Running Head: HEALTH IMPACT ASSESSMENT 1

Heath Impact Assessment

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Introduction

Agricultural policy, goods and processes are critical factors of the health

of people. More than two-thirds of people are dependent on agriculture in

developing countries. Agriculture spends the most significant time, and the

majority of revenues are spent basically on food. Most people's health is closely

related to agriculture, and agriculture dominates rural life.

Agriculture converts the inputs into food and other goods such as solar

radiation, soils, irrigation water, labour, rain, agricultural products and seeds

through labour technology and work organization. Equal effort frequently does

not identify health hazards present and intended in farm operations, which often

negate health efforts and harmful effects on agriculture. At the same time,

farmers are always ready to collaborate to eliminate known, existing and visible

health concerns that may impede farming expansion.

Health and agriculture must work together to strengthen and support each

other's objectives. Both sectors should consider the impact of agricultural

activities on the health of especially vulnerable people and farmers as a whole at

the local level. Health and agriculture should focus on equity-based agrarian

components. These objectives should be supported by a clear description of the

health sector's role in agriculture.

Only a tiny portion of irrigation potential has been developed in Kenya

and many other African nations (see the first study of Ngigi). A significant

percentage of the irrigated area is for the cultivation of rice. Rice demand is

increasing throughout the continent, and the total area under cultivation is
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expected to rise. Unfortunately, during floods of rice production, malaria, other

vector and waterborne diseases are frequently associated with elevated health

hazards (Baker,2015). In Kenya, for instance, research shows that 70 times more

malaria vectors hit human beings compared to adjacent non-irrigated regions The

succession of species and peaks in vector density associated with rice are well

documented.

Objective

This paper offers a health impact assessment (HIA) of enhanced

irrigation for smallholders in Kenya. The evaluation aims to identify the

potential for human health and family income improvement through improved

management of agro-ecosystems. HIA, therefore, gives the tools to allow

intersectoral collaboration to incorporate health protection and mitigate

consequences on the health of water resource projects and other forms of

development.

Methodology used

The methodology in this HIA was primarily qualitative and included

secondary information from both published reports and key informants. To

combine health, environmental and social consequences, a socio-environmental

health model was employed. Reports and other information produced during

earlier Tana River Environmental Assessment (EA) studies were beneficial in

this respect in the absence of visits to the site. The latter was not possible within

the restricted period of HIA, especially given the general lack of safety in most

research areas.
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The four key steps for HIA were taken and they are as below:

• Identification of community stakeholders. They relate to diverse people

in the project region, generally grouped in the current HIA, depending on their

employment, geographical location or ethnicity.

Health risks identification. Under the HIA method, a possible cause of

damage is a health hazard. The five types of health risks are discussed in this

work; communicable illnesses, non-communicable diseases, malnutrition,

injuries and psychological problems.

• Assessment of health risks. The health risk is a measure of the

probability that a particular group of individuals will face a possible danger at a

specific time or location. For this project project, the evaluation was confined to

indicating that the health risk would be increased or reduced if the smallholder

irrigation in the Tana River basin would be significantly increased. The

following considerations have been applied to evaluate the health hazards of

growing irrigation: demographic, institutional, and environmental risk factors.

• Risk management recommendations and mitigation methods.

Safeguards and mitigation actions can prevent adverse health effects and

optimize health possibilities when prepared in advance or included in the

drafting of projects. They include efforts to maintain the environment and to

provide certain essential health services.

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Stakeholder Communities

Indigenous Rural Populations

For HIA, the stakeholder communities in the Upper Tana and Lower

Tana regions are arbitrarily classified according to geographical position in the

proposed project area. The Grand Falls/Mutonga Hydro Power Project that

divides the Upper and Lower Tana regions. Three districts in the Upper Tana

area: Embu, Tharaka Nithi and Mwingi. There are numerous ethnic groupings,

including Embu, Meru, Mbeere, Tharaka and Kamba (Muriuki, 2014). Mixed

farming is used in communities in the Upper Tana region. Maize and millet are

the primary food crops, and the most frequent cash crops are cotton, millet and

green grams. Livestock is an essential part of their agricultural systems.

The main section of the Lower Tana falls administratively between the

districts of Tana and Garissa. The Tana River itself serves as the border between

the two. The Somali, Boran, Pokomo and Orma are the main groups in the area.

The Tana River district is mainly populated by the pastors of Orma and Pokomo,

while the rural people of Garissa are virtually entirely pastoralists from Somalia.

