Flood control embankments contribute to the improvement of the health status of children in rural Bangladesh

Abstract

Every year, Bangladesh experiences major floods that inundate about one-third of the country. Therefore, flood control projects that comprise earthen dikes and irrigation/drainage systems are built along the major rivers to protect the people living in low-lying areas, stabilize the river banks and improve agricultural productivity. However, the adverse effects of these projects are regularly emphasized, such as environmental degradation and reduction of fishing supplies. The Demographic Surveillance System of the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) was used to assess the effect of a flood control programme on the mortality of 0-4-year-old children residing in the Matlab study area. Adjusted mortality rates were used in comparing four adjacent child populations residing either inside or outside a flood-control embankment and according to the type of health services provided in this area. Between the periods 1983-86 and 1989-92, the crude child mortality in the total study area decreased by 37%, from 185.9 per 1000 live births to 117.9 per 1000 live births. Following the construction of the embankment, death rates outside were up to 29% higher in 1-4-year-old children and 9% higher for 0-4-year age group compared to the flood-protected area (P < 0.001). Simultaneously, in the same study area, health interventions contributed to a 40% reduction in mortality among children less than 5 years of age in all causes of deaths (P < 0.001). Migration patterns and the effect of distances to the hospital are discussed.

PIP: Bangladesh has major floods every year which inundate about 33% of the country. Flood control projects which comprise earthen dikes and irrigation/drainage systems are therefore built along the major rivers to protect people living in low-lying areas, stabilize the river banks, and improve agricultural productivity by allowing the year-round cultivation of high-yielding varieties of rice using modern methods of cultivation. These projects, however, also restrict the seasonal deposit of silt upon the flood plains, block the flushing action of receding flood water, lead to the destruction of small fisheries, and cause farmers' lands to be appropriated for use in the development of embankment infrastructure. The International Center for Diarrheal Diseases Research, Bangladesh's Demographic Surveillance System was used to assess the effect of flood control programs upon the mortality of 0-4 year olds living in the Matlab study area. Adjusted mortality rates were used in the comparison of 4 adjacent child populations living either inside or outside of a flood-control embankment and according to the type of health services provided in the area. The level of crude child mortality in the study area was 185.9/1000 live births during 1983-86, a period before the completion of the flood control program. However, during 1989-92, crude child mortality decreased by 37% to 117.9/1000. Following construction of the embankment, death rates outside of the protected area were up to 29% higher among 1-4 year olds and 9% higher among those aged 0-4 compared to children in the flood-protected area. Health interventions in the study area contributed to a 40% reduction in under-5 child mortality in all causes of death.