Water Associated Diseases and DamsWater Associated Diseases and Dams

Mutamad A. Amin, Faiza Hussein and Mutamad A. Amin, Faiza Hussein and Durra M. HusseinDurra M. Hussein

Ahfad University for WomenAhfad University for Women

IntroductionIntroduction..

The construction of dams and irrigation schemes in The construction of dams and irrigation schemes in tropical areas can cause great modifications in tropical areas can cause great modifications in the environment which favoure the spread and the environment which favoure the spread and multiplications of vector-borne parasitic diseasesmultiplications of vector-borne parasitic diseases . .

Filariasis, malaria, onchocerciasis and Filariasis, malaria, onchocerciasis and schistosomiasis are the major parasitic diseases schistosomiasis are the major parasitic diseases associated with ecological and social changes in associated with ecological and social changes in water resources projects. Table (1) shows global water resources projects. Table (1) shows global distribution of major parasitic diseasesdistribution of major parasitic diseases

Table (1) Global distribution of major parasitic Table (1) Global distribution of major parasitic

diseasesdiseases associated with water resources associated with water resources development Source WHOdevelopment Source WHO

DiseaseDisease number number

endemicendemic

countriescountries

Exposed Exposed populationpopulation

((millionsmillions ) )

Infected Infected population population

(millions)(millions)

SchistosomiasisSchistosomiasisLymphatic filariasisLymphatic filariasis

OnchocerciasisOnchocerciasis

MalariaMalaria

7676

6969

3434

9999

600600

752752

166166

22002200

200200

7575

2525

257Africa 257Africa onlyonly

Water resources development and vector-borne diseases in the Sudan

aa) ) Dams.Several dams were built for conservation and supply of water into canalization systems; these are :

Sennar Dam established in 1925 mainly to irrigate Gzira /Managil scheme.•Jebel Awlia dam established in 1959,

•Khashm –el Girba established in 1964, settlement people of wadi halfa. •Roseires dam established in 1964 (2) to provide electric power.

• Lake Nasser : is a vast reservoir in southern Egypt and northern Sudan. Strictly, "Lake Nasser" refers only to the much larger portion of the lake that is in Egyptian territory (83% of the total), with the Sudanese preferring to call their smaller body of water Lake Nuba. It was created as a result of the construction of the

Aswan High Dam across the waters of the Nile between.

Under construction.. The Merowe High Dam, also known as Merowe Multi-Purpose Hydro Project or Hamdab

Dam, is a large construction project in northern Sudan . The main purpose of the dam will be the generation of electricity. Its dimensions make it the largest contemporary hydropower project in Africa. Before the construction began, an estimated 55,000 to 70,000 people were residents of the area which will be covered by the reservoir lake.( 3 )

b)The major irrigation schemes in the Sudan are shown in Table (2b)The major irrigation schemes in the Sudan are shown in Table (2))

Relevant Relevant informationinformation GeziraGeziraEl GirbaEl Girba Kenana Kenana

SugarSugar RahadRahad

Established inEstablished in::

Size in acresSize in acres::

Settled populationSettled population::

SeasonalSeasonal labourerslabourers :: Snails reported inSnails reported in: :

First evidence of schistosomiasis

19251925

20000002000000

20000002000000

500000500000

19271927

19281928

19641964

8200082000

5000050000

2000020000

19681968 19701970

19751975

8100081000??

85,00085,000

2000020000

19781978

19791979

19781978

300000300000 100000100000

2000020000

19791979

19851985

Adverse health effects of major irrigation schemes in the Sudan 1.Malaria

Malaria is the major health problem in the Sudan and the whole Malaria is the major health problem in the Sudan and the whole country is now considered endemic, with varying degrees. The country is now considered endemic, with varying degrees. The malaria endemic range from holo-endemic in the South to hypo- malaria endemic range from holo-endemic in the South to hypo- endemic in the North with epidemics out breaks. Malaria incidence endemic in the North with epidemics out breaks. Malaria incidence in Sudan was estimated to be in Sudan was estimated to be about 9 million episodes in 2002about 9 million episodes in 2002 and the number of deaths due to malaria was about and the number of deaths due to malaria was about 44,00044,000 . ( 4, . ( 4, 5). The reported high incidence and mortality was attributed to 5). The reported high incidence and mortality was attributed to chloroquine resistance and shortages in funds for vector control. chloroquine resistance and shortages in funds for vector control. Report of Malaria National Control Programme for 2006 indicated Report of Malaria National Control Programme for 2006 indicated reductions in prevalence ( 3-5 million cases ) and mortality ( 1100 reductions in prevalence ( 3-5 million cases ) and mortality ( 1100

cases )cases )

