water sources, infrastructure, space and the dynamics of ...

Supervisor: Ulla MortbergCo-supervisor: Jan-Erik GustafssonWATER SOURCES, INFRASTRUCTURE,SPACE AND THE DYNAMICS OFENVIRONMENTAL DISEASES INSABOBA DISTRICT, NORTHERNGHANA: USING GISMatthew Biniyam KursahDecember 2009TRITA-LWR Master Degree ProjectISSN 1651-064XLWR-EX-09-13

Matthew Biniyam KursahTRITA LWR Master Thesis© M.B. Kursah 2009Master ThesisDepartment of Land and Water Resources EngineeringRoyal Institute of Technology (KTH)SE-100 44 STOCKHOLM, Swedenii

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISABSTRACTThis research was undertaken in Saboba district of Northern Ghana to examine the relationbetween water sources, infrastructure and space on one hand and dynamics of environmentaldiseases on the other. The specific causes of high environmental diseases in the district werealso identified. The top three leading diseases (Malaria, Typhoid and Respiratory TractInfections, RTI) in the district are environmental, wherein the first two is water-related. Thestudy discovered that there was an inverse significant correlation between incidences ofMalaria, Typhoid and RTI on one hand and distances to major town on the other. However,the correlation between the former and distances to watercourses, roads, the type of landcover and elevation (except malaria and distance to roads) had no significant relationship. Itwas discovered that women were disproportionately affected by environmental diseases. Thestudy also discovered that the immediate health threats for the people of Saboba district arethe life and death immediacy of Malaria, Typhoid and respiratory diseases. These threats aremainly derived from synergic human causes from household environments, characterised byfar-from-door-clean-water, near-the-door-faeces, uncontrolled sewage, presence of dugout pits,frequent interruption of pipe water, poor waste disposal, poverty and illiteracy. For causes,the study concluded that the high rates of environmental diseases; especially malaria andTyphoid, were largely due to lack of and/or inappropriate infrastructural constructions. It issuggested that health officials in the district need to reprioritise health campaigns to createmore awareness on the commonest diseases in the district rather than tolling theinternational health campaign trends.Key words: Environmental diseases; Free-range; Space; Stagnant water; Waterrelateddiseasesiii

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISDEDICATIONI dedicate this work to my dearest Dad and Mum; Unalong-bor Biniyam Kursah andTeshilla Yakpaa, whose love and care brought me this far in life.v

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISSAMMANFATTNINGDenna forskning genomfördes i Saboba området i norra Ghana för att undersökaförhållandet mellan vatten källor, yta och dynamik av miljösjukdomar. Studien identifieradespecifika orsaker till miljösjukdomar - infrastrukturell uppbyggnad, med särskilt avseende påvattenrelaterade sjukdomar i området. Primära och sekundära datakällor användes i dennaforskning. Frågeformulären administrerades (stickprov) mellan augusti-oktober, 2007, till 130svarande (15 år och över) i området, medan sekundära data inkluderade nationella och lokalapublikationer. Geografiskt informationssystem (GIS) och Statistiskt paket för socialvetenskap (SPSS) användes för att analysera data. Med användandet av GIS (ArcGIS) ochSPSS undersöktes specifika variabler såsom avstånd till större stad, vattenresurser, vägar ochlandtäcke och höjden undersöktes för att se dess korrelation med graden av miljösjukdomar iområdet.För området i allmänhet identifierade forskningen att fritt utspridd avföring rangordnas somdet mest trängande miljöproblem, följt av brist av rent/behandlat vatten, vildmarksbränder,närvaro av stillastående vatten och nerskräpad miljö. Detta emellertid skiljer sig åt från platstill plats inom området. Frånsett Wapuli där brist på vatten anses som ett huvudproblem, iandra utvalda områden, har problematiken att göra med vattenkvalitet. De allmännavattenkällorna i området är källor, floder och strömmar (50.2%), borrhål (17.2%), grävda hål(12.7%), brunnar (12.4%) och rörlett (7.4%). Det avslöjades också att många av invånarnainte dricker vatten från borrhåll på grund av långa avstånd och/eller som de säger; dessvatten är för lätt och släcker inte törsten. Forskningen identifierade också att medvetenheten omde vanligaste sjukdomarna i området är allmänt låg. De topp fyra ledande sjukdomarna(malaria, tyfus, respiratoriska områdesinfektioner - RTI och diarré) i området ärmiljömässiga, där de första två är vattenrelaterade. Studien upptäckte också att de omgåendehälsohoten för folket i Saboba området är liv- och dödomedelbarheten av malaria, tyfus ochrespiratoriska sjukdomar. Dessa hot härleds främst från synergistiska mänskliga orsaker frånhushållsmiljöer, karakteriserat av långt-från-dörr-rent-vatten, nära-dörren-avföring, okontrolleratavfall, närvaro av utgrävda gropar, upprepade avbrott av rörlett vatten, dålig avfallshantering,fattigdom, analfabetism och okunnighet. Den höga graden av vedanvändningen som bränslei matlagning och den rök som alstras kan förklara den höga förekomsten av respiratoriskasjukdomar i området. Studien upptäckte att det finns en viktig omvänd korrelation mellanförekomsten av malaria, tyfus och RTI å ena sidan och avståndet till närmaste stad å andrasidan. Emellertid, korrelationen mellan den förstnämnda och avståndet till vattenkällor,vägar, landtäcke och höjden (med undanta malaria och avstånd till vägar) har inget signifikantförhållande. Studien upptäckte också att kvinnor inte deltar aktivt i beslut som angårsamhället och påverkades oproportionellt av miljösjukdomar, med det faktum att flerkvinnor än män är utsatta för rök och partiklar genom matlagning, kolframställning etc.Denna studie rekommenderar hälsotjänstemän i området och andra intressenter attomprioritera hälsokampanjer för att skapa större medvetenhet om de vanligaste sjukdomarnai området - malaria, tyfus, RTI och diarré, i stället för att förkunna de nationella ellerinternationella hälsokampanjstrenderna. Områdets rådgivande församling manas också till attinförliva det existerande extralegala (traditionell inrättelse), in i det formella rättsliga system,som en väg till att nå grundligt stöd för vattenförsörjningen. Detta är tack vare faktumet attvanliga lagar sågs för att vara brett bekanta och följda då det kom från folket av folket och förfolket.vii

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISACKNOWLEDGEMENTI will first acknowledge God for guiding me throughout the research. Much gratitude goes tomy Supervisor, Assistant Professor Ulla Mörtberg for her corrections and suggestionsthroughout the research. Associate Professor Jan-Erik Gustafsson is also commended for hisassistance in this research. I will like to express my heart-felt gratitude to all persons andinstitutions that helped sustain Linneaus-Palme Scholarship Programme, a programme ofwhich I benefited. Acknowledgements to Prof. Alex Asiedu and Dr. (Mrs) MariamaAwumbila for their immense contributions in shaping my academic life, during myassociation with the Department of Geography and Resource Development, University ofGhana. Daniel Kenaston (CAM) and Kenneth Wunjagi (IDC) have also shaped my lifepositively – many thanks to them. I also acknowledge the support of the management of theSaboba Medical Centre (SMC) and Wapuli Health Centre (WHC) for their readiness inproviding health data used in this research. Many thanks to all my family members for theirencouragement and support rendered to me. I acknowledged my friends: Joseph Sukpen,Sula Peter, Juliana Manu, Samuel Gmalu, Faustina Lasim, Bernard Ntiamoah, SeraphineKogo, Gladys Dondo, Michael Commander Hormenu and Magdalena Grün for theirencouragement and support. Peter Mpuan is also acknowledged for helping me duringadministration of questionnaires. To many others, whose names, space will not allow tomention individually, I say Ni nii lituln pam.ix

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISABBREVIATIONSBOOT: Build-Own-Operate-TransferBOT: Build-Operate-TransferCAM: Charity African MissionCPP:Convention Peoples’ PartyCSIS-SNL: Centre for Strategic and International Studies-Sandia NationalLaboratoriesCWIQ: Core Welfare Indicators QuestionnaireDHMT: District Health Management TeamDPCU: District Planning Co-ordinating Unit, SabobaE.P SEC: Evangelical Presbyterian Secondary SchoolFDB: Food and Drugs BoardGGWEP: Ghana Guinea Worms Eradication ProgrammeGHC/Cedis Ghanaian currency – it was almost equal to US dollar as at July 2007GHS: Ghana Health ServiceGIS:Geographic Information SystemGSS:Ghana Statistical ServiceIDC:Integrate Development CentreIWMI: International Water Management InstituteKVIP: Improved Pit (a type of low-cost toilet facility)NGOs: Non-Governmental Organisation(s)PNDC: Provisional National Defence CouncilRTI:Respiratory Tract InfectionsSABTEC: Saboba Technical InstituteSCDA: Saboba-Chereponi District AssemblySDA:Saboba District AssemblySPSS: Statistical Package for Social ScientistsSSA:Sub-Saharan AfricaUNICEF: United Nations International Children's FundWCED: World Commission on Environment and DevelopmentWHO: World Health Organisationxi

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISTABLE OF CONTENTSABSTRACT...................................................................................................................... iiiDEDICATION ................................................................................................................. vSAMMANFATTNING .................................................................................................. viiACKNOWLEDGEMENT .............................................................................................. ixABBREVIATIONS.......................................................................................................... xiTABLE OF CONTENTS ............................................................................................. xiiiCHAPTER 1 ................................................................................................................... 1Introduction .............................................................................................................................. 1Problem Statement .................................................................................................................. 2Research Questions ........................................................................................................................................................ 2Goal and objectives......................................................................................................................................................... 2Expected outcome .......................................................................................................................................................... 3Hypothesis and propositions ............................................................................................................................................. 3Rationale for the study .................................................................................................................................................... 3Delimitation ................................................................................................................................................................. 3Literature review ...................................................................................................................... 4Causes of water scarcity ................................................................................................................................................... 4Effects of scarcity of water resources .................................................................................................................................... 4Difficulties in managing water resources .............................................................................................................................. 5Strategies for efficient water resources management ................................................................................................................. 6Ghana situations of water supply and management ............................................................................................................... 6Burning of mosquito coil and Respiratory Tract Infections (RTI) ............................................................................................. 7CHAPTER 2 ...................................................................................................................... 8The study area ......................................................................................................................... 8Physical morphology and Drainage .................................................................................................................................... 8Climate and Vegetation .................................................................................................................................................. 8Population of the area ..................................................................................................................................................... 9Economic Activities and Agricultural Land use ................................................................................................................... 9Cultural Practices and Beliefs ......................................................................................................................................... 10Poverty Levels ............................................................................................................................................................. 11Conceptual Framework of the Study ...................................................................................... 11Categorisation of Stakeholders ............................................................................................... 12Methods and materials ........................................................................................................... 13Data Sources .............................................................................................................................................................. 13Sampling ................................................................................................................................................................... 13Statistical analysis ....................................................................................................................................................... 14Spatial Analysis ......................................................................................................................................................... 14Interviews ............................................................................................................................... 15CHAPTER 3 .................................................................................................................... 15Results and discussion ........................................................................................................... 15Field problems ............................................................................................................................................................ 15Basic characteristics of respondents ................................................................................................................................... 15Disease pattern in Saboba district ................................................................................................................................... 16Preventive strategies for environmental diseases in the district: Respondents’ view ........................................................................ 16Management of water resources in Saboba district ............................................................... 19xiii

Matthew Biniyam KursahTRITA LWR Master ThesisManagement of water resources: History before 1988 ........................................................................................................... 19Water management: traditional value system and the modern positivism .................................................................................. 20Management of water resources: the past and the present compared ......................................................................................... 21Management of water: effectiveness of customary and district systems ........................................................................................ 21Sources of water in the selected areas .................................................................................... 21Saboba Town ............................................................................................................................................................. 21Bordagbalm ................................................................................................................................................................ 22Wapuli ...................................................................................................................................................................... 22Water Management Strategies in Saboba District .............................................................................................................. 22Pressing Environmental Problems in Saboba District ........................................................... 23Gender and Environmental Diseases in Saboba District ....................................................... 23Conclusion from interviews conducted in the district ........................................................... 28Interview of an individual .............................................................................................................................................. 28Interview with operator of the Saboba Community Water distribution plant ............................................................................. 29Interview with the head of Saboba District Environmental Health Unit .................................................................................. 29Interview with the Claim Officer of the NHIS, Saboba ....................................................................................................... 29Interview with Medical Assistant (MA) in Wapuli Health Centre ........................................................................................ 29Position of the propositions of this research ........................................................................................................................ 29Space and environmental diseases ......................................................................................... 30Interpretation of the size of a correlation ............................................................................................................................ 30Method used ............................................................................................................................................................... 31Space and environmental diseases: GIS analysis ................................................................... 31Distances of settlements to the main town (district capital) in Saboba district ............................................................................ 31Distances of settlements to roads in Saboba district ............................................................................................................. 31Distances of settlements to rivers in Saboba district ............................................................................................................. 31Distances of settlements to watercourses in the Saboba district ................................................................................................ 31Type of Land cover and location of settlements in Saboba district ........................................................................................... 32Elevation (in metres) and settlements in Saboba district ....................................................................................................... 32Space and incidence of malaria ........................................................................................................................................ 42Space and incidence of Typhoid ....................................................................................................................................... 44Space and incidence of RTI ............................................................................................................................................ 45Position of the hypothesis ............................................................................................................................................... 45Infrastructural construction and environmental diseases in Saboba district ......................... 46Analysis of causes of environmental diseases in Saboba district .............................................................................................. 46Burning of mosquito coil and RTI: The Local case ............................................................................................................. 51CHAPTER 4 ................................................................................................................ 53Conclusion and Recommendations ....................................................................................... 53Spatial issues .............................................................................................................................................................. 53Pressing environmental problems ..................................................................................................................................... 53Housing, toilet facilities and sanitation ............................................................................................................................. 53Water issues ............................................................................................................................................................... 54Health issues .............................................................................................................................................................. 55National Health Insurance Scheme (NHIS) ..................................................................................................................... 55Political and gender issues .............................................................................................................................................. 56Causes of high prevalence of environmental diseases in Saboba district ..................................................................................... 56Conclusion .............................................................................................................................. 57xiv

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISRecommendations .................................................................................................................. 58Health officials ............................................................................................................................................................ 58District Assembly ........................................................................................................................................................ 59Government Ministries ................................................................................................................................................. 59Local Communities ...................................................................................................................................................... 59Scientists and Epidemiologists ........................................................................................................................................ 60Policy Direction and Focus ............................................................................................................................................ 60Further Research areas ................................................................................................................................................. 60References .............................................................................................................................. 61Appendix I ................................................................................................................................ iAppendix II ............................................................................................................................ iiiAppendix III ............................................................................................................................ vGender and Environmental Diseases in Saboba District ........................................................................................................ vAppendix IV .......................................................................................................................... viixv

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISCHAPTER 1IntroductionFrom the beginning of the 21st century, most countries are faced withdevelopmental challenges of how to manage their water resources toensure sustainable use and reduce its health consequences. This problemis estimated to be more prevalent in developing countries. For example,the International Water Management Institute (IWMI, 2000) haveestimated that by 2025, water shortages will be more prevalent amongpoorer countries, and that Sub-Saharan Africa (SSA) will face watersupply shortages due to economic constraints to develop safe drinkingwater, as well as excessive population growth. This may deny thesecountries from achieving the target of the Millennium DevelopmentGoals (MDGs) on water availability and quality. World HealthOrganisation and United Nations Children's Fund, WHO and UNICEF,(2004) have also stated that more than one billion people on earthcurrently rely on water sources that are unsafe, unreliable, or difficult toaccess for their daily domestic use. As a result, millions of people, mostof them children, women and the aged are dying annually from diseasesrelated to poor water quality. Vörösmarty et al (2000) believe themagnitude of this challenge could double in the next two decades. WhileWHO (2004) stated that diarrhoeal diseases are responsible for 1.8million annual death, it also estimated that 88% of that burden isattributable to unsafe water supply and sanitation – largely in developingcountries, where Ghana is not an exception. WHO (2004) noted that; “asignificant amount of these diseases could be prevented… throughbetter access to safe water supply, adequate sanitation facilities and betterhygienic practices”.Ghana is no exemption from this estimated health burden, due in part tothe depletion in quality of its water resources. Such depletion of waterquality has become key problem facing Ghana, making herdevelopmental objectives ever more daunting, as it places healthconsequences on the people and reduce their productivity. Recognisingthis need to reduce water-related health problems by protecting waterresources, the revised population policy of Ghana (Ghana, 1994) statesthat “Government’s new policies are to tackle the growing problems of… river pollution and toxic waste, through specific interventionmeasures including education and awareness programmes...” (p. 7). Aspart of efforts to help avert this problem, government has mandated theWater Resources Commission (WRC) to develop a Buffer Zone Policyto protect riverbanks and other water sourcesMost of these health problems occur in poorer areas such as SabobaDistrict of Northern Ghana. The health impacts and problems stretchout further and further in both space and time. Despite the recognitionof the relation between water need and health related problems, itsintegration are yet to be clearly systematised and understood in Ghana,and many other developing countries. Spatial aspect on micro level ofthis health problem is not also identified, at least not in Saboba district.In order to allow informed decision-making on interventions aimed atprevention and control of environmental diseases, and specifically,water-related diseases, it is crucial to carry out research into its spatialdynamics and causes in each specific region.1

Matthew Biniyam KursahTRITA LWR Master ThesisProblem StatementSustainable development which emerged with a built-in intergenerationalequity defined to include the interest of future generations, gained fameafter the publication of Brundtland Report, WCED (1987). Thesustainable use of resources, now popularised, underlies the perceptionof the use of natural resources such as water in the Ghanaian culture. Asput forward by a popular Ghanaian chief, natural resources such as waterbelongs to a countless number of people, many of whom are dead, the living and thoseyet unborn (Nana Ofori Atta II, 1912-1942). It is also widely known thatavailability of good quality water and its quantity on one hand and betterhealth of people on the other are intrinsically linked (WHO, 2004).Generally, Saboba district has enough water needed by its population.The district is not part of areas in Ghana considered as water stressed tocause many health problems. However, while working with IntegratedDevelopment Centre (IDC), a local Non-Governmental Organisation(NGO), implementing the newly established Community HealthInsurance Scheme, it was discovered that about 70% of the diseasesreported at the hospitals and brought to the NGO outfit were waterrelateddiseases such as Malaria, Typhoid and diarrhoeal. The proportionwas even greater when the health burdens were classified asenvironmental diseases to include respiratory infections. Also, in all casesfrom 2002 to 2005, there have been astronomical increases in the ratesof disease prevalence; with 57.5% for Malaria, diarrhoeal diseases(58.6%), and Typhoid rising by 4698% (District Health ManagementTeam, DHMT, 2006). If Nana Ofori Atta II and the Ghanaian concepttowards natural resources (stated above) is indeed in practice, then onewill think that the water resources will be carefully protected andmanaged well for the present and the future generations yet unborn. Thespatial dimension to these diseases has not yet being given muchattention. What is conspicuously unclear is whether these diseases haveany relation with proximity to watercourses, district capital (main town),roads, the type of land cover and elevation? If these environmentaldiseases have relation to watercourses, then another puzzle thereforearises – what is happening to the water resources in the district that iscausing these health complications even though the government hasprovided pipe-borne water in the district. This study therefore seeks tounravel these puzzles.Research QuestionsThis study seeks to provide explanatory answers to the followingquestions;1 Whether there are legal frameworks for protecting water resources in theSaboba district?2 Is there a spatial relation between environmental diseases and distancesto the main town, roads, watercourses, the type of land cover andelevation (also referred as spatial variables)?3 What is causing the higher rates of water-related diseases in the district?Goal and objectivesThe goal of this study is to look into the spatial dynamics and causes ofhigh rates of environmental diseases, with special reference to waterrelateddiseases, in Saboba District.The Specific Objectives are to;Identify traditional and modern methods of protecting waterresources in Saboba district.2

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISIdentify the most pressing environmental problems in the district.Identify whether women and men are proportionately affected byenvironmental diseases.Use GIS to identify the spatial dynamics of environmentaldiseases.Identify the causes of high rates of environmental diseases in thedistrict and provide recommendations based on the study.Expected outcomeThe research is expected to; 1) contribute to knowledge in reducingenvironmental diseases in general and 2) broaden the knowledge of theuse of GIS as a tool to analyse health issues.Hypothesis and propositionsIn this study, it is hypothesised that; there is a significant relationshipbetween distances to the main town, roads, watercourses, the type ofland cover and elevation on one hand and environmental diseases on theother in Saboba district. In this study, two propositions are made. Theseare; 1). Environmental diseases are increasing at faster rates in Sabobadistrict and 2) environmental diseases affect more women than men.Rationale for the studyDue to the increasing rates of water-related diseases shown above byWHO and UNICEF (2004) and IWMI (2000) and the growing need forinterventions aimed at disease prevention and control, it is crucial tocarry out research into the spatial dynamics of these diseases. This studywill enable stakeholders in the case of Saboba district to design areaspecificintervention measures, as well as proactive decisions through theintegration of water management and health policies. For example, thestudy on the spatial dimension of these diseases will provide the neededinformation for the development of effective water and healthintervention policies suitable for each specific community. Also, byidentifying the past water management practices, the stakeholders will beable to integrate water and health policies in a way that is economicallyand culturally feasible in Saboba district, and Ghana in general.DelimitationThis research did not deal with the chemical components of water andthe biology of diseases, due largely to insufficient knowledge in waterchemistry and molecular biology and epidemiology respectively. Also,time, cost and resource constraints did not permit administration ofquestionnaires in all communities in the district; hence only fivecommunities were sampled. It is also worth to note that when theresearch began, the study area was originally limited to Saboba subdistrict(part of Saboba/Chereponi district). However, in February, 2008,the study area gains a full district status and named Saboba district. Theother part is named Chereponi district. Such changes are subsequentlyeffected, but some few aspects of the description of the study area stillmaintain features of the old district, since there has not yet been anyclear demarcation of the northern boundary between the two districts. Iam also aware of the classification of water related diseases as water borne,water washed, water based etc, but as this is not the focus of the research,water related as used here encompasses all of these diseases. It is alsoworth to note that, though the focus of this study is on water relateddiseases, RTI has been included for readers to see the trends ofenvironmental diseases in the district beyond those related to water.3

