SW. Sci. Med. Vol. 16. pp. I I27 to I 145. 1982 0277-9536/82;1 I I l27-19SO3.

OQ~O
Printed m Great Britain. All rights reserved Copyright Q 1982 Pergamon Press Ltd

MAN-MADE LAKES AND MAN-MADE DISEASES

TOWARDS A POLICY RESOLUTION

JOHN M. HUNTER*. LUIS F&Y+ and DAVID SCOTTS

Abstract-Throughout the tropical world, in Africa. Asia and Latin America. the construction of water
impoundments, for irrigation and other purposes. in areas of endemic water-related diseases. has inexor-
ably intensified community levels of infection. and also created new areas of transmission. The clearest
‘indicator’ disease is schistosomiasis. but others are involved such as malaria and the filariases. An
assessment for the future suggests a worsening situation because of population growth, the demand for
food production. and the increased technological capacity of the ‘bulldozer revolution’ to effect earth
impoundments. The typical sectoral dichotomy in which a department of agriculture creates a disease
outbreak through its development activity. leaving its counterpart department of public health to cope
on a curative basis, where possible. is strongly deplored. A policy position is offered whereby disease
prevention measures are integrated with development projects from the beginning and infrastructural
investment and operational costs for health maintenance are identified and incorporated in the total
benefit-cost analysis. The need for a communications network on ecological and health effects is pointed
out; and a typology for registration of dams is offered in support of policy implementation.

RETROSPECTz ECOLOGICAL DISRUPTION local conditions of life through housing difficulties,

