Changing patterns of health in communities impacted by a bioenergy project in northern Sierra Leone.

Astrid Knoblauch,Habib Kamara,Mohamed Bah,Jürg Utzinger,Mark Divall,Mary Hodges,Hamid Turay,Jusufu Paye,Anita Kargbo,Yaobi Zhang,Mirko Winkler,Emmanuel Nyorkor

doi:10.3390/ijerph111212997

Abstract

Large private sector investments in low- and middle-income countries are often critically evaluated with regards to their environmental, social, human rights, and health impacts. A health impact assessment, including a baseline health survey, was commissioned by the Addax Bioenergy Sierra Leone project in 2010. As part of the monitoring, a follow-up survey was conducted three years later. A set of health indicators was assessed at six impacted and two control sites. Most of these indices improved, particularly at the impacted sites. The prevalences of stunting, wasting, and Plasmodium falciparum in children under five years of age decreased significantly at impacted sites (all p < 0.05) and non-significantly at control sites. Anemia in children and in women of reproductive age (15–49 years) decreased significantly at impacted and control sites (p < 0.05 and p < 0.001, respectively). Health facility-based deliveries increased significantly at the impacted sites (p < 0.05). The prevalences of helminth infections in children aged 10–15 years remained approximately at the same levels, although focal increases at the impacted sites were noted. Access to improved sanitation decreased significantly (p < 0.05) at control and non-significantly at impacted sites. Water quality remained poor without significant changes. The epidemiologic monitoring of a bioenergy project provides a useful contribution for evidence-based decision-making.

Highlights

Large private sector investments in low- and middle-income countries, including agricultural, water resources development and management, and extractive industry projects, are increasingly being developed in remote areas, often associated with vulnerable communities and, subject to international scrutiny [1,2]
Approval for the study was provided by the Sierra Leone Ethics and Scientific Review Committee of the Ministry of Health and Sanitation (MoHS)
Children found with concurrent P. falciparum infection and anemia were treated with the required Artemisinin-based combination therapy (ACT) dosage, followed by iron supplements

Summary

Introduction

Large private sector investments in low- and middle-income countries, including agricultural, water resources development and management, and extractive industry projects, are increasingly being developed in remote areas, often associated with vulnerable communities and, subject to international scrutiny [1,2]. The discussion revolves around potential project-related impacts on the environment, people’s health, social cohesion, and human rights [3,4,5]. Potential positive impacts include improved public infrastructure, capacity building, socioeconomic benefits, and better health [8,9]. Potential negative impacts may involve loss of land, environmental degradation, disruption of social cohesion, and widening of wealth disparities [2,10,11,12]. Located near Makeni in Northern Sierra Leone, the ABSL project holds a land lease of 14,300 ha, which is used as a sugarcane plantation to produce an estimated 85,000 m3 of ethanol annually, which is to be used for export and the local market [16]. By 2016, sugarcane residual processing will produce 32 MW of electricity per year, of which 15 MW are to be fed into the national grid, contributing 20% of the national requirements

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Conclusion