys and plain

Landslides = hills

Avalanches = Himalaya


Mal nutrition Status of the Children(n = 5244)

0

20

40

60

Height for age Wt for height Wt for age % o

f

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