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Health effects of Climate Change
Initiatives in Bangladesh
Paolo Vineis
Aneire Khan
Imperial College London
Which strategy in low-income, high-risk countries?
Capacity building:
- improvement of health statistics, hospital records, hospital discharge data …
- use of remote sensing data and GIS to assess “exposures” (eg frequency of
floods, drought, changes in vegetation and agricultural practices, spreading of
vectors) …
- need for good epidemiological studies with formal design
- proposals and training for adaptation and mitigation
Climate & health effects in Bangladesh
•
Bangladesh is vulnerable to
natural hazards and the future
effects of climate change.
– Deltaic plains of the Ganges,
Brahmaputra Meghna rivers
– Suffer from acute climate events –
floods, droughts, cyclones
– Long-term environmental
degradation → salinization & soil
degradation
– Effects likely to be exacerbated by
climate change & sea-level rise
Research questions
•
Feasibility study that will provide the necessary tools to address
the following questions:
1. What are the health effects of environmental salinization?
2. Do climate-induced events (e.g. floods and droughts) affect
micronutrient intake in rural populations?
Specific goals:
•
Measure variation in solute composition in drinking water sources in coastal
villages, develop protocols for measuring urinary salt excretion in order to
design a cross-sectional study on hypertension and CVD risk.
•
Perform exploratory hospital-based case-control study on association
between water source & (pre)clampsia among pregnant women in the same
area
•
Define a set of markers of micronutrient intake that can be used assess
health impacts of floods in rural Bangladeshi women
Map showing different SLR scenarios to
estimate how much salt water will intrude inland
•
Rising sea levels in the Bay of
Bengal encroaching inland in the
southern districts of Bangladesh resulting in salinization
•
•
Currently saline 2.8 million ha
20 million people currently
affected by varying degrees
•
In the last 50 years, salinity has
risen by 45%
Simplified causal diagram of salinity & health
Shrimp farming
Poor land
management
Runoff
Rainfall,
Monsoon
River flow
Snowmelt
Sea-level
rise
CLIMATE CHANGE
Estuarine
intrusion
Saltwater
intrusion
[shallow
groundwater]
Surface water
salinity
[downstream]
[river]
Pond water
[consumption]
Health
effects
% prevalence of hypertensive disorders in women
attending antenatal check-ups [May – July 2007]
16
14
12
10
preeclampsia
eclampsia
hypertension
8
6
4
2
0
Dacope
Terokhada
Matwail
Choice of study area for salinity study
•
•
Shyamnagar, a sub-district in Satkhira:
– Cross sectional study of water sources, their salinity and urinary
salt concentrations in a range of coastal villages
Dacope, a sub-district in Khulna:
– Case control study: Higher rates of (pre)clampsia among pregnant
women are associated with consumption of saline drinking water
at home
•
Baseline survey in 3 villages in Shyamnagar: 61% of households used pond
water for drinking and 81% used it for household purposes in the dry
season.
•
Access to tube wells was extremely limited and NGOs are currently
supporting rainwater harvesting intervention.
Rainfall, flooding and droughts
•
•
•
More than 80% of the 2,300 mm of annual precipitation in Bangladesh occurs during
the monsoon period
A quarter of the country is currently flood-prone in a normal hydrological year, which
may increase up to 39% under climate change scenarios in the next century.
Predictions:
– episodes of heavy rainfall and drought are likely to become more frequent and
severe
– increased frequency and severity of hot spells & heavy precipitation events are
expected to have negative impacts on crop yield and areas of cultivatable land
Historical flood extents in Bangladesh [OECD 2003]
Most of
Bangladesh at
high risk from
flooding, sealevel rise, and
stronger storms
Floods
 Injuries
 Population displacement
 Adverse effects on food production
 Freshwater availability and quality
 Increased risk of infectious diseases - diarrhoeal diseases
 Toxic contamination
 Mental health
• Higher rates of stunting and wasting among flood exposed preschool children and higher rates of chronic energy deficiency among
flood exposed women (Del Ninno 2001).
Low precipitation: drought
 Acute and chronic nutritional problems
-




undernutrition, protein-energy
malnutrition, micro-nutrient deficiency
Infectious diseases
Respiratory diseases
Deaths
Production of wheat and rice might no longer
be economically suitable under climate change.
 Protein-energy and micronutrient-related malnutrition have been
reported in children in post flood affected areas (ICDDR,B).
 A study found that drought, lack of food were associated with increased risk
of mortality from diarrhoeal diseases (Aziz 1991)
Floods, drought & micronutrient deficiency
•
A large segment of population in South Asian region including Bangladesh
suffer from micronutrient deficiencies
•
Usually occurs in frequently flooded, low-lying areas where, over time,
micronutrients have been washed out of the soil
•
Reflected in Bangladeshi soils: low level of certain minerals in rice,
vegetables, and staples of the rural and poor Bangladeshi diet
•
Severe micronutrient deficiency in women, a common problem in rural
Bangladesh, increases the risk of bearing children with low birth weight, and
other health problems.
•
Short and longer term impacts of flooding on micronutrient deficiency have
not been well researched.
The impact on women
•
Women suffer disproportionately
more during disasters
– 70% of world’s poor are women
– Women account for the majority of
climate-related deaths
 Biological vulnerabilities:
– Nutrition
– Reproductive health
 Social vulnerabilities:
–
–
–
–
•
Poverty
Discrimination
Stigma
Sexual violence
Need for international climate
policies to be gender aware
Choice of study area for a micronutrient
study
•
HEALS cohort (Columbia University & Bangladesh)
– Rural sub-district, Araihazar.
•
Significantly affected by river floods in 2004, 2005 and 2007, while regular
yearly monsoon rainfall and flooding affect inhabitants in areas of flat land.
Population-based cohort: 20,000 participants between 18 - 75 years of age
A full questionnaire interview including validated FFQ filled at baseline
(2000-2002).
•
•
 This cohort provides an ideal setting to conduct a pilot study to investigate
changes in micro-nutrients intake of rural women attributable to climate
variability.
•
Compare nutritional indices in the dry season and after monsoon floods
using data collected among the 200 participants (100 from villages of flat
land; 100 from areas of higher land surface), and carry out multivariate
analysis, adjusting for potential confounders
Given the uncertainties on the extent of micronutrient deficiency → this
component is a pilot study to assess the frequency of deficiencies in two
areas with different likelihood of floods.
The purpose is to contribute to the design of proper studies on nutritional
impacts of flooding and drought in the HEALS cohort.
Capacity Building
•
The study will support research capacity in
Bangladesh, building upon existing facilities and
experiences (BCAS, HEALS, KMC).
•
Experience from HEALS will be used to develop
research tools and transfer of expertise to other
study areas.
•
Training of nurses and interviewers to build an
infrastructure that can be used in future welldesigned studies on climate change effects in
Bangladesh.
Training local scientists to monitor salinity in
drinking water
•
•
Disseminate our research findings and foster
discussion among local community health
representatives, local political bodies, &
collaborators, for developing awareness &
adaptation strategies