According to the preceding EA ,the natural flood pattern of the river has evolved

and depends on both arable and pastoral farms. The Pokomo practices flood-

recession farming for its primary crops. The Orma have created a transhumance

system that connects dry-season grassing on the floodplain and wet-season

grassing in the hinterland. Although nomadic, the pastoral system of Somalia

depends on the river for reservoir water for up to six months of the year.
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The ceasefire in Hola since 1989 has hampered the performance of the

project and its owners, who were unable to cultivate. The Bura Irrigation Project

was an ambitious plan launched in 1977 to create jobs and contribute to foreign

exchange income through cash crops such as cotton. The system has

subsequently failed because of several issues, including machinery breakup and

overall maladministration. Currently, in Bura, the settlers and their families live

in extreme poverty, drought and hunger. The total population of around 20,000 is

formed of former farmers who came to Bura for a promise of irrigated land.
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Malaria endemicity in Kenya

Health facilities available in the Lower and Upper Tana regions .

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The Secondary Communities

Many development projects are drawing immigrants from a vast

hinterland, impoverished and jobless. As squatters in the field of the project, they

are particularly exposed to illnesses caused by poor living circumstances. They

maintain relationships with their original households and can transmit infections

home to dependents that become susceptible in turn. Women immigrants are at

risk for certain dangers, such as household violence, but both women and men

are at risk of sexually transmitted illnesses, including AIDS.

Health Risk Assessment

Common health risks

There was already significant documentation in connection to medical

and epidemiological studies in Kenya at its publication. The magazine covered

specific health concerns, including communicable illnesses, e.g. primarily

malaria, meningitis, filariasis and Schistosomiasis; non-communicable diseases,

e.g. cancer, diabetes, malnutrition; damage due to accidents in trafficking; and

mental illness..

Malaria is not just the primary cause of morbidity and participation in

ambulatory medical institutions in the research region but in much of Kenya in

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general. More than 5 million malaria cases are recorded annually in the country.

Operations in Kenya under the Ministry of Health (MoH) are easy to examine

under two main categories: a) curative and b) preventive and advertise. These

services are, in most cases, delivered in an integrated and complete way.

There is a general hospital in each of Kenya's around 41 districts at the

district or province headquarters concerning cures. The average number of beds

in a hospital district is 200. At least one general hospital with 500 beds on

average is available in the provinces. Provincial hospitals provide services to

professionals in many medical areas.

Clinics (static or mobile), health centers and distributors at the local,

community or village levels must provide basic or primary healthcare. Most of

these facilities belong to the central government, local government agencies and

non-governmental organizations.

Malaria

Review of disease

Malaria is prevalent from Embu to the Indian Ocean along the Tana

River. According to a new categorization of malaria endemicity, the Upper Tana

area in the colder and higher elevations is characterized by unstable endemicity

and low, stable low-ground endemicity. Stable endemic malaria is found in

Lower Tana on the Kenyan coast.

In locations with unstable malaria, clinical symptoms of the illness occur

periodically during peak transmission times, and persons of all ages might have

severe episodes. The disease defines intermittent transmission in these regions

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that can be yearly, biennial or variably epidemic. Embu, Tharaka Nithi and

Mwingi are districts with unstable malaria near the Tana.

Intense perpetual transmission of plasmodium parasites are in areas of

stable malaria. In children in the first five years of life and women during

pregnancy, severe infections are most prevalent. The death rate for children

under the age of five is the greatest. In populations in regions with persistent

malaria, partial immunity develops due to frequent exposure to the parasite

leading to protection against serious illness in most elderly and adults. In the

planned project area, districts with stable malaria include the Tana River, Garissa

and Lamu.

Factors of Community risk

Upper Tana communities. The indigenous population generally has low

malaria immunity owing to the volatility of the disease. The rise in irrigation of

smallholders will attract immigrants, both immune and non-immune, along with

employment and various economic activities. The former group is likely to

represent an asymptomatic reservoir of plasmodium parasites acquired during

previous trips in places of high endemicity.

The villages of Lower Tana. The malaria immunity among the

communities in Hola, Bura and farther downstream in the delta area is more

robust than in the Upper Tana area due to increased previous illness exposure.

Any increase in small-scale irrigation will lead to new immigration of immune

and non-immune people into the regions.

Environmental risk factors

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Climate changes dramatically affect the mosquito's existence and the

growth of malaria parasites and thus their impact on the transmission and

seasonal prevalence of the illness. Precipitation, temperature and humidity are

the most significant climatic variables.

Rainfall influences the transmission of malaria primarily by providing

watery environments ideal for breeding vectors. The complex Anopheles

Gambiae is the primary vector of malaria in much of East Africa (Mutero,2002).

In the delta of the river Tana, the complex consists of a combination of An.

gambiae s.str. and An. arabiensis, the latter is the primary or only upstream

species in the Lower Tana and the Upper Tana.