AND DISEASE
The construction of dams, formation of man-made
lakes and development of irrigation projects in trop-
ical areas introduce important changes in the environ-
ment and, in parallel, produce a number of risks to
human health, apart from the evident benefits
brought to the macroeconomy of a country or the
production of some specific economic advance. With
reference to environmental changes, water resources
development projects tend in general to cause some
degradation of the environment through the destruc-
tion of forest galleries, increased soil erosion, and the
production of biotopes more favorable than before to
intermediate hosts or vectors of parasitic or infectious
diseases.
At a local level, the inhabitants of submerged or
requisitioned lands are affected by economic and
social disturbances. even when resettlement programs
have been implemented to minimize these problems.
Children and pregnant women are particularly
exposed to risk during the years between the aban-
donment of cultivated lands and the necessary adap-
tation to a new situation. This adaptation is often
associated with changes in life style and activities, and
equilibrium with the new ecosystem may not be
attained for some years.
Population migrations induced by actual or poss-
ible ‘opportunities for work provided during construc-
tion of water development projects can aggravate the
*Department of Geography and Department of Com-
munity Health Science. Michigan State University. East
Lansing. Ml. 48824. U.S.A.
tWH0 consultant parasitologist. Brazil. Present address:
c/o O.M.S.. Caixa Postal 377. Mauuto. Mozambique.
:Formerly ProJect Manager. UNDP.‘WHO Project for
Research on the Epidemiology and Methodology of the
Control of Schistosomiasis in Man-Made Lakes
(TDR-304). Present address: P.O. Box M 217. Accra.
Ghana.
1127
overcrowding, rising costs of living, commercial
speculation, prostitution and other social problems,
as well as the introduction of new sources of diseases
(or new diseases) and immigrants immunologically
susceptible to the endemic diseases prevailing in the
area of development.
In Brazil. for instance, important risks to human
health and welfare appearing in circumstances such as
those described above, include: (a) occupational disks:
accidents, some occupational diseases; (b) infections
in adults: respiratory diseases, many parasitic diseases
such as malaria, Chagas’ disease, venereal diseases,
leishmaniasis, schistosomiasis and filariasis, yellow
fever and other arbovirus infections; (c) infections in
children: respiratory and virus infections. diarrhoea
hookworm and other intestinal parasites. schistoso-
miasis, malaria, Chagas’ disease. leishmaniasis (kala-
azar), etc.; (d) non-infectious conditions in children:
malnutrition, deficient development, perinatal mor-
tality, domestic and other accidents; and (e) general
social risks: inadequate relocation procedures, loss of
traditional economic activities, failure in adaptation
of the resettled population. unemployment, social
insecurity and insufficiency of the family budget with
its consequences on educational, hygienic and nu-
tritional conditions.
In general. risks appear, or sometimes disappear. in
a sequential order, those immediately following the
implementation of a water resources development
project being qualitatively or quantitatively different
from those arising during the construction period ‘or
those occurring in the normal operation of an hydro-
electric plant and its catchment area.
Limitations of‘data
The risk of spread of parasitic infections associated
with the development of water resources has been
stressed on many occasions. Some of these warnings
are contained in documents prepared during the plan-
1128 JOHN M. HUNTER rr al
ning stages of particular schemes. others are found in
papers dealing more generally with the health hazards
of water development. The conditions most frequently
listed as being most apt to spread in tropical zones
are schistosomiasis, malaria, bacterial and helminthic
intestinal infections, arbovirus infections. and other
specific infections which have a regional distribution,
e.g. filariasis, trypanosomiasis. and dengue haemorr-
hagic fever.
Evidence of the impact on health would be most
valuable where a direct comparison can be made
between pre- and post-development data (qualitative
and quantitative) relating to parasitic diseases in a
particular area. There are, however, few instances
where such comparison is possible and two main
reasons for this are: (i) the absence of pre- and post-
development data, or the availability of data which
are inadequate for the purpose of comparison; (ii) a
natural reluctance on the part of governments to pub-
lish reports which indicate that water resources devel-
opment projects have resulted in any deterioration of
the health of the local residents or immigrants. This
latter situation, in itself, suggests the need for a sys-
tematic study of the health hazards associated with
new water impoundment and irrigation schemes.
Where direct comparison of pre- and post-develop-
ment data is impossible, an alternative technique is to
contrast the distribution and prevalence of selected
parasitic infections in the area affected by the devel-
opment with the situation in a nearby undeveloped
but otherwise comparable locality. Again there are
few examples where this has been done.
Finally, examination of post-development data
alone indicate that the prevalences of particular infec-
tions are ‘high’, i.e. higher than in some other part of
the country or in the country as a whole, and it is
often this quality of information which must rightly
serve to incriminate water development schemes as a
hazard to health.
It would be expected that the group of infections
described as ‘water-related’ would become increas-
ingly prevalent as uncontrolled use of water increases,
and as the association between man and water
becomes closer. The best illustration of this is found
in the high prevalences of schistosomiasis existing in
endemic areas, the Nile Valley providing an excellent
example of the consequences of intensive water use. In
the case of other water-related infections, however,
such a clear association is not so apparent, or at least
is not so well documented. Schistosomiasis claims
prior attention for a number of reasons: an increase
in prevalence associated with greater use of water in
the endemic areas has been an experience common to
many countries in Africa now engaged in water devel-
opment schemes; it is observed simultaneously across
the whole African continent; these increases have
often been of a very high magnitude, are relatively
easy to detect, and have frequently caused a public
outcry to a dramatic sign of the infection, i.e. intense
haematuria in a large proportion of the children.
With the other parasitic infections, if an increase of
prevalence has resulted from a new closer contact
with water, it has apparently been more localized, not
so readily associated with the cause, and probably less
dramatic.
The purpose of this presentation is to examine evi-
.
dence that water development projects have resulted
in increased prevalence in specific parasitic infections.
Ajrica
The number of instances where a comparison has
been made between disease distribution and intensity
in pre- and post-development situations are relatively
few and relate almost exclusively to schistosomiasis.
Egypt. Construction of the Low Dam at Aswan in
the early 1930s allowed perennial irrigation in a
number of provinces in Egypt. This was followed by
an increase of Schistosoma haematobium between 1934
and 1937 in four areas which were investigated; levels
of prevalence varying from 2-119; rose to 4475”,
[l]. The new high dam at Aswan. which has produced
more extensive perennial irrigation, has also resulted
in a change of schistosomiasis transmission patterns
in both Upper and Lower Egypt. The malaria epi-
demic of 1942/1943 which occurred in Upper Egypt
and caused 130,000 deaths was due to an invasion of
Anopheles gambiae from the Sudan [Z] and must be
seen as a consequence of water development.
Ghana, Lake Volta. Large-scale surveys for urinary
schistosomiasis were undertaken over much of Ghana
in the decade before the Akosombo Dam was built.
Low prevalences (5-10x in children) were found
around the area which was later impounded. Within a
year of the lake reaching its maximum level (1968).
very high prevalences (up to 90% and over in children
aged 10-14 years) were found in lakeside com-
munities. There are some 150,000 people living along
the lakeshore. This example provides irrefutable evi-
dence of a major hazard of the rapid spread of uri-
nary schistosomiasis at an explosive level and on a
large scale resulting from a water resources develop-
ment program. Further proof of the impact of the
lake was given by a study of prevalence in hinterland
communities lying away from the lake. The preva-
lence fell progressively along a transect of 7 km, and
was related to a decreasing degree of dependence on
the lake for domestic water needs [3].
Ivory Coast. The dam across the Bandama Valley
to impound Lake Kossou was completed in 1972. It is
claimed that there has since been a marked rise in
urinary and intestinal schistosomiasis in the Ivory
Coast but the data on which this statement is based
would have to be examined.
Kenya. Mosquito surveys in the irrigated and non-
irrigated areas of the Kano Plain project, Nyanza
Province, showed a reduction in the number of spe-
cies and a change in the composition of the popula-
tion with about a Cfold increase in the house-entry
rate in the irrigated areas. It would be expected that
following the increase of settlement in the area, there
would be an increase in malaria transmission, but
there appears to be no data on this point. In the same
province, some 10,fMlOsmall ponds were dug with the
aim of increasing fish production. They resulted in
considerable breeding of malaria vectors, but no
assessment of the effect on public health seems to
have been made.
Mali. In the Cercle de Bandiagara (population
160,000) urinary schistosomiasis has been known for a
long time. In recent years a program to build about
50 small dams was begun, with about 20 having been
completed in 1977. No surveys were made before this
 Man-made lakes and man-made
work started. But a comparison of the first two
studies made in 1976 and 1977 showed an increase in
the prevalence, from 79.4 to 93.40/, during the year in
the same population. In addition, the local trans-
mission of 5. mansoni was demonstrated for the first
time in the 1977 survey. It can be concluded that the
barrage system has probably enhanced transmission.
Surveys carried out by the Organisation de Coordin-
ation et de Cooperation pour la lutte contre les
Grandes Endemies (OCCGE) have demonstrated
high levels of schistosomiasis associated with the cul-
tivation of rice along the flood plain of the Niger.
Nigeria. Dazo and Biles [4, 51 carried out studies of
schistosomiasis prevalence and intensity at Kainji
Lake in 1970 and 1971. They examined three small
communities living on the lakeshore and one, New
Bussa. which had been resettled well away from the
lake. Prevalence, intensity of infection and incidence
were much higher in the lakeshore villages than in
New Bussa.
Sudan. Irrigation of the Gezira by the construction
of the Sennar Dam in 1924 and extension of the irri-
gation system after 1950 has resulted in a progressive
increase in schistosomiasis. The prevalence of S. hae-
matohium rose from less than 1% in the period
19241944 to 21% in adults and 45% in children in
1952. 5. mansoni prevalences were 5% in 1947. 8.8% in
1952, and between 77 and 86% in the 7-9 year old
age-group in 1973 [6,7].
Asia
In Asia, clear evidence of the adverse effects on
health of water impoundment schemes, drawn by a
comparison of pre- and post-development data on the
distribution and prevalence of parasitic diseases, is
not often found [S]. The reasons for this situation
have been suggested above, in the discussion on data
limitations.
Three main types of water resource development in
Asia may be found: (i) multipurpose projects for hyd-
ro-electric power, irrigation and flood control; (ii) irri-
gation projects; and (iii) water supply projects. There
would seem to be practically no health problems as-
sociated with water supply developments, or surpris-
ingly, with irrigation schemes where the land irrigated
is less than 16.000 ha. Of the 15 most important
diseases endemic in the region. all have some poten-
tial for spread in water development schemes from
(in order of importance) malaria. dengue haemor-
rhagic fever. Japanese B. encephalitis. filariasis. soil
transmitted helminths, schistosomiasis. liver, lung
and intestinal flukes. to cholera and dysenteric infec-
tions.
Indonesia. The recent development of water
resources in Indonesia has lagged behind that of
Malaysia, the Philippines and Thailand, despite the
fact that its population is greater than that of the
other three countries combined. There is however a
considerable program of development for the future.
In Indonesia, as in the other three Asian countries
considered. there is very little precise information
available on the prevalence and distribution of para-
sitic diseases. and only a few surveys have been under-
taken. Malaria and filariasis are considered to consti-
tute a threat of spread in development schemes.
Prevalence rates of intestinal helminths (ascariasis. tri-
diseases 1129
churiasis and hookworm infections) range from 70 to
80%. Diarrhoeal disease of unidentified etiology is
common and cholera is prevalent in some areas.
5. japonicum has been found in two small, almost
adjacent. areas in Central Sulawesi Island which un-
fortunately lie close to the only water development
project (irrigation) in this island (population 9.4 mil-
lion).
Malaysia. In West Malaysia, no studies have been
made of the health problems relating to communities
associated with the water development projects.
Instead. profiles of parasitic diseases are based on
data from health centers in the provinces in which the
schemes are situated. In East Malaysia. i.e. Sabah and
Sarawak. where there is great potential for water
resources development. projects are planned but not
yet implemented. Formerly malaria and filariasis were
major public health problems, but control programs
of recent years have greatly reduced the prevalences
so that today the main problems are intestinal
helminthiases (ascariasis. hookworm and trichuriasis)
with bacterial intestinal infections resulting from poor
environmental sanitation.
Schistosomiasis (i.e. 5. japonicum) is not endemic in
Malaysia but one case was found in an aboriginal in
Pahang State in 1974 and since then 11 more cases of
infection have been detected: no intermediate snail
host has yet been identified. As in Thailand, there
may be a risk of spread of this infection throughout
the vast water resources schemes either in operation
or in the planning stage.
Dams built for hydro-electric power, and there are
many, are considered to be relatively free from health
hazards, being sited in uninhabited mountainous
areas or perhaps otherwise protected. Irrigation
schemes present a greater risk for the spread of infeo
tions. However, the small schemes in the States of
Perlis and Negeri Sembilan, for example, are said to
be insignificant in their effects on public health. (This
contrasts markedly with the situation in Africa where
schistosomiasis is endemic and small impoundments
have a considerable potential for the spread of the
infection.)
The example of the Muda irrigation scheme in the
State of Kedah demonstrates certain features of large
water resources development projects: completed in
1970, it provides irrigation for 105,000 ha on which
60.000 families reside with 1.5 ha each; no infor-
mation on the health of these families is available but
in the State of Kedah filariasis was reduced from
26.7% in 1957 to 0.7% in 1966. as a result of a control
program. A study carried out among 435 persons in 6
villages showed a low prevalence of malaria, up to
1.03%; stool examinations showed Ascaris and Tri-
churis (although not hookworm) but the prevalences
are not given. A number of studies on the impact of
water impoundments on health are planned and will
include a sequence of surveys among people living in
the development areas; some of these surveys have
begun.
Philippines. Water development schemes are com-
paratively recent in the Philippines. but a vast future
program is being envisaged. There are 39 schemes in
operation. 12 are under construction and a further
812 are being planned or considered. Many of the
dams already built are solely for the generation of
1130 JOHN M. HUNTER rt a/.
hydro-electric power and relatively few are for irriga-
tion purposes.
On the relationship of water development projects
to health, Harinasuta et al. [8] state:
“Since there (are) no studies on the intestinal parasitic
infections in the indigenous people residing in the vicinity
of any dam areas. and also no available valid data from the
health centers on the Islands where those dams are situ-
ated, the review of the parasitic diseases of the gastro-
intestinal system in the Philippines reported by Cabrera in
1971 (see Ref. [9]) is used as a model representing the
intestinal parasitic infections among inhabitants in the dam
areas. The report revealed the prevalences of these infec-
tions in the endemic areas as follows: ascariasii 84.1 per-
cent, trichuriasis 34.6 percent, hookworm infection 13.6
percent, strongyloidiasis 1.6 percent, amoebiasis 9.3 per-
cent. These prevalences remained much the same as those
found in many surveys which have been made since 1908”.
Account must be taken of the presence of S. japoni-
cum in the Philippines. There is an endemic belt
across the eastern, southern islands, Southern Luzon,
Leyte, Mindanao and Jolo, estimated to have over
200,000 cases of the infection. For obvious reasons no
water development schemes have been carried out in
the endemic areas but a threat of extension of S. japo-
nicum into the system of dams as the program de-
velops momentum is very real.
Neither malaria nor filariasis are considered to be
serious problems in the Philippines at present, but
they could become important if water development
projects permitted uncontrolled breeding of the mos-
quito vectors. The number of cases of infective hepa-
titis is increasing.
Thailand. The risk of spread of the various parasitic
infections is to be emphasized, with schistosomiasis
being the major public health problem in water
resources development. S. japonicum is not established
as an endemic disease in the country. A small focus of
infection (50 cases) was found 18 years ago in the Ta
Pee river basin in southern Thailand but, in spite of
intensive searches, the intermediate’snail host was not
discovered. In 1974 two more cases were diagnosed
(in Bangkok) from the same locality. Recently a few
cases have been reported from Ubol Province and
from Central Thailand; the infection has been shown
to be by S. mekongi (more correctly termed S. japoni-
cum) and the intermediate host is Lithoglyphopsis
aperta (Temcharoen). This snail has been found in
abundance in Ubol Province in the Mun river which
drains into the Mekong river. There clearly exists a
very real risk of the spread of this infection into water
development projects in the area. There is also a risk
of spread of venereal disease by importation in
migrants in water development schemes, as has
occurred, for example, during the construction of the
Bhumiphol dam. None of the data on parasitic dis-
ease found in the epidemiological records of the
health centres in the provinces refer specifically to the
situations obtaining in association with water devel-
opment projects.
A contrast between the situations in Aji+ca and Asia
In Africa, schistosomiasis is endemic over much of
the populated areas of the continent. Its transmission
is undoubtedly enhanced by an increase in man-water
contact and, from the data at present available. the
infection clearly constitutes the greatest single im-
mediate threat to health in the development of water
resources. Other parasitic infections may also be
increasing but they have received less attention. for
resources are limited. and it is understandable that
these should be largely devoted to monitoring the