Matthew Biniyam KursahTRITA LWR Master ThesisLiterature reviewIn order to achieve the 7 th Millennium Development Goal – to “half by2015 the proportion of people without sustainable access to safedrinking water and basic sanitation”, Ghana needs to understand issuessuch as causes of water mismanagement/scarcity and impact on health,the effects, difficulties in managing water resources, information needsfor efficient water management and finally the managing strategies. Thissection extensively looks at these issues.Causes of water scarcityAccording to International Water Management Institute, IWMI, (2000)by 2025 water shortages will be more prevalent among poorer countriessuch as in Sub-Saharan Africa (SSA). The institute attributed this tolimited resources, rapid population growth and climatic changes. It alsostated that, generally, the developed countries of North America andEurope will not see a serious threat to water supply by 2025. This is notonly due to their relative wealth, but more importantly; the populationwill “match up” with the available water resources. This shows that thepredicted water stress has both human (population growth) and natural(climatic) causes.Centre for Strategic and International Studies-Sandia NationalLaboratories, CSIS-SNL, (2005) is also of the view that acrossdeveloping and developed regions, poor governance andmismanagement of natural resources, together with high populationgrowth, rising level of urbanisation and economic development have ledto a growing disparity between water supply and demand. Among otherthings, CSIS-SNL (2005) concluded that this trend is leading the worldtowards a tipping point in the history of mankind.Like CSIS-SNL, (2005), Gardner-Outlaw and Engelman (1997) statedthat the global trends in population growth, economic development,industrialisation, and urbanisation, among others, are pushing all ofhumanity towards a period marked by unexpected water scarcity, poorerwater quality and deterioration of sanitation conditions. The writersconcluded that by 2050, a quarter of the world’s population will live in acountry experiencing persistent water shortages.According to Garrett Hardin’s (1968) Science essay, The Tragedy of theCommons, natural resources such as water is engulfed in a social trap thatentails rivalry over resources between individual interests and thecommon good. Garrett Hardin’s theory is an affirmation of Aristotle 1 ,who believes that that which is common to the greatest number has the least carebestowed upon it. It can therefore be argued that the mismanagement ofwater resources (common good) such as rivers, lakes and other waterbodies are suffering from Garrett Hardin’s tragedy of the commons.Effects of scarcity of water resourcesPostel and Wolf (2001) stated that water stress can cause conflict orintensify conflicts and political tensions that may not have been directlycaused by water scarcity such as Bolivian Water Wars of 2000. Gradualreductions over time in the quality and/or quantity of fresh water canadd to the instability of a region by depleting the health of a populationand obstructing economic development, especially in the downstreamareas of distressed river basins. The writers believe that regions that aremore prone to water related conflicts include Sub-Saharan African (SSA),1 Aristotle, Politics 1261b344

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISIndia, Iran and Pakistan. The politicisations of water issues and violentprotest (e.g. Ghana since 2001) may also occur in reaction to waterprivatisation.On a similar vein like Postel and Wolf (2001), CSIS-SNL (2005) notedthat water is the basic foundation of life; and human prosperity,economic development and political stability will be retarded in thoseregions where the quality and reliability of water supplies remainuncertain. With no access to a reliable and appropriate source of water,families, usually women (and girls) spend a lot of their time fetchingwater. Water-related diseases and the time spent in fetching water, keepchildren from attending school and retard the adults’ productivity. Theopportunity forgone in terms of productivity can reach hundreds ofmillion of dollars, even in poorer regions.According to WHO and UNICEF (2004) more than one billion peopleon Earth (near one-sixth of the world’s population) currently rely onwater sources that are unsafe, unreliable, or difficult to access for theirdaily domestic uses. The organisation also estimated that about one-thirdof the world’s population lack access to basic water and sanitationfacilities. As a result, millions of people, most of them children, womenand the aged are suffering and dying annually from diseases related topoor water quality. Vörösmarty et al (2000) believe the magnitude of thischallenge can double in the next two decades. To them, aside thereduction in productivity caused by inadequate access to safe drinkingwater and improved sanitation is what is dubbed the silent killer of thedeveloping world.Also Gleick (2002a) is of the view that by the year 2025, more peoplecould die of water-related diseases than will perish from the HIV/AIDSpandemic. These trends will have great consequences for prosperity andstability, unless the trend of this problem is drastically reduced (Gleick,2002b). He believes that today than later, should be the starting line.Difficulties in managing water resourcesBotterweg and Rodda (1999) have pointed out that water management isa complex process since it involves many actors at different levels,especially when it crosses national boundary. In this latter case, theyargued that national authorities are dependent on the compliance ofactors they cannot force by traditional government measures. To them,the success of management initiatives is dependant on among otherthings persuasion, incentives, and the flow of information between theseactors. The writers concluded that due to the fact that there are manyactors involved and none can force the other actors to comply makewater management issues more complex.Huisman et al (2000) work compliments Botterweg and Rodda (1999)above. They added that most cross-border commissions cannot force themember states to adopt laws, or firms to use the best availabletechnology. Hence, their role is often simply to advise the governments.It is for this reason that the judicial (drafting of agreements andadjudication) and the police service (law enforcement) will beinstrumental in water resources management.Ehin (2003) states that people behaviours toward water management aredriven by knowledge, expertise and the role of culture, norms, values andhabits. Thus, experts from the different disciplines and societal normshave different viewpoints that are difficult to integrate. For example, thepollution control person wants to talk about putting an end to pollution. Theeconomist is interested in comparing treatment costs versus source5

Matthew Biniyam KursahTRITA LWR Master Thesisprotection, while the planner wants to talk about site. Ehin furtherargued that ecologists are interesting in preserving the integrity ofecological subsystems, while sociologists emphasise that the mostimportant actors are human beings, whose patterns of socialestablishment are crucial for planning viable solutions to achievingsustainability of water. Also, the public health expert is interested indiscussions about parasites and all impurities contained in water. Thedifferent views are often treated incoherently. While there is no doubtthat any of the viewpoints is important as the other, their continuetreatment as separate views hinder effective water management practices.Attempts should therefore be made to integrate the various views.However, Elin (2003) noted that the problem is that it is difficult for oneperson with one of the view points to understand others’ views due tothe dilemma of dealing with different mindframes.Strategies for efficient water resources managementSmith (1981) “built” upon Garrett Hardin’s (1968) Tragedy of the Commontheory reviewed earlier. Smith believes that the problem ofoverexploitation is the results of resources being under public ratherthan private ownership. By its very nature, a property resource owned bythe commons is in effects owned by everyone and owned by no one (ibid). As aresult, no one has an incentive to maintain/preserve it, leading tooveruse or waste of the common resource in question. The writertherefore came to the conclusion that private ownership results insustained-yield use and preservation. In principle, Smith thus advocatesfor privatisation of water as the best managing strategy. However, he hasalso failed to show how water sources can become a private property –managed and protected by whom?CSIS-SNL (2005) believes that increasing local participation in theplanning, implementation, and maintenance of water projects wouldimprove sustainability by preventing oversight, incorporate localknowledge and needs, and make it acceptable in the “eyes” of thecommunity. The institute also argued that incorporating publicparticipation will help combine health, social and economies aspects ofthe people. For this to be effective, there must be efficient decentralisedadministration. However, low levels of public education, such as the casein Saboba district, sharp societal divides and possible corruption act toobstruct civil society in making rational and unbiased decisions. Myopinion is that the solutions/strategies being adopted to manage waterresources must first gain policy priority and be specific to thesocioeconomic, political and geographic conditions of the regionconcerned.Ghana situations of water supply and managementNsiah-Gyabaah (2001) in his research titled “The looming nationaldilemma of water crisis in peri-urban areas in Ghana” pointed out thatmisuse of water and wastage through pipe burst, pollution throughagriculture, rapid population growth, urbanisation and domestic wastedisposal systems were among the causes of peri-urban water supplyproblems in the country. He noted that the increase in population andurbanisation, particularly the conversion of watersheds into residentialand farmland areas has led to the depletion of water resources, especiallyits quality. He concluded that Ghana needs an explicit water policy inorder to solve the recurrence of the inadequacy in water supply. On asimilar view but much further, Arapto and Adisenu (2006) are of theview that ineffective community participation is as a result of the factthat the general public in Ghana hold the view that it is the responsibility6

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISof the government to provide for them. It is also derived from theconsistent reading of politics into water provision projects andmaintenance. Generally, people in the villages think that the services theNGO’s are offering are being offered by the government and under nocircumstances should they offer free services to the government or payutility bill regularly. Besides, when somebody from one political party isleading a project, others on the opposing side fail to participate for fearthat their opponent might score “cheap” political points (Arapto andAdisenu, 2006). I think it is important to educate people and erase theperception that it is solely the governments’ responsibility to provide andmanage water for them.Burning of mosquito coil and Respiratory Tract Infections (RTI)Research suggests that more fine particles are produced from a singlemosquito coil than 75 cigarettes (Gopal Raj, 2003). Burning coils doesnot only irritate eyes, lungs and the air passages, but also substancesadhering to those particles as well as chemicals in the smoke could becarcinogenic. According to Weili et al (2003) burning mosquito coilsindoors generates smoke that can control mosquitoes effectively but thesmoke may contain pollutants of health concern. They discovered thatpollutant concentrations resulting from burning mosquito coils couldsubstantially exceed health-based air quality standards. They alsoidentified a large suite of volatile organic compounds, includingcarcinogens and suspected carcinogens, in the coil smoke. The findingssuggest that exposure to the smoke of mosquito coils can posesignificant acute and chronic health risks. For example, burning onemosquito coil would release the same amount of PM 2.5 mass as burning75-137 cigarettes, while the emission of formaldehyde from burning onecoil can be as high as that released from burning 51 cigarettes (Weili et al,2003).A university of California – Riverside (2003) study conducted by BobKrieger, Travis Dinoff and Xiaofei Zhang found that the mosquito coilmade in some Asian countries that people often use to ward offmosquitoes may be releasing cancer-causing smoke. The source statesthat it is“possible that the coils are exposing users to bischloromethyl ether, a potent lungcarcinogen....high exposure can occur if the coils are used overnight, as they often are…Thesecoils purchased in stores in the United States do not list S-2 or octachlorodipropyl ether(banned in US) as an ingredient."The presence of unregistered components in some of these coils maymake their regulation and control much harder, especially in developingcountries like Ghana.Jürgen and Ulrich (2006) did a study by exposing groups of rats (noseonly)to 6 hours a day, 5 days a week for 13 weeks to an averageparticulate concentration of 30 mg m -3 from coils that contain theinsecticidal ingredient, transfluthrin. During the course of the exposurerats exposed to the smoke of burning mosquito coils manufactured inIndonesia showed clinical signs suggestive of acute upper respiratorytract effects. The results of this study support the conclusion thatsmokes from burning mosquito coils is high enough to cause acuteupper respiratory tract effects. However, Jürgen and Ulrich (2006) studyalso found that the presence of common wood-combustion products(such as aliphatic aldehydes) did not cause any adverse effect in the lowerrespiratory tract or any other extrapulmonary organ.To sum up, the literature review has shown that the causes of waterresources scarcity are both climate change (natural factor) and human7

Matthew Biniyam KursahTRITA LWR Master ThesisCHAPTER 2factors, but largely due to the latter such as population growth, lack ofresources to manage water efficiently, poor water policies, socio-culturaland political factors. The review identified water-related healthcomplications, political and social strives, and slow economic andagricultural development as the negative consequences of water scarcity.It also showed that water management information is not unambiguous,containing features of rational, value-based, cultural and habitual traits.Indeed, it can be concluded that there is no such thing as neutral andobjective approach towards water management issues. Finally, theintegrative system of managing water resources; combining the health,social and economy aspects of the people will be the most efficientstrategies to manage water resources for the benefit of the present andfuture generations. The premise of the review is that water is our right tolife, and good health our right to existence.The study areaSaboba district is a newly formed district after the separation of theformer Saboba-Chereponi district in the early part of 2008, following thetrend of 1988 PNDC Decentralisation Policy. It lies at the extremenorth-eastern part of Northern Region of Ghana (Fig. 1). It is locatedbetween latitude 9° 20"N and 9° 70" N and longitude 0° 00" and 0°30"E. Its capital, Saboba, is a border town with River Oti to the east,almost serving as the international boundary between Ghana and Togo.The newly created Chereponi district is to the north of the district,Gushiegu district (west), Yendi district (southwest) and Zabzugu-Tataledistrict to the south. Saboba, Kpalba, Demon and Wapuli are thedistrict’s major population centres.Physical morphology and DrainageGenerally, Saboba district is an undulating lowland area of about 150metres, dissected by River Oti drainage system. During raining season,especially between July and September, the district capital (Saboba), theother major settlements (Wapuli, Kpalba and Demon) and the peripheralvillages (Sobiba, Galimata, Bordagbalm, Dicheen, Sanguli etc) are eithercompletely or partially cut-off due to the intervening streams and floodwaters. The main river with its dendritic pattern, Oti, runs along theeastern border of the district, towards the Ghana-Togo boundary. Otitributaries (stream) are many and most of them pass through or are neartowns and villages, carrying along the waste products of the areas.During raining season, severe flooding is common as a result of spilloverof River Oti water. One important geomorphological feature in thedistrict is a crescent–shaped valley which links both sides to River OtiValley, forming an Ox-bow lake at Borgbaln, on the Saboba-Kpotaab(Togo) road.Climate and VegetationSaboba district is situated in the warm and dry savannah zone of Ghana.Average monthly temperatures range from 25 to 35°C. It has low anderratic rainfall and long dry season (October to April) accompanied byintense heat and sparse vegetation, which is subjected to annualbushfires. The north-east trade winds (harmattan) are common fromNovember to February and further facilitate intense bushfires. Therainfall is single-maxima type with annual totals varying between 750 mmand 1050 mm. The rains come mainly from April to September (couldstart in March), torrential in nature and often causes flooding and8

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISerosion leading to the formation of gullies. The area consists of mainlygrassland, interspersed with guinea savannah woodland characterised bydrought resistant trees like baobab, sheanut, acacia and neem.Population of the areaAccording to Ghana Statistical Service, GSS, (2005a) the population ofthe former Saboba-Chereponi District in 2000 was 93,847 with 47,051(50.1%) being females and 46,796 (49.9%) males. The population wasestimated to be 113,087 in 2005, of which about half of it could be thepopulation of Saboba district alone. The growth rate is estimated to be2.9% and sex ratio is 99.5. The population in the district have beenincreasing considerably due to high birth rate and reducing death rates.Another factor is the return of Konkombas (indigenes) from the nearbydistricts after the 1994 ethnic conflict and the booming of tradingactivities. The 1994 ethnic conflict between Konkombas and Kombas onone hand and Dagombas, Nanumbas and Mamprusis on the othercaused many Konkombas to move to Saboba district where many ofthem consider as their “native” place. The movement of Konkombas toSaboba area is still occurring, but on a limited scale. The urbanpopulation is less than 20%. The population of the district is made up ofmainly one ethnic group, Konkombas (indigenes), who form over 80%of the district’s population. Other minor ethnic groups are the Moshies,Ewes, Basaris, Dagaatis and Akans. Varied religious bodies such asChristianity, Traditional African Religion and Islam exist.Economic Activities and Agricultural Land useMore than 80% of the population in the district is engaged in rain-fedsubsistent agriculture. Cultivable land area is about 40% with extensionofficer/farmer ratio of 1:5,996 (District Planning Coordinating Unit,2002). There is only one farming season, which coincides with the rainsfrom April to October. The hoes and bullocks are the main methods ofland preparation. However, tractor ploughing is increasingly being usedof late, due to the so-called mechanisation of agriculture. The people areengaged in both food and cash crop production such as rice, maize,millet, yam, cassava, cotton and cashew. The inhabitants also rear (freerange)animals like cattle, goats, sheep, pigs and poultry. Trading, foodprocessing, fishing, pottery and shea butter processing are thecommercial and small-scale industrial activities undertaken in the district.Studies conducted by the District Assembly and Integrated DevelopmentCentre (2004) show that women are engaged in only the less skillintensiveactivities such as petty trading and pottery due to little/noeducational background and ownership of capital.Education, Transport and Social FacilitiesFormal education was first introduced to the inhabitants in 1944, and hassprung up subsequently after the introduction of the policy of FreeCompulsory Basic Education by the Convention People’s Party (CPP)Government in 1950/60s. There are currently one Senior High School,one Technical institute and several Junior High Schools, primaries andday-nurseries in the district. None of the roads within Saboba district ismotorable in all seasons. The roads are all paved and gravelled type, withfeatures of third class category. Also present are all categories offootpaths. Basic social amenities like health centres, pipe borne waterand electricity are also present.9

OberadeYusungaManieBilyimbaMatthew Biniyam KursahBaguliNadugu No.1FaliPhysical Map of Saboba DistrictWabonAsareGarikukaMagie UgandoJilmaKinabusiaSambangTRITA LWR Master ThesisNakaku No. 1TekasuKukpeneKokoliWalaKunjuulW. Utindan-do Kpardor MulpedoJanbokBitin-do ZegbeliTogin TombuAcheridoInagmabuniSagbe Old NambiriNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheli³LifurTisung JagridoKpeguKpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni!.KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamSettlementsRiversContoursRoadsLand Surface!. Water BodiesFigure 1: Physical Map of Saboba DistrictBoaduNanwalbuJamboKpalbaBichaanGnalajodoWambong Demon GbonYakaliJamoni1: 400000Cultural Practices and BeliefsThe indigenes of Saboba district practice patrilineal system ofinheritance. However, education, Christianity and westernisation haveinfiltrated and changed some cultural practices. Culturally, women arenot greatly involved in general decision making of the society. There hasbeen and still a stereotyped belief that women’s roles are mainlyhousehold duties, thus, fetching water, cooking, washing dishes andcloths, bathing and caring for the young ones, while the men’s duty areto provide security, shelter, food and defence for the family. Men aretherefore supreme in the family and their decisions are often final. It isnot surprising to hear sentences like; upii mu ye ba?,aah! gma mu tii upii10

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISmpuan ngbaan? upii aah siikuu mu gaa ti doo la che? – meaning “who is awoman? what! who gave woman this authority? Where will a woman’seducation ends her? respectively. Generally, women do not have rights toland ownership. However, there are in-depth regulations to this issue.Poverty LevelsAccording to Core Welfare Indicators Questionnaire (CWIQ) II SurveyReport (2003) 44.4% of the district’s population is considered poor andanother 26.2% very poor, given a total of 70.6% (seven in ten) of thepopulation, being generally poor. The report also indicated that only0.9% is non-poor, 1.9% somewhat non-poor and 26.6% in-between. Interms of gender and poverty, women are the worse affected IDC (2004).Conceptual Framework of the StudyThe analysis of this study is based on the conceptual frameworkprovided by Songsore and McGranahan (1993) shown in Figure 2. Themodel is slightly modified by replacing the condition of water resources forenvironmental conditions in the original framework. This is to narrow theperimeters of the framework from its broad emphasis on environmentalissues in general, to only water aspect of the environment. Theframework is based on the fact that water and health of any humanpopulation are inextricably linked. Thus, the way water resources aremanaged and the access to defence mechanisms determine, to a largeextent, the health status of the population and gender variations in waterrelated diseases.Saboba district like elsewhere in Ghana is exposed on a daily basis to lifethreatening and health–threatening pollutants, pathogens, disease vectorsand physical hazards in its water bodies from various sources, bothdirectly and indirectly. The starting point in most cases is some form ofhuman activity, or rarely, a natural process which releases pollutants(Songsore et al, 1998, Songsore et al, 2005) into the water bodies.According to this conceptual logic, the differentials in water-relateddiseases within Saboba population are a function of the synergicinteraction between risk factors that the condition of water bodies haveplaced on the population, for instance the presence in the householdwater sources of a pathogen or disease vector and socio-economicdefence systems as expressed or materialized in different locations withtheir specific ecological conditions and the residents´ socio-economiccircumstances (Songsore and McGranahan, 1993, Songsore et al, 2005).The differences within the wider area in the district in health risks can beexplained by uneven access of social groups to critical assets that enablethe individual or household or indeed the community at large to achievesome protection from environmental risk factors. As shown in theframework, protection can result from any one or a combination of thefollowing: 1) access to water services such as portable and reliable watersupply, sanitation facilities, garbage collection services etc, 2) access,both in the physical and economic sense, to medical services (bothpreventive and curative), 3) good nutritional practice and healtheducation, 4) hygienic practice or behaviour, and 5) customs or norms.The sum total of the risk factors provided by the condition of water ahousehold or individual faces can be taken to determine the probabilityof exposure to conditions including ill health, and consequently theburden of ill health (Songsore and McGranahan, 1993, Songsore et al,1998).11

