Schistosomiasis Control in Kwabeng

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Schistosomiasis Control in Kwabeng

• Social, Environmental, and Engineering Challenges
  
• to Reducing Schistosomiasis Incidence
• in a Rural Town in Eastern Ghana

Tufts University Department of Civil and
Environmental Engineering
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Project Team

• Student Members
• Casey Caldwell, Robert Curry, Charline Han, Daron
  Kurkjian, Kelly Sanborn, and Katie Shuman
• Faculty Advisors
• John Durant and David Gute

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The Problem

• Schistosomiasis is water-borne parasitic disease
  that is contracted by coming into contact with
  contaminated water

• We hypothesized that hydraulic alterations to the
  river in Kwabeng have increased the incidence of
  schistosomiasis

Source Rob Curry
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Life Cycle of Schistosomiasis
Source http//www.payer.de/entwicklung/entw2039.g
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Long Term Project Objective

• Decrease, if not eliminate, the incidence of
  schistosomiasis in Kwabeng, Ghana
• Promote better management of water resources in
  Kwabeng
• Assess the transportability of our approach to
  other affected communities

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First Year Project Objectives

• Research the nature and complexity of the problem
• Establish baseline data for Kwabeng
• Create relationships with community members
• Design a matrix to determine the best possible
  solutions

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Research Methods in Kwabeng

• Gathered water data
• Velocity, Temperature, pH, Dissolved Oxygen,
  Specific Conductivity

Source Rob Curry
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Research Methods in Kwabeng

• Identified presence of schistosomiasis in water
  and in children
• Collected snails
• Identified schistosomes in snails
• Conducted school surveys to determine incidence
  of infection in children, along with river use
  habits

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Snail and Velocity Correlation
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Research Methods in Kwabeng

• Met with community members and leaders
• Gathered community acceptance and historical data
  for the town
• Helped establish a committee to continue project
  efforts in Kwabeng

Source Katie Shuman
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Research Methods in Kwabeng

• Made maps of the before and after mining company
  changes
• Used a GPS unit, measuring tape, and compass
• Digitized the maps for use in GIS

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Identifying Interventions

• Identified three types of interventions
• Reduce number of snails in the river
• Prevent people from exposure to parasites
• Reduce the population of parasites in snails

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Selection Criteria

• Cost
• Relative cost taking into account capital cost
  and O M
• Feasibility
• How possible the intervention technology is in
  Kwabeng
• Access to equipment
• Human health and safety concerns
• Community Acceptance
• How well the proposed solution resonates with the
  community
• Cultural, political and economic implications

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Selection Criteria Continued

• Efficacy
• Success rate in decreasing the incidence of
  schistosomiasis
• Can the intervention stand alone
• Has it been successful in other areas
• Sustainability
• Longevity of the intervention

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Numbering System

• Cost
• 1 most expensive 5 least expensive
• Feasibility
• 1 least feasible 5 most feasible
• Community Acceptance
• 1 not supported 5 very supported
• Efficacy
• 1 not effective 5 very effective
• at decreasing infection
• Sustainability
• 1 not sustainable 5 indefinitely sustainable

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All Possible Rated Interventions
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Snail Control Reducing the amount of snails in
the river
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Biological Controls

• Adding Terrestrial Plants for Shade
• Shade reduces aquatic plant life in river,
  habitat of the snails
• Competing land requirements from farmers near
  banks of river
• Correlation between high shade and low/no snail
  population

• Harvesting Aquatic Plants
• High labor demand
• Competing growth surfaces reduce efficacy
• Continual removal of aquatic plants will lower
  biological productivity of river
• Kwabeng community view option as drastic

Source http//www.kauai-vacation-rentals.com/sha
desofgreen/100shades.htm
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Biological Controls

• Increase Snail Predator Population
• Fishing of beneficial predators would limit snail
  reduction gains
• Ecological equilibrium would require constant
  addition of fish to effectively reduce snail
  populations
• Risk of unintended consequences of species
  introduction
• Population monitoring costs high
• Increase Direct Snail Competitors
• Competitive species could be local foods (certain
  snail species)
• Ecological equilibrium between species will
  require excessive competitor population

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Chemical Controls

• Herbicide
• Ineffective long term solution
• Risk to farmers who irrigate from river water
• Town water supply impacted
• Molluscicide
• Requires 8 hour contact time with river
• Temporary solution
• If implemented incorrectly could increase
  chemical resistance of snails
• Towns water supply impacted

