Abstract
BackgroundAlteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding.MethodsUsing a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence.ResultsIn Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases.ConclusionsThe construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.
Highlights
Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood
With the exception of onchocerciasis, whose vector habitat is fast moving streams, the rates of nearly every disease whose host or vector depend on standing water sources increase when water resource management programs are implemented by governments or NGOs [1,2,3,4,5,6,7,8]
Mid-year populations are appropriate to use for longitudinal studies such as this, since they approximately balance out the number of births and deaths that a bari experiences during each year
Summary
Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding. Several empirical studies have examined the impact of water construction projects on communicable disease rates. Even if public health is given consideration in the planning stages of water resource projects, the true impact of changes to aquatic systems on human health may not be known for decades. Comparing pre- and post-development health data provides the clearest understanding of how changes in water supplies have affected the disease experience of local populations [4]. Negative (due to decreased risk of flooding further from river)
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