Matthew Biniyam KursahTRITA LWR Master ThesisCondition of Water (quality and quantity)Vector and pathogen prevalenceEcological contextNaturalAnthropogenicWater risk factors/hazardsSocio-economic mediation (including age and sex)DefenceKnowledge and wealthAccess toWater servicesAccess tomedicalservicesNutrition &healtheducationHygienepracticeCustomsServiceEfficiencyHealth outcomeFigure 2: Linkages between Condition of Water Resources, Wealth and Health in SabobaDistrict. Modified after Songsore and McGranahan (1993)Categorisation of StakeholdersWater resources management and health situations concern individual,national and international bodies. For this study, stakeholders have beencategorised as beneficiaries/target groups, implementers, decisionmakersand financiers.Beneficiaries/Target groups: Saboba District Assembly, the District HealthInsurance Scheme, Saboba Medical Centre, individuals, children, womenand aged, the general public and employers – since employees’ medicalbills and absenteeism due to ill-health will be reduced.Decision-makers: Saboba District Assembly, Chiefs, Utindan, Umoadanbor,ministries of Water Resources, Works and Housing, Education andScience, Health, and Local Government and Rural Development, GhanaWater Commission (GWC) and Ghana Water Company Ltd (GWCL12

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISImplementers: Saboba District Assembly, the District Health InsuranceScheme, Chiefs and opinion leaders, Utindan (land-chiefs), Umoadanbor(river-chiefs), ministries of Health, Water Resources, Works andHousing, Education and Science, and Information and NationalOrientation, judicial service (adjudication) and police service (lawenforcement).Financiers: Government of Ghana, Saboba District Assembly (CommonFund), ministries of Water Resources, Works and Housing, Educationand Science, Health, and Local Government and Rural Development,Ghana Water Commission, Ghana water company Ltd (GWCL), donors(DANIDA, USAID and CIDA), individuals/companies and SabobaMember of Parliament (MP Common Fund).Methods and materialsThis section explains how the data used in this study was acquired andanalysed.Data SourcesPrimary and secondary sources of data were used in this research (Fig. 3).The sources of secondary data included Saboba Medical Centre (SMC)and Wapuli Health Centre (WHC) patient-records, annual report of theDistrict Health and Management Team (DHMT), the Saboba DistrictHealth Insurance records and Ghana Statistical Service (GSS). Thesources of primary data included questionnaire, structured andunstructured interviews, and personal observations and analysis. Myexperiences gained while working with Integrated Development Centre(IDC) – a local NGO formally in-charged of the implementation of thedistrict’s Health Insurance Scheme and creating awareness programmeson behalf of Community Water and Sanitation Agency (CWSA) andDanish International Development Agency (DANIDA) is also used. Thesources of GIS data are Centre for Remote Sensing and GeographicInformation Service (CERGIS) of University of Ghana and Allotey et al(1999).SamplingFor the collection of primary data, questionnaires were administeredusing random sampling to respondents aged 15 years and above,between August and October of 2007. The questionnaires wereadministered to 130 respondents in five selected areas: CentralTownship, Toma and Chief-section, which form the Saboba town(bigger town) and its environs, Wapuli (a small town) and Bordagbalm (avillage). Also, 5020, 4080 and 4000 records of individuals (that includedthe type of disease one was treated on, the place the person resides andthe cost of treatment) were sampled from Saboba Medical Centre (SMC),Wapuli Health Centre (WHC) and the National Health Insurance Office,Saboba, respectively. Since such detail information (place, cost etc) aremissing after data collation, I had to sample rough and hand-writtenrecorded sources. Similar data from other areas with clinics and healthposts (of which flooded roads prevented me from accessing) wasretrieved from the District Health Management Team (DHMT) annualreport, which reports on the health statistics of the district. All thesesources contained almost similar data and were only taken to comparewhether they all follow the same trend before any conclusion could bedrawn. In Wapuli, the trend was a bit undefined, hence a previous year(2006) records of 6,484 was used to see the trend of event. I will urgeanyone who wants to undertake similar research; especially involvingspatial analysis of health, in the district to rely on the first hand-written13

Matthew Biniyam KursahTRITA LWR Master Thesisrecords from the hospital, clinics and health posts. This is because, andsadly of course, the more the data goes up the health administrativeladder, the more space become unimportant variables and omitted fromthe data. I will like to caution readers that when it comes to the spatialanalysis in chapter 3, the totals may not add-up to the sampled size sincesome villages are not on the map, hence their respective healthincidences are not shown as well.Statistical analysisTrends, changes, relationships and variations of variables from the datacollected were done using Statistical Package for Social Sciences (SPSS).SPSS was used to present the various views from the questionnairesadministered to respondents. Simple statistical methods such as tablesand graphs are used to show distribution and trends, while percentagesand ratios are used to depict rates of health indices.Spatial AnalysisGeographic Information System (GIS – ArcGIS) was used to identifyspatial dimensions of water related diseases in the district. The incidencesof the three leading diseases (Malaria, Typhoid and RTI) in the districtand distances to major towns, roads and watercourses, and the type ofland cover and elevation were extracted using ArcGIS tool: Spatial Analyst– Distance – Straight line. The results was extracted into DBF 4 – MSExcel and then to SPSS where the significance was tested usingcorrelation. For the purpose of this study, 0.05 level is consideredsignificant, and any variables with a correlation higher than 0.05 isconsidered insignificant. The dependent variables includedenvironmental diseases, geographically defined, while the independentvariables are the distances to the urban area (the main town in thedistrict), watercourses, roads, the type of land cover and elevation.Figure 3: Data collection process14

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISInterviewsA number of persons representing various departments and units oftheir respective offices were interviewed. These included the MedicalAssistant (Wapuli Health Centre), Claim Officer (National HealthInsurance Scheme, Saboba), Operator (Saboba Community Waterdistribution plant), Head of the District Environmental Health unit (forthe former Saboba-Chereponi District) and some individuals. Theinterviews with the individuals such as chiefs, elders and opinion leaderswere unstructured type.CHAPTER 3Results and discussionData gathered from the field survey between August and October (2007)are presented and analysed in this section. The data are both secondaryand primary (from personal field survey using questionnaires andinterviews). The cross tabulation of respondents answers is done usingStatistical Package for Social Sciences (SPSS). The questionnaires wereadministered to 130 respondents in five selected areas: CentralTownship, Toma and Chief-section, which form the Saboba town(bigger town) and its environs, Wapuli (a small town) and Bordagbalm (avillage). Chief-section area for the purpose of this study extended fromthe Chief-section itself, Borgbaln, Tilangbeni to Borkuln, while Tomaalso included Na-logni, Lower Kakpeni and its surroundings.Field problemsLike any social science research, this study faced problems such asunwillingness by some few respondents who normally perceive questionslike this as a mechanism to impose tax on them. The problem also arosebecause the people complained that a lot of studies have asked for suchinformation but nothing has been done. One other problem was theissue of getting as many women willing to answer questionnaires, as intheir views, questions concerning the area was primarily under men’sauthority. The more rural an area was, the more this constituted aproblem. The strategy used to address these concerns was to firsteducate the people that the research was purely academic and assurancethat the information they provide will be handled confidentially.Basic characteristics of respondentsTable 1a shows the number of respondents by place and sex. Thenumber of respondents was proportionate to the total population ofeach selected area. The table shows that 61.5% of the respondents weremales while 38.5% were females. In all the selected areas, the number ofmales is more than that of females, except in Chief-section area where53.3% were females as against 46.7% males. The variation in the sexesmay be due to the fact that issues concerning human welfare and thesociety in the communities are presumably under men’s authority in thedistrict.Table 1b also shows that Saboba district is predominantly youthfulpopulation as 41.5% of the respondents are between 14 and 20 years,35.4% (20-29) and only 3.1% are between 70 and 79 years.Table 2 shows that 27% (34) of the respondents have no education,5.6% (7) had basic education, 10.3% (13) for Junior High School (JHS)or Middle School (MS) and 48.4% (61) attended Senior High School(SHS). However, the level of education reduced to 4.8% (6) forTeacher/Nursing Training College (TTC/NTC) and 4% (5) had auniversity degree.15

Matthew Biniyam KursahTRITA LWR Master ThesisTable 3 shows that 45.6% (57) of the respondents were students and33.6% (42) are engaged in farming. There is low unemployment rate asonly 3.2% (4) identified themselves as unemployed.Disease pattern in Saboba districtA four-year trend of the top 10 diseases in the district from 2002 to 2005show a dramatic increases in the rates of disease prevalence; with 57.5%for Malaria, diarrhoeal diseases (58.6%), RTI (422.7%), intestinal worms(1481.5%) and Typhoid from 161 to 7,725, giving 4698.1% increase(Table 4). More surprisingly, Typhoid has gained the second top positionin disease prevalence in the district as at September 2007 (Table 5).Figure 4 depicts how the trend of diseases will have being (greenline) ifthe environmental diseases (Malaria, Typhoid and RTI) were reduced byhalf based on the objectives of the MDGs, through sound environmentaland water management practices, but the annual increase were tocontinue. The gains for the district will measure hundreds of thousandscedis through savings, increased productivity and reduce ill stress.Preventive strategies for environmental diseases in the district: Respondents’viewTable 6 shows the views of respondents on which diseases receive muchhealth awareness campaigns. Though, there are slight variations in eacharea, generally, Malaria with 32.0% (41) is ranked first. It is followed inthat order by 24.2% (31) for HIV/AIDS, 10.9% (14) for Guinea wormsand Poliomyelitis with 10.2% (13). This has implication on what diseasepeople think are most common in the district. Interestingly, only one(Malaria) of the four top leading diseases (Table 4 and 5) in the district isranked among the four targeted diseases in health campaigns.The most highly ranked diseases (Table 7) are used to determine the fourcommonest diseases in Saboba district. In the district as a whole; Malaria,Typhoid, Diarrhoea and Guinea worms are ranked as the most commondiseases. For the selected areas, Malaria, Typhoid, Guinea worms andDiarrhoea are ranked in Central town, while Malaria, Typhoid, Diarrhoeaand Guinea worms for Toma. Chief-section has Malaria, Typhoid,Diarrhoea and Guinea worms and Bordagbalm has Malaria andPoliomyelitis in its ranking. Lastly, Malaria, Typhoid, Diarrhoea andGuinea worms are the diseases thought to be highest in Wapuli.Table 7 shows that Malaria and Typhoid are seen as the most dominantdiseases in the district and in all the chosen areas, except in Bordagbalmwhere Poliomyelitis is placed second. Diarrhoea is placed third in mostareas – Toma, Chief-section and Wapuli. However, Guinea worms areplaced third in Central Township and fourth in the rest of the areasexcept in Bordagbalm. The placement of Guinea Worms by respondentsis not supported by hospitals and official reports which ranked Malaria atthe top, followed by Typhoid, RTI and diarrhoeal diseases. According toGGWEP, 2006, (Appendix II) Saboba district is almost at the zero caseof Guinea Worms infections, and DHMT (2006) has also stated thatGuinea worm had also seen a reduction from 86 to 51 cases in 2006. Thediscrepancies between respondents’ views and the official sources can beexplained by three main reasons; 1) the popular campaigns againstGuinea Worms supported by former US president, Jimmy Carter, haveironically made people to think that the disease is widespread (see Table6), 2) many Guinea Worms patients do not seek the orthodox medicaltreatment as there are many traditional treatments, and therefore thelikelihood of its under-recording is high, and 3) people still “reside” inthe devastation era of Guinea worms some decades ago. More16

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISinterestingly and conspicuously missing in the respondents ranking ofmost common diseases is RTI which is placed third in hospitals andofficial reports. The explanation is that 1) most patients are not told thedisease(s) they are being treated and therefore unaware of it presence(see Box 1), and 2) RTI is a group of related diseases and people mightnot be aware of all of them.Also, health campaign posters in the district reveal the direction ofemphasis on curative rather than preventive measures towardsenvironmental diseases, especially for malaria. As shown in Appendix IVö to r (seen in Wapuli Health Centre), three out of the four posters werecurative campaign towards malaria, while the remaining one waspreventive measure (the use of mosquito net). It is pertinent to note thatnone of the four campaign posters against malaria has anything to dowith reducing mosquito breeding. Comparatively, all the three differenttypes of HIV/AIDS campaign posters were preventive ones. Otherposters in the said appendix, were preventive posters for diseases whichare either nonexistent, nearly eradicated or with very low rates in thedistrict such as Guinea worms, measles, elephantiasis and polio, thoughwith funding support from international community.Table 1a Respondents by place and sexPlaceSexMale Percent Female Percent TotalCentral township 14 60.8 9 39.1 23Toma 19 55.9 15 44.1 34Chief section 14 46.7 16 53.3 30Bordagbalm 13 81.3 3 18.8 16Wapuli 20 74.1 7 25.9 27Total 80 61.5 50 38.5 130Table 1b Ages of respondentsAge range Frequency Percent≤ 15 < 20 54 41.520-29 46 35.430-39 16 12.340-49 5 3.850-59 3 2.360-69 2 1.570-79 4 3.1Total 130 100Table 2 Educational level of respondentsEducational LevelPlaceNo Basic JHS/MS SHS Diplomat/ University TotaleducationTTC/NTCCentral Town 0 2 4 11 3 3 23Toma 4 3 1 23 2 1 34Chief-Section 8 0 2 18 0 1 29Bordagbalm 13 0 2 1 0 0 16Wapuli 9 2 4 8 1 0 24Total 34 7 13 61 6 5 12617

Matthew Biniyam KursahTRITA LWR Master ThesisTable 3 Occupation of respondentsOccupationPlaceFarming Self employed/tradeStudent Teaching/NurseCivilServantUnemployedTotalCentral Town 1 3 13 2 2 2 23Toma 5 3 23 1 1 1 34Chief-section 9 2 14 1 3 1 30Bordagbalm 15 0 1 0 0 0 16Wapuli 12 2 6 2 0 0 22Total 42 10 57 6 4 4 125Table 4 Four-year trend of the top 10 diseases in Saboba District. Source: DHMT (2006)DiseaseYear2002 2003 2004 20051 Malaria 16,806 23,459 20,729 26,467 87,4612 Diarrhoeal 4,350 5,532 4,833 6,899 21,6143 RTI 1,639 3,853 5,745 8,567 19,8044 Skin disease 2,055 3,194 3,872 5,233 14,3545 Accidents 1956 1,602 3,233 2,281 9,0726 Anaemia 192 825 1,324 2,243 4,5847 Intestinal worms 130 463 1,036 2,056 3,6858 Typhoid 161 287 3,844 7,725 12,0179 Gynaecological disorders 685 311 546 624 2,16610 Hypertension 69 431 540 695 1,735TotalTotal 28,043 39,957 45,702 62,790 176,492Table 5 Sampled results of the top 10 diseases in Saboba District in 2007Source: Sampled from SMC Record Book (2007)Disease Frequency PercentMalaria 4827 50.6Typhoid 1142 12RTI 944 9.9Diarrhoeal dis. 316 3.3Wounds 153 1.6Infections 92 1.0Skin diseases 90 0.9Intestinal worms 68 0.7Hypertension 49 0.51Fever 48 0.5Total of Top 10 Diseases 7729 81Total Sampled Size 9547 10018

FrequencyWater sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISScenario: If Environmental Diseases were Reduced by Half700006000050000400003000020000Total of Top 10 Diseases BurdenScenario (Reduce Environmentaldiseases by Half)1000002002 2003 2004 2005YearFigure 4: A Scenario showing environmental diseases being reduced by half in SabobadistrictManagement of water resources in Saboba districtThe past and the present water management practices are compared andcontrast in this section. This is to enable me make conclusion on whichof the water governing system is most effective in the district.Management of water resources: History before 1988This section presents and analyses information derived fromunstructured interviews and discussions with chiefs, Umoadanbor (riverchief),older people and opinion leaders. The water sources available inthe district were mainly from Oti basin, streams, dams and natural wells.In the past, water bodies were fully in the hands of the Umoadanbor,chiefs and village leaders. The Umoadanbor ((in all cases male, and mostlythe eldest in the village/town) were the custodians of the water (riverineforest included). The Umoadanbor and sometimes with Utindan (landchief)perform sacrifices to the gods to usher in water resources for yetanother farming and fishing seasons to conform to micro-climaticconditions of the area. One could not by-pass Utindan and Umoadanbor inthe use of any of these resources (e.g. fishing) under their jurisdiction. Asa result, water resources were always under control in terms of itsutilisation. The Umoadanbor usually appoints a person from thecommunity as water security guard to enforce strict rules; while customarylaws, conventions and norms restricted majority of the people frompolluting it. This is the system under which Nana Ofori Atta II notion ofnatural resources management works. With several interviews anddiscussions with the elders in the communities, it was revealed that thebeginning of erosion of authorities and powers of the Umoadanbor,Utindan and other local leaders coincided (and in fact a consequence of)government’s 1988 Decentralisation Policy that created the districtassemblies with the highest local authority and power. Therefore, theperiod before 1988 Decentralisation Policy is herein referred to as the“past” (governed by customary laws) while 1988 onwards is referred toas the “present” (mainly controlled by government/district laws).19

Matthew Biniyam KursahTRITA LWR Master ThesisWater management: traditional value system and the modern positivismLike most parts in Ghana during the period of low population growthand localisation of water resources as well as market, the intergenerationalequity was and could be safeguarded in Saboba district. Thiswas sustained by the traditional management practices of the use ofwater resources. Quite often, the socio-cultural ideologies andphilosophies mostly inclined on cultures were been used for theprotection of water which was considered sacred in the district. Theseindigenous strategies are usually predicated on customs and traditionsthat have strong totemic significance, as they were handed-down fromancestral lineages (Benneh et al, 1998 and Toulmin et al, 2002). It isinteresting to note that those norms were more respected and compliedwith in the communities within the district due largely to theirapprehensive consequences. Some management strategies included theuse of moral laws and taboos, restrictions, adherence to religious beliefsand sometimes outright ban-on-use of certain sections/whole of waterbody when its vulnerability to contamination seems imminent. Somewater and other natural resources were been deified. Thus, like the biblicalprohibitions thy shall not or taboos, were enshrined in the value systemsto control the use of environment that will have health repercussions onpeople. Within the district for example, one was forbidden to send acooking pot (usually dirty) to riverside or cut vegetation along rivervalleys. The rationale was to reduce water pollution and siltation as aresult of downstream erosion of river/stream courses, respectively.Offenders were seen as invoking the spirits of limoawaal (river-gods)which will punish them accordingly, hence giving credence to the view ofNana Ofori Atta II.However, the incorporation of the district, like any part in Ghana, intothe modern system, decentralisation policy, rapid population growth,changes in socio-economic conditions and lifestyle have led to therelegation of these traditional management practices of the use of water.Thus, the use of water resources in the district is now largely governedby the modern positivist view of the relationship between society andnature. The profit motive rather than the previous value systemsregulating water and environment control this current perspective view.The goal of positivism is to achieve objectivity in problem solving.Therefore, issues relating to the subjective world of value systems (suchas thy shall not or taboos) are now regarded as unscientific and hence notworth exploring (Kendie, 1997). In most cases these are seen as obstaclesto be eliminated (Goulet, 1986). The ordinary person can now use waterresources and vegetation along it without any control by eithertraditional authority or District Assembly. As one respondent fromBordagbalm echoed; “dandana aabiim aah ki pak iiyaajakaar” (the youth oftoday don’t longer respect ancestral laws).Currently, management and protection of water resources is one of theleast concerns in the district. Water is left to suffer the Hardin’s Tragedy ofthe Common syndrome, as a woman respondent stated if clothes are dirty, weuse water to wash it. So, Karaachi (intellectual) what can be used to wash water too?(my translation). Illiteracy and total lack of health concerns play a criticalrole in this case. As a result, the traditional norms and value systemsgoverning the relationship between nature and society have beenreplaced in the district by the modern positivist view. However, modernpositivism has not been able to adopt adequate practices and methods tosustain water resources. The effect of this changing perception onenvironment, and specifically water use, has contributed to a20

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISconsiderable increase in water related diseases such as Typhoid. This hasfurther deepened the poverty levels of the people, especially women inthe district. Pervasive poverty in turn forces people to make desperatechoices with regards to the use of their environment such as free-rangedefecation, waste dumping etc. These choices frequently increase theirwater related health risks.Management of water resources: the past and the present comparedTable 8 shows various customary (CL) and government/district lawswith the aim of protecting water resources in the district. Both legalsystems largely use punitive system of managing and protecting waterbodies. A glance at the table shows that customary laws protected waterresources in its entirety than government laws. For example, 8.1% (7) ofrespondents mention do not cut trees along rivers or water bodies while nonemention that for government/district laws. The reasons for suchrestrictions are; 1) to prevent river bank erosion and siltation, and 2) toprevent farming and use of fertiliser very close to sources of drinkingwater.Management of water: effectiveness of customary and district systemsFigure 5 shows that more than a third (41.8%) of the respondents saidthat the customary laws were highly effective, 36.1% (medium), while22.1% said its effectiveness was low. However, a reverse is the case forgovernment/district laws in protecting water resources. Close to half(49.5%) of the respondents believe the effectiveness was low, 44%(medium), while only 6.5% said it was highly effective. This low ratingfor government/district laws is due to four reasons; 1) lack of effectivewater policy and low implementation of government machinery, 2) thefact that the government laws are made top-down, unlike customary lawswhich came from the people by the people and for the people, 3) due to socialallegiance and instant punishment meted out to offenders, people weremore likely to obey customary laws, and 4) Umoadanbor ownership of thewater resources was on small territories and easily monitored than largeterritorial boundaries of the district. This gives credence to furtherdecentralisation of water management policies.Sources of water in the selected areasThe sources of water for some selected areas in the district are presentedin this section. I selected Saboba Town, Bordagbalm and Wapuli becauseof the variations that exist between the areas, and also due to the factthat these were the chosen areas for administration of questionnaires.Saboba TownSaboba town consists of about 15–20% of the district’s population. Ifthe surrounding villages are added, the proportion will even be greater.The main source of water in the town before mid-1990 was mainly fromthe Moadani dam located some few metres to Umoadanbor-do (River-Chief’s Home) and wells. The town used to have only 3 boreholes – oneeach at SABTECH, Moadani and Chief-section. However, the ones atSABTECH and Moadani have been out of operation over 10 years agodue to lack of maintenance. Two new boreholes have been added atMoadani recently, of which water from one of them already have badscent. To avoid being seen as bias, the NGOs usually site the boreholesfarther away from any of the organised communities, since they cannotprovide all of them with boreholes. As a result, many of the boreholesare sited at farther distance from users, which are usually inaccessibleduring rainy seasons when water gathers the intervening culverts, streamsand valleys. Many of the inhabitants do not use the borehole water21