most sensitive index of impact, schistosomiasis. rather
than used in the surveillance of infections showing
changes in the levels of transmission which may occur
less frequently, and be more localized and less drama-
tic in their effect.
In contrast, schistosomiasis in the countries con-
sidered in Asia is contained within a few relatively
small endemic foci and it has been possible, in each of
the four countries, to construct a large system of
water resources development projects in infection-free
areas without the introduction of S. japonicum. As a
consequence, the impact of water related projects on
health must be measured by less satisfactory par-
ameters than those provided by schistosomiasis; and
findings may be obscured by long-term operations
against, for example, malaria and hlariases. Thus in
Asia where impoundment schemes have been in oper-
ation for a considerable period there does not appear
to be any documentary evidence that their impact on
health has been examined specifically. The risks of
schistosomiasis becoming established in the future.
however, are undoubtedly grave.
Latin America
The changes introduced by dam construction and
other water resources development projects can create
or aggravate health risks in different ways that can be
simplified by a grouping into two categories: one
where the ecosystem is fundamentally concerned, the
other where demographic or socioeconomic factors
are preponderant. In the first group, parasitic and
infectious diseases take pride of place.
Aggravation of health risks due to changes in the
ecosystem. In the Parana Paraguay basin, malaria,
leishmaniasis, and yellow fever are endemic problems
that can be aggravated by water impoundments and
irrigation projects through increasing the number of
breeding places for anophelines or through bringing
people in closer contact with the ecological niches of
phlebotomine and culicine vectors of sylvatic infec-
tions. Another feared risk is the introduction of schis-
tosomiasis in the project areas because endemic foci
already exist in some aflluents of this hydrographic
basin. Raising the water table and, possibly. a higher
atmospheric humidity will increase soil-borne para-
sitic and protozoan infections that will also be simul-
taneously favored by the anticipated increase in popu-
lation density. In the Sio Francisco basin, the same
problems exist but with lesser risks for yellow fever
and greater ones for schistosomiasis. Kala-azar and
plague are still present in this region. In the Amazon
basin, where the construction of man-made lakes is
just starting, malaria is highly endemic and the con-
trol projects aim at eradication only in the long term.
Here, every lake will multiply the breeding places of
Anophekes darlingi, the most important vector. Other
anthropodborne diseases of relevance in this large
equatorial region are yellow fever, encephalitis and
 Man-made lakes and man-made diseases
certain other virus infections, cutaneous, muco-cuta-
neous and visceral leishmaniasis, and also filariasis,
with onchocerciasis in the north-central part of the
Amazon region and bancroftian filariasis in the orien-
tal part. Hookworm, ascaris and trichuris infections
are highly prevalent and widely distributed through-
out the area. Ecologically and epidemiologically, the
Araguaia-Tocantins basin resembles that of the Ama-
zon, particularly where the Tucurui Dam is being
constructed. In that area. there has been an aggrava-
tion of the malaria incidence in recent years, and dur-
ing the first half of 1978 an exacerbation of sylvatic
yellow fever produced 16 confirmed cases. Equivalent
risks are found in many places of northern South
America as well as in Central America and the Carib-
bean islands.
Aggravation of’ health risks due to demographic and
socioeconomic fhctors. Migratory movements, popula-
tion resettlement, and working conditions created by
water resources development projects, are other
sources of risk. The increase in the density of the
human population and the invasion of sylvatic eco-
systems has exacerbated the transmission of a number
of the diseases discussed above. Yet other diseases are
due to poor living conditions. Crowding is respon-
sible, for instance, for a high incidence of respiratory
infections and for a relatively high rate of tubercu-
losis. The scarcity of water in the houses and the
absence of sanitary facilities in most of the residential
areas around dam building sites explain the excep-
tional frequency of enteritis and other diarrhoeal dis-
eases, as well as one of their consequences, dehy-
dration. In houses made of dried mud, the invasion
and colonization of the triatomid vectors of Chagas’
disease is a permanent risk over the entire continent.
with very limited free areas. The massive arrival of
immigrants has everywhere caused housing problems,
increases in rents and food costs, and employment
instability as well as unemployment. All these factors
contribute to a lowering of nutritional status and to
increased susceptibility to infections. A predominance
of single men in the labor population has stimulated
prostitution and produced high frequencies of vener-
eal diseases, particularly gonorrhea and syphilis.
If these risks have not resulted in dramatic situ-
ations in most of the dam construction areas in Latin
America, it is because the existence of preventive
health services and their active engagement in control
measures have contributed to the containment of the
risks to low levels. Sometimes, the high costs of con-
trol operations have been supported by those in
charge of the project, as for example in Itaipu or in
Sobradinho. These costs have been particularly im-
portant when the risks were not foreseen and reduced
by preventive measures.
A true appreciation of the influence of water
resources development projects on health risks
requires a specific survey including pre- and post-
impoundment data, or some other statistical analyses
that can avoid the dilution of a higher rate of preva-
lence in the project zone with the lower prevalences
existing outside this area. An example can be found in
the study conducted by the Superintend2ncia de Cam-
panhas de Saude Publica [IO] on the influence of the
transamazonian road on the prevalence of malaria
(see Table 1).
1131
Table 1. Influence of the transamazonian road on the dis-
tribution of malaria prevalence
Prevalence of malaria*
Transamazonian road Other areas
area of the state
State (7;) (7,)
Maranhio 12.3 5.0
Para 14.5 3.9
Amazonas 17.7 7.4
Acre 22.8 1.9
*Percentage of positive blood examinations.
In general, health risks are greater in highly ende-
mic areas of disease with economically weak popula-
tions. Organizational and budgetary resources for an
appraisal of the future risks and early preventive
intervention are not expected in projects of medium
or small capacity. In countries or regions without ad-
equate infrastructures for the control of health risks,
these may in turn effectively damage the local popula-
tion and later require more costly procedures to cope
with the situation.
In the foregoing discussion of disease effects in
Africa, Asia and Latin America, the general acceler-
ation of disease transmission in water impoundments
and irrigation schemes has been described. Old ende-
mic foci of infection have been greatly enlarged and
exacerbated and new diseases have sometimes been
introduced. The patterns of disease intensification
that have emerged reflect man’s efforts to change the
environment for purposes of economic development.
PROSPECT: ‘FUTURE SHOCK
Construction growth rates
Apart from the currently serious situation. the im-
plications for the future are exceedingly grave unless
the necessary ameliorating and counteractive steps
are taken. This prognosis is based upon what can
be ascertained regarding the present rate of dam
construction and future plans and feasibility studies.
Information on Africa. Asia and South America is
discussed later, but, in general. growth trends in the
rates of construction would seem to be following an
exponential curve. According to the International
Commission on Large Dams [ll]. over 350 dams
with a height of over 15 m come into existence each
year thereby adding to a current inventory of
lO,OOO-12,000 such dams [12]. Regarding the con-
struction of megadams, with a surface area exceeding
1000 km, three existed before 1950, 8 were built in the
next decade, 1950-1959, and 21 in 1960-1969 [13].
Lake Volta, the world’s largest man-made impound-
ment. is 15 times larger than Lake Geneva; and the
great river basins such as Amazonia Zaire and Mek-
ong have hardly been tapped. McJunkin [12] argued
that only 227(, of Africa’s potentially arable land was
cultivated, and the corresponding proportion for
South America was a mere I I’:,. He claimed that
millions of hectares of land would be brought under
irrigation in the years to come.
Undoubtedly. it is the pressure of population in-
crease in the developing world that demands an
 1132 JOHN M. HUNTER et al.
expansion of agricultural production. This is achiev-
able through intensification of water impoundment
and irrigation. Worthington [14] cited the example of
Mexico, an arid country, with its population increas-
ing at a phenomenal rate of 3.6% per year. Indeed,
faced with food demands for the world’s increasing
population, extended water management, i.e. more
land under irrigation, appears inevitable. An estimate
by Houston [lS] suggested that in addition to the
existing 50 million hectares of land in the world under
irrigation (including irrigated areas that need to be
improved or rehabilitated), an additional 23 million
hectares of irrigated land will be added, i.e. an in-
crease of 46% by 1985 giving an enormous increase of
production. Thus man-water contact, vector popula-
tions, and disease incidence will predictably rise
sharply and, furthermore, will appear on a quantitat-
ively greater scale than ever before. This is truly a
‘future shock’ situation. A pessimistic but probably
not unrealistic view may be expressed that developing
countries have just reached the ‘foothills’ of the dis-
ease transmission and water problem, and that the
‘mountains’ lie ahead.
The ‘bulldozer revolution’ and small impoundments
Small impoundments tend to serve more purposes
than do large dams. A small multi-purpose project
may be used for fishing, water supplies, cattle and
livestock watering, irrigation, and flood control.
Usually, population and animal contact with water is
high, so that disease transmission rates are corre-
spondingly increased. Some specific examples are
given below for Africa, Asia and Latin America, but
in general large regions in the developing countries
are found to be dotted with small dams. In aggregate
they are highly significant in agricultural production
and probably exceed large dams in importance of dis-
ease effects.
Comprehensive data are not available. However, it
Seems certain that the rate of construction of small
dams is increasing rapidly. One reason for this in-
crease, apart from improved knowledge of agronomic
and hydrological techniques and from the accruing
production benefits, is the ‘bulldozer revolution’: that
is to say, the ready availability of ‘bulldozers’ and
other earth-moving equipment for purchase, loan,
lease, rent or shared ownership has led to consider-
able earth-moving capability at local community
levels. The results are that, in addition to government-
supported agricultural projects, village communities
and farmer cooperatives in the tropical world can, on
their own initiative, construct small water impound-
ments. Even churches, missions and voluntary agen-
cies are able to participate in this activity.
Without denying their agricultural benefits, the
small impoundments are hazardous to health since
they generate a high risk of disease transmission and
are usually totally without provision of health care
measures. Furthermore, small impoundments, es-
pecially when they are not financed by the govern-
ment, are often affected by problems of maintenance,
seepage and water discipline, all of which favor the
extension of vector habitats. The rapid increase of
construction of small dams, desirable as it is, consti-
tutes an ominous threat to health. The development
of disease prevention programs is therefore urgently
needed around these constructions, as well as support
for maintenance of earthworks.
Time-lag between infection and pathology
In the case of schistosomiasis, public awareness
emerges slowly because of the insidious onset of the
disease and rather slow appearance of grosser clinical
manifestations. Depending on variable intensities of
infection, the full pathologies in severe cases may not
develop for l&20 years. Thus there is a long time-lag
between the onset of infection. which can be rapid.
say a year or two, in a new irrigation scheme, and the
onset of disabling sickness. Peasant stoicism bringing,
as it does, a phlegmatic acceptance of disease. com-
pounded by ignorance of etiology and an absence of
politicization, generally prevents public outcry. The
community demand for health care services is accord-
ingly muted and the proliferation of new schemes
continues, often recklessly disregarding future health
costs. In this respect, the role of health agencies is to
help prevent ‘future shock by creating an informed
body of opinion that will insist on the inclusion of
adequate health-care infrastructures in all future
schemes of water impoundment and irrigation.
Aji+ca
Water impoundment schemes vary in size and for
the sake of simplicity can be graded into large.
medium and small, using either the classification of
the Knoxville International Symposium on Man-
Made Lakes [16] or that of the most recent World
Register of Dams prepared by the International Com-
mission on Large Dams [l 11. Information on
national programs for the construction of large and
medium impoundments is easier to obtain that for
small dams; the larger impoundments are fewer,
require central funds and other resources, and are di-
rected perhaps to a national objective, while small
dams generally derive from local needs, decisions and
inputs. Thus the rate of increase in the number of
impoundments can be gauged by examining fairly ac-
curate and complete data on large dams and by aug-
menting these with the rare, incomplete but often im-
pressive statements on the numbers of small im-
poundments being constructed.
Large impoundments. In Table 2, which is based on
the World Register of Dams [ll]. the number of
dams and the time of their construction are
presented: (a) for 29 out of the 31 listed countries of
Africa, Zimbabwe and South Africa being the two
exceptions; and (b) for the 25 countries lying between
latitude 23”3O’N and 23”3O’S,i.e. in tropical Africa.
These figures suggest that in the countries of trop-
ical Africa the rate of increase in large dam construc-
tion between one decade and the next is now at least
50% and may be higher. Since 1973, several new im-
poundments have been proposed in Ghana. Mali and
Nigeria and some, which are not listed in the World
Register of Dams [l I], are already under construc-
tion. Nigeria has recently allocated 10 million Naira
(approx. US $17.500.000) for feasibility studies and
engineering design alone, for proposed dams and irri-
gation schemes in 9 river basins [17]. In the Sudan. a
 Man-made lakes and man-made diseases
Table 2. Rate of construction
Countries
(a) In 29 countries
(b) In 25 ‘tropical’ countries
*Figures according to information gathered up to 1972 but including projects for
the future.
Table 3. Names and dates of construction of some of the
major dams in Africa
Date of completion
. Dam (country) of construction
Aswan. low dam (Egypt) 1933
Owen Falls (Uganda) 1954
Kariba (Zambia/Zimbabwe) 1959
Akosombo (Ghana) 1965
Kainji (Nigeria) 1968
Aswan, high dam (Egypt) 1970
Kafue (Zambia) 1971
Kossou (Ivory Coast) 1972
Cabora Bassa (Mozambique) (1980):’
Kpong (Ghana) (1981)?
large new irrigation system. the Rahad, has been de-
veloped and further irrigation extensions to the
Gezira are planned.
The huge Gezira irrigation system comprises
850,000 ha and consists of the original Gezira scheme
of 1925 and the Managil extension finished in 1962.
The scheme, with some 2 million people, is divided
into 14 groups which are further subdivided into 107
blocks, the basic irrigation units. Additional to the
Gezira area proper, several large towns are situated
within or in close proximity to the’ area, e.g. Wad
Medani, Hassaheisa and Sennar. Tenant farmers in
the Gezira live in small villages of about 1000 people
each. and there are numerous unregistered villages of
Fellata from Nigeria and immigrants from the
western Sudan. During the cotton season there exist
in addition many temporary camps built by seasonal
laborers who may number as many as half a million
people.
Small irnpoItrtdr,l~llrs. In Ghana, for example. about
120 small dams are being constructed in the Upper
Region with foreign aid. Recently technical assistance
has been proposed for the construction of 20 dams in
order to support an agricultural program in the
Northern Region. Some further indication of the scale
on which small dams are being constructed comes
from Nyanza Province in Kenya where a program
began in 1957; within 3 years SO.OBOhad been built.
In Mali. a system of 50 small dams is being estab-
lished in the Cercle de Bandiagra (population 160,000)
to promote vegetable growing. By 1977 about 20 of
these had been completed or were under construction
[18]. Another example would be the construction.
with foreign technical assistance. of 57 small dams in
an area of northern Cameroun where numerous
1133
of large dams in Africa (pre-19X&1971)
Number of dams constructed
Pre-1950 1951-1960 1961-1970 1971*
26 28 38 28
5 19 28 18
water-related diseases are endemic and where, in con-
sequence, a considerable disease impact may be
expected. No health measures are included in the
project [ 191.
Asia
Two sources of information on water resources de-
velopment projects relating to Indonesia, Malaysia,
Philippines and Thailand have been available for this
review: (i) the World Register of Dams [ll] which
lists only large impoundments; and (ii) the report by
Harinasuta et al. 183 which describes projects in each
country. Relevant information contained in the World
Register of Dams [l l] is summarized in Table 4
which presents the number of large dams by the
decade of their construction for each country. These
figures show a considerable increase in the construc-
tion of large dams between the two decades
1951-1960 and 1961-1970. For the period 1971-1976,
the data are necessarily incomplete and several of the
10 dams in Thailand were still under construction.
Such useful information as could be readily
extracted from the report by Harinasuta et al. [S] is
summarized in the following sections by country [20].
In general three main types of dam are described for
these countries: the multipurpose dam for hydro-elec-
tric power, irrigation and flood control: the dam pri-
marily for hydro-electric power; and the dam for irri-
gation projects.
Indonesia. In the last 10-15 years the Government
has been greatly concerned with the development of
water resources. Most of the new projects are sited on
the Island of Java (Table 5) where 647: of the
country’s population of 137 million live.
Malaysia. A number of water development projects
from the current Development Plan (19761980) are
indicated below. In East Malaysia one major hydro-
electric project will be implemented soon in Sabah.
and similar projects are proposed for Sarawak. but
they are still being studied. In West Malaysia. some of
the projects are already in operation or about to be
implemented: (i) 2 irrigation projects for 75,OOBha of
agricultural land in Perak State; (ii) 5 impoundments
for hydroelectric power and irrigation of the Pahang
river basin: (iii) the Kenyir multipurpose project in
the Trengganu river basin for hydro-electric power
and irrigation of 198.000 ha: (iv) a project to increase
irrigation to cover 48.000 ha in the agriculture project
in North West Selangor; (v) in Selangor. a hydro-
electric project (Gambak) and relatively small water
supply schemes; (vi) a major development in the
Kelantan river basin for hydro-electric power and
irrigation of over 100.000 ha: and (vii) a number of
water supply schemes in the Southern States.
1134 JOHN M. HUNTER rt al.