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Increasing the River Velocity

• Increase slope channel
• Effective, but impractical
• Major earth moving needed
• Water supply weir would need to be removed
• Changes to the water supply system drastic
• Reduce Cross-Sectional Area
• Entire river would need width contraction high
  expense
• Maintenance against erosion could be high, with
  seasonal storm and flood events
• Community skeptical of option

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Increasing the River Velocity

• Increase Input Through River Restoration
• Rejoin the Awusu and the Abodusu Rivers
• Partnership with Mining Co. necessary
• Earth moving equipment in hands of Mining Co.
• Experience in river alterations
• Highly effective
• Desired by many in community

Source Charline Han
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Alternatives to Using the River
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Public Showers

• Construction, operation, and maintenance costs
• Adults would be willing to pay a small fee, but
  children would have to be free.
• Attendant needed for maintenance and up keep.
• Need cooperation with Ghana Water Ltd.
• Does not prevent river use
• Must be coupled with other interventions

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Public Wells

• Construction, operation, and maintenance costs
• Dont know depth to water table
• Small fee for usage (1-2)
• Community is resistant to using wells because
  they are usually hand dug and the water does not
  come from the river
• Does not prevent river use
• Must be coupled with other interventions

Source Charline Han
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Public Taps

• Construction, operation, and maintenance costs
• Many taps already in town
• Small fee for usage (1-2)
• Does not prevent river use
• Must be coupled with other interventions

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Recreation Area

• Construction cost and constructability.
• Are supplies available in Ghana?
• Will Children use it?
• Does not prevent river use
• Must be coupled with other interventions

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Expand Household Distribution System

• Implementation costs high as are recurring costs
• Not everyone has a house
• Requires cooperation of Ghana Water Ltd.
• Does not prevent river use
• Must be coupled with other interventions

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Schistosome Control Reducing parasite population
in snails
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Medical Treatment-Increase Staff for Existing
School Visit Treatment System

• Currently one nurse conducts school visits to
  evaluate childrens health
• Students are required to self-assess illnesses
• Town clinic run by Ghana Health Services,
  therefore requires cooperation
• Community questions current systems
  accountability and supports increased assistance
• Long term monitoring needed

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Medical Treatment-Monthly Free Schistosomiasis
Screening and Drug Distribution Days

• Salary of nurse, MDs, and lab techs
• Cost of Praziquantel (most common drug used for
  treatment)
• Reinfection rate a concern
• Medication does not confer immunity
• Reduces egg return to the river, thus breaking
  life cycle

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Latrines - Reducing Egg Return to River from
Humans

• Construction, operation, and maintenance costs
• Small income generated because adults would pay
  to use latrines
• Latrines already exist in town and are not widely
  used because of their cost to the users
• Finite life span, therefore lacks sustainability
• Reduces egg return to the river, thus breaking
  life cycle

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Town-wide Education Campaign

• Two target populations children and adults
• Cost of educated health personnel
• Behavioral changes are often difficult to
  implement and sustain
• Constant reeducation necessary
• Preventing schistosomiasis is not presently a
  priority in Kwabeng

Source Charline Han
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No Action Alternative

• Side effect of schistosomiasis is anemia, which
  makes people feel weak and decreases worker
  productivity
• Community is invested in working with us to find
  a solution
• Hypothesis that incidence rates on the rise

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Conclusions and Recommendations

• Top three interventions
• Increase river velocity by river restoration
• Town-wide education campaign
• Monthly schistosomiasis screening and treatment
  days
• Interventions can be used in conjunction with
  each other
• Lower scoring interventions can be used to
  supplement main intervention

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Future Work

• Ongoing
• Locate sources of funding
• Identify international partners
• Year 2 In depth data collection on the
  recommended interventions and selection of the
  best intervention
• Year 3 Design of selected intervention
• Year 4 Implementation
• Year 5 Monitoring and evaluation

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Acknowledgements

• Professors John Durant and David Gute
• Kwabena Kyei-Aboagye
• Dr. Kwame Boadu
• Kwabeng District Superintendent of Schools
• Professor Manu, University of Ghana
• Provost Bharucha
• Tufts University Center for Children
• Department of Civil and Environmental Engineering