Matthew Biniyam KursahTRITA LWR Master Thesisbecause of distance or as they say it is too light and does not quench thirst.Currently, the pipe water supplied by the Saboba Community WaterPlant is the main source of drinking water for the town. The water plantis operating beyond its carrying capacity, and political influences anddictates (extension for political gains) and poor maintenance lead tooverstress, resulting in its frequent breakdown. Lack of funds topurchase chemicals for treating water, has necessitated the pumping ofuntreated water to residents. With only 400 pipes in the town for over15,000 people, of which about 100 have already been disconnected, havefurther complicated the water problem in Saboba town and its environs(Box 2). The Moadani dam, wells and dugout pits still serve as majorwater supply to the people of Saboba town, especially duringinterruptions in pipe water supply and in rainy seasons (Fig. 14).BordagbalmBordagbalm is a typical village, about 8 km from Saboba on the Saboba-Wapuli road. During the last census in 2000, the total population of thevillage was 276 (143 males and 133 females). The village depended ononly one borehole with very bad scented water, until last year when thesecond one was provided. The community complained that the secondone has also been plunged into the old adage (bad scent) and unsuitablefor drinking. Natural wells, water along culverts and dugout pits havesubsequently become major water supply in this community. Theproblem is compounded as many will not drink the borehole waterbecause they complained that, apart from the bad scent, it is also too lightor too soft for drinking.WapuliWapuli has 1328 people (641 males and 687 females) as at 2000. UnlikeBordagbalm, Wapuli has features of a small town, than a village. Themain sources of water to the people include boreholes, intermittentstreams of River Oti, dugout pits and both natural and artificial wells.Among the three selected areas, only respondents from Wapuli, whoapart from reporting on inadequate clean water, have also significantlymentioned shortage of water as a pressing problem facing thecommunity (Table 9).Water Management Strategies in Saboba DistrictRespondents were asked about their main sources of water for drinking,cooking, bathing and washing. Appendix I shows the results. Someinteresting characteristics can be identified. As one moves from sourcesof drinking water to sources of water for washing, the use of boreholesand pipe water (improved sources) drastically reduce from 64.1% (82)for drinking, 57.0% (73) for cooking, 26.6% (34) for bathing to as low as12.5% (16) for washing, while water sources from dams/wells/ponds,dug-out pits and rivers/streams (unimproved sources) increase from35.9% (46) for drinking, 43% (55) for cooking, 73.4% (94) for bathingand to 87.5% (112) for washing. This shows how limited boreholes andpipe borne water are available in the district, hence forcing the people toadopt managing strategies where the unimproved water is mainly usedfor bathing and improved ones for drinking. Also, more people use pipewater in the three areas of Saboba town than in the peripheral areas(Wapuli and Bordagbalm), while more use borehole in the periphery thanin Saboba Town (Appendix I). However, children and those who cannotafford to pay water bills may use any water to the detriment of theirhealth. Also, many will drink water from the unimproved sources whensupply from the improved sources is interrupted, as it is usually the case.22

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISPressing Environmental Problems in Saboba DistrictTable 9 shows the most pressing environmental problems in the districtfrom the results of the questionnaire. The most ranked ones (five) arecompared and analysed. In general, the pressing environmental problemsin Saboba District include free-range defecation, lack of clean/treatedwater, bushfires, presence of stagnant water and littered environment.However, what is considered the most pressing environmental problemsin each specific area differs. Ranking them in Central Township depictspoor drainage at the top; bushfires, free-range defecation, lack ofclean/treated water and presence of stagnant water follows in that order.Free-range defecation, bushfires (same level as 1 st ), lack of clean/treatedwater, littered environment (same level as 3 rd ) and presence of stagnantwater are the environmental problems in Toma, while Chief-section haslack of clean water, bushfires, free-range defecation, deforestation andland degradation. Free-range defecation, presence of stagnant water,weedy environment and littered environment are ranked in Bordagbalm,and lack of clean/treated water, free-range defecation, water shortages,poor drainage and bushfires in Wapuli. There is no clear differencebetween the various environmental problems in each particular place.Gender and Environmental Diseases in Saboba DistrictTable 10 shows very high illiteracy rate in the district for both men(73.7%) and women (81.3%), with a total average of 77.5%, which ishigher than the regional and national averages of 72.3% and 38%respectively. Also, more males get educated than females due to thestereotype roles of woman in the district as being mainly householdchores and child bearing and caring. Lower education of women andother issues mentioned in the conceptual framework may be at work inputting women at risks to these environmental diseases.Figure 6 and appendix IIIa depict that women are disproportionatelyaffected by water related diseases, as more than half (54.2%) of thepeople treated with water related diseases in Saboba Medical Centre(SMC) were women compared to 45.8% for men. However, for otherdiseases, a sharp reverse is the case as 54.5% were men and 45.5% beingwomen. The explanation is that generally, more men have access to thedefence mechanisms listed in the conceptual framework of this study(Fig. 2), due to their control of resources and power in the family.Therefore, women higher percentage (54.2%) of water related diseasesclearly shows that they are largely affected by these diseases than theirmen counterparts. Also, more women (54.5%) than men (45.5%)reported with RTI, owning to the fact that more women are exposed toenvironmental hazards (e.g. cooking with firewood) than men. The tablealso shows that 67.3% of Genital and Sexually Transmitted Infections(STIs) were women and only 32.7% being men. This confirms the widelyheld view that more women than men are suffering from HIV/AIDSand other STIs (Oppong, 1998 p.1) due to their vulnerability. A medicaland psychological research is needed to determine why more womenthan men get hypertension.Data from WHC (Fig. 7 and appendix III b), just like in SMC, show thatwomen formed 51.5% of cases of water related diseases such as Malariaand Onchocerciasis and 48.5% for men. For other diseases such asHepatitis, Anaemia, Yaws and Epilepsy, a sharp contrast occurred with57.9% being men and 42.1% women. Again, women (60%) predominatein Genital and STIs as against 40.0% men. Also, 52.6% and 63.2%women and 47.8% and 36.8% men reported on RTI and Pneumoniarespectively. The analysis shows that water related diseases such as23

Matthew Biniyam KursahTRITA LWR Master ThesisMalaria and Bilharzia and environmental diseases such as RTI andPneumonia are dominated by women. The narrowed gap of reportedcases between women and men in WHC compared to SMC can beexplained by the fact that Typhoid is not treated in the former. It mayalso be due to the low reporting rate for women, since according toGhana Statistical Service (2005b) only 2.4% of the population can accessclinic within the locality, which may easily discourage people, mostlywomen without transport mode (bicycle) from accessing clinic.Table 6: Which disease receive much attention in the health campaigns in Saboba DistrictCentralTownship Toma Chief-Section Bordagbalm WapuliType of disease No. % No. % No. % No. % No. % TotalMalaria 7 30.4 12 35.3 11 36.7 2 12.5 9 36.0 41HIV/AIDS 2 8.7 9 26.5 5 16.7 11 68.8 4 16.0 31G. worms 5 21.7 3 8.8 2 6.7 0 - 4 16.0 14Poliomyelitis 3 13.0 2 5.9 2 6.7 3 18.8 3 12.0 13Typhoid 1 4.4 5 14.7 4 13.3 0 - 3 12.0 13Cholera 1 4.4 1 2.9 2 6.7 0 - 0 - 4Diarrhoea 2 8.7 0 - 2 6.7 0 - 0 - 4TB 0 - 0 - 2 6.7 0 - 0 - 2Yellow fever 0 - 1 2.9 0 - 0 - 1 4.0 2CSM 0 - 0 - 0 - 0 - 1 4.0 1Trachoma 1 4.4 0 - 0 - 0 - 0 - 1Anaemia 0 - 1 2.9 0 - 0 - 0 - 1Total 23 100 34 100 30 100 16 100 25 100 128Table 7: Respondents views on the most common diseases in the selected areasType ofdiseaseCentralTownship Toma Chief-Section Bordagbalm WapuliNo. % No. % No. % No. % No. % TotalMalaria 13 56.5 22 64.7 18 60.0 14 93.3 18 66.7 85Typhoid 5 21.7 8 23.5 7 23.3 0 - 4 14.8 24Diarrhoea 1 4.4 2 5.9 2 6.7 0 - 2 7.4 7G. worms 3 13.0 2 5.9 1 3.3 0 - 1 3.7 7Cholera 0 - 0 - 0 - 0 - 1 3.7 1Yellow fever 0 - 0 - 1 3.3 0 - 0 - 1Poliomyelitis 0 - 0 - 0 - 1 6.7 0 - 1Hernia 1 4.4 0 - 0 - 0 - 0 - 1Convulsion 0 - 0 - 0 - 0 - 1 3.7 1Anaemia 0 - 0 - 1 3.3 0 - 0 - 1Total 23 100 34 100 30 100 15 100 27 100 129Table 8: Comparing Customary and Government/District (G/DL) laws in protecting waterCustomary laws G/D lawsCustomary and Government/district LawsNo. % No. %No washing/swimming into drinking water sources 31 36.1 20 22.0Do not enter with feet/sandals into drinking water sources 26 30.2 18 19.8Do not cut trees along water bodies (the gods dwells in veg.) 7 8.1 - -No human/animal defecation/urine into/near water sources 7 8.1 14 15.4Self-help project to clean up water sources is compulsory 4 4.7 1 1.1Do not use fertiliser close to drinking water bodies 3 3.5 7 7.7No metallic objects into water bodies 2 2.3 - -No usage of chemicals in fishing 2 2.3 7 7.7Wounds/guinea worms patients shouldn’t enter into water 1 1.2 8 8.8Particular days restrictions for some activities in the rivers 1 1.2 - -Do not build close to water bodies - - 1 1.1Pay utility bills to provide water - - 1 1.1None exist 2 2.3 14 15.4Total 86 100 91 10024

PercentagesWater sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISTable 9: Pressing environmental problems in Saboba District (1st Choice)Most pressingCentralTownship TomaChiefsection Wapuli Bordagbalmenvironmental problem No. % No. % No. % No. % No. % TotalLack of clean water 2 9.1 5 14.7 8 26.7 7 26.9 - - 22Poor drainage 5 22.7 - - - - 2 7.7 - - 7Bushfires 4 18.2 6 17.7 6 20.0 2 7.7 - - 18Littered environment 1 4.6 5 14.7 1 3.3 1 3.9 1 6.3 9Stagnant water 2 9.1 4 11.8 1 3.3 2 7.7 6 37.5 15Free-range defecation 3 13.6 6 17.7 3 10.0 4 15.4 7 43.8 23Noise pollution 2 9.1 - - - - - - - - 2Erosion 2 9.1 - - - - - - - - 2Disease outbreak 1 4.6 - - - - - - - - 1Deforestation - - 1 2.9 3 10.0 - - - - 4Poor waste mg’t. - - 1 2.9 2 6.7 1 3.9 - - 4Poor road network - - 1 2.9 - - - - - - 1Overgrazing - - 2 5.9 - - 2 7.7 - - 4Land degradation - - 1 2.9 - - - - - - 1Food shortages - - 2 5.9 - - - - - - 2Unplanned buildings - - - - 1 3.3 - - - - 1Flooding - - - - 1 3.3 - - - - 1Land degradation - - - - 3 10.0 - - - - 3Weedy environment - - - - - - 1 3.9 2 12.5 3Water shortages - - - - 1 3.3 3 11.5 - - 4Few sanitary officers - - - - - - 1 3.9 - - 1Total 22 100 34 100 30 100 26 100 16 100 128Table 10: Population who have never being to school (6+ years in percent)Source: 2000 Population and Housing Census, Ghana Statistical Service (2005)SexPlaceMaleFemaleTotalSaboba district 73.7 81.3 77.5Northern Region 66.6 77.9 72.3National - - 38.060504049.536.14441.83022.1Customary LawsGovernment/District Laws20100Low Medium HighLevel of Effectiveness6.5Figure 5: Comparison between effectiveness of customary and government/district laws25

PercentagePercentageMatthew Biniyam KursahTRITA LWR Master Thesis7067.1 67.366.76054.254.55045.845.54032.932.733.3302010Female (%)Male (%)0Water related diseasesRTINon-water related diseasesDiseasesSTIsHypertensionFigure 6: Sex and diseases in Saboba district (SMC). Source: SMC Record Book (2007)9080706050403020100Water related diseases51.548.5 52.247.84753RTINon-water related diseasesDiseasesSTIs604083.8Hypertension16.2Female (%)Male (%)Figure 7: Sex and diseases in Saboba district (WHC). Source: Wapuli Health Centre (2007)This section presents summarised interviews I had with heads and representatives of some departments. Itstarts with an interview with an individual.Box 1Health officials and patient communication on diseases: Author’s internet chat with Faustina, 27,(Diplomat holder)Fausti: I’m not well, I have just come back from hospitalMatthew: what is wrong?Fausti: I have stomach problemMatthew: what is wrong with it?Fausti: It has been paining me for more than two (2) weeks now, so I went and they gave me plentyinjections and said it’s GNID, which I don’t understand. At the moment I am typing with one handbecause I have cannular on the other.Matthew: ok…… and the health officer didn’t inform you what that sickness is? Surprising!!Fausti: Yes, but what can we do?26

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISBox 2Interview with the operator of the Saboba Community Water distribution plant on 17 th September,2007Author: Tell me about your operational workOperator: Saboba Community Water is managed by Saboba Water and Sanitation DevelopmentBoard, appointed by the “community”. Currently, population is more than the capacity of the plant, asoutlet is far more than intake. There are 4 zones in Saboba and its surroundings, and each zone getwater supply every other 4 th day. We have shortages of alloy from Tamale, due in part to nonpayment/delayof water bills.Author: What are the handicaps of your operation?Operator: As I said already; non/delay in payment of water bills, frequent shortages of alloy and otherchemicals for treating the water. There was no alloy at all in 2006 due to financial constraints. Nonpaymentof salaries eg we have been working for three (3) months without salary. No meters (flat ratesfor everyone), lack of logistics (eg bikes), natural hazards (eg thunder strike), lack of communitycompliance, high maintenance cost, low salaries (no motivation), and no social security payment forworkers are some other problems we face here. Also, political interferences and politicisation –extension of pipelines for political gain without changing pumps or increasing plant’s capacity andfailure to buy chlorine since 2003. In 2005, we had to borrow from Yendi, but that could not continueagain. We get only 7.5 kw of electricity instead of 15 kw needed for full operationAuthor: Despite the problems, do you think you have been able to provide enough good drinkingwater for the people?Operator: No….. Because we still have very high water related diseases in the district.Author: Why are there still water related diseases in this town?Operator: Many people still drink water from wells, dams, dugout pits etc because they cannot paywater bills (poverty), while some complain that the pipe water smells due to chemicals usage(alloy/chlorine) and will not drink it. Also, some are also just reluctant to change from the kind ofwater they are used to, and disconnection makes people go for water from dugout pits etc. We have400 stand-pipes and about 100 are disconnected already, with more underway to be disconnected fornon-payment of water bills. To reconnect, one has to pay a penalty of GHC4 plus full amount owed.Box 3Interview with the head of Saboba District Environmental Health Officer (SDEHO), 18 th Sept, 2007Author: What are the functions of your unit?SDEHO: Monitor and gather data in the area of water quality, sanitation, weed, building layouts, foodhygiene, school health, waste management etc but you can see my office now. Only two chairs and a table; nodata files….absolutely nothing.Author: What is the state of environmental diseases in this district?SDEHO: Very high eg Malaria, Typhoid and diarrhoeal diseases.Author: Are there some specific causes of these diseases here?SEDHO. Absolutely YES; I will take you out to the town centre and other areas and show you somehealth bombs there. For Malaria, it’s due to the present of stagnant water, improper/lack of drainagesystems (the gutters overflow all the time), unclean/weedy surroundings. The concern had being onpumping drugs eg artesunate-amodiaquine to cure diseases instead of preventing/reducing its occurrence.For Typhoid; dirty toilets, free-range defecation, and the general lack of good hygiene.Author: What problems affect your unit in discharging its functions?SDEHO: Lack of data and resources, due to lack of commitment and motivation from thegovernment/district. There is also lack of policy priority; policy of government is curative rather thanpreventive (where this unit falls under). No labourers until Zoomlion Ghana Ltd provided 5 manuallabourers for the former Saboba-Chereponi district. Only one toilet cleaner in the district, stationed inSaboba township. Sanitation has not been the district priority and environmental units lackgovernment/district support. Political corruption and influences, low salaries and lack of logistics areother problems we face.Box 4Interview with the Claim Officer of the National Health Insurance Scheme (NHIS), Saboba district, on19 th Sept., 2007Author: What functions does your office do?Claim Officer: By receiving premium, we pay hospital bills of registered members.Author: Tell me basic facts about the health schemeClaim Officer: Premium of GHC8.0 and additional GHC1.0 for registration. There is no premiumrequirement for people under 18 and 70+ years. People from 19 to 69 years are to pay a premium andregister anyone in the household who is under 18 or above 70 years for free. We have 26,00027

Matthew Biniyam KursahTRITA LWR Master Thesisregistered/renewed members this year. Common diseases reported are Malaria and Typhoid (in order).There is higher hospital attendance, hence very high monthly bills. Registration starts in October andends in December each year, after which we have 3 months maturity period.Author: Why are Malaria and Typhoid rates very high (as you mentioned above)Claim Officer: Lack of clean water, living around waterlogged areas, inadequate use of mosquito netsand weedy environment/surroundings. The Saboba Community Water plant pumps direct water fromthe river to the people without treatment.Author: What problems confront this health scheme?Claim Officer: Inadequate logistics, 1) mobility problem hinders the registration of people in thevillages because of intervening streams and water 2) the act of people adding non-household peopleunder 18 and 70+ years to their lists, and 3) age inflation or reduction to benefit the free registration ofpeople under 18 and 70+ years and extremely high hospital bills for members of the scheme.Author: Does the scheme cover all diseases?Claim Officer: No… HIV/AIDS, brain surgery, overseas treatment and criminal abortion are notcovered.Author: Tell me some basic facts about the health scheme in this districtClaim Officer: It started in 2002 but finally took off in 2003 by Integrated Development Centre (IDC)funded by DANIDA. The government took control of it in 2005/2006. Total premium andregistration fees for this year amounted to GHC30,000.00. Monthly bills amount to GHC35,000.00,with about GHC23,000.00 going to SMC alone in August. Without government financial support, thescheme is unsustainable.Author: What is your expectation for 2007/2008?Claim Officer: We expect higher reported cases of environmental diseases dues to heavy rains thisseasonBox 5Interview with Medical Assistant (MA) in Wapuli Health Centre (WHC)Author: What is the state of water related diseases in Wapuli area?MA: Very high; due to broken pots, calabashes, used cans, trunk of trees (especially dry ones), greywater and stored cow dump which serve as breeding grounds for mosquito larvae. Free-rangedefecation is mainly responsible for high Typhoid cases here. We do not treat Typhoid here, so peoplethought to have Typhoid is referred to Saboba Medical Centre (some go to Yendi) for treatment.Through migrant labour, guinea worms resurface from time to time.Author: In your clinic, I have seen only curative campaign posters; do you have some preventive ones?MA: Yes. However, I agree with you that there are fewer preventive campaign postersBox 6Basic facts about health services in Saboba district1 hospital and 1 doctor (sometimes without a doctor at all)3 health centres: Sambuli, Wapuli and Kpalba, and 2 medical assistants (all in mission health centres)Doctor/population and nurses/population ratio are 1:108,692 and 1: 2,944 respectively.Bed/population ratio 1:2,243, while access to health services is 11.4%, compared to 57.6% for Ghana(DPCU, 2007)Conclusion from interviews conducted in the districtThe study interviewed individuals (one analysed), operator of the districtwater supply plant, head of the District Environmental Health unit,Claim Officer of the district’s Health Insurance Scheme and the MedicalAssistant of Wapuli Health Centre. This section analyses the outcomes.Interview of an individualThe interview in Box 1 above shows that lack of awareness on the typeof disease being treated has very little to do with ones educational levelor age, but rather lack of concern and powerlessness. This is because theinterviewee holds a DBS (Diplomat in Business Secretarial) and is grownenough (27 years old). The tone of the interviewee (Quote: which I don’tunderstand...Yes, but what can we do) shows that she would have like toknow the kind of disease she is being treated. This reinforces the view28