Table 4. Rate of construction of large dams in four countries of Asia

(pre-195Ck1971)

Country Pre-1950 1951-1960 1961-1970 1971’

Indonesia 13 3 8 -
Malaysia 2 1 8
Philippines 2 3 2 -
Thailand - 9 27 10
Total 3 3 z i-d

*Figures according to information gathered up to 1972 but including

projects for the future.

Philippines. The rate of growth to be expected in Latin America

water development projects in the Philippines is
clearly Seen from an inventory of projects made in
1978 by the National Water Resource Council. Out of
a total of 861 dams, reservoirs and irrigation systems:
(i) 39 are in operation, 12 under construction, 177
awaiting construction; (ii) 31 are under investigation
and study and 361 have been identified for investiga-
tion and study; and (iii) feasibility studies have been
completed on 12 projects and tentative planning
studies have been made on a further 229.
ThniluM. An important program has already been
carried out for the development of water resources in
Thailand. In the Fourth Five-Year Development Plan
for the period 1977-1981 proposals were made for
further schemes to be undertaken. (i) Northern Region.
One small scale multipurpose dam (Mae Gnud) is due
for completion in 1980; three others were built
between 1964 and 1973. Two small scale dams are at
present under construction to irrigate 47,520 ha; the
total number of these dams will then be 131, irrigating
294,000 ha. (ii) Central Region. A second large multi-
purpose dam (Srinagarind) is due to be commissioned
in 1980, providing hydra-electric power and water to
irrigate 500,000 ha of agricultural land. Many small
irrigation dams have been constructed in the last 20
years; one, the Phitsanulok dam, is under construc-
tion and should be completed in 1984; it will irrigate
187,500 ha. (iii) North-East Region. Four large multi-
purpose dams and several large and small dams for
irrigation have already been provided in the region.
No further projects are being undertaken during the
current Development Plan. (iv) Southern Region. One
large multipurpose dam is due to be completed in
1981, to produce hydro-electric power and to irrigate
48,000 ha in the first phase and 20,000 ha in the
second phase. There are also plans to construct three
dams in the Ta Pee river basin, to irrigate 100,000 ha.
The number of man-made lakes being constructed
in Latin America is continually increasing, as can be
seen in Table 6 which summarizes data from the
World Register of Dams [l 11. In Brazil, for instance,
future developments can be anticipated if it is con-
sidered that, from the estimated total hydro-electric
potential of 80,000 MW. only about 18,000 MW are
presently harnessed, through the activity of more than
400 hydra-electric plants. Two giant plants are cur-
rently under construction: Itaipu (12,600 MW) on the
Parana river and Tucurui (8000 MW) on the Tocan-
tins river. The rate of new construction is around 10
important lakes per year.
Numerous small and medium sized impoundments
(some 800 in the northeastern part of Brazil only)
have been built for irrigation or other purposes. There
will always be new ones as the cultivated areas in-
crease or agricultural technology is improved. In 1976
in Venezuela. there were 54 man-made lakes, 4 were
under construction and 8 others planned. The irri-
gated surface, which was 64,914 ha in 1968. increased
to 74,251 ha in 1972. Since then, about 5000 ha of
irrigated land have been added to that of the preced-
ing year. In 1975, more than 90,000 ha were under
irrigation. The Quinquennial Programme of Hy-
draulic Resources for 19761980 considered the possi-
bility of attaining a total of 246,916 ha of cultivated
land under irrigation by the end of this decade.
CONSIDERATlONS OF POLICY AND
IMPLEMENTATION
The dilemma
National and international efforts to improve the
quality of life in the developing world through the
provision of better nutrition and the generation of

Table 5. Numbers of water resources projects on Java and other islands (1965-1978)

Number of projects

Implemented Under construction Proposed

Type of Other Other Other

dam Java islands Java islands Java islands

Multipurpose 2 3 1
Hydro-electric - 2 13 -
1rriga:ion I - 1
 Man-made lakes and man-made diseases 1135

Table 6. Rate of construction of large dams in 21 countries of Latin America

(pre-1950-1971)

Pre-1950 1951-1960 1961-1970 1971* Total

1. Argentina 22 13 16 15 66
2. Brazil 119 111 97 93 420
3. Chile 34 7 10 15 66
4. Cuba 2 2 17 28 49
5. Colombia - 5 18 42 65
6. Costa Rica - 2 1 4
7. Dominican Republic - - 1 1
8. El Salvador - 2 1 1 4
9. Ecuador - - 1 1 2
10. Haiti - - - 1
11. Honduras - - I 1 2
12. Jamaica 2 - - - 2
13. Mexico 75 45 132 7 259
14. Nicaragua - 1 - 3 4
15. Panama 2 - 2 1 5
16. Paraguay - - 1 1 2
17. Peru 35 5 13 23 76
18. Surinam - - 1 - 1
19. Trinidad and Tobago 2 - - 3
20. Uruguay 1 2 - - 3
21. Venezuelat 9 IO 22 25 66