2. Schistosomiasis

Schistsomiasis is now a major public health problem

in the Sudan with social and economic implications .

the National Schistosomiasis Control Programme

showed point prevalence rates up to 56.7%

for intestinal schistosomiasis in the White Nile, 45 %

in Gezira Managil/ Irrigation Scheme and 49%

for urinar type in Girba Irrigation Scheme,

Eastern Sudan. Five million people are estimated

to be infected and the prevalence rates in sugar schemes are over 50%. It is not acceptable

that Khartoum , the capital of Sudan is endemic

with scistosomiasis , a disease of rural poor settings

33.. Onchocerciasis, River blindnessOnchocerciasis, River blindness

An estimated 5 million people are at risk of river blindness (onchocerciasis) An estimated 5 million people are at risk of river blindness (onchocerciasis) in the whole of Sudan. The highest incidence of blinding onchocerciasis in the whole of Sudan. The highest incidence of blinding onchocerciasis occurs in southern Sudan, which includes the area affected by civil war. occurs in southern Sudan, which includes the area affected by civil war. After the 1995 . The Carter Center works with the government of Sudan, After the 1995 . The Carter Center works with the government of Sudan, other non governmental organizations, and the African Programme for other non governmental organizations, and the African Programme for Onchocerciasis Control. together, under the umbrella organization of the Onchocerciasis Control. together, under the umbrella organization of the National Onchocerciasis Task Force, they establish community-based National Onchocerciasis Task Force, they establish community-based treatment programs, which raise awareness in villages andtreatment programs, which raise awareness in villages and enable the enable the

distribution of drugdistribution of drug

..44.. Lymphatic Filariasis (LF)Lymphatic Filariasis (LF) Lymphatic Filariasis is a chronic parasitic disease caused by Lymphatic Filariasis is a chronic parasitic disease caused by

three nematodes, namely Wuchereria bancrofti , Brugia three nematodes, namely Wuchereria bancrofti , Brugia malayi and B. timorimalayi and B. timori . .

8383 tropical and subtropical countriestropical and subtropical countries . . 120120 million persons was affectedmillion persons was affected

1.11.1 billion being at riskbillion being at risk..4040 million incapacitated or disfigured with swelling of the million incapacitated or disfigured with swelling of the

limbs and breasts (lymphoedema) and genitals (hydrocele)limbs and breasts (lymphoedema) and genitals (hydrocele)

Second leading cause of permanent disability worldwideSecond leading cause of permanent disability worldwide . .The disease is considered as an important cause of economic The disease is considered as an important cause of economic losses and social stigmalosses and social stigma..

More than 90% of the filariasis cases of the EMRO are living in Sudan . Sudan was unable to finish the mapping and to stat the MDA program for elimination of lymphatic filariasis because of the war there. Although of war mapping has been done is many areas in Sudan . None of the examined areas were negative. This would raise the suggestion that all Sudanese are living in filariasis endemic areas. WHO is now supporting two offices in Sudan, one in the North in Khartoum and the other is in Juba..

lymphoedema of armslymphoedema of arms::

TransmissionTransmission:: The disease is transmitted by all type mosquitoesThe disease is transmitted by all type mosquitoes

Distribution of LF in Sudan

Challenges introduced by dams and water resources

development projects

The changes introduced by dams and irrigation systems The changes introduced by dams and irrigation systems aggravate health risks in different ways. With regards to aggravate health risks in different ways. With regards to parasitic diseases, effects includeparasitic diseases, effects include: :

11 . .Create suitable habitats – design of the scheme, irrigation Create suitable habitats – design of the scheme, irrigation practices and water management techniques and crop practices and water management techniques and crop

rotation (1)rotation (1)

22 . .Displacement, migration, and settlementDisplacement, migration, and settlement. .

Important considerationsImportant considerations

11--The need for a sound national control planThe need for a sound national control plan Except for malaria , all other parasitic diseases are not regarded as a public heath priority by policy makers and health authorities in most endemic countries including the Sudan and as such receive little or none financial support. WHO assigned thirteen diseases including schistosomiasis onchocerciasis , filariasis as Neglected Tropical Diseases-NTDs. They are neglected simply because it is more difficult to include chronic disability and illness into the agenda of ministries of health, especially in presence of more important diseases such as HIV/AIDS, TB and malaria . To convince decision makers a sound cost-effective national plan with a clear strategy and objectives should be produced. The basis of the plan can be envisaged as follows :Epidemiology / public health importance An adequate appraisal of the epidemiology of the disease ,( transmission, morbidity, disease burden socio –economic aspects etc) is necessary in order to develop a sound control strategy . In 1993, the World Bank Development Report (Investing in Health ) introduced a system of disability adjusted life years lost (DALYs) as a measure of disease burden.