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISthat lack of awareness of the particular disease being treated may be dueto powerlessness. It also shows that some people in the district do notknow it is their legal right to ask and be told the disease they are beingdiagnosed.Interview with operator of the Saboba Community Water distribution plantThe interview in Box 2 shows that the water plant is highly bedevilledwith consistent and unending problems, including overstress andpoliticisation as noted by Arapto and Adisenu (2006). It also depicts thatthe operation of the water plant is unsustainable without funding fromother sources. The water supplied from the plant and the other sourcesof water does not seem to have vast differences in quality. The sectionconcludes that the onus is on all stakeholders in the district to wake-upand give more priority to the community water plant.Interview with the head of Saboba District Environmental Health UnitThe interview shows that the unit is woefully under-resourced and datastarvedto an extent that it cannot perform its functions. An in-depthrevelation about the causes of environmental diseases in the district bythe officer clearly shows that its personnel are highly qualified and haveup-to-date knowledge on specific environmental issues in the district.What remains is to provide resources to the unit and allow the staff touse their technical knowledge without political influences and control.Interview with the Claim Officer of the NHIS, SabobaThe interview depicts that the health insurance is highly bedevilled withproblems ranging from fraud, relating to age inflation and reduction – tobenefit from free registration. It illustrates the difficulties in hastilyimplementing policies merely for political gains without first doingunderground works such as getting citizen or national identificationcards. The insurance scheme is doing quite well in the district despite allthe problems facing it. The analysis of income and expenditure alsoshows that the scheme is highly unsustainable without governmentfunding, as the total annual premium cannot pay two months’ hospitalbills of members.Interview with Medical Assistant (MA) in Wapuli Health CentreThe outcome of this interview is not only a revelation of the vastexperiences and knowledge of the health officials, but also depicts thatthey have an in-depth idea above the causes of environmental diseases intheir respective area of operation. The problem here is inadequateresources and equipment to work effectively. The readiness andopenness to provide information throughout this study reveals howserious the health officials are ready to help reduce environmental healthburdens in the district. Therefore, their experiences can easily be tappedinto the formulation of any preventive health policies.In conclusion, the interview reveals that the reason for highenvironmental diseases in the district is not one of lack of requiredinstitutions or qualified personnel but rather lack of resources,unnecessary politicisation and misguided political influences on watersupply system.Position of the propositions of this researchThis section assesses the validity of the stated propositions of thisresearch. The two Propositions underlying this study are;Environmental diseases are increasing at faster rates in Saboba districtEnvironmental diseases affect more women than men29

Matthew Biniyam KursahTRITA LWR Master Thesis1. Environmental diseases are increasing at faster rates in Saboba district: Table 4and 5 showed that there have been consistent increases in the rates ofenvironmental diseases between 2002 and 2005 with 57.5% for Malaria,diarrhoeal diseases (58.6%), RTI (422.7%), intestinal worms (1481.5%)and Typhoid from 161 cases to 7,725, giving 4698.1% increase (Table 4).Though, data for 2006 was inaccessible during the study period, the 2007records show a similar trend (Table 5). Based on these records, the statedproposition is accepted.2. Environmental diseases affect more women than men: Figure 6 and appendixIIIa depict that women are disproportionately affected by environmentaldiseases, as more than half (54.2%) of the incidences of environmentaldiseases in SMC were women compared to 45.8% being men. Womenform approximately 51% of the district’s population (Ghana StatisticalService, 2005a), and therefore their proportion of 54.2% depictsdisproportion. For non-environmental diseases, a reverse is the case as54.5% were men and 45.5% being women. More women than men alsoreported with RTI. The explanation is that generally, more men thanwoman have access to the defence mechanisms listed in Figure 2, due totheir control of resources and power in the family. However, there islower rate or proportion of women suffering from environmentaldiseases in Wapuli area (Fig. 7). This may be due to the fact that WHCdoes not treat some environmental diseases such as Typhoid, of whichdata from SMC shows women are disproportionately affected, hencelowering women aggregate rate. Based from the above analysis (alsofrom Appendix IIIa and b), the concerned proposition is accepted.Space and environmental diseasesThis chapter looks at whether there is any relationship between spaceand environmental diseases in Saboba district. In this regard, distance ofsettlements from major town (district capital), roads, watercourses, andthe type of land cover and elevation were tested with incidence ofenvironmental diseases in the district using correlation.Interpretation of the size of a correlationMany researchers have offered guidelines for the interpretation of acorrelation coefficient. Cohen (1988) for example, has suggested theinterpretations in Table 11. Though, Cohen’s interpretation lacks clear-cutboundaries between small, medium or large (since the upper limits for oneclass is the same at the lower limit for the succeeding class), it isnevertheless very useful. The coefficient ranges from −1 to 1. A value of1 shows that the linear equation describes the relationship perfectly andpositively. This implies that, all data points lie on a straight line where Yincreases with X. A score of −1 shows that all data points lie on a singleline, but when Y increases, X decreases. A value of zero depicts thatthere is no linear relationship between the variables under consideration(Cohen, 1988). I will like to note here that the criteria used are in someways arbitrary and should not be looked too strictly, since thesignificance or otherwise of a correlation coefficient depends on thecircumstances and purposes. This is because physical science researchwith high quality instruments and social science with varying factors maynot set the same significant level. It is also worth to note that thesignificance does not necessarily imply causation and that large and smallshould not be strictly taken as synonyms for good and bad.30

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISTable 11: Criteria for Interpreting Correlation. Source: Cohen (1988)Correlation Negative PositiveSmall −0.3 to −0.1 0.1 to 0.3Medium −0.5 to −0.3 0.3 to 0.5Large −1.0 to −0.5 0.5 to 1.0Method usedDistances to major towns, roads and watercourses were extracted usingArcGIS tool – Spatial Analyst – Distance – Straight line. The resultswere saved into DBF 4 format – MS Excel and then to SPSS where thesignificance was tested using correlation (2-tailed) with the three leading(environmental) diseases (Malaria, Typhoid and RTI) in the district. Forthe purpose of this study, 0.05 levels are considered significant. It isworth noting that percentage of reported diseases to population in eacharea is used in this study, and not the raw figure. Figure 8 to 13 show thevarious map outcomes, while Table 12 shows its corresponding values.Space and environmental diseases: GIS analysisWith the aid of GIS (ArcGIS), this section analyses the relation betweenenvironmental diseases and the above mentioned spatial variables.Distances of settlements to the main town (district capital) in Saboba districtFigure 8 shows that majority of the settlements in Saboba district islocated beyond 10 km (10,000 metres) from the major town (Saboba)where the only hospital in the district is located. Poor road networks andfloods further impede movement of people to the district capital.Distances from each settlement to the major town were extracted usingGIS (results are affected by distances to major towns in neighbouringdistricts). The results are shown in column 12 of Table 12Distances of settlements to roads in Saboba districtThe research also tried to find out whether there are any relationshipbetween closeness to road and the three environmental diseases,especially RTI, through smoke and dust from moving vehicles. Thereported cases of these diseases of each settlement and its correspondentdistances to the nearest vertices of a road are shown in the map in Figure9, and its values in column 8,9,10 and 13 in Table 12. The outcome isimputed into SPSS to find correlation between the two variables, and theresults shown and analysed later in this section.Distances of settlements to rivers in Saboba districtFigure 10 depicts distances of each settlement with respect to the nearestriver course (excluding streams, lakes and dams). A number of thesettlements are located within 6 km (6000 metres) from the rivers. Theassumption/analogy is that the more closer a settlement is to a river, thehigher the rates of water-related diseases – example, malaria.Distances of settlements to watercourses in the Saboba districtFigure 11 shows distances of each settlement with respect to the nearestwatercourse (stream, lake, dam etc). The reported disease values of eachsettlement and its correspondent distance to watercourses are shown incolumn 8,9,10 and 14 in Table 12. Majority of the settlements are locatedwithin 3 km (3000 metres) to the nearest watercourse. However, veryfew of these water bodies provide water for the communities due to theirseasonality of flow. The analogy is that the more closer a settlement is towatercourses, the higher its risks of water-related diseases. Thisassumption was tested by correlating distances of settlements to31

Matthew Biniyam KursahTRITA LWR Master Thesisincidences of the three leading environmental diseases (Malaria, Typhoidand RTI) in Saboba district.Type of Land cover and location of settlements in Saboba districtWhether land cover has any bearing on environmental diseases is veryimportant for mitigation measures, as it will help direct interventionpolicies towards a specific area whose land cover type has predisposedthe inhabitants to higher environmental hazards/diseases. This studytries to identify if incidences of environmental diseases occur primarily ina particular type of land cover shown in Figure 12. The various diseasevalues of each settlement and the corresponding land cover type areshown in column 8,9,10 and 15 in Table 12Elevation (in metres) and settlements in Saboba districtFigure 13 shows that about 80% of the district is between 100-150metres in height and the rest fall within 150-200 and 50-100 metresmarks. This depicts that Saboba district is generally a lowlying plain areawith floodable potentials, as it usually does, with great environmentalhealth risks. The various disease values of each settlement and thecorresponding elevation are shown in column 8,9,10 and 16 of Table 12.32

BilyimbaBaguliWater sources, infrastructure, Nadugu space No.1 and the dynamics of environmental diseases in Saboba District: Using GISFaliNakaku No. 1TekasuWabonAsareKukpeneGarikuka!.SambangAcheridoSettlementsRiversContoursRoadsW. Utindan-doBitin-doInagmabuniMagie UgandoKinabusiaKpardorZegbeliBoaduNanwalbuJamboDemonYakaliJamoniJilmaJanbokToginSagbeGbonKokoliWalaKunjuulTombuNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheliLifur³Tisung JagridoKpeguKpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni !. KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamDistance to Major Town (Metres)0 - 25002501 - 50005001 - 75007501 - 1000010001 - 43500WambongMulpedoKpalbaBichaanGnalajodo1:400,000Old NambiriFigure 8: Map of Saboba district showing distance of settlements to majortown33

BilyimbaMatthew Biniyam Kursah Nadugu No.1SambangBaguliFaliWabonGarikukaMagie UgandoJilmaKinabusiaTRITA LWR Master ThesisNakaku No. 1TekasuAsareKukpeneKokoliWalaKunjuulW. Utindan-do Kpardor MulpedoJanbokBitin-do ZegbeliTogin TombuAcheridoInagmabuniSagbe Old NambiriNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheliLifurTisung³JagridoKpeguKpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni !. KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamBoaduSettlementsNanwalbuRiversJamboKpalbaContoursBichaanGnalajodoRoadsWambong Demon GbonDistance to Roads (Metres)!.0 - 10001001 - 20002001 - 30003001 - 1000010001 and aboveYakaliJamoni1:400,000Figure 9: Map of Saboba district showing distance of settlements to roads34

BilyimbaBaguliWater sources, infrastructure, Nadugu space No.1and the dynamics of environmental diseases in Saboba District: Using GISFaliNakaku No. 1TekasuAsareWabonGarikukaKukpeneMagie UgandoJilmaKokoliKinabusiaWalaSambangKunjuulW. Utindan-do Kpardor MulpedoJanbokBitin-do ZegbeliTogin TombuAcheridoInagmabuniSagbe Old NambiriNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheliLifurTisung JagridoKpegu ³³Kpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni !. KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniSettlementsWadigKudok KutuliPoon-BamRoadsBoaduRiversNanwalbuDistance to Rivers (Metres)JamboKpalba0 - 1000BichaanGnalajodo1001 - 2000Wambong Demon Gbon2001 - 30003001 - 6000Yakali6001 - 18000 Jamoni1:400,000!.18001 and aboveFigure 10: Map of Saboba district showing distance of settlements to rivers35

ManieBilyimbaBaguliMatthew Biniyam Kursah Nadugu No.1WabonFaliGarikukaAsareTRITA LWR Master ThesisNakaku No. 1TekasuKukpeneSambangMagie UgandoKinabusiaJilmaKokoliWalaKunjuulAcheridoSettlementsRoads!.W. Utindan-doBitin-doKpardorZegbeliToginNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheliLifurTisung JagridoKpeguKpasasene Nalogni No. 2YankaziaUnido³BodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni !. KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamDistance to Watercourses (Metres)0 - 160161 - 725726 - 1,8511,852 - 2,8012,802 - 10,297RiversInagmabuniBoaduNanwalbuJamboWambongMulpedoDemonYakaliJamoniJanbokKpalbaBichaanGnalajodoSagbeGbonTombuOld Nambiri1:400,0001:400,00000Figure 11: Map of Saboba district showing distance of settlements to watercourses36

ManieBilyimbaBaguliWater sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISNadugu No.1FaliNakaku No. 1TekasuWabonAsareKukpeneGarikukaMagie UgandoJilmaKokoliKinabusiaWalaSambangKunjuulW. Utindan-doJanbokKpardor MulpedoBitin-do ZegbeliTogin TombuAcheridoInagmabuniSagbe Old NambiriNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoJabuniNafecheliSanguliLifur³Tisung JagridoKpeguKpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni!.KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamBoaduSettlementsNanwalbu RiversJamboKpalbaContours BichaanGnalajodoWambong Demon Roads GbonSettlementsSettlementsRiversRiversLanduse TypeContoursContoursRoads !.RoadsLandcover TypeLanduse Landuse Type TypeWidely open cultivated savannahClosed savannah woodland 0 (>25Closed savanna woodland (>25 trees/ha)Widely woodland Widely open cultivated open (6-10 cultivated trees/ha)savanna savanna woodland woodland (6-10 trees/ha) (6-10 trees/ha)Open cultivated savannah woodlandGrassland with/without with/without scattered tree/shrub scatteredOpen(11-20 Open cultivatedtrees/ha) cultivated savanna savanna woodland woodland (11-20 trees/ha) (11-20 trees/ha) trees/shrubOpen Open savanna cultivated woodland savannahRiverine(25 trees/ha) woodland (>20 trees/haFigure Grassland 12: with/without Map of scattered Saboba tree/shrub district showing settlements and type of land coverGrassland with/without scattered tree/shrubRiverine savanna vegetation37Closed Riverine cultivated savanna savanna vegetation woodland (>20 trees/ha)Closed cultivated savanna woodland (>20 trees/ha)YakaliWidely open cultivated savanna woodland (6-10 trees/ha)Jamoni1:400000Open cultivated savanna woodland (11-20 trees/ha)1:400,000Open savanna woodland (

ManieBilyimbaMatthew Biniyam KursahNadugu No.1SambangBaguliFaliWabonGarikukaMagie UgandoJilmaKinabusiaTRITA LWR Master ThesisNakaku No. 1TekasuAsareKukpeneKokoliWalaKunjuulW. Utindan-do Kpardor MulpedoJanbokBitin-do ZegbeliTogin TombuAcheridoInagmabuniSagbe Old NambiriNakpeuNaatagBukobChakpelangbini WagbalTingbalShegbini Wajori BiwaldoSanguliJabuniNafecheli³LifurTisung JagridoKpeguKpasasene Nalogni No. 2YankaziaUnidoBodulSobibaWadejoKuwaniNakpalNayiliToma BorgbalnBuriburniNabuar Nalogni !. KiteekKujoniNakpani BukpamMpeasemGarimataKacheKujoni WayuubKungibJajelNakuru KabonbuSaladoNansonKuchaKudaniGbaniSambuli KuchachbuniWadigKudok KutuliPoon-BamSettlementsBoaduRiversNanwalbuJamboKpalbaContoursBichaanGnalajodoRoadsWambong Demon Gbon!.50-100YakaliJamoni100-150150-2001: 400000Figure 13: Map of Saboba district showing settlements and their elevations (in metres)38

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISTable 12: Space and environmental diseases in Saboba district|Diseases occurrences| | Percentage of diseases | [ Distances to; (in metres]Code Place Malaria Typhoid RTI Total Pop Malaria Typhoid RTI Total Capital Roads Water Landcover * Elevation7 Biwaldo 31 4 1 36 270 11.48 1.48 .37 13.33 23741.3 10836.4 2127 2 10011 Bordagbalm 18 3 0 21 276 6.52 1.09 .00 7.61 8268.0 366.00 2807 3 15012 Borgbaln 39 7 2 48 207 18.84 3.38 .97 23.19 1306.1 1208.11 26 2 10014 Buakuln 66 2 4 72 236 27.97 .85 1.69 30.51 1566.2 857.51 905 2 10015 Bukob 14 1 0 15 328 4.27 .30 .00 4.57 25109.5 3886.77 90 2 10016 Bukpalba 2 0 0 2 32 6.25 .00 .00 6.25 33593.9 853.85 1193 2 10017 Bukpam 2 2 0 4 395 .51 .51 .00 1.01 27353.6 680.08 890 3 10018 Bungen 23 4 1 28 240 9.58 1.67 .42 11.67 16792.5 3080.58 875 2 10020 Chagban 2 1 0 3 275 .73 .36 .00 1.09 29506.4 479.09 1510 2 10021 Chagbani 2 0 0 2 288 .69 .00 .00 .69 48641.1 7710.05 39 3 10025 Dicheen 18 2 2 22 115 15.65 1.74 1.74 19.13 1899.4 984.89 995 2 10026 Dokundo 5 2 0 7 102 4.90 1.96 .00 6.86 4257.4 3131.75 300 2 10028 Garikuka 2 0 0 2 899 .22 .00 .00 .22 54294.5 88.39 1700 3 15029 Garimata 11 0 0 11 130 8.46 .00 .00 8.46 14587.5 645.17 961 2 10030 Gbangbanponi 13 0 0 13 491 2.65 .00 .00 2.65 26063.8 1948.23 202 2 2 10031 Gbani 2 0 0 2 143 1.40 .00 .00 1.40 27500.3 1971.44 425 3 10033 Gbon 1 0 0 1 229 .44 .00 .00 .44 40209.1 8608.20 1063 3 5037 Jagrido 26 2 0 28 289 9.00 .69 .00 9.69 34754.2 8510.65 1829 2 10038 Jajel 2 0 0 2 109 1.83 .00 .00 1.83 41065.4 8693.10 1842 3 10043 Jilma 3 0 0 3 396 .76 .00 .00 .76 48063.1 7120.65 1491 3 10045 Kabonbu 1 0 1 2 73 1.37 .00 1.37 2.74 19402.6 2280.49 2380 2 10046 Kache 20 2 2 24 143 13.99 1.40 1.40 16.78 10336.2 5177.95 1450 2 10048 Kikpasoni 2 0 0 2 134 1.49 .00 .00 1.49 27659.6 9781.70 2306 3 10049 Kimoateek 72 8 6 86 230 31.30 3.48 2.61 37.39 2101.5 739.61 48 3 10050 Kinabusia 1 1 1 3 186 .54 .54 .54 1.61 52124.5 1968.39 195 3 15051 Kiteek 79 3 8 90 312 25.32 .96 2.56 28.85 3053.30 1990.13 55 2 10054 Kpalba 4 3 0 7 692 .58 .43 .00 1.01 35043.8 269.26 1350 3 10057 Kpegu 207 24 19 250 755 27.42 3.18 2.52 33.11 14075.0 146.3 1386 2 10058 Kucha 5 2 1 8 357 1.40 .56 .28 2.24 16563.8 5497.8 79 2 10039

Matthew Biniyam KursahTRITA LWR Master Thesis59 Kuchabonu 5 1 0 6 35 14.29 2.86 .00 17.14 43541.2 6797.10 52 2 10063 Kujoni 55 4 5 64 627 8.77 .64 .80 10.21 19292.1 2637.22 954 3 10065 Kungib 5 0 3 8 118 4.24 .00 2.54 6.78 12687.3 11525.9 57 2 10067 Kunkunzoli 14 3 4 21 670 2.09 .45 .60 3.13 23826.1 933.6 1629 2 10068 Kutuli 7 1 3 11 267 2.62 .37 1.12 4.12 27796.1 134.63 36 2 10070 Kuwani 29 1 0 30 120 24.17 .83 .00 25.00 2201.6 635.36 955 3 10071 Labaldo 40 6 2 48 452 8.85 1.33 .44 10.62 18591.6 4476.96 2557 2 10073 Lifur 12 0 0 12 173 6.94 .00 .00 6.94 18563.2 7435.40 2388 2 10074 Liwalbu 14 1 1 16 184 7.61 .54 .54 8.70 28072.6 2082.25 700 2 10076 Moagbar 13 2 2 17 194 6.70 1.03 1.03 8.76 11314 4224.96 1336 2 10080 Mulpedo 13 2 1 16 148 8.78 1.35 .68 10.81 41380.6 8013.70 436 2 10081 Naatag 26 2 0 28 330 7.88 .61 .00 8.48 40235.7 1445.31 600 3 15082 Nabuar 30 4 0 34 113 26.55 3.54 .00 30.09 12771.5 1608.23 1713 2 10083 Naduni 1 0 0 1 96 1.04 .00 .00 1.04 46071.5 5052.90 1352 2 10085 Nakpal 0 1 0 1 59 .00 1.69 .00 1.69 34637 343.92 2027 3 10087 Nakpeu 5 3 0 8 98 5.10 3.06 .00 8.16 56958.0 18200.3 725 3 15089 Nalogni 74 5 2 81 430 17.21 1.16 .47 18.84 2774.17 846.78 795 2 10091 Nanchang 29 2 2 33 178 16.29 1.12 1.12 18.54 10247.8 3630.64 25 2 10092 Nankpando 50 5 1 56 346 14.45 1.45 .29 16.18 7457.60 1318.44 1317 2 10094 Nanwalbu 1 0 0 1 127 .79 .00 .00 .79 35406.7 9792.65 2820 2 10095 Nanyundo 7 1 1 9 99 7.07 1.01 1.01 9.09 32228.2 9001.60 2152 2 10096 Nawalbu 4 1 0 5 294 1.36 .34 .00 1.70 27329.6 2253.13 700 2 10097 Nayili 15 2 1 18 329 4.56 .61 .30 5.47 19890.1 637.50 975 3 10098 Nayil-Sachido 13 3 1 17 132 9.85 2.27 .76 12.88 22766.8 2894.18 1777 3 100100 N-nalog 8 1 0 9 218 3.67 .46 .00 4.13 19012.8 1007.55 901 2 100101 Old Nambiri 11 0 1 12 195 5.64 .00 .51 6.15 29193.5 3057.83 1175 2 100105 Saboba 857 113 87 1057 3687 23.24 3.06 2.36 28.67 256.48 412.50 825 2 100106 Sagbe 19 6 6 31 287 6.62 2.09 2.09 10.80 30081.8 6960.25 460 2 100107 Sajigbam 8 0 0 8 131 6.11 .00 .00 6.11 20524.3 11854 2917 2 150110 Sambuli 12 1 4 17 1735 .69 .06 .23 .98 21554.9 39.53 1706 2 100111 Sanguli 58 6 7 71 581 9.98 1.03 1.20 12.22 18040.8 27.95 2705 2 100113 Sobiba 157 16 10 183 722 21.75 2.22 1.39 25.35 7979.90 277.55 79 3 100114 Tilangbeni 47 5 1 53 201 23.38 2.49 .50 26.37 1901.03 1570.88 29 2 10040