Total 302 207 334 258 1101

*Figures according to information gathered up to 1972 but including projects for the
future. Nevertheless. the numbers here represent in general only a fraction of the
projects currently planned or the dams under construction.
tupdated according to Direction General de Recursos Hidraulicos [21].

more income are highly laudable. Such ‘development’
efforts necessarily take the form of interventions to
change the status quo ante and to alter the existing
order of man-environment relationships. The ensuing
change requires adaptations which are inherently
stressful. Responses to stress may be adaptive and
beneficial rather than negative, depending upon cir-
cumstances including time. However, in the develop-
ing world, observation reveals many seriously mal-
adapted responses to the forces of change created by
development activity. Furthermore, developmental
interventions have produced unexpected conse-
quences, all of which bear negatively on the health of
populations.
It is now widely known that economic development
activities mediated through the introduction of radi-
cal changes of man-environment relationships may
also disrupt disease patterns by creating new areas of
prevalence. new foci and, often, serious outbreaks of
disease. Indeed there are very few newly introduced
economic activities that are entirely free of adverse
repercussions on health. Thus, ironically, economic
activity, under the banner of ‘development’, is creating
ill health, which is a strange form of societal self-
abuse. Water management schemes are particularly
implicated because they set off a series of ecosystem
disturbances that involve parasitic and infectious dis-
ease transmission cycles. The literature of medical
science is now replete with accounts of dramatic in-
creases in water-related diseases such as malaria and
schistosomiasis in water impoundment schemes in the
tropical world. Furthermore. given the present rate of
water impoundment. and in view of known future
plans in many countries. it appears that the problem
of disease generation will become exponentially more
serious unless the necessary preventive measures are
taken.
The premise of’ complementarity. It is argued that
economic development and health are wholly interde-
pendent ; indeed they are indivisible. Economic
growth through the dissemination of production
benefits should promote good health rather than
create illness and disease, as is frequently the case
today. It is thus conceptually unacceptable that econ-
omic development planning and health maintenance
should appear to be antagonistic rather than comple-
mentary entities. Increasing illness will ultimately
jeopardize economic development no matter how suc-
cessful the latter appears to be in the short run. The
policy position maintained here is that health and
development are mutually reinforcing. one promoting
the other, both enhancing the quality of life.
Disregard of ComplementaritJ. It is dysfunctional
and counter-productive in economic development
planning to ignore the health-sequelae of water im-
poundment schemes. Time-lag effects do not minimize
this responsibility. Some decades ago. it could be
argued that those engaged in water development
planning were innocently unaware of the health con-
sequences of their actions, that the arts and sciences
of development planning using water impoundment
were uninformed. ecologically naive. and ill-equipped
to anticipate the unknown and the unintended. Such
excuses no longer exist. Much is known and there is a
widespread consciousness of ecological sequelae of
water impoundment. Sufficient evidence has now
accumulated to show that the ecological conse-
quences of water resources development. including
1136 JOHN M. HUNTER et
the increase of parasitic and infectious diseases, are
predictable empirically. It is argued also that refuge
cannot be taken in narrow sectoral planning compart-
ments because the real world is not disaggregated in
this way. It is untenable to divide the problems of
river basin development into separate administrative
and bureaucratic entities. Furthermore, it appears
highly unethical to create and then ignore health
hazards. This may also be regarded as a misallocation
of real costs.
Ma/distribution of risks and benefits. Typically, in
those water impoundment schemes involving irriga-
tion and power production, significant regional asym-
metries of benefit and risk are found. People living in
towns and participants in the wider national economy
enjoy electricity, wage employment and other econ-
omic benefits generated through the water develop-
ment scheme, whereas people at the lake-side suffer
from increased disease and are even worse off than
before. Through this inequity of distribution of bene-
fits, the effect of the water impoundment scheme is to
exaggerate social and economic disequilibrium in dif-
ferent parts of the country. Environmental degrada-
tion in one place, the lake area, stands in stark con-
trast to improvement in the quality of life elsewhere.
To remedy this situation national planning mechan-
isms must be established with the purpose of reducing
regional inequalities through both risk reduction and
the better spread of benefits.
It is argued that the absence of coordination among
administrative bureaucracies such as the Ministries
responsible for agriculture, water supply, electricity,
education and health, is inefficient and wasteful of
national resources. Such institutional separatism
usually results in water impoundment schemes being
implemented by relatively capital-rich bureaucracies
that unintentionally create outbreaks of disease; and
then the cost of managing these disease out-breaks is
transferred to the capital-poor, under-financed and
infrastructurally weaker health-care services. In other
words, the agencies that create the problem do not
share the subsequent disease costs; whereas, in justice,
populations enjoying the scheme’s wider benefits
should assist those suffering from it; or better yet,
help avoid the problem in the first place.
DeJning the basic challenge. How should the econ-
omic premise that disease burdens are the inescapable
price of progress-in this case, of increased energy
generation and agricultural production through irri-
gation-be regarded? One view is that the construc-
tion of many new dams and reservoirs is imperative,
that environmental and health costs are inevitable
and therefore must be absorbed in order to secure
overall benefits [12]. The case is cited of a foreign
journalist becoming persona non grata in country ‘X
for critically exposing the schistosomiasis problem,
allegedly inflating its importance beyond that of food
production. Putting aside the question of responsible
reporting, it is not an ‘either or’ situation: preventive
health care measures can be introduced into water
development projects without impairing their ef-
ficiency and there is a distinct possibility that such
measures will increase production efficiency. In any
case is it econometrically valid to omit future health
costs from the debit-credit balance?
Continuing experience in the tropical world shows
al.
that the apparent interests of water impoundments
and irrigation schemes on the one hand and of human
health on the other are allowed to function as inimi-
cal, antagonistically opposed entities. Worthington
[14] admits that irrigated agriculture and health are
actually seen as opposed, in the narrow view, but
argues that they can be made complementary. To
make them complementary is a basic challenge. Full
policy recognition of the essential complementarity of
economic development and health would afford the
opportunity for coordinated planning for prevention
or minimization of health hazards emerging from
water impoundment schemes. This would share the
benefits and the costs over the nation as a whole.
Preventive measures would also promote greater
economic production efficiency. Furthermore, as pre-
ventive health care costs are lower than curative costs.
the total real costs to the country would be reduced.
Continuing transgressions of the essential comple-
mentarity of development and health cannot be
allowed to go unchallenged.
A policy solution
The principle should be established that, ideally,
economic development shall not create sickness thus
paralleling the physician’s Hippocratic oath primum
non nocere. This goal, which obtains within reason-
able limits and circumstances, follows from the
premise of complementarity. The major position held
here is that water development projects should take
into account health protection through all the stages
of planning, design, building and subsequent oper-
ation of a project. This would ensure that develop-
mental interventions be evaluated in their ecological
entirety so as to avoid or minimize the negative con-
sequences to human health.
Integrated regional planning. Health services should
not be developed separately in a water impoundment
scheme, but should be an integral part of regional,
spatial land-use planning. In this sense it is not suf-
ficient to prevent disease: health care must be part of
a wider plan for the lake, its surroundings, and
broader spheres of influence, the whole being con-
sidered as a geographical and economic entity. The
‘global’ approach, or integrated regional planning
incorporating health care, will, at the same time, serve
the cause of environmental protection. Afforestation.
fauna1 and floral maintenance, ecosystem stability and
prevention of eutrophication, and pollution of the
lake and of the downstream area by industrial efflu-
ents, of agriculturally introduced herbicides and pesti-
cides, would all be considered conjointly.
Incorporation of health costs. The infrastructural
costs of health care services and health maintenance
should be incorporated with the engineering and pub-
lic works infrastructural costs of the water impound-
ment scheme. Capital costs thus aggregated will more
realistically reflect total costs. Health maintenance
costs, after the completion of the impoundment
scheme, will be supported from the gross income of
that scheme or from some proportionate equivalency
of it, as for example, I or 0.5% of gross income from
power generation or from cotton or sugar production.
This income would cover the regular, recurrent costs
of the operation of health maintenance services and
would be chargeable to the gross income of the
 Man-made lakes and man-made diseases
scheme. In this way, the economic benefits generated
by the scheme will also cover health maintenance.
Such support would exist on a continuing, permanent
basis and could cover the costs of screening, surveil-
lance. prevention, treatment. education and vector
and intermediate host control.
Preventive measures. The existence of adequate
health services and of an infrastructure for the control
of some endemic diseases, can. in certain areas, reduce
or eliminate specific risks and make the genera1 health
situation apparently normal. In such cases, the less
dramatic problems will probably remain unnoticed,
and the slow-developing risks such as those depen-
dent on eutrophication. on cumulative pollution. or
on the deterioration of human living conditions, will
not be predicted. Many risks can be prevented at
lower costs than those of curative medicine, and, if
preventive measures are taken sufficiently early, they
will require less personnel, less equipment and less
material than after the breeding areas of disease vec-
tors or intermediate hosts have expanded, the preva-
lence rates of diseases have increased or. simply, the
number of people in need of protection has multi-
plied. While economies can be gained on reductions
of sick-leave, of consultations, and of medical care,
perhaps increased work productivity and social tran-
quility are more important benefits.
Policy implementation
A national auhoriry. A national authority might be
created with responsibilities for overseeing water im-
poundments and irrigation systems, e.g. a national
water development authority. Ideally the authority
would be at a very high administrative tier, say cabi-
net or presidential level. It would thus be administra-
tively superior to the individual departments respon-
sible for public works, power, agriculture, education,
health, transport and other functions. It would be
constituted so’as to be in a position to advise and
guide lesser, administratively more narrow sectoral
interests. Its expertise would comprise a combination
of physicians, public health specialists. parasitologists.
microbiologists, engineers, biologists, ecologists, agri-
culturalists, economists and other related pro-
fessionals and administrators. It would have the re-
sponsibility to set national goals and priorities for
water impoundment and irrigation schemes including
economic interests and health maintenance. Encour-
aging precedents for the creation of national water
impoundment and irrigation authorities may be
found in the success achieved by certain bi-national
water development organizations. such as those
embracing the frontier river basins of Paraguay-
Brazil and Argehtina-Uruguay.
Impact assessment. Each proposed scheme should
be preceded by a survey with analysis and evaluation
of the findings relating to the potential impact upon
health as well as the economic outcome. Such a
review would necessarily have to be holistic and
multidisciplinary. It would identify the unintended
negative side effects on health which could be antici-
pated, along with cost-benefit analyses of prevention.
treatment and control measures. The preparation of
appropriate guidelines for such impact assessment
statements could be developed with the collaboration
of scientists in developing countries and of inter-
1137
national scientific and technical agencies, including
the World Health Organization.
Integrated development. A further concept arises out
of national and international experiences. The necess-
ary protection of the environment to ensure the great-
est longevity of man-made lakes. to maintain the
quality of water and to avoid most of the health risks
produced by these projects. requires also an adequate
utilization of the land which is geographically and
economically influenced by the lake. This means that
the use 3f the land around the impoundment, the
establishment of new settlements and the industrial,
agricultural or other activities must be planned and
regulated in accordance with ecological principles and
sanitary and social interests. This type of planning
activity is the most economic and efficient way to
prevent or to control risks to health. as well as to
improve the quality of life in the area. One of the
purposes of the planning activity is to ensure that a
reasonable part of the investment and of the benefits
produced by the water-resources development project
is administered in such a way that local development
could be financed and guided adequately. It is time to
alter the former tendency of generating with each
such project an asymmetry in the distribution of
benefits and risks, that is, the risks occurring around
the man-made lake, with the benefits occurring in
industrialized urban areas.
Aspects of integrated development includes: (i)
Multisectoral planning. Only through integrated, mul-
tisectoral planning activity, evolving around the water
impoundment scheme, will it be possible to achieve
an effective resolution of the varying goals of power
production. increased agricultural production and im-
proved health. (ii) Health guidelines. Guidelines even-
tually leading to specific technical manuals, will have
to be established to promote integrated development
planning, including health planning measures. Health
guidelines should aim at being concise. explicit and
widely applicable. Recommendations for the creation
of multidisciplinary planning teams would be in-
cluded. Any technical manuals subsequently devel-
oped should be multidisciplinary and strongly inte-
grated by the application of systems methodology. (iii)
Sectoral synthesis. It will be necessary to integrate sec-
toral planning for agronomics. ecology, economics,
environmental monitoring, health services, clinics,
health surveillance, housing, hygiene. hydrology, lim-
nology, social activity, vector biology, wildlife eco-
logy, and so on. (iv) Regional synthesis. Just as sec-
toral synthesis is necessary in integrated development
planning, so is regional, i.e. geographical or spatial.
synthesis essential. In this spatial sense, an integration
of planning should be effected between areas above
and below the dam. around the impoundment in the
different parts of the watershed, and also beyond
watershed boundaries. The impact of impoundment
projects typically affects population migration from
distant areas. new marketing zones. and. higher levels
of spatial integration within the national spatial econ-
omy. (v) Cost synthesis. Along with regional and sec-
toral syntheses, cost synthesis should be effected by
aggregating all components of infrastructural COStS
plus the components of operational and maintenance
costs. Appropriate health related costs for such aggre-
gation will be identified in all the different sectors of

