Schistosomiasis Control in Kwabeng

1. 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

2. Project Team • Student Members: • Casey Caldwell, Robert Curry, Charline Han, Daron Kurkjian, Kelly Sanborn, and Katie Shuman • Faculty Advisors: • John Durant and David Gute Tufts University, Dept. of Civil & Environmental Engineering

3. 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 Tufts University, Dept. of Civil & Environmental Engineering

4. Life Cycle of Schistosomiasis Source: http://www.payer.de/entwicklung/entw2039.gif Tufts University, Dept. of Civil & Environmental Engineering

5. 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 Tufts University, Dept. of Civil & Environmental Engineering

6. 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 Tufts University, Dept. of Civil & Environmental Engineering

7. Research Methods in Kwabeng • Gathered water data • Velocity, Temperature, pH, Dissolved Oxygen, Specific Conductivity Source: Rob Curry Tufts University, Dept. of Civil & Environmental Engineering

8. 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 Tufts University, Dept. of Civil & Environmental Engineering

9. Snail and Velocity Correlation Tufts University, Dept. of Civil & Environmental Engineering

10. 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 Tufts University, Dept. of Civil & Environmental Engineering

11. 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 Tufts University, Dept. of Civil & Environmental Engineering

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16. 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 Tufts University, Dept. of Civil & Environmental Engineering

17. 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 Tufts University, Dept. of Civil & Environmental Engineering

18. 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 Tufts University, Dept. of Civil & Environmental Engineering

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20. 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 Tufts University, Dept. of Civil & Environmental Engineering

21. All Possible Rated Interventions Tufts University, Dept. of Civil & Environmental Engineering

22. Snail Control: Reducing the amount of snails in the river Tufts University, Dept. of Civil & Environmental Engineering

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24. 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/shadesofgreen/100shades.htm Tufts University, Dept. of Civil & Environmental Engineering

25. 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 Tufts University, Dept. of Civil & Environmental Engineering

26. 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 Tufts University, Dept. of Civil & Environmental Engineering

27. 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 Tufts University, Dept. of Civil & Environmental Engineering

28. 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 Tufts University, Dept. of Civil & Environmental Engineering

29. Alternatives to Using the River Tufts University, Dept. of Civil & Environmental Engineering

30. 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 Tufts University, Dept. of Civil & Environmental Engineering

31. Public Wells • Construction, operation, and maintenance costs • Don’t 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 Tufts University, Dept. of Civil & Environmental Engineering

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33. 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 Tufts University, Dept. of Civil & Environmental Engineering

34. 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 Tufts University, Dept. of Civil & Environmental Engineering

35. 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 Tufts University, Dept. of Civil & Environmental Engineering

36. Schistosome Control: Reducing parasite population in snails Tufts University, Dept. of Civil & Environmental Engineering

37. Medical Treatment-Increase Staff for Existing School Visit Treatment System • Currently one nurse conducts school visits to evaluate children’s health • Students are required to self-assess illnesses • Town clinic run by Ghana Health Services, therefore requires cooperation • Community questions current system’s accountability and supports increased assistance • Long term monitoring needed Tufts University, Dept. of Civil & Environmental Engineering

38. 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 Tufts University, Dept. of Civil & Environmental Engineering

39. 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 Tufts University, Dept. of Civil & Environmental Engineering

40. 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 Tufts University, Dept. of Civil & Environmental Engineering

41. 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 Tufts University, Dept. of Civil & Environmental Engineering

42. 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 Tufts University, Dept. of Civil & Environmental Engineering

43. 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 Tufts University, Dept. of Civil & Environmental Engineering

44. 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 Tufts University, Dept. of Civil & Environmental Engineering