 In general, An. gambiae s.str. and An. arabiensis breed in various water

types, the most conspicuous being open daylight swimming pools. The origin of

these pools ranges between hoof prints around ponds and water holes and pools

caused by overflows of rivers or by receding rivers. Many of these locations

include human action, in particular during the rehabilitation of seasonal crop

wetlands. In this regard, rice fields are a fertile source of The Gambia, especially

An. arabiensis (Njuki et al. 2014). There are many distinct types of water present

in a flooded or partly flooded rice field whose features are sometimes difficult to

characterize with accuracy. Rice fields are typically the most abundant of

mosquitoes around 2-3 weeks following transplantation of rice plant. Later,

when rice is cultivated fully, it breeds at a lower level and mainly on the

margins.
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Regarding the impact of other climate conditions, when the temperature

is below 16 °C, malaria parasites in the mosquito cease to grow. The optimal

conditions for plasmodium generation and transmission are in the Anopheles

when the average temperature is within the range of 20−30 °C. By contrast, the

average relative humidity is at least 60 per cent. A high moisture relative spreads

the mosquito's life and enables the mosquito to survive long enough to transmit

the illness to many individuals.

Smallholder irrigation projects may be as famous as larger extensive

systems if water drainage in vector populations and accompanying malaria

transmission is not managed correctly. In the many tiny pools produced by

footprints during rice transplantation, mosquito breeding is most prolific even in

the vast rice irrigation systems. If smallholder irrigation trends are anticipated to

increase, particularly in the event of more frequent Tana floods, the vector

breeding habitat will also grow, worsening the malaria issue today.

Institutional risk factors

Both NGOs and MOH in the Lower and Upper Tana Districts are

engaged in promoting insecticide-treated bed nets to protect them from mosquito

bites. Community-based structures are typically used to start grassroots

organizations with total cost bed-net recovery. Unfortunately, the failure rates of

many community initiatives are high mainly because communities cannot pay

either the networks or the drugs they get. Despite having stations at each site

with medical facilities, the MOH's Vector-Borne Diseases Division (DVBD) is

dormant mainly due to a lack of finances on operations and vehicles. The already
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familiar resistance of malaria parasites to the primary curative medication,

chloroquine, is an additional confusing element in malaria. Alternative

medicines, such as Fansidar, are not available to most families.

Findings concluded summary

The assessment based on the community, environmental and institutional

risk factors indicates that the risk of malaria increases among people living in the

Upper and Lower Tana region when rice and other crops under smallholder

irrigation grow. The development of mosquito breeding sites by minor irrigation

in the Upper Tana area would enhance the populations of malaria vectors.

Immigrants from malaria zones should offer a reservoir of parasites that might

lead to the spread of malaria for most of the year. In the downstream region, the

vector habitat will also grow due to human activities connected to transhumance

and increased smallholder irrigation.

Risk Management and Mitigation Measures

When irrigation is expanded, overall poverty is undoubtedly one of the

most serious issues affecting the stakeholders' communities. Solidation of

economic empowerment production and marketing systems would thus rate high

amongst ways to enhance health and the general well-being of societies. In the

case of malaria, a community-based health education campaign should be

established to promote knowledge of illnesses and potential management

methods at the commencement of irrigation extension in specific regions.

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For malaria and Schistosomiasis, it may be cheap to screen the eaves and

windows with mosquito-resistant mesh wire to limit the contact between

mosquitoes. Both the government and NGOs should assist communities in

creating sustained methods to distribute mosquito networks medicated with

antimalarial and pesticide. These measures are essential in preventing increased

mortality, especially among pregnant women and children under five.

Conclusion

The HIA indicates that expanding irrigation in the Tana Basin will

improve farming systems and human nutrition and well-being among people at

the bottom of the basin. However, the danger of numerous infectious illnesses,

including malaria and Schistosomiasis, would also be increased. Protections

against negative consequences should be included to optimize their efficacy as

soon as possible.
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References

Njuki, J., Waithanji, E., Sakwa, B., Kariuki, J., Mukewa, E., & Ngige, J.

(2014). Can market-based approaches to technology development and

dissemination benefit women smallholder farmers?: A qualitative

assessment of gender dynamics in the ownership, purchase, and use of

irrigation pumps in Kenya and Tanzania (Vol. 1357). Intl Food Policy

Res Inst.

Mutero, C. M. (2002). Health impact assessment of increased irrigation in the

Tana River Basin, Kenya. The Changing Face of Irrigation in Kenya:

Opportunities for anticipating change in eastern and southern Africa,

211-29.

Muriuki, J. M. (2014). Epidemiology and control of malaria in irrigated parts of

Tana river county, Kenya (Doctoral dissertation, University of Nairobi).

Baker, T., Kiptala, J., Olaka, L., Oates, N., Hussain, A., & McCartney, M.

(2015). Baseline review and ecosystem services assessment of the Tana

River Basin, Kenya (Vol. 165). International Water Management Institute

(IWMI).