1138 JOHN M. HUNTER
the scheme such as water impoundment, agricultural
production, housing and population activity, and vec-
tor biology and control.
National regulations. An impact statement might be
considered a prerequisite for the planning activity and
for authorization of continuation of planning. The
proposed strategies for integrated development
should conform to national guidelines and national
regulation where these exist. These should constitute
further approved steps in the authorization of con-
tinuation of planning. Regulations should be devel-
oped to cover the continuous evaluation of health
impact, as well as other forms of environmental evalu-
ation of the impoundment schemes after their con-
struction. In other words, the regulations should
extend beyond the initial creation of the scheme into
its continuing, long-term operation.
Conditional financing and provision of‘funds. Appli-
cations for funding support and offers of grants
should be regarded as invalid unless they conform
with national regulations. The planning steps for inte-
grated development should constitute a prior con-
dition for the negotiation of loans from the World
Bank and other international financing bodies. The
disbursement of nationally generated funds for im-
poundment schemes should also comply with the con-
ditions.
Capital costs of the necessary health care infra-
structures such as buildings, clinics and outpatient
facilities in rural areas, should be included in the inte-
grated capital costs. In addition, the costs of recruit-
ing and training the necessary teams of health care
professionals for rural areas which are usually de-
ficient in such personnel, should be included in the
initial ‘start-up’ costs. In a developing country, ad-
ditional health care personnel will not normally be
available to meet the extra demands created by new
projects. Recurring costs for health services, screening
treatment, vector control and health education,
should be included in the standard budget planning
for recurrent operational costs of the scheme as a
whole. These latter funds should be derived directly
or indirectly from the gross income of the scheme.
This should be done as needed or on some equiva-
lency basis such as a proportion of the income equi-
valency of power generation, or of agricultural pro-
duction. The recurrent costs should also include the
costs of regular health surveillance and evaluation, as
well as environmental monitoring.
‘Future risk’ research. Except for some evident or
explosive problems, health protection in general
requires the existence of a multidisciplinary team
which has an active work-program and which can
initiate the necessary surveys, interpret the resultant
data, and plan or implement programs for prevention
or control of actual disease risks. Such a team using
suitable ecological and epidemiological techniques,
must be able to estimate disease risks with sufficient
precision to recommend. if necessary, essential
changes in the plans of the water resources develop-
ment project or in the organization and use of land
under the influence of the future lake in such a way
that risks would be eliminated or that the preventive
measures proposed could minimize their conse-
quences. This eco-epidemiological team should be
represented in every water-resources development
*
et al.
project or group of projects under the same authority
from the beginning of the enterprise and should have
a voice at the decision-making level.
Essential for policy implementation will be the
ability to respond rapidly to problems as they arise.
An effective response capability can be developed
upon the basis of information provided by an ongoing
research program that will measure disruptions in the
ecosystem. Projects would include ecosystem research
involving the dynamics of change of flora. fauna. hyd-
rology, agriculture and human social and health con-
ditions. These could be small-scale, modestly funded.
and at a pilot level.
The rate of water impoundment in the tropical
world should be recognized. The great majority of
such impoundments do not appear on national and
international registers. Indeed, within any one given
country, the Ministry of Health may not be informed
by the Ministry of Agriculture of the existence of
many such schemes nor of plans to create new ones in
the near future. Comprehensive data are extremely
difficult to obtain. Nevertheless’given the population
pressure and the increasing demand for food supplies,
together with what is known directly and indirectly of
national plans for water impoundments, it is essential
that health planners recognize that the problem of
water-related diseases is rapidly increasing in magni-
tude. After the normal lapse of time required for the
build-up of reservoirs of infection, the impact on
human health will be correspondingly enlarged.
Scientific attention has focused almost exclusively
on the largest of the water bodies in the tropical
world. These are not only important as problems in
their own right, but also have symbolic value for
human achievement. However, it is likely that small
water impoundments, in an aggregate quantitative
sense, have equally great or even greater significance
for human health. For instance, the intensity of cer-
carial infestation and of water contact per unit of
shore line and per unit volume of water is greater in
small impoundments than in large lakes, and there-
fore small impoundments can become intense foci of
schistosomiasis transmission. It is recommended that
future risk research be directed towards the problems
of disease transmission in small impoundments.
It is also recommended that organizational steps be
taken to compile national registers of small impound-
ments and to develop regulations and integrated plan-
ning strategies for preventive health measures. These
may have to be modified and adapted from the inte-
grated planning strategies developed for major im-
poundments. ‘Future risk’ research should involve
continuous evaluation and comparison of different
preventive and control strategies in both large and
small impoundments. Organizational mechanisms
should be developed to cycle research findings back
into integrated planning strategies, and national regu-
lations, through the appropriate national authorities.
This could be described as the research feed-back
loop.
Communications network on ecological and health
effects
Need. At present there is no international scientific
or technical network that addresses itself in a holistic
fashion to the problems of ecology and health in
 Man-made lakes and man-made diseases 1139