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GIS115 Tingbaal 6 4 2 12 101 5.94 3.96 1.98 11.88 41095 6977.60 672 3 100116 Tingbal 8 1 1 10 140 5.71 .71 .71 7.14 23081.8 4162.50 975 2 100120 Toma 144 15 4 163 616 23.38 2.44 .65 26.46 2303.87 387.50 1796 2 100123 Ugando 6 1 0 7 390 1.54 .26 .00 1.79 52467.5 150.52 336 3 150124 Umoadanbor-do 1 0 0 1 99 1.01 .00 .00 1.01 1587.43 2247.25 855 3 100125 Unido 8 2 1 11 42 19.05 4.76 2.38 26.19 11161.4 215.78 1407 3 100126 W. Utindan-do 4 0 0 4 134 2.99 .00 .00 2.99 51074.5 16723.1 400 3 150129 Wadig 1 1 0 2 227 .44 .44 .00 .88 36915.1 11304.6 3521 3 100135 Wapuli 30 9 4 43 1328 2.26 .68 .30 3.24 26280.9 167.71 965 3 100136 Wayuub 1 0 0 1 74 1.35 .00 .00 1.35 15533.9 605.83 450 2 100139 Yankazia 7 2 1 10 765 .92 .26 .13 1.31 29471.5 127.95 689 3 100* For land cover: “2” means widely open cultivated savannah woodland (6-10 trees/ha), and “3” means Open cultivatedsavannah woodland (11-20 trees/ha)41

Matthew Biniyam KursahTRITA LWR Master ThesisSpace and incidence of malariaThis section presents and analyses results of the correlation betweendistances to the main town, watercourses, roads, the type of land coverand elevation on one hand and environmental diseases on the other.Table 13 shows correlation between malaria and distance to the maintown (district capital). The rationale behind this was to find out whetherdistances to major town which is the hub of health, educational, social,economic and political activities in the district have any relationship withthe occurrence of Malaria incidences. The premises are that; 1) the majortown serve as the district capital with relatively better water managementsystems, 2) majority of the most educated (defence mechanism) peopleare found in the major town, and 3) poverty is dominant in the ruralareas than the major town (hub of economic activities). However, Table13 shows that Malaria and distance to major towns (including majortowns in neighbouring districts) have an inverse correlation withsignificance of 0.001 levels. This can be explained by six main reasons; 1)the relatively dense population in Saboba township and high number ofpersonal-house ownerships (Table 15) created so many dugout pits formosquitoes to breed, 2) the dilapidated and open gutters found in themajor town serve as good grounds for mosquito larvae to grow, 3) thereare more open containers such as used cans, broken bottles etc inSaboba township than in the peripheries due to higher population, 4)relatively low hospital attendance of the peripheral areas due totransportation difficulties, illiteracy etc, 5) the open type public toilets (Fig.15) are only available in the major town; these toilets serve as reservoirfor breeding mosquitoes, and 6) the township has a poorer sanitationthan the periphery.Table 14 shows that the relationship between Malaria and distance toroads also has an inverse relationship with a significance level of 0.026.This means that more Malaria cases are reported close to road networks.However, the closeness to roads in itself does not directly determine thepresence of stagnant water to facilitate breeding of mosquito (anopheles)larvae but rather 1) the concentration of large population along roadnetworks means more dugout pits as a results of the need for buildings(Fig. 1), 2) the gutters constructed along road networks and the potholesfound on these third class roads in the district may have served asbreeding grounds for mosquito larvae, and 3) low hospital attendance ofthose in the periphery due to transportational difficulties; account forthis relationship. This shows that Malaria is largely an urban health problemin the district.With a significant level of 0.108 and correlation of -0.190, Table 15shows that there is no significant correlation between incidence ofMalaria and distances to conventional water sources (river and streams).Three main reasons explain this surprising result. Firstly, the more visiblewater bodies are rivers and streams with flowing current – such flows donot facilitate high breeding of mosquitoes. Secondly, the usuallytemporary, small, stagnant and open grey water bodies which facilitatethe growth of mosquitoes are not shown in the GIS analysis. Thepresence of water does not necessarily make it breeding grounds formosquitoes, but rather the prevailing condition of the water. The thirdreason that explains this otherwise surprising result is the length ofexposure of intermittent rivers and streams to the breeding ofmosquitoes. Though, these watercourses do dry-out and “cut” at someof its sections, which could facilitate the breeding of mosquitoes, it ishindered by the differences in the timing of the dry-out period (around42

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GIS% of Malaria to PopulationDistance to major towns% of Malaria toPopulationNovember to February) and the peak for mosquito breeding (aroundMarch to October) in the district. During my fieldwork and interviews, Iheard many people saying that Kaekae/Harmattan (northeast trade winds,which usually begin from Nov. to February) should come and drive awaythese mosquitoes. Thus, the local weather condition in the district makesconventional watercourses unimportant source for mosquito breeding,compared to the dug-out pits, potholes and gutters.The correlation between incidence of Malaria and topography is shownto be highly insignificant. Table 16 shows the significant level of 0.255which is much higher than the significant level of 0.05 set for this study.The following reasons explain this phenomena; 1) Saboba district is agenerally lowlying area with most of the contour values ranging between50 to 150m which does not provide any competitive advantage to anyarea in terms of the conducive environment needed for the growth ofmosquito larvae or absence of stagnant water, and 2) the generalavailability of used cans, broken calabashes, trunk of trees, polythenebags etc with a high capacity to retain rain water for mosquitoes to breedfurther invalidates the significant of these two variables.Table 13 Correlation between % of malaria to population and distance to maintown. ** Correlation is significant at the 0.01 level (2-tailed).Distance to roads% of RTI to population Dist. to major townsPearson Correlation 1 -0.651(**)Sig. (2-tailed . 0.001N 73 73Pearson Correlation -0.651(**) 1Sig. (2-tailed) 0.001 .N 73 73Table 14 correlation between percent of malaria to population and distance to roads* Correlation is significant at the 0.05 level (2-tailed).% of Malaria to Population Distance to roadsPearson Correlation 1 -0.261*Sig. (2-tailed . 0.026N 73 73Pearson Correlation -0.261* 1Sig. (2-tailed) 0.026 .N 73 73Table 15 Correlation between % of malaria to population and distance to watercourses% of Malaria toPopulationDistance to water%t of Malaria toPopulationElevation% of Malaria to Population Distance to waterPearson Correlation 1 -0.190Sig. (2-tailed . 0.108N 73 73Pearson Correlation -0.190 1Sig. (2-tailed) 0.108 .N 73 73Table 16 Correlation between percent of malaria to population and elevation% of Malaria to Population ElevationPearson Correlation 1 -0.135Sig. (2-tailed) . 0.255N 73 73Pearson Correlation -0.135 1Sig. (2-tailed) 0.255 .N 73 7343

Matthew Biniyam KursahTRITA LWR Master ThesisSpace and incidence of TyphoidLike Malaria, the incidence of Typhoid occur more towards the maintowns than the interiors. With a significant level of 0.004 (Table 17),Typhoid can also be described as becoming predominantly an urbanhealth problem. Vary reasons explain this occurrence; 1) many times thepipe water pumped to the towns are not treated, 2) though, the habit offree-range defecating is very common in every part of the district, therelatively dense population of the Saboba township and the poor natureof disposing waste from the public toilets (Fig. 15 and 21) worsen it case,3) most of the boreholes in the district are found in the peripheral areas,and 4) lower hospital attendance of peripheral areas due totransportation difficulties, illiteracy etc.The correlation between Typhoid and distance to water bodies (Table18) showed that there is no significant relationship between the twovariables. The level of significance is 0.151, a value far above the 0.05level set for this study. The following reasons explain this occurrence; 1)the water bodies used in the analysis are rivers and larger streams withflowing current – such flows does not highly facilitate the growth ofbacterium Salmonella enterica serovar Typhi, but rather the flow into dams andother relatively stable watercourses, and 2) the widespread of temporarywater bodies such as dugout pits, opened gutters in the district helpspreads Typhoid irrespective of location to major water bodies. Thisshows that environmental health problems are basically human-induced.Table 19 also shows that elevation and Typhoid have no significancerelationship. With significance level of 0.610, elevation does notinfluence Typhoid occurrences in Saboba district. This is because Sabobadistrict is a generally lowlying area with contour values ranging between50 to 150m which does not give any causative preferences (uplandlowlandflow of germs through water) to any area in the district.Table 17 Correlation between % of typhoid to population and distance to major town.** Correlation is significant at the 0.01 level (2-tailed% of Typhoid toPopulationDistance to MajorTowns% of Typhoid to Population Dist. to major TownsPearson Correlation 1 -0.334(**)Sig. (2-tailed . 0.004N 73 73Pearson Correlation -0.334(**) 1Sig. (2-tailed) 0.004 .N 73 73Table 18 Correlation . between % of typhoid to population and distance to watercourses% of Typhoid toPopulationDistance to water% of Typhoid to population Distance to waterPearson Correlation 1 -0.170Sig. (2-tailed . 0.151N 73 73Pearson Correlation -0.170 1Sig. (2-tailed) 0.151 .N 73 73Table 19 Correlation between percentage of Typhoid to population and elevation% of Typhoid to PopulationElevation% of Typhoid to Population ElevationPearson Correlation 1 -0.061Sig. (2-tailed . 0.610N 73 73Pearson Correlation -0.061 1Sig. (2-tailed) 0.610 .N 73 7344

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISSpace and incidence of RTILike Malaria and Typhoid, Table 20 shows that the correlation issignificant at 0.001 between RTI and the distance to major towns inSaboba district. The explanations are that, 1) though there are fewcars/vehicles on the highways, their number (usually withoutenvironmental regulations) is greater in the townships causing a lot ofemissions and dust, and 2) the relative concentration of populations inthe townships and the use of woodfuel for cooking exposes greaternumber of people to smoke from burning wood. The latter explains whymore women (54.5%) than men (45.5%) are affected with RTI asmentioned above. Even though, the residents in the Saboba Townshiphave better defence mechanisms such as education, wealth etc (seeconceptual framework) and are therefore able to reduce the hazards ofenvironment, those defence mechanisms does not prevent emission anddust from vehicular movement. The third reason may be due to lowhospital attendance of the peripheral areas.There was no significant correlation between RTI and distances to roadsin Saboba district (Table 21). The only possible relationship betweenroads and respiratory diseases is through the emissions and dust fromcars/vehicular movement in the third class roads in the district.However, with few numbers of vehicles that plies the roads,characterised by potholes, serve to limit or reduce speed and thus helpedto minimise the emission of smoke and dust. However, the emissionsand dust may be greater in Saboba Township due to its nodal nature interms of vehicular movement. The widespread of bushfires, the high useof woodfuel and charcoal for cooking and the kaekae (North-East tradewinds), accompanied by dust (harmattan winds) may explain thewidespread of respiratory diseases in the district, irrespective ofgeography, except in Saboba Township, where its nodal nature invehicular movement may have worsen its case.Table 22 shows that there is no significant correlation (0.104 levels)between RTI and land-cover type. The reason is that; 1) Saboba districtis generally an open savannah area with similar characteristics, 2) thedistrict is predominantly farming communities that use the slash and burnmethod of land preparation without any geographic differences, and 3)the North-East trade winds (Harmattan) accompanied by dust affect thewhole district irrespective of the location, with the exception of therelatively populated Saboba township which is more disposed torespiratory diseases due to concentration of cars/vehicles and burning offuelwood during cooking.Position of the hypothesisThis part validates or otherwise of the hypothesis of the study. Thestated hypothesis is that;There is a significant relationship between distances to the main town, roads,watercourses, the type of land cover and elevation on one hand and environmentaldiseases on the other in Saboba district.Tables 13, 17 and 20 show an inverse significant relationship at 0.001levels between distances to the main town and the three leading(environmental) diseases (Malaria, Typhoid and RTI) in the district. Thismeans that environmental diseases decrease from the main town towardsthe periphery. Table 14 also shows that incidence of Malaria and distanceto roads has an inverse significant relationship at 0.05 levels. The reasonsfor these trends have been stated above. However, Tables 15, 16, 18, 19,21 and 22 showed that there is no significant relationship between45

Matthew Biniyam KursahTRITA LWR Master Thesisdistances to watercourses, road networks, the type of land cover andelevation on one hand and the environmental diseases on the other.Therefore, the stated hypothesis is only partially accepted.To sum up, the various spatial variables do not significantly influenceenvironmental diseases in Saboba district. Apart from the fact thatenvironmental diseases are becoming an urbanised problem, the othervariables proved to have no effects on the occurrences of the threemajor environmental diseases. The breakdown of infrastructural facilitiessuch as gutters, toilets and waste disposal systems, high hospitalattendants (compared to the peripheral areas) and the non-treatment ofpipe water for the town may explain why environmental diseases werediscovered to be common in Saboba town than the peripheral areas.Table 20 Correlation between RTI in relation to population and distance to majortown. ** Correlation is significant at the 0.01 level (2-tailed).% of RTI toPopulationDistance to MajorTowns% of RTI to Population Dist. to Major TownsPearson Correlation 1 -0.447(**)Sig. (2-tailed) . 0.001N 73 73Pearson Correlation -0.447(**) 1Sig. (2-tailed) 0.001 .N 73 73Table 21 Correlation between RTI in relation to population and distance to roads% of RTI to PopulationDistance to roads% of RTI to Population Distance to RoadsPearson Correlation 1 -0.137Sig. (2-tailed . 0.248N 73 73Pearson Correlation -0.137 1Sig. (2-tailed) 0.248 .N 73 73Table 22 Correlation between RTI in relation to population and type of land cover% of RTI to Population Type of land coverPearson Correlation 1 -0.192% of RTI to Population Sig. (2-tailed) . 0.104N 73 73Type of land cover Pearson Correlation -0.192 1Sig. (2-tailed) 0.104 .N 73 73Infrastructural construction and environmental diseases in Saboba districtThe preceding sections show that environmental diseases are generallyrampant in the district, and that distances to water, roads, and the type ofland cover and topography have little links to occurrences of thesediseases. This section therefore presents and analyses the specific factorsthat explain the high environmental diseases (special reference to waterrelated diseases) in Saboba district. Since some clinics in the district donot treat Typhoid and other illness, in such cases, I relied on data fromthe only hospital (SMC) in the district which treats these ailments.Analysis of causes of environmental diseases in Saboba districtFrom Table 23, 94.2% of houses in the district are constructed withmud/mud bricks or earth, and only 2.8% are constructed with concretemade from cement. During the field trip in the area, I noticed that willbe-buildersexcavated mud/earth material in each plot of land theyintended to build, leaving almost every constructed house with at least a46

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISpit containing stagnant water near the house. This has implications onthe health of the people, since the stagnant water become reservoir forbreeding mosquitoes (the causal agent of Malaria). During the rainyseason, as water springs out from these dugout pits, it becomes a sourceof domestic water (Fig. 14).Table 24 shows that only 1.3%, 1.5% and 4.4% of the population in thedistrict have access to water closet (WC), KVIP (a type of low-costtoilet) and public toilets respectively. Due to frequent interruptions inpipe water supply, not all the 1.3% of those who have access to WC douse it at all times, while unsanitary conditions of the KVIP and publictoilets (Fig. 15) largely discourage many from using it. The proximity ofthese public toilets to the residential houses (Fig. 15), dugout pits andsome water sources place nearby residents in a health bomb. The tablealso depicts that a large proportion of the people (91.1%) use any place(free-range) as toilet. This is far above the average (75.9%) in theNorthern region.Table 23: Main material for wall construction (%)Source: 2000 Population and Housing Census, Ghana Statistical Service (2005)MaterialPlaceSaboba districtNorthern regionMud/mud brick/earth 94.2 82.6Cement blocks/concrete 2.8 10.8Sandcrete 0.1 2.8Palm leaves/thatch 1.2 1.6Wood 0.9 1.0Other 3.0 6.6Table 24: Household access to toilet facility (%)Source: 2000 Population and Housing Census, Ghana Statistical Service (2005b)PlaceType of toilet facilitySaboba districtNorthern regionWC 1.3 2.5Pit-latrine 0.6 2.0KVIP 1.5 2.3Bucket/pan 0.4 1.6Facility in another house 0.7 1.6Public toilet 4.4 1.0Free-range/ no facility 91.1 75.9Other - 0.2Figure 17 shows that more than half (50.2%) of the population in thedistrict use springs, streams, and river water (compared with 27.2% inNorthern Region), and 12.7% (dugout pits), 12.4% (wells) as theirsources of domestic water supply. Only 7.4% and 17.2% of thepopulation in the district have access to pipes and borehole waterrespectively. The fact that 91.1% of the population have no toiletfacilities (free-range) and 62.9% uses water from spring/stream anddugout pits (Fig. 14) explains the high incidence of Typhoid in thedistrict, as the human faeces with the bacterium Salmonella enterica serovarTyphi are easily washed into such water sources.Figure 18 shows that less than half (49.5%) of the population of Sabobadistrict have access to sources of drinking water within 30 minutes,compared to an average of 94.1% for Ghana. On the other hand, 50.5%get to the nearest sources of drinking water at a time of 30 minutes andabove, compared with only 5.9% for Ghana. Interestingly, 34.1% get47

Matthew Biniyam KursahTRITA LWR Master Thesistheir drinking water at a time of 60+ minutes. The breakdown in thepipe system often forces many people to travel farther to get drinkingwater. The rich and educated in the society often resort to buying sachetwater (Appendix IV n) as an alternative, while the poor, women andchildren, resort to drinking any available water to the detriment of theirhealth (Ghana Statistical Service, 2000).Table 25 depicts that 94.2% of the population own their houses whileonly 3.0% rents. Also, 2.6% have rent-free and 0.1% of the populationperch. The high number of personal house ownerships and the fact that94.2% are constructed with mud/earth (Table 23) explains why there aremany dugout pits containing stagnant water in the district.Table 26 depicts that wood constitutes 93.2% (compared with 83.7% forNorthern region) of fuel for cooking while charcoal forms 3.5% in thedistrict. Such high use of fuel wood with its resultant smoke and the factthat 52.1% and 34.3% (Fig. 19) use open space and separate cooking spacesrespectively, may explain why Respiratory Tract Infections (RTI) arehigh in the disease prevalence rate in the district, especially amongwomen. This also explains why more women than men are affected withrespiratory diseases (Fig. 6 and 7 and appendix III a and b). This is not agood statistics for the district since more than half (52.4%) of thepopulation travel over 30 km to access the only hospital in the district.With poor transport networks coupled with seasonal flooding,accessibility and utilisation of health care is very low; especially forwomen (Ghana Statistical Service, 2005a).Table 27 shows that 92.0% of the population in the district useunimproved waste disposal systems – dump elsewhere (79.6%), buried method(9.3%) and burned method (3.1%), compared to only 34.1% for Ghana.The inequality is much greater as 8.0% of population in the districtcompared to 65.9% for Ghana have access to improved methods ofwaste disposal such as public dump and collected methods. A personalobservation on the reality in Saboba district shows that the public dumps(6.8%) and the collected method (1.3%) are in fact not safe in itself (Fig. 21).According to CWIQ II Survey Report (Ghana Statistical Service, 2005c)only 5.2% of the population in the district have access to safe sanitation,compared to 58.7% for the Regional capital, Tamale.Figure 20 shows results of respondents’ views on the causes of highwater related diseases in the district. The most frequently ranked causesare compared here. The figure shows that the top five general causes ofhigh water related diseases in Saboba district are 1) lack of clean ortreated water, 2) free-range defecation especially close to water bodies, 3)presence of stagnant water, due in part to poor drainage systems, 4)littered environment and 5) washing or swimming or stepping intodrinking water sources. Specifically, lack of clean or treated water, freerangedefecation, littered environment, washing or swimming or steppinginto water bodies and presence of stagnant water is ranked highest inCentral Township, while Toma has presence of stagnant water and lackof drains, lack of clean or treated water, free-range defecation, washingor swimming or stepping into water bodies and pollution of water as themajor causes of higher water related diseases. For Chief-section, freerangedefecation, lack of clean or treated water, presence of stagnantwater, littered environment and washing or swimming or stepping intowater bodies came first, while presence of stagnant water and lack ofdrains, lack of clean or treated water, littered environment, high exposureto sunlight and poor diet for Bordagbalm.48

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISFigure 14: A woman and her son fetching water from a dugout pit at Toma, while theirdog stands watching.Figure 15: Samples of Public toilets in Saboba Township (Referred as “a” and “b” respectively)Figure 16: Some sources of drinking water in Saboba districta. Children swimming before fetching the same water for domestic useb. Lady fetching water from a Well49