Country-specific data for the burden of disease could support the justification

for control.

• •Integration with related diseasesA cost- effective approach is to integrate the control of related A cost- effective approach is to integrate the control of related diseases. An example of a successful story was the Blue Nile health diseases. An example of a successful story was the Blue Nile health Project, SudanProject, Sudan.(6.(6))

•Integration into primary health care settings

The greatest challenge is to extend diagnosis and regular The greatest challenge is to extend diagnosis and regular chemotherapy coverage as a public health intervention to chemotherapy coverage as a public health intervention to reach all individuals at risk of the morbidity caused by reach all individuals at risk of the morbidity caused by parasitic diseases. Vertical campaigns are no longer parasitic diseases. Vertical campaigns are no longer appropriate .Since the late 1970s, when morbidity control appropriate .Since the late 1970s, when morbidity control became the preferred strategy, schistosomiasis control became the preferred strategy, schistosomiasis control programmes have increasingly been integrated into primary programmes have increasingly been integrated into primary health care settings and schools health care settings and schools (7)(7)

•• Intersectoral cooperation

Transmission control requires an intersectoral approach and multi-angle Transmission control requires an intersectoral approach and multi-angle control efforts for water supply, sanitation and environmental control efforts for water supply, sanitation and environmental managementmanagement..

22 - -Capacity building needsCapacity building needs

Improved capacity of the health system at all levels especially Improved capacity of the health system at all levels especially at periphery level is crucial for achieving sustainable at periphery level is crucial for achieving sustainable controlcontrol . .

This requires accessibility of drugs, a capacity to diagnose, and This requires accessibility of drugs, a capacity to diagnose, and

a capacity to treat and capacity for vector controla capacity to treat and capacity for vector control.. 33--population movementspopulation movements- -

The impact of population movements on transmission and The impact of population movements on transmission and control of tropical diseases has been demonstrated in control of tropical diseases has been demonstrated in several countries. In Sudan imported and migrant several countries. In Sudan imported and migrant agricultural labourers played a significant role in the agricultural labourers played a significant role in the spread of schistosomiasis and malaria in water resource spread of schistosomiasis and malaria in water resource development schemes (8,9,10) Of great significance was development schemes (8,9,10) Of great significance was the spread of drug resistant strain of Plasmodium the spread of drug resistant strain of Plasmodium falciparum. The active transmission of schistosomiasis falciparum. The active transmission of schistosomiasis around Khartoum is caused by displaced communities around Khartoum is caused by displaced communities coming from endemic areas from Southern and Western coming from endemic areas from Southern and Western SudanSudan

4-New water resource development projectsWHO (2001) recommended to the World Commission on Dams (WCD) that WHO (2001) recommended to the World Commission on Dams (WCD) that health impact assessment (HIA) to be included as an integral component in health impact assessment (HIA) to be included as an integral component in the planning of dams and other major water infrastructure projects and a the planning of dams and other major water infrastructure projects and a health component should be negotiated as a budget item for all project health component should be negotiated as a budget item for all project loans in order to safeguard and enhance health. Parasitic diseases have a loans in order to safeguard and enhance health. Parasitic diseases have a stake in both environmental impact assessment (EIA) and social impact stake in both environmental impact assessment (EIA) and social impact assessment (SIA) (1)assessment (SIA) (1)

5 -Operational research needsOperational research is required to improve intervention strategies, diagnostic Operational research is required to improve intervention strategies, diagnostic techniques and to facilitate human behaviour change and social science techniques and to facilitate human behaviour change and social science and to address many other questionsand to address many other questions..

RecommendationsRecommendations..

The economic justification for development of water resources for The economic justification for development of water resources for agriculture and electric power in the Sudan is beyond argumentagriculture and electric power in the Sudan is beyond argument.. The following recommendations are thought to be relevant to The following recommendations are thought to be relevant to

situation in Sudansituation in Sudan..

1-There is a need for a cost-effective comprehensive integrated national plan with clearly defined objectives and strategies. Specific data for the burden of the disease could support the justification for control .

2 - Plans of action at state levels and plans of operation at district levels have to be developed. Vertical campaigns are no longer appropriate. Control activities need to be integrated into primary health care settings and schools.

3 -There is a need for capacity building at state and district levels ( accessibility of drugs, a capacity to diagnose, and a capacity to treat and capacity for snail control.)

4-There is a need for health, environmental and social impact assessment in the newly developing dams and irrigation schemes.

5 -A budget item for prevention and control of water associated diseases need to be included in the budget of water resource development projects

with government contribution..

ALL THE BESTFishing Eagles are a common bird along the NileFishing Eagles are a common bird along the Nile