Health effects of Climate Change Initiatives in Bangladesh

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Health effects of Climate ChangeInitiatives in
Bangladesh

• Paolo Vineis
• Aneire Khan
• Imperial College London

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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
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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

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Research questions

• Feasibility study that will provide the necessary
  tools to address the following questions
• What are the health effects of environmental
  salinization?
• Do climate-induced events (e.g. floods and
  droughts) affect micronutrient intake in rural
  populations?

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• 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

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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

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Simplified causal diagram of salinity health
Shrimp farming Poor land management
CLIMATE CHANGE
Runoff
Rainfall, Monsoon
River flow
Snowmelt
Surface water salinity downstream river
Pond water consumption
Estuarine intrusion
Sea-level rise
Saltwater intrusion shallow groundwater
Health effects
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prevalence of hypertensive disorders in women
attending antenatal check-ups May July 2007
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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.

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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

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Historical flood extents in Bangladesh OECD
2003
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Most of Bangladesh at high risk from flooding,
sea-level rise, and stronger storms
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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 pre-school children and higher rates of
  chronic energy deficiency among flood exposed
  women (Del Ninno 2001).

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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)

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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.

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The impact on women

• Women suffer disproportionately more during
  disasters
• 70 of worlds 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

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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.

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• 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.

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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
  well-designed 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