water development schemes. Research is slow and FAO Food and Agriculture Organiz-
piecemeal in its progress and suffers from lack of both ation
coordination and exchange of information. With the UNDP United Nations Development Pro-
increasing use of dams, the need for an international gram
communications network is clearly felt. In particular,
there is no international register of water impound- Leadership: Key members: The environment:
ment schemes. There is of course the valuable ICOLD UNEP United National Environment
register of large dams but this necessarily excludes the Program
smaller impoundments and is limited to engineering UNESCO- United Nations Educational,
data on the dam itself. MAB Scientific and Cultural Organiza-
Among the numerous international scientific and tion-Man and the Biosphere Pro-
technical organizations concerned with water devel- gram
opment, hydrology, dams and irrigation, there exists a ICSU-SCOPE International Council of Scientific
considerable degree of institutional separatism. In this Unions-Scientific Committee on
sense, matters of the environment and of ecology, in- Problems of the Environment [22]
cluding health, are neglected. It would be useful there-
Leadership: Key members: Financial support:
fore for international coordination to be effected to World Bank
monitor the growing problems of water impound-
African Development Bank
ment. ecology and health. Asian Development Bank
Objectives. The first objective of the proposed
Inter-American Development Bank
network would be to create an international register
of water development schemes. This register would ScientiJic and technical international membership:
cover all large schemes and as many of the small COWAR Committee on Water Research
impoundments as can be identified and recorded. The IAH International Association of Hy-
second objective would be to establish an inter- drogeologists
national clearing house for the exchange of scientific IAHS International Association of Hy-
and technical information. This would help solve drological Science
some of the problems such as lack of information IBP International Biological Program
flow, gaps in information, and other communications ICID International Commission on Irri-
deficiencies which inhibit the vigorous development of gation and Drainage
international thought and the design of constructive ICOLD International Commission on
responses. The third objective of the network would Large Dams
be to develop a functional typology of water im- IGU International Geographical Union
poundments and irrigation schemes. Such a typology IHP International Hydrological Pro-
would offer many advantages, some of which are: (i) a gram
research data base; (ii) the generation of international ISSS International Society of Soil
projects. Precedents in this area include the Soil Map Science
of the World (FAO/UNESCO), the World Atlas of IUBS International Union of Biological
Salt-affected Soils (UNESCO), the World Map of Sciences
Desertification. and the World Map of Soil Deteriora- IWRA International Water Resources As-
tion; (iii) an information base for ecosystem modelling sociation
in ecology and health aspects of water related devel- SIL International Association of Lim-
opment schemes; (iv) an information base for training nology
and education; (v) an early warning system for threats WMO World Meteorological Organiz-
to public health; and (vi) a data base for the gener- ation
ation of problem response capability.
National organkations with international programs:
Structure. The scientific and technical disciplines
involved in the network will include among others ACSAD Arab Centre for the Study of Arid
agronomy, biology, botany, climatology, ecology, Zones and Dry Lands
economics, engineering, hydrology, geography. ASCE American Society of Civil Engin-
meteorology, soil science, zoology and related social eers
sciences such as anthropology, demography and AWWA American Water Works Associ-
sociology. as well as systems analysis. The medical ation
and biomedical sciences together with health care NAS National Academy of Sciences
planning disciplines. prompted and assisted through ORSTOM Office de la Recherche Scientifique
the World Health Organization, will have a particu- et Technique Outre-Mer
larly important role to play in identifying and re- USDA United States Department of Agri-
sponding to problems of ecology and health. culture
Membership. A nucleus of international groups for
Bilateral aid programs: donor countries
collaboration in order to create a register and func-
tional typology or water impoundme& is suggested Multilateral aid programs: all to be included
below. Numerous additions are to be made.
Typolog),fbr registration
Leadership: Ke_v members: Agricultural production and The purposes of this section are to suggest: (i) a
health: tentative outline for registration of water impound-
WHO World Health Organization ments; (ii) a starting point for the development of a
1140 JOHN M. HUNTER et al.
rudimentary, functional typology, which should be
subsequently refined and rendered more technically
specific; (iii) an organizational basis for the mainten-
ance of national and international registers, with
accompanying provision of services to participating
countries; (iv) a basis for global monitoring of health
effects around water impoundments, both large and
small; and (v) that a register and typology will aug-
ment the research data base for the examination of
health effects around water impoundments.
Need. There is a growing awareness of the need to
understand both current and projected growth rates
in the Construction of water impoundment schemes,
particularly in the developing tropical world. Lack of
cognizance of such development is becoming increas-
ingly disquieting to health officials concerned with the
disease effects produced by water impoundments. In
particular, the dimensions, that is to say, the quanti-
tative basis of the phenomena, need to be established.
Data are lacking on numbers, size, and other specific
characteristics of impoundments and irrigation
schemes, including engineering, hydrological, agrono-
mic, and human health characteristics. Specific quan-
titative data should be collected on a continuing
basis. Water-related ecological and health phenom-
ena regarding human diseases, zoonoses and vectors,
need to be identified. The proposed register would
assist in this respect ‘and in specific problem recog-
nition. A functional typology that identifies different
categories of impoundments for different purposes
would help to identify problems, priorities, and needs
in the promotion of toth health services and disease
research at the international level.
Size-ordering of lakes. Size-ordering of lakes is of
medical significance. For example, schistosomiasis
transmission reflects cercarial infestation per unit
volume of water and per linear unit of shoreline and
thus small water impoundments are potentially more
dangerous in aggregate than large lakes. In this way, a
number of small impoundments will collectively
transmit more schistosomiasis than a large lake of
equal total size. There are also other significant eco-
logical differences that obtain by lake size. For
example the proliferation of rooted or floating vegeta-
tion which provides a substrate for the intermediate
snail hosts of schistosomiasis tends to be correlated
with size of water habitat. The construction of small
water impoundments is growing at a rapid rate in
many developing countries. Yet in fact little is known
about these impoundments. They are not registered
because they are not large, and because they are built
not only by different branches of government but also
by voluntary and lo&l-organizations, with no centra-
lized information available. Size-ordering registration
will draw attention to the importance of small lakes
and impoundments.
The Knoxville Symposium in 1971 [16] suggested
criteria for differentiating between ponds, lakes, and
large lakes, recommending depth thresholds of 3 and
lOm, and size thresholds of 10 and 100 km*. How-
ever, from the disease transmission point of view,
more attention should be focused on smaller im-
poundments. For this reason, six size groups are pro-
posed in Table 7.
By about 1970, it is estimated that there were about
260 ‘size 5’ dams in the world. and 40 ‘size 6’ dams.
Lake Volta. at approx. 8500 km’. is at present the
largest.
Aerial photography and remote sensing ,fi)r monitor-
ing water impoundments. Each country could easily
effect the physical counting of impoundments. par-
ticularly small impoundments. through monitoring by
aerial photography and by remote sensing. At the
simplest level, this would provide the numbers of im-
poundments, their geographical location, and calcula-
tions of surface area. The method would be efficient.
inexpensive and comprehensive. It could also be used
as a basis for the design of sample field investigations
of disease areas as well as for other forms of enquiry.
(See Appendix 1 for more detail.)
Descriptive variables for registration. In the data
registration process, it will be useful to recognize dif-
ferent groups or clusters of descriptive variables that
will define the varying characteristics of water devel-
opment schemes. These will be considered for possible
use in registration and for the development of a
health-related typology of water impoundment
projects. A list of headings is given below and is
amplified in Appendix 2: (1) gross size variables of
water body; (2) limnological variables of water body;
(3) irrigation design and practice; (4) irrigated crop
production; (5) non-irrigated crop production; (6)
livestock production; (7) game biomass; (8) aquatic
biomass; (9) forestry production; (10) ecosystem
characteristics: soils, rainfall, vegetation; (11) power
production; (12) lake transport and communications;
(13) population: settlement and demography vari-
ables; (14) population: employment and occupational
activities; (15) human disease variables; (16) zoonoses;
(17) vector biology variables; and (18) health care ser-
vices. The above list is open-ended, comprising merely
suggestions for discussion, evaluation and review. In
all cases, technically and scientifically appropriate
parameters are to be identified.
A size-ordering of descriptive characteristics is
appropriate. The foregoing descriptive variables and
groups of variables, which are detailed in Appendix 2,
may be size-ordered in categories for convenience of
data retrieval and analysis. A log scale of five class-
intervals would cover most needs, i.e. -x, x. 10x.
100x, 1000x. This would assist retrieval capability in a
matrix framework.
Central registration authority. An international
multi-agency, coordination body could be established
to operate a continuing program of registration. It
should embrace FAO, WHO, the World Bank and
other agencies and foundations, together with insti-
Table 7. Proposed size-ordering of man-
made lakes for health risks registration
and surveillance
Depth Area
Size-order (m) (km?
Size 1 lake <3 <I
Size 2 lake <3 >l
Size 3 lake <3 > IO
Size 4 lake >3 > 10
Size 5 lake > IO >loo
Size 6 lake > 10 >looo
 Man-made lakes and man-made diseases
tutions in developing countries such as the National
Academy of Sciences and Ministries responsible for
health and agriculture. The registration authority
would establish and maintain a central international
register, and make its scientific and technical content
available to governments, scientific bodies, and devel-
opment agencies. An important role of the proposed
central authority would be to establish guidelines for
registration. Scientific and technical descriptions
would have to be standardized, including the design
of registration forms.
Participation by yocernments. Participation by
governments would of course be optional and would
vary from country to country. It would be normal to
expect incomplete and partial registration of data.
The considerable difficulties that will be faced by
governments in assembling the data should be recog-
nized, even for basic information such as the name of
the impoundment, its location and its surface area.
The more technical and scientific parameters will
require the establishment of survey and monitoring
systems. These would have long-term benefits in
terms of limnological, ecological and health research;
but technical assistance would be necessary to set up
the systems. Categories of reporting could be devel-
oped such as ‘first order’, ‘second order’, ‘third order’.
and so on in decreasing levels of detail; according to
priority and interest levels, and program capability
and support. If it is effectively demonstrated that a
water impoundment registry and data bank will have
utility in agricultural planning and management and
will be beneficial for ecology and health monitoring,
then active cooperation of governments will be more
readily forthcoming, despite the difficulties of data
collection.
Operarional ~~ff~ome~. In terms of service. an inter-
national registration authority could and should give
considerable assistance to the participating countries.
If requested, data-processing services could be pro-
vided. Health information including disease preva-
lence would be included. The authority would de-
velop data storage, retrieval and access capabilities
and would provide standardized information. It
would also specifically meet technical requests for
planning purposes and research management. There
would thus be a direct feed:back to participating
countries as a service in support of the planning and
management of water bodies. ‘On-line’ service would
be provided where possible to governments and to the
scientific and technical community.
In terms of monitoring. the authority would serve
as a centralized information conduit, and would pro-
mote a worldwide monitoring of the health and eco-
logical status of water schemes on the register. The
registration authority would also provide a funda-
mental data base that would assist in research design
and in research strategies. The on-line data base, with
all of the variables attached by impoundments. would
facilitate cross-referencing of findings and would pro-
mo&e multi-disciplinary research, with obvious impli-
cations for health studies. Data retrieval could be
made by any particular groupings of key variables: by
the proposed six size categories. by wet tropical areas
or by dry tropical areas. or by any other criteria or
aggregates of criteria, including diseases. This re-
trieval capability would provide a direct feed-back to
16I I-_(
S.S.M.
1141
those engaged in health planning. management and
research. The end result should be assistance in the
prevention and control of disease and promotion of
better health in the developing world.
CONCLUSION
Although the presentation of evidence above is
necessarily selective and incomplete, it is well known
and clearly established that water development
projects aggravate health risks in the tropical world.
Furthermore. increasing rates of construction of im-
poundments. both large scale and small. offer a dis-
maying prospect of continued serious deterioration of
health in the future. Hitherto. medical services have
been left to cope on a curative basis. where possible.
with the disease outcomes of development; but it is
argued that programs of disease prevention. inte-
grated with the development projects. would effect
much better maintenance of human health. Invest-
ment and operational costs for health would be incor-
porated in the planning budgets. Major decisions of
policy and implementation need to be formulated by
governments, and by international and bilateral tech-
nical assistance agencies. to address this problem. A
communications network on ecological and health
effects, together with registration of and access to in-
formation, are vehicles that will assist in determining
strategies for disease control in the context of devel-
opment planning. Above all, however, governments
and agencies need to make a policy commitment to
recognize the processes that inadvertently generate
adverse health risks. and to attempt to minimize them
through integrated multisectoral planning.
Acknowledgmlrnrs-This paper is adapted from a report
which was- first prepared at the request of the Parasitic
Diseases Program. World Health Organization. Geneva.
The authors’-views. however. are personal. and do not
necessarily reflect the position of the World Health Organ-
ization. We are deeply indebted to Dr A. Davis. Chief.
Parasitic Diseases Program. and Dr .I. Deom. Schistoso-
miasis and Helminthic Infections. World Health Organiz-
ation. for their stimulus. encouragement and support.
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APPENDIX 1
AIRPHOTOGRAPHY AND REMOTE SENSING
Surceillance tecAnolog,b
Levels of accuracy in remote sensing are rapidly increas-
ing. More detailed, scientifically valuable information is
becoming retrievable through these mechanisms. Resolu-
tion in Landsat imagery has improved recently from I to
0.25 hectare. Literally thousands of satellites are in orbit
representing a great capacity for the collection of scientific
information. For example, it is possible to identify vegeta-
tion and land-use patterns as well as changes in those pat-
terns over time. Such environmental information is closely
related to the habitat of vectors and of intermediate hosts
and to zoonotic reservoirs. There is a distinct need to
engage in this frontier of technology in order to develop
techniques for the monitoring of disease risk. The oppor-
tunity awaits scientific leadership in this area of health
applications research. A first step would be to develop an
experimental. prototype program.
I143
UIilil)
There are three primary goals of aerial photography and
remote sensing: (i) immediate practical applications. There is
immediate utility for project management at the practical
level through appropriate information retrieval on a daily,
weekly or monthly basis. A good example would be the
proposed utilization of teledetection and teletransmission
by the Onchocerciasis Control Program in the Volta River
Basin in support of their spraying campaign against Simu-
Control. lium in West Africa [23]. (ii) Planning and program design.
A second goal of remote sensing is the assembly of an
inventory and data base for planning the future develop-
ment of natural resources. (iii) Research. Specifically
focused projects. related to health, can effectively utilize
remote sensing technology. For example. it is possible, at
the prototype level at least, to identify malaria habitats.
Applications of remote sensing for data collection and sur-
veillance of man-made lakes including small impound-
ments should be considered.
Aerial dara accumulation
(i) Types of data.(a) Aerial photoyraphy and phorograrn-
metry. These are photographic images taken from aero-
planes; they are appropriate for the detailed study of small
areas. Great precision can be achieved at scales of, for
example 1: 5000. (b) Remote sensing, sarellite imagery and
telederection. This is an area of innovation and technologi-
cal growth. Magnetic tape retrieval is available to all devel-
oping countries. Machine print-out capability of the data
recorded by the satellites includes computer mapping in
color (e.g. land .use and crop regions in rural tropical
areas). (c) Automated relerransmission. Networks of terres-
trial stations can be established. for example around lakes,
in river basins, in ecological zones. and by country. These
stations would be identified by telemetric code. would
operate automatically and would send signals to satellites
overhead giving environmental parameters such as water
in Africa. level and amount of rainfall. Through teletransmission,
data could be rapidly collated in different ways as required
for the near-instantaneous provision of information to be
used in research and project management. (d) Direct ques-
tioning. A further capability to be derived from a network
of automated telemetric monitoring stations would be to
fly over such stations by helicopter and. by signal. to ask
them direct questions. This would provide immediate,
localized data, which are valuable if needs demand. though
more costly infrastructurally.
(ii) Uriliry jbr disease control. (a) Register. Remote sens-
ing is available at low cost and could be utilized for the
basic identification of lakes. establishing their numbers.
size and geographical coordinates. This would be especially
valuable for the large numbers of smaller impoundments
that escape the registration process. (See text for note on
monitoring for registration.) (b) Encironmental moniroriny.
Remote sensing is extremely valuable for ecological analy-
sis. Environmental status and environmental changes can
be monitored around large lakes, and also in regions of
extensive use of small impoundments. (c) Human hahitar.
Remote sensing can be used to collect information on
settlements and settlement trends. on location of villages
and changes of locations, and on agricultural systems and
areas of cultivation, grazing. and burning practices. (d) Dis-
ease habitats. With the appropriate development of
research methodologies and the design of prototype pro-
grams. it would be possible to identify disease habitats. i.e.
environmental areas of high risk of disease transmission. In
particular. the capability of automatic monitoring of water-
body levels and of other habitat characteristics over wide
areas in the developing world could eventually be related.
effectively. to parameters of insect populations. snail vet-
tars and other man-disease habitat relationships.
1144 JOHN M. HUNTERcf al.