PercentagesPercentagesMatthew Biniyam KursahTRITA LWR Master Thesis605040302010050.227.222.417.2 1712.712.412.619.67.40.1 1.2Saboba district Northern RegionPipe in/ outsideBoreholeSpring/stream/rain/riverWellDugoutotherPlaceFigure 17: Comparison of main sources of drinking water between Saboba district andNorthern Region. Source: 2000 Population and Housing Census, Ghana Statistical Service(2005b)9085.380706050403020103910.5 8.81334.13.6 3.4 1.50.8Saboba districtGhana00-14 15-29 30-44 45-59 60+Time (in minutes))Figure 18: Household by time it takes to reach the nearest supply of drinking water (%)Source: Ghana 2003 Core Welfare Indicators Questionnaire (CWIQ II) Survey Report(GSS, 2005c)In Wapuli, lack of clean or treated water, pollution of water, free-rangedefecation, littered environment and washing or swimming or steppinginto water bodies were highly ranked as the main causes of the highwater related diseases. The ranking for Bordagbalm reveals inadequateknowledge concerning health issues and disease prevention measures dueto higher illiteracy rate and ignorance.Table 25: Type of household owning (%). Source: 2000 Population and HousingCensus, Ghana Statistical Service (2005b)Type of household ownership Saboba district (%)Owning 94.2Renting 3.0Rent-free 2.6Perching 0.150

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISTable 26: Household main fuel for cookingSource: 2000 Population and Housing Census, Ghana Statistical Service (2005b)PlaceType of fuel for cookingSaboba districtNorthern RegionWood 93.2 83.7Charcoal 3.5 11.7Kerosene 2.5 1.3L.P.G 0.3 1.0Electricity 0.1 0.7No cooking 0.2 1.4Other 0.3 0.1Table 27: Main method of waste disposal. Source: Ghana 2003 Core WelfareIndicators Questionnaire (CWIQ II) Survey Report (Aug, 2005c)Quality of the method Method Saboba district GhanaCollected 1.3 6.0Improved methodPublic dump 6.8 59.9Total 8.0 65.9Burned by household 3.1 7.5Dump elsewhere 79.6 23.2Unimproved method Buried by household 9.3 3.1Other - 0.2Total 92.0 34.1This section concludes that both the lack of and inappropriateconstruction of infrastructural facilities may explain the high incidencesof water related diseases in Saboba district. The infrastructuralconstructions such as houses, roads, gutters etc have left a great numberof dugout pits which serve as reservoir for breeding mosquitoes duringrainy season when filled with water. The ineffectiveness of the pipewater supply have also left the inhabitants with no feasible option thanto use these dugout pits as sources of water, with greater health risks.Burning of mosquito coil and RTI: The Local caseMosquito coils and burning of plant matter are widely used in thedistrict. While sleeping with a burning mosquito coil in the room maynot be pleasant, but however, if the option is to do nothing and beingbitten by mosquitoes or sleep in a stuffy mosquito net, many people inSaboba district, and Ghana as a whole, opt for the coil as the lesser ofthe three evils. There is no exact conclusion on the effects of burningmosquito coils on human health, and I am certainly not equipped withknowledge in epidemiology to be drawn into this argument. However,considering the amount of smoke emission and the type of housing (withsmall or no window at all), mosquito coils may pose more danger for theoccurrence of RTI in the district. Furthermore, some of the mosquitocoils have not pass through the Food and Drugs Board (FDB – agencychecking on quality of products for human use) and therefore theirefficacy and quality cannot be guaranteed. The worse case is for thosewho burn dried plants matter (leaves, stems etc) in their rooms (whilesleeping in it at the same time) in order to produce smoke to drive awaymosquitoes. Though, FDB often denounces some of the illegal mosquitocoils, the high illiteracy rates in the district and the inadequate access tocommunication facilities such as Televisions and radios have putinhabitants in the Saboba district, and other similar areas, into a positionwhere they continue to use banned products (mosquito coils). The laxityof enforcement agencies is also part of this problem. This researchtherefore challenges experts in health fields to undertake specificresearch on the effects of mosquito coils on users’ health in the district.51

PercentagesMatthew Biniyam KursahTRITA LWR Master Thesis10.72.934.3No cookingSeparate exclusive/shareOpen space in compoundother52.1Figure 19: Type of household cooking space in Saboba district.Source: 2000 Population and Housing Census, Ghana Statistical Service (2005b)120100806040200Central Township5.35.35.310.510.55.321.136.8Toma6.13 6.115.224.221.221.2Chief-section3.63.610.714.314.332.121.4Bordagbalm6.312.52531.325Wapuli3.93.97.719.211.511.511.530.8Poor dietPoor water storageFarming/fertilizer use close to waterHigh expose to sunlightPresence of animal dumpIlliteracyChemical usage in fishingPollution of waterWashing/swimming/step water bodiesLittered environmentPresence of stagnant water/No drainsFree-range defecationLack of clean/treated waterSelected AreasFigure 20: Place-specific causes of water-related diseases in the districtFigure 21: District Environmental Health Officer showing the author some health bombin Saboba Township. a) Public waste dump, b) Faeces from public toilet is buried herec) Indiscriminate waste dump, respectively52

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISCHAPTER 4This chapter concludes that the immediate environmental threats for thepeople of Saboba district may not be the long-term effects of globalwarming, cumulative exposure to carcinogens, or decade-longdesertification but rather the life and death immediacy of Malaria,Typhoid and respiratory diseases. Their threats are derived from humanmadehousehold environments, characterised by near-the-door-faeces, farfrom-door-waterand uncontrolled sewage. Widespread of bushfires, thehigh use of woodfuel for cooking may explain the widespread ofrespiratory diseases in the district, irrespective of geography. The effectsof burning mosquito coils and plant matter on RTI need furtherscientific discovery. However, from a rationale and social scienceperspectives, this study holds the view that the smoke produced byburning mosquito coil and plant matter may dispose excessive users torespiratory problems.Conclusion and RecommendationsThe four leading diseases (Malaria, Typhoid, RTI and diarrhoea) inSaboba district can be seen as environmental diseases, wherein the firsttwo, Malaria (50.6%) and Typhoid (12%) are water-related (Table 4 and5). Though, the third ranked disease, RTI (9.9%) is environmental, it isnot directly related to water. The study identified lack of access to cleanwater, pipe system interruptions, presence of stagnant water and freerangedefecation as the major causes of high environmental diseases inthe district. Below are the other findings of the research.Spatial issuesMost of the settlements in the district are sited along the River Otidrainage system. Disease prevalence, pressing environmental problemsand their solutions differ from place to place. The study also identifiedthat there is an inverse significant correlation (at 0.01 levels) betweenincidences of Malaria, Typhoid and RTI on one hand and distances tomajor town on the other. However, the correlation between the formerand distances to watercourses, roads, the type of land cover andtopography have no significant relationship. There are also morereported cases of malaria close to road networks in the district due topopulation concentration and easy access to hospitals and clinics. Theexplanations for all these variations have been stated above. In general,space as mentioned above have limited effects on the incidences ofenvironmental diseases, hence the stated hypothesis for this study is notwholly acceptable in Saboba district.Pressing environmental problemsThe study found different perceptions of the most pressingenvironmental problems and the most common diseases in the district.For the district in general, free-range defecation is identified as the mostpressing environment problem, followed by lack of clean or treatedwater, bushfires, presence of stagnant water and littered environment.Though, there are differences in ranking from each specific area that wasselected, free-range defecation, poor drainage, presence of stagnantwater, lack of clean water and bushfires run across all areas, except inWapuli where shortage of water is a pressing environmental problem.Housing, toilet facilities and sanitationMost of the housing structures in Saboba district are built with mud orearth (Table 23), majority of which are in deploring stage, needing repairs53

Matthew Biniyam KursahTRITA LWR Master Thesis(Appendix IV b and c). Erosion caused by torrential rains and theintensive winning of sand or mud mainly for constructional purposescreate several gullies, pits and potholes which are filled with stagnantwater during the rainy season in the district. Also, effluent and wastewere found to be discharged into open space and free-range,respectively, creating bad odour and health risks. The study discoveredthat 91.1% of households in the district have no toilet facility, 1.3% havewater closets (WC), while 1.5% use KVIP (Table 24). Households withinadequate or no toilet facilities are compelled to rely on the free-rangesystem. This has significant implications for transmission of bacteriasuch as bacterium Salmonella enterica serovar Typhi (causal agent of Typhoid),and consequently for the health and well-being of communities, which inturn, may impact negatively on productivity.Water issuesThe study also discovered that the commonest sources of drinking waterin the district are the springs, rivers, rain and streams (50.2%). Boreholes(17.2%), dug-out pits (12.7%), wells (12.4%) and pipe-borne (7.4%)follow in that order (Ghana Statistical Service, 2005b). This means thatonly 24.6% of households have access to potable water (pipe-borne andboreholes). This inadequacy of potable water has given rise to high waterrelated diseases such as Typhoid in the district. It was also identified thatsources of water for domestic uses vary with the most improved onesmainly use for drinking and others for washing and bathing (AppendixI). Access to good drinking water is inadequate in Saboba Township,while Wapuli experiences shortages during the dry season. Personalobservation and interviews with the head of Environmental HealthOffice, health officials and some residents revealed that there are manydugout pits in the district, owing to the type of material (mud or earth)used in building and the type of housing and housing ownership. Inaddition, the study discovered that there are many stagnant water andfilthy drains in the Saboba Township (Appendix IV b and c) serving asbreeding grounds for mosquito (anopheles) larvae.Currently, the pipe borne water supplied by the plant of SabobaCommunity Water is the main source of drinking water for the town.However, frequent interruptions in its flow in Saboba town have becomea normal practice. Many times, since 2002, the pipe water is pumpeduntreated due to lack of funds to purchase chemicals. The water plant isforced to operate beyond its carrying capacity, while maintenance is verypoor. Thus, the plant is overstressed, resulting in frequent breakdowns.Political influences and dictates (extension for political gains) includingreading political meanings into development projects, as stated byArapto and Asiedu (2006), is further putting the plant in a faster state ofdilapidation. Personal observation discovered that sometimes, one canhardly see through-to-the-bottom of a bucket filled with water from thetown’s water plant. This speaks about the low quality of the water. Othersources of water are even worse. The study discovered that with only400 pipes in the town, of which about 100 have already beendisconnected (at the time of interview with the operating manager of theplant) due to non-payment of water bills, have further complicated thewater problem in Saboba Township and its environs (Box 2). Theunclean water from Moadani dam, wells, streams and dugout pits stillserve as major domestic water sources to the people of Saboba,especially during interruptions in the flow of pipe water and in the rainyseasons (Fig. 14). The worst case is found in the surrounding villageswhere water from culverts is used for domestic purposes during rainy-54

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISseasons, when it becomes inaccessible to go to the dams or boreholes(Appendix IV k). It was also discovered that most of the boreholes inthe district are sited farther from users, usually inaccessible during rainyseasons when water gathers the intervening culverts and valleys. Thereason for drilling boreholes farther from some communities is to avoid(usually NGOs) been seen as bias in favour of one community over theother, since one borehole will have to serve several communities. Thus,for the purpose of allowing access by all communities, the boreholes areusually sited at a place not nearest-to-anybody and farther-to-everybody. A goodnumber of the recorded boreholes in the district have not functioned foryears. The boreholes at SABTEC, Moadani (Appendix IV i) and Hilltopare few examples. Water taken from some of the boreholes (exampleBordagbalm) had a very bad scent, similar to a spoilt egg. My discussionswith the inhabitants and other stakeholders revealed that many of thepeople do not drink borehole water because – as they put it, its water istoo light and does not quench thirst.Health issuesThe knowledge on the most common diseases in the district is very low.The study also discovered that health care delivery is inadequate,characterized by a number of factors like poor physical access to healthfacilities, inadequate health officials and a doctor or patient ratio of about1:108,692 (Box 6). Personal observation during the field trip identified thatpoor road networks due to seasonal flooding hinders health awarenessprogrammes. Also, poor data collection and management due toinadequate staff capacity have made it difficult for effective monitoringof health awareness programmes.The study also identified that very often people who attend hospitals andclinics do not know the type of sickness they have being treated (Box 1),as very few people answered a question asking the type of disease they werediagnosed while others stated they did not know. The research identifiedthat, though, all environmental diseases are on an increasing trend in thedistrict, the increases for Typhoid are very alarming. The top ten (10)diseases in Saboba district showed that Typhoid cases has increasetremendously from just 161 reported cases and 8 th position in 2002 to7,725 in 2005 (Table 4), resulting in 4698.1% increase to capture thethird leading disease prevalence after Malaria and RTI in the district.Preliminary data from SMC as at the third-quarter of 2007 shows thatTyphoid has become the second leading single disease in the district.However, Malaria has consistently maintained it top spot (Table 4 and 5).No single respondent rated broken pots, calabashes, used cans, trunk oftrees (Appendix IV e and g) and stored cow dung in the houses as causes ofhigh malaria (reservoirs for breeding mosquitoes) as emphasised by theMedical Assistant of Wapuli Health Centre (Box 5). This means that thepeople of Saboba district still lack some of the reasons that account forhigh rates of Malaria in the district. The widespread of bushfires, highuse of woodfuel for cooking, inappropriate use of mosquito coils and theHarmattan, accompanied by dust, may explain the widespread ofrespiratory diseases in the district, irrespective of geography, except inSaboba Township where population and vehicular concentration makes it aspecial case.National Health Insurance Scheme (NHIS)The NHIS is bedevilled with 1) inadequate logistics, 2) mobility problemto register people in the villages because of intervening streams andfloods, 3) the act of people adding non-household people of under 1855

Matthew Biniyam KursahTRITA LWR Master Thesisand the 70+ years to their lists, 4) age inflation or reduction to benefitfrom the free registration, and 5) extremely high hospital bills formembers of the scheme (Box 4). Therefore, the problem of the healthscheme is simply resource constraint and fraud from the public. NHIS isurged to engage in effective health awareness programmes since it willbenefit immensely from good health of the public – less hospital bills.Political and gender issuesDuring the field study, I did not find any concrete water policy in thedistrict. The study revealed that customary laws are more wholistic inmanaging and protecting water resources in the district than governmentor district laws. Customary laws are also widely known and obeyed with41.8% of the respondents believed it was highly effective , 36.1%(medium) and only 22.1% rated it as lowly effective; compared to 6.5%,44% and 49.5% for high, medium and low, respectively, for governmentor district laws (Fig. 5). Also, 15.4% of the respondent said there are nogovernment or district laws protecting water resources in the district asagainst 2.3% for customary laws (Table 8). This is because customarylaws are seen to have come from the people by the people and for the people. Thisanalysis therefore questions, as many have done, the effectiveness of topdownapproach to policy formulation and implementation.The study also discovered that women do not actively participate indecision making and issues concerning the communities. This was clearlyseen during the administration of questionnaires where women referredme to direct the questions to their men counterpart. In most cases(mostly in villages) the women had to first seek permission from men orhusbands before being interviewed – partly why they were underrepresented in the sampling. The study also discovered that women weredisproportionately affected by water related diseases as more than half(54.2%) of the patients diagnosed of water-related disease in SMC werewomen compared to 45.8% for men. Also, more women (54.5%) thanmen (45.5%) reported with RTI. However, a sharp reverse is the case forother diseases, as 54.5% were men and 45.5% being women. Theexplanation is that generally, more men have access to the defencemechanisms against environmental hazards (Fig. 2) due to their controlof resources and power in the family. However, data from WHC showlesser proportion of women (51.5%), but still higher compared to men(48.5%). This may be due to the non-treatment of disease like Typhoidat WHC and physical accessibility (long distances). For other diseases,just like in SMC, a sharp contrast occurred with 57.9% being men and42.1% women. WHC data also shows that Genital and STIspredominantly affects women (60.0%) than men (40.0%).Causes of high prevalence of environmental diseases in Saboba districtThe study identified a number of factors that have predisposed Sabobadistrict to higher rates of water-related (and in general, environmentaldiseases) such as Malaria and Typhoid in Saboba district. Many of thecauses are synergic in character as discussed below;Presence of dugout pits created by the large use of mud or earth (94.2%) asthe main building material and their subsequent fill-up with water duringrainy season has made it possible for mosquito larvae to breed. The useof such pits as a place of toilet (free-range) and sources of water furtherexplains the high occurrence of Typhoid. Closely related to this, is thepresence of stagnant water found in potholes, disposed tin cans, brokencalabashes and other containers.56

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISConclusionGrowing population and inadequacy of toilet facilities, including uncleanness ofthe few existing public ones have pushed 91.1% of the population to usethe free-range system resulting in increasing rates of Typhoid. This laidcredence to IWMI (2000) view stated above.Inadequacy of clean or treated water and frequent interruption in the flow of pipewater is identified as another causal factor for the high incidences ofwater related diseases in Saboba district. Even with the presence of pipeborne water in the district, majority of the population still drink waterfrom unimproved sources as 50.2% drink water from streams or springsor rivers, 12.7% (dugout pits) and 12.4% from Wells. Only 17.2% ofthe total population in the district drink water from boreholes and 7.4%from pipes (improved sources). The high proportion of unimprovedsources of water is due to 1) lack of access to pipes and boreholes formany communities, 2) frequent interruption in existing pipe watersupply, 3) disconnection of pipes due to non-payment of water bills, and4) many people especially from the periphery will not drink boreholewater because it is too light and does not quench taste or smells badly.The research also discovered lack of waste disposal system as responsible forthe high environmental diseases in the district, as 92% uses unimprovedmethods of waste disposal such as dump elsewhere, burn and buried methods.The indiscriminate and large dumping of used tin-cans, broken calabash andpolythene bags in the district are also found to contain water for a long timeafter rain, serving as reservoir for breeding mosquito larvae. Openedunderground tanks and public toilets also breeds a lot of mosquitoes(Appendix IV f and Fig. 15b)Poverty has also been identified as one other cause of high environmentaldiseases in the district. Poverty accounted for why people cannot paytheir water bills leading to disconnection of pipes. It is also responsiblefor high illiteracy, inability (financially) to acquire a personal toilet facilityand the general lack of defence mechanisms shown in the conceptualframework.Illiteracy and ignorance have it part to blame for the high incidences ofwater related diseases, and environmental diseases in general. Complainsthat borehole water is too light and does not quench thirst were largely seen tobe more perceptual, and a consequent of ignorance than reality.The free-range system of animal rearing, especially pigs, have resulted inanimals dump littered almost every where, while some share the samesource of water with humans. Their faecal matter is easily washed intowater bodies, while some create potholes or drainage blockage thatfacilitates the breeding of mosquitoes (Appendix IV c).The cause of high rates of RTI may be the use of woodfuel for cooking,bushfires, the inappropriate use of mosquito coils or plant matter anddust from the Harmattan. The effect of environmentally unfriendly carsand lorries on RTI in the district does not seem to play an importantrole, due to fewer cars and the rough nature (potholes) of the roads.Generally, the higher rate of environmental diseases in Saboba district islargely a human induced phenomenon; hence natural causes have verylimited impact. The study discovered that the immediate environmentalthreats for the people of Saboba district may not be the long-term effectsof cumulative exposure to carcinogens or/and effects of global warming,or even decade-long desertification but rather the life and deathimmediacy of Malaria, Typhoid and respiratory diseases. These threatsare mainly synergic human factors derived from household57

Matthew Biniyam KursahTRITA LWR Master Thesisenvironments, characterised by near-the-door-faeces, far-from-door-clean-water,uncontrolled sewage, presence of dugout pits, frequent interruption ofpipe water, poor waste disposal, poverty, illiteracy and ignorance. Thehigh use of woodfuel for cooking (also charcoal processing), and tosome extent the widespread of bushfires and the Harmattan,accompanied by dust, may explain the widespread of respiratory diseasesin the district, irrespective of geography. Due to the fewer number ofvehicles that ply the roads in the district and the nature of potholes onthe road (reduces speed), the emission of smoke and dust are generallyminimal, and therefore may have limited effects on the health (RTI) ofthe people. It is not surprising that the study did not find any significantrelationship between RTI and distance to roads in the district. Theintervention measures to reduce health burdens (malaria and otherdiseases) in the district must not target only settlements alongconventional watercourses (rivers, streams etc) but the entire district as awhole, with focus on eliminating potholes and stagnant water. This studyhighlights that issues of environment, specifically water and diseasesmust be treated multi-sectorial manner, including departments of;finance, health, sanitation, agriculture, animal husbandry and water; andabove all, a strong political will, since water is a right to life, and goodhealth a right to existence. The study finally concludes that the policy forthe district must accept that water has no substitute and could be the oilcrisis of 21 st century, and its inadequacy in quality could be devastating onthe health of the people. It must also be understood that the districtcannot solve the 21 st century water challenge with 20 th centurybureaucracy and laws.RecommendationsBased on the study, the following recommendations are made to helpinfluence and redirect health, water and social policies for the benefit ofthe citizenry in Saboba district, and Ghana as a whole.Health officialsThis study recommends that health officials, and also district assemblyand the NGOs, to reprioritise their health campaigns to create moreawareness on the most common diseases in the district such as Malaria,Typhoid, RTI and diarrhoea, rather than tolling the international-diseasecampaign-trends. While it is important to campaign against HIV/AIDSand Guinea worms, doing so by neglecting Malaria, Typhoid and RTI isinappropriate, hence there is the need for the campaigns to also embracethese diseases. It is surprising to see that people in Saboba district ratedGuinea worms as the third most common disease, when in fact thedisease is almost completely eradicated in the district. Health officialsshould keep Spatio-temporal data of patient’s attendance for monitoringand assessment of disease patterns, trends and occurrence.It is recommended that intervention measures towards creation ofawareness to minimise water related diseases must not focus on onlycommunities along the conventional watercourses (rivers, streams etc)but must take the whole district in its entity into consideration, since thestudy discovered no significant correlation between these water coursesand water related diseases in the district. Health officials should make it apriority to explain to patient clearly the disease they are diagnosed of, itscausal agent and how it can be prevented. Though, the high number ofpatients waiting for treatment is usually the deterrent factor, thisexplanation to patients will in the long-run reduce the disease burdenand the stress on the health centres. It is also recommended to healthofficials, district assembly and the NGOs to shift from the curative58

