Water Associated Diseases and Dams Mutamad A. Amin, Faiza Hussein and Durra M. Hussein Ahfad University for Women

Introduction. Introduction. The construction of dams and irrigation schemes in tropical areas can cause great modifications in the environment which favoure the spread and multiplications of vector-borne parasitic diseases. Filariasis, malaria, onchocerciasis and schistosomiasis are the major parasitic diseases associated with ecological and social changes in water resources projects. Table (1) shows global distribution of major parasitic diseases

Table (1) Global distribution of major parasitic diseases associated with water resources development Source WHO Infected population (millions) Exposed population (millions) number endemic number endemiccountriesDisease Africa only Schistosomiasis Lymphatic filariasis OnchocerciasisMalaria

Water resources development and vector-borne diseases in the Sudan a ) a ) 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.reservoirEgyptSudanAswan High DamNile. 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 )Sudan electricityhydropower

b)The major irrigation schemes in the Sudan are shown in Table (2 ) Rahad Kenana Sugar El Girba Gezira Gezira Relevant information ?85, Established in: Size in acres: Settled population: Seasonal labourers : Snails reported in : First evidence of schistosomiasis

Adverse health effects of major irrigation schemes in the Sudan 1.Malaria Malaria is the major health problem in the Sudan and the whole country is now considered endemic, with varying degrees. The malaria endemic range from holo-endemic in the South to hypo- endemic in the North with epidemics out breaks. Malaria incidence in Sudan was estimated to be about 9 million episodes in 2002 and the number of deaths due to malaria was about 44,000. ( 4, 5). The reported high incidence and mortality was attributed to chloroquine resistance and shortages in funds for vector control. Report of Malaria National Control Programme for 2006 indicated reductions in prevalence ( 3-5 million cases ) and mortality ( 1100 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

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

.4. Lymphatic Filariasis (LF) Lymphatic Filariasis is a chronic parasitic disease caused by three nematodes, namely Wuchereria bancrofti, Brugia malayi and B. timori. Lymphatic Filariasis is a chronic parasitic disease caused by three nematodes, namely Wuchereria bancrofti, Brugia malayi and B. timori. 83 tropical and subtropical countries. 120 million persons was affected 120 million persons was affected 1.1 billion being at risk. 40 million incapacitated or disfigured with swelling of the limbs and breasts (lymphoedema) and genitals (hydrocele) 40 million incapacitated or disfigured with swelling of the limbs and breasts (lymphoedema) and genitals (hydrocele) Second leading cause of permanent disability worldwide. Second leading cause of permanent disability worldwide. The disease is considered as an important cause of economic losses 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 arms:

Transmission: The disease is transmitted by all type mosquitoes The 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 aggravate health risks in different ways. With regards to parasitic diseases, effects include : 1. Create suitable habitats – design of the scheme, irrigation practices and water management techniques and crop rotation (1) 2. Displacement, migration, and settlement.

Important considerations 1-The 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 diseases A cost- effective approach is to integrate the control of related diseases. An example of a successful story was the Blue Nile health Project, Sudan.(6 ) Integration into primary health care settings The greatest challenge is to extend diagnosis and regular chemotherapy coverage as a public health intervention to reach all individuals at risk of the morbidity caused by parasitic diseases. Vertical campaigns are no longer appropriate.Since the late 1970s, when morbidity control became the preferred strategy, schistosomiasis control programmes have increasingly been integrated into primary health care settings and schools (7) Intersectoral cooperation Transmission control requires an intersectoral approach and multi-angle control efforts for water supply, sanitation and environmental management.

2- Capacity building needs Improved capacity of the health system at all levels especially at periphery level is crucial for achieving sustainable control. Improved capacity of the health system at all levels especially at periphery level is crucial for achieving sustainable control. This requires accessibility of drugs, a capacity to diagnose, and a capacity to treat and capacity for vector control. 3-population movements - 3-population movements - The impact of population movements on transmission and control of tropical diseases has been demonstrated in several countries. In Sudan imported and migrant agricultural labourers played a significant role in the spread of schistosomiasis and malaria in water resource development schemes (8,9,10) Of great significance was the spread of drug resistant strain of Plasmodium falciparum. The active transmission of schistosomiasis around Khartoum is caused by displaced communities coming from endemic areas from Southern and Western Sudan The impact of population movements on transmission and control of tropical diseases has been demonstrated in several countries. In Sudan imported and migrant agricultural labourers played a significant role in the spread of schistosomiasis and malaria in water resource development schemes (8,9,10) Of great significance was the spread of drug resistant strain of Plasmodium falciparum. The active transmission of schistosomiasis around Khartoum is caused by displaced communities coming from endemic areas from Southern and Western Sudan

4-New water resource development projects WHO (2001) recommended to the World Commission on Dams (WCD) that health impact assessment (HIA) to be included as an integral component in the planning of dams and other major water infrastructure projects and a health component should be negotiated as a budget item for all project loans in order to safeguard and enhance health. Parasitic diseases have a stake in both environmental impact assessment (EIA) and social impact assessment (SIA) (1) 5- Operational research needs Operational research is required to improve intervention strategies, diagnostic techniques and to facilitate human behaviour change and social science and to address many other questions. Recommendations. The economic justification for development of water resources for agriculture and electric power in the Sudan is beyond argument. The following recommendations are thought to be relevant to situation 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 BEST Fishing Eagles are a common bird along the Nile