APPENDIX 2 7. Game biomass

Area definitions to be determined
DESCRIPTIVE VARIABLES Sustained yield offtake per year in defined areas around
the lake. kg/km’
The following lists of groups of descriptive variables of Hunters and gatherers. families and dependents.
water development schemes are intended to serve (a) as numbers (zoonotic contact)
guidelines for a national and international registration pro-
Other biomass characteristics.
gram, and (b) as a representative set of descriptors for the 1
preparation of a functional health-related typology of 8. Aquatic biomass
water control schemes. In all cases. these lists are merely Fish: sustained yield offtake, fish harvests. kg per year
preliminary suggestions for review, and technically and Other aquatic foodstuffs
scientifically appropriate parameters will need to be ident- Fishermen: families and dependents. numbers (water
ified. contact).
I. Gross six variables of‘ water body 9. Forestry production
Area. km2 Area definitions to be determined
Depth. m Sustained yield harvesting by species defined per unit
Shoreline length, km area around the lake
Grassline volume-high water. 106, m’ Other forest products
Grassline volume-low water. 10”. m3 Numbers engaged (relevant for zoonotic health risks).
Volume per unit of surface area
Seasonal flux coefficient IO. Ecosystem characteristics: soils. rainfall, Fegetation
IO year flux coefficient. Ecosystem area definitions to be determined both
upstream and downstream, within the watershed, and
2. Limnological variables of water body beyond
Water chemicals Rainfall, mm/year
Water pH Rainfall. number of dry and/or wet months per year
Water suspended particles Temperatures per month and per year
Water trace-elements Evaporation
Water thermal characteristics Evapotranspiration
Water movements and currents Soil distributions, catenas. profiles
Water stratification Watershed: monitoring of erosion sources; protection:
Water photo-sensitivity characteristics reserves, fences. barriers. boundaries
Water phyto-plankton Water-table characteristics; seasonal flux, and time-
Water zoo-plankton trends, run-off, parameters. seasonal and other vari-
‘Age’ of lake. ations
Vegetation patterns, floristic communities, species, stab-
3. Irrigation design and practice ility and flux. measures. fauna1 communities. eco-
Water irrigation volume-high water. ha/m types.
Water irrigation volume-low water, ha/m 1I. Power production
Storage capacity
Service areas both regional and national to be defined
Offtake capacity
Consumer type definitions also to be established
Pipes, pumps. gravity Bow. open or covered channels
Power potential. MW, Head-m
Sub-impoundments
Spillway characteristics
Networks of channels. aquaducts
Other engineering characteristics.
Spray, sprinkler systems
Periods of irrigation by areas, and duration of flow 12. Lake transport and communications
Drawdown area km2, lo6 ha
Service areas to be defined
Discrete hydrological units
Unified hydrological units Wider connections to be defined
People per km per year by type of lake vehicle
Water table characteristics
Volume of goods per km per year by type of lake ve-
‘Age’ of irrigation areas.
hicle
Value of goods per km per year by type of lake vehicle
4. Irrigated crop production
Type of goods volume per year lake transport
Areas by crop type, e.g. cotton, sugar, vegetables, tree Schedules, formal commercial
crops Schedules, informal commercial
Water need characteristics: applications, durations, Other
amounts. by crop by time of day by season (relevant Transportation axes by direction by distance.
for water contact)
Crop micro-climate characteristics (relevant for vector 13. Population: settlement and demography variables
control). Appropriate area definitions to be made for each popu-
lation group
5. Non-irrigated crop production Numbers displaced and relocated, ‘relocatees’
Crop-type and other characteristics. Numbers involved in ‘host’ communities
Numbers of ‘immigrants’
6. Livestock production Numbers not moving and not receiving ‘relocatees’.
Livestock watering capacity: numbers. aggregate or viz. ‘stable residual population’
bovine equivalents Numbers, densities per unit area defined
Carrying capacity: numbers Time-related net population balance per unit area
Herder families and dependents, numbers defined: equilibrium
Area definitions of cattle raising activity (zoonotic Con- Population numbers within 1 km of lake-shore, 2 km,
tact). 5km
 Man-made lakes and man-made diseases 1145

Migration source areas 15. Human disease wriuhks

Migration. ‘source’ regional characteristics Area definitions to be made
Age, sex. demographic characteristics of the four popu- Types of diseases
lation groups. viz. relocatees. hosts, immigrants, and Presence or absence
the stable. residual communities Prevalences
Geographical spheres of influence of the water im- lncidences
poundment scheme Other variables.
Villages. towns, settlement patterns. by lake location
Settlements by other environmental and population 16. Zoonosrs
characteristics Area definitions to be determined
Settlement patterns of populations at disease risk. Zoonoses to be listed
Other variables.
14. Population: employment und occuporionul acfiriries
Area specific definitions necessary 17. Vector hiologr wriahles
Numbers and characteristics: fishing Area definitions to be determined
Number and characteristics: irrigation project. work by Species to be listed
field plots and by techniques (occupational water Data on prevalence and intensities and infectivity
contact) levels.
Numbers and characteristics: traditional livestock rais-
ing 18. Health care sercices
Numbers and characteristics: traditional hunting and Area definitions to be determined
gathering activities Health care services infrastructure
Numbers and characteristics: power production Health care services personnel
employment Population vaccination levels
Numbers and characteristics: trading activities Utilization of traditional health care services
Numbers and characteristics: artisan activities. Other information.