Anthonj, Carmen: Mosquitoes and Maladies among Men using Marshes : Is the Contraction of Diseases in Wetlands a Question of Use?. - Bonn, 2017. - Dissertation, Rheinische Friedrich-Wilhelms-Universität Bonn.
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author = {{Carmen Anthonj}},
title = {Mosquitoes and Maladies among Men using Marshes : Is the Contraction of Diseases in Wetlands a Question of Use?},
school = {Rheinische Friedrich-Wilhelms-Universität Bonn},
year = 2017,
month = nov,

note = {In environments where water is scarce, as is the case in semiarid areas in rural East Africa, fragile wetland ecosystems are increasingly being tapped in order to combat food insecurity and to provide important life-support systems in otherwise uninhabitable landscapes. This extensive use, however, makes their interaction troublesome, given that wetlands are known sources of disease-causing microorganisms and invertebrates.
Assuming that people using marshes for different purposes are at different risk of contracting water-related infectious diseases while at the same time being highly dependent on staying physically healthy in order to maintain their livelihoods from the natural resources provided by the wetlands, this study addresses the ramifications of wetland use and disease exposure by presenting a case study from the Kenyan Ewaso Narok Swamp. The floodplain of the semiarid East African highlands served for investigating the four most prominent wetland user groups, namely smallholder and commercial farmers, pastoralists and people working in the service sector. Mixed methods were adopted and included a cross-sectional survey and observational assessment (n=400), as well as in-depth interviews with the target population (n=20), key informants and experts (n=8). Special attention was directed to malaria, onchocerciasis, typhoid fever, diarrhoeal diseases, trachoma and schistosomiasis, with these diseases representing the four categories of water-related disease transmission as defined by Bradley (1974).
The grounded theoretical model shows that different wetland uses entail different health risk factors. Exposure to infectious agents depends upon the type of use, occupational characteristics, time and duration spent in wetlands. Water-related infectious disease transmission is mostly driven by the intensity of users’ physical contact to water, characteristics of pathogens and vectors of disease. Whereas several publications have linked crop production to the contraction of diseases, fewer are available on health risks identified with the use of domestic water or with pastoralism in wetlands.
Health risk assessments from the Ewaso Narok Swamp relating syndromic surveillance of self-reported abdominal complaints, fever, skin and eye conditions of wetland users to multiple risk factors in descriptive, univariate and multivariate analyses reveal that the contraction of diseases mainly takes place in the domestic domain, whereas the occupational risks play a minor role in the investigated population. Unsafe water sources, little or discontinuous water supply, inadequate sanitation and poor hygiene, as well as poor environmental hygiene (WASH) are high risk factors. Besides human behavioural practices in the domestic domain, cultural aspects and health beliefs mattered in the exposure as well as the prevention of any sort of water-related infectious diseases.
Perceptions of the population revealed that the awareness level towards water-related health risks, the connections between wetlands and adverse health effects and the environment-animal-human health nexus is generally high. Particularly unsafe WASH were being regarded as risk factors for infectious diseases, particularly for diarrhoeal diseases and typhoid fever. Moreover, the wetlands’ water resources providing mosquito breeding sites were rated as harmful and exposing users to malaria. Occupational factors were widely perceived risk factors as well, but understood as way less hazardous than risks in the domestic domain.
Differences between different user groups became apparent in terms of health-related behaviour, actual health risks and health risk perceptions.
The relevance of these ramifications results from the growing population, increasing use and modification of wetlands in East Africa, all of which accelerate the pollution, as well as the presence and proliferation of pathogens, with the users’ behaviour determining their risk of contracting diseases. The most efficient way in breaking the transmission routes is the safe WASH. This study from the Ewaso Narok Swamp, however, reveals that WASH is highly insufficient for large parts of the wetland users, lagging far behind the nationwide average for rural populations in the Republic of Kenya. Thus, even though the users understand the situation and risks that come along with inadequate WASH: as long as improved infrastructure and options are lacking, the prevention of diseases in wetlands will remain difficult. Wetlands expose their users to different water-related infectious diseases, while at the same time the necessary infrastructure to stay healthy or get adequately treated is not sufficiently provided. This transforms wetland use and disease exposure into an enhancing vicious circle with transmission routes difficult to be disrupted and with risk perceptions only limitedly mattering as long as options to proactively act or to react are not in place.
This study points to wetlands as being a two-sided coin, acting as a driver for development, but also as an impediment in terms of human health.
As falling ill impairs the users´ (agricultural) productivity and quality of life, it is crucial to integrate the framework on use-related disease exposure into wetland management activities and the concept of wise wetland use (Horwitz et al. 2012), health education programmes and disease prevention and control strategies. Such would present good starting points for a health-adapted wetland management, which is of crucial importance. Along with findings from the other studies conducted within the GlobE Wetlands in East Africa project, the results from this work have been integrated into a holistic Health Impact Assessment guidance document for wetlands. Besides, the results may contribute to the health and environmental sustainability targets of the United Nations Sustainable Development Agenda.},

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