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GIStreatment of diseases (such as the current artesunate-amodiaquinecampaigns) to preventive measures such as closing of all pits or potholesaround houses and the use of mosquito nets.District AssemblyIt is recommended to the district assembly to incorporate extralegalmanagement of water resources by including the traditional setup such asUmoadanbor, Utindan and chiefs into the formal management system as away of gaining grassroots support for water management. The assemblyis encouraged to provide funding and logistics to the Saboba CommunityWater Development Board to provide treated and uninterrupted pipewater supply to the communities. It is surprising to note that the watercompany has not bought chlorine since 2003.This study also recommends to the district assembly to provide moreresources to the District Environmental Health Office so that it canundertake some health campaigns and monitor water and sanitationconditions in the district. The district assembly should repair all damagedand non-functioning boreholes (examples are Moadani, SABTECH andHilltop boreholes) for the communities and encourage the public to takeresponsibility of maintenance in the future. The assembly also need totake a serious attention to ascertain why some boreholes’ water(Bordagbalm, Moadani etc) smells and devise remedies to avoid drillingin such geological areas, as it makes no sense providing borehole waterwhen the communities do not use it. A good number of boreholes arepartially inaccessible to users during rainy seasons when water floods theintervening streams, valleys and lowlying areas. It is recommended thatefforts be put in place to consider all-year-round accessibility when drillingnew boreholes for communities in the district. A bye-law is also neededto encourage people to close or cover up any sand-winning pit(s) dug forbuilding purposes. Alternatively, common areas should be earmarked forsand winning purposes while careful steps are taken to disinfect it tomake it difficult for mosquitoes to breed. There is also the need toprovide waste bins for the district. The ongoing efforts of ZoomlionGhana Ltd is in the right direction and commendable. However, moreneed to be done if there is to be any environmental health gains.Government MinistriesThe various government ministries are also urged to collaborate inreducing environmental and specifically water related diseases through amulti-sector and integrative management plans with other departmentsincluding sanitation, environment, finance, and health as suggested byWorld Bank (2002). The involvement of local communities will be a plusfor the success of such plans. To help reduce age inflation or reductionand remove fraud, the ongoing National Identification Card System mustbe fastened. Also, the District Electoral Commission should release thedistrict’s register for the NHIS to use to verify ages of people.Local CommunitiesThe local communities are encouraged to grow a plant, which is locallybut sarcastically named unadon-born, which literally means, mosquito love orpartner (Appendix IV a) around their houses. The plant is largely andunquestionably known to repel mosquitoes. Also, the use of mosquitonets is one of the best options available. The people should also beencouraged to contribute money to maintain or drill boreholes forthemselves, since the days when governments needed to provideeverything for its people (socialism) are over. The general public is urgedto end the burning of plant matter in their rooms. Alternatively the59

Matthew Biniyam KursahTRITA LWR Master Thesisburning should be done many hours before they go to sleep in the roomto avoid inhaling particulates and smog generated by the burning.Scientists and EpidemiologistsThis research raised an inconclusive view about the exact effects ofburning mosquito coils on respiratory diseases, and as such recommendsto scientists and epidemiologists to investigate the matter further andhelps resolve the puzzles. The Food and Drugs Board (FDB) is alsourged to step further and educate people on the use of mosquito’s coilsand other repellents.Policy Direction and FocusThe policy for the country must be made clear as noted by Nsiah-Gyabaah (2001) and accept that water has no substitute and could be theoil crisis of 21 st century. More investment from the government is needed,while Public Private Partnership (PPP), BOT or BOOT could beencouraged in a way that will not over privatised water and increase costfor the people. In whichever investment type that dominates, access andaffordability of water and the involvement of local people in the wholeprocess must be the priority of any water policy.Further Research areas1. A research on accessibility of health care and health services in thedistrict is required to fully understand spatial dynamics of health issues inthe district since some people may not attend hospitals or clinics eventhough they are ill – due to several reasons. In this case, it may beinappropriate to use hospitals or clinics records (as I did) as basis fordetermine the relation between space and disease patterns. This is whereresearch on health accessibility will be important.2. Also, the effects of burning mosquito coils and plant matter on RTIneed further specific scientific study.3. Further research is needed to fully discovered reasons whywatercourses do not influence Malaria rates in Saboba district.60

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISReferencesAllotey, J., Baidoo, A. and Mårtensson, U., (1999). “Best Practices of Environmental InformationSystems (EIS): The Case of Ghana”, In: Prévost, Y.A. and Gilruth, P. 1999. TowardsEnvironmentally Sustainable Development in Sub-Saharan Africa, Environmental Information Systemsin Sub-Saharan Africa, EIS Publications: Post UNCED Series, pp 1-10.Arapto, P. and Adisenu, E., (2006). Challenges of Community Participation in an Integrated Watsan Project ina Peri-urban Set up: The Case of Old Ningo. PRONET, Accra.Benneh, G., Awusabo-Asare, K.., Abane, A. M., Kendie, S. B. and Delali, B. M., (1998). A Report onPopulation, Poverty and Environmental Degradation in the Western Region of Ghana, United NationsFund for Population Activties (UNFPA), Accra.Botterweg, T. and Rodda D. W., (1999). “Danube River Basin: Progress with the EnvironmentalProgramme”, Water Science and Technology, 40 (10), pp 1-8.Cohen, J., (1988). Statistical power analysis for the behavioural sciences, (2nd ed.) Hillsdale, NJ: LawrenceErlbaum Associates.Centre for Remote Sensing and Geographic Information Service (2007). GIS data for Saboba-Chereponi District, CERGIS, University of Ghana, Legon.Demsetz H., (1967). “Toward a Theory of Property Rights”, American Economic Review, 57 (May1967), pp 354-356.DHMT – District Health Management Team, (2006). Annual Health Report, Ghana Health Service,Saboba District, Saboba.Ehin, P., (2003). Theoretical approaches to public participation, MANTRA-East working report, February2003, Tartu, Estonia.Gardner-Outlaw, T. and Engelman, R., (1997). Sustaining water, easing scarcity (2 nd ed), PopulationAction International, Washington DC.GGWEP – Ghana Guinea Worms Eradication Programme (2006). Guinea Worm Race: Districts inNorthern Ghana, Ghana Health Service, Accra.Ghana (1994). Ghana Population Policy, Ministry of Finance, Accra.Ghana Statistical Service (2000). Ghana Living Standards Survey Report: Fourth Round, Ghana StatisticalService, AccraGhana Statistical Service (2005a). 2000 Population and Housing Census: Analysis of National Data andImplications for Planning, Ghana Statistical Service, Accra.Ghana Statistical Service (2005b). 2000 Population and Housing Census: Analysis of District Data andImplications for Planning, Northern Region, Ghana Statistical Service, Accra.Ghana Statistical Service (2005c). Core Welfare Indicators Questionnaire (CWIQ II) Survey Report 2003,Ghana Statistical Service, Accra, Ghana.Gleick, P. H., (2002a). Dirty water: estimated deaths from water-related diseases, 2000-2020. Pacific InstituteResearch, California.Gleick, P. H., (2002b). The world’s water: biennial report on freshwater resources 2002-2003, Island Press,Washington D.C.Goulet, D., (1986). “Three Rationalities in Development Decision Making”, World Development, 14(2), pp 301-317.Hardin, G., (1968). “The Tragedy of the Commons”, Science, 162, pp 1243-1248.Huisman, P., de Jong, J. and Wieriks, J.P., (2000). “Transboundary cooperation in shared riverbasins: experiences from Rhine, and North Sea”, Water Policy 2 (12), pp 83-97.Integrated Development Centre, IDC, (2004). Implementation of Poverty Alleviation Fund, IDC, Saboba.Kendie, S.B., (1997). Opportunities for Resource Management and Sustainable Rural Development Systems,Presented at the International Seminar on Sustainable Rural Development in Sub-SaharanAfrican. July 21-25, UNDP, AccraNsiah-Gyabah, K., (2001). The Looming national dilemma of water crisis in peri-Urban areas in Ghana,DFID, Kumasi, Ghana.61

Matthew Biniyam KursahTRITA LWR Master ThesisOppong, J. R., (1998). “A Vulnerability Interpretation of the Geography of HIV/AIDS in Ghana,1986–1995”, The Professional Geographer, 50 (4), pp 437-448.Jürgen, P. and Mohr Ulrich, M., (2006). “Mosquito coil smoke inhalation toxicity. Part II:Subchronic nose-only inhalation study in rats”, Journal of Applied Toxicology, 26 (3), pp 279-292.Postel, S. L. and Wolf, A. T., (2001). “Dehydrating Conflict”, Foreign Policy, 126 (Sept/Oct), pp 60-67.Smith, R. J., (1981). “Resolving the Tragedy of the Commons by Creating Private Property Rightsin Wildlife”, Cato Journal, 1 (2), Fall 1981, pp 439-468.Saboba Medical Centre (SMC, 2007). Patient Attendance Record Book 2007, GHS, Saboba.Songsore, J. and Mcgranahan, G,. (1993). “Environment, Wealth and Health: Towards an analysisof intra-urban differentials within Greater Accra Metropolitan Area, Ghana”, Environment andUrbanization, 5(2), pp 10-34.Songsore, J., Nabila, J. S., Amuzu, A.T., Tutu, K.. A., Yangyuru, Y., Mcgranahan, G. and Kjellen,M., (1998). Proxy indicators for rapid assessment of environmental health status of residential areas: The case ofthe Greater Accra Metropolitan Area (GAMA), Ghana, Stockholm Environment Institute,Stockholm.Songsore, J., Nabila, J.S., Yangyuoru, Y., Amuah, E., Bosque-Hamilton, E.K.., Etsibah, K.K,.,Gustafsson, J-E. and Jacks, G, (2005). State of environmental health report of the Greater AccraMetropolitan Area 2001, Ghana Universities Press, Accra, Ghana.Toulmin, C., Delville P. L. and Traore, S., (2002). The Dynamics of Resource Tenure in West Africa,International Institute for Environment and Development, London - UK..Vörösmarty, C. J., Green, P., Salisbury, J. and Lammers, R. B., (2000). “Global water resources:vulnerability from climate change and population growth”, Science, 289 (5477), pp 284-288.Weili, L., Zhang, J., Hashim, J. H., Jalaludin, J., Hashim, Z., and Goldstein, B. D., (2003).“Mosquito Coil Emissions and Health Implications”, Environmental Health Perspectives 111 (12),Sept. 2003, pp 1454-1460.World Bank (2002). World Development Indicators, The World Bank, New York.WHO and UNICEF (2004). Joint Monitoring Programme for Water Supply and Sanitation, Meeting theMDG drinking water and sanitation target: a mid-term assessment of progress, World Health Organizationand United Nations Children’s Fund, New York and Geneva.World Commission on Environment and Development, WCED, (1987) Our Common Future (TheBrundtland Report), Oxford University Press, Oxford, UKOther referencesAristotle, Politics, 1261b34, http://www.aspanet.org/scriptcontent/PDFs/interviewIreneRubin.pdfCentre for Strategic and International Studies-Sandia National Laboratories, (2005). Addressing OurGlobal Water Future, www.sandia.gov/water/docs/CSIS-SNL_OGWF_9-28-05.PDF(7/6/2007).Environment Agency www.environment-agency.gov.uk (7/06/2007)Ghana Home Page: www.ghanaweb.com/GhanaHomePage/Ghana News Agency (2007). Government to Protect Riverbanks General News Agency, 23 May, 2007,AccraGhana News Agency (2007) Peri-urban water supply situation in Accra: Causes and Solutions. Sunday, 24June 2007. www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=125917(Accessed on the 01/07/2007).Gopal Raj, N (2003) Researchers concerned over effects of mosquito coils, The Hindu, Online edition ofIndia's National Newspaper Monday, Sept. 08, 2003, Nationalwww.thehindujobs.com/thehindu/2003/09/08/stories/2003090803631200.htm (8/08/2008).International Water Management Institute, IWMI (2000) www.iwmi.cgiar.org/Research_Impacts/index.aspx (05/07/07).62

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISLundgren, A. and Akerberg, H., (2006). Rainwater harvesting in the peri-urban areas of Accra: status andprospect, Stockholm www.lwr.kth.se/Publikationer/PDF_Files/LWR_EX_06_13.PDF(01/7/07).Saboba-Chereponi district’s Home Page: www.sabobachereponi.ghanadistricts.gov.gh/ (10-11- 07)University of California - Riverside (2003). UC Riverside Study Indicates Mosquito Coils May CauseCancer. ScienceDaily. www.sciencedaily.com/releases/2003/09/030908072025. (21/8/2008).WHO (2004). Water supply and sanitation links to health: facts and figures updated 2004.www.who.int/water_sanitation_health/ publications/facts2004/en/index.html.63

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Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISAppendix IMain Source of Drinking Water in Selected Areas in Saboba DistrictSources of water for drinkingImprovedsourcesCentral TomaPlaceChief Bordagbalm Wapuli TotalTownshipSectionNo. % No. % No. % No % No. %Borehole 3 13.6 9 26.5 5 17.2 7 43.8 15 55.6 39Pipe 11 50 20 58.8 8 27.6 1 6.2 1 3.7 41Sachet water 2 9.1 0 - 0 - 0 - 0 - 2Sub-total 16 72.7 29 85.3 13 44.8 8 50 16 59.3 82Dam/well 4 18.2 1 2.9 11 38 0 - 11 40.7 27Unimproved Dug-out pit 0 - 0 - 0 - 8 50 0 - 8sources Riv/streams 2 9.1 2 5.9 5 17.2 0 - 0 - 9Rain water 0 - 2 5.9 0 - 0 - 0 - 2Sub-total 6 27.3 5 14.7 16 55.2 8 50 11 40.7 46Grand-Total 22 100 34 100 29 100 16 100 27 100 128Main Source of Water for Cooking in Selected Areas in the DistrictSources of water for cooking Central TomaPlaceChief Bordagbalm Wapuli TotalTownshipSectionNo. % No. % No. % No. % No. %Improved Borehole 2 9.1 8 23.5 8 27.6 5 31.3 9 33.3 32sources Pipe 12 54.6 21 61.8 7 24.1 0 - 1 3.7 41Sub-total 14 63.7 29 85.3 15 51.7 5 31.3 10 37.0 73Unimproved Dam/well 5 22.7 3 8.8 10 34.5 1 6.3 15 55.6 34sources Dug-out pit - - - - - - 10 62.5 0 - 10Riv/streams 3 13.7 1 2.9 4 13.8 0 - 2 7.4 10Rain water - - 1 2.9 - - 0 - - - 1Sub-total 8 36.3 5 14.7 14 48.3 11 68.8 17 63.0 55Grand-Total 22 100 34 100 29 100 16 100 27 100 128Main Source of Water for Bathing in Selected Areas in the DistrictSources of bathing waterCentral TomaPlaceChief Bordagbalm Wapuli TotalTownshipSectionNo. % No. % No. % No. % No. %Improved Borehole 5 22.7 3 8.8 5 17.2 0 - 3 11.1 16sources Pipe 7 31.8 9 26.5 2 6.9 0 - 0 - 18Sub-total 12 54.5 12 35.3 7 24.1 - - 3 11.1 34Unimproved Dam/well/pond 9 41.0 16 47.1 13 44.8 3 18.8 18 66.7 59sources Dug-out pit 0 - 2 5.9 0 - 13 81.2 0 - 15Rivers/streams 1 4.6 4 11.8 9 31.0 0 - 6 22.2 20Sub-total 10 45.6 22 64.7 22 75.9 16 100 24 88.9 94Grand-Total 22 100 34 100 29 100 16 100 27 100 128Main Source of Water for Washing in Selected Areas in the DistrictSources of water for washing C. Township TomaPlaceC. Section Bordagbalm Wapuli TotalNo. % No. % No. % No % No. %Improved Borehole 0 - 0 - 1 3.5 0 - 2 7.4 3sources Pipe 3 13.6 6 17.7 4 13.8 0 - - - 13Sub-total 3 13.6 6 17.7 5 17.3 0 - 2 7.4 16Unimproved Dam/well/pond 16 72.8 21 61.8 11 37.9 3 18.8 20 74.1 71sources Dug-out pit - - 1 2.9 - - 13 81.2 - - 14Rivers/streams 3 13.6 6 17.7 13 44.8 - - 5 18.5 27Sub-total 19 86.4 28 82.4 24 82.7 16 100 25 92.6 112Grand-Total 22 100 34 100 29 100 16 100 27 100 128i

Matthew Biniyam KursahTRITA LWR Master Thesisii

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISAppendix IIGuinea worm race in 2006 (Saboba district is almost at “Zero Case” line)iii

Matthew Biniyam KursahTRITA LWR Master Thesisiv

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISAppendix IIIGender and Environmental Diseases in Saboba Districta. Sex, waterborne and Non Water-borne Diseases (Saboba Medical Centre).Source: SMC Record Book, June – mid-September 2007SexWater related diseasesMale Percent Female Percent TotalMalaria 1348 45.8 1595 54.1 2943Typhoid 164 46.9 186 53.1 350Worms 6 31.6 13 68.4 19Bilharzia 1 33.3 2 66.7 3Onchocerciasis 0 0.0 1 100.0 1Total 1519 45.8 1797 54.2 3316Non water related diseases Male Percent Female Percent TotalSeptic sores/wounds 43 58.1 31 41.9 74UTI 23 65.7 12 34.3 35LISH/LIH 24 96.0 1 4.0 25Gastritis 18 60.0 12 40.0 30Helmiths 10 83.3 2 16.7 12Fever 8 72.7 3 27.3 11Trauma 4 100.0 0 0.0 4Anaemia 10 66.7 5 33.3 15Pneumonia 4 66.7 2 33.3 6Ear infections 9 50.0 9 50.0 18Rheumatism 2 66.7 1 33.3 3Hernia 10 83.3 2 16.7 12Epilepsy 3 100.0 0 0.0 3Eye infection 6 50.0 6 50.0 12Diabetes 1 50.0 1 50.0 2Malnutrition 1 50.0 1 50.0 2Jaundice 1 100.0 0 0.0 1Pruritus 6 50.0 6 50.0 12Chicken pox 2 100.0 0 0.0 2Scabies 1 50.0 1 50.0 2Dog bite 3 60.0 2 40.0 5Chicken pox 2 100.0 0 0.0 2TB 3 100.0 0 0.0 3Dermatitis 2 100.0 0 0.0 2Nephritic syndrome 2 100.0 0 0.0 2Sub-total 198 67.1 97 32.9 295RTI 96 45.5 115 54.5 211Genital and STIs 16 32.7 33 67.3 49Hypertension 11 33.3 22 66.7 33Convulsion 3 42.9 4 57.9 7Sub-Total 126 54.5 174 45.5 595v

Matthew Biniyam KursahTRITA LWR Master Thesisb. Sex, Water-Related and Non Water-Related Diseases (Wapuli Health Centre)Source: WHC Record Book (2006 and 2007Water-related diseasesSexMale Percent Female Percent TotalMalaria 1661 48.3 1777 51.7 3438Typhoid - - - - -Worms 19 65.5 10 34.5 29Bilharzia 6 66.7 3 33.3 9Onchocerciasis 3 60.0 2 40.0 5Sub-Total 1689 48.5 1792 51.5 3481Non water-related diseases Male Percent Female Percent TotalHepatitis 9 56.3 7 43.7 16Anaemia 73 51.4 69 48.6 142Epilepsy 207 62.0 127 38.0 334Eye infection 76 56.7 58 43.3 134Malnutrition 9 53.0 8 47.0 17Yaws 25 73.5 9 26.5 34Chicken pox 3 50.0 3 50.0 6Snake bite 45 50.6 44 49.4 89Dog bite 9 47.4 10 52.6 19Pneumonia 14 36.8 24 63.2 38Ear infections 46 49.5 47 50.5 93Other heart diseases 22 45.8 26 54.2 48Rheumatism and Joints 143 45.0 175 55.0 318Sub-Total 681 53.0 607 47.0 1288RTI 649 47.8 710 52.2 1359Genital and STIs 46 40.0 69 60.0 115Hypertension 24 16.2 124 83.8 148Sub-Total 719 44.3 903 55.7 1622c. Mosquito biting human skin and transferring Plasmodium falciparumand Plasmodium vivaxCredit: James Gathany, Centers for Disease Control and Prevention,Atlanta, GAvi

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISAppendix IVInfrastructure construction and inappropriate health campaigns ascauses of higher environmental diseases in Saboba district of NorthernGhanaa) Unadon-born Plant (This plant repels Mosquitoes) b. Grey water left open inSaboba Townc) A pig making use of grey water d) A pig creates potholes that could reservewatere) Sand winning pits (waste is dumpedin)f) Water reservoirs left open (mosquitoescan breed here)vii

Matthew Biniyam KursahTRITA LWR Master Thesisg)Tree trunk capable of retaining water for mosquito larvae to breedh) A broken calabash containing water i) A break-down borehole at Moadani, Sabobaj) Young girls buying water (flat rates) k) Young girls fetching water from roadsidel) Swimming, washing, fetching the same water for domestic use while cattle drink atopposite sideviii

Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISm) Example of open storage of water n) Sachet water (Accessible to the “wealthy” ones))Ö) Health Campaigns posters for malaria at hospital/clinics (these are all curative campaigns)p) Preventive measures for Guinea worm, Elephantiasis, Measles and Polioq) Preventive campaign posters, but only for HIV/AIDSr) The only preventive campaign poster for malaria(what about breeding grounds for mosquito?)ix