Can Health Risk Perception act as a Tool in Wetland Management?

Description

INTRODUCTION
Worldwide and particularly in East Africa, the growing food insecurity and water scarcity have increasingly been motivating people to settle along wetlands and make use of their abundant water resources and ecosystem services. In the course of this extensive occupational and domestic use, the capacities of wetlands are often depleted by overuse, making them become more and more ‘unhealthy’. In particular, the degradation and contamination of water, as well as poor infrastructure, pose a range of risk factors that potentially expose users to water-related diseases. Health risk assessments in wetlands are scarce to date, and in order to fill this gap, an assessment of risk perceptions in wetlands, referring to subjective judgements of individuals towards health hazards they might be exposed to, is vital. Although the pivotal role of health risk perception for health risk behaviour and management is widely acknowledged, the extent to which wetland users are aware of use-related risks has not been studied so far. Such research, however, should be considered in a sustainable management of wetlands.

METHODS
A study conducted in the semiarid highland floodplain Ewaso Narok Swamp, Kenya, addressed water-related diseases in wetlands, assessed the related health risk perception by wetland users and evaluated their health-related behaviour. A mixed-method approach included a broad set of empirical data collected during a household survey (n=400), observational assessment (n=397) and in-depth interviews (n=20) conducted among the four most prominent user groups around the wetland, namely smallholder farmers, commercial farmers, pastoralists and service sector workers. A triangulation of quantitative and qualitative results is presented.

RESULTS and DISCUSSION
Wetland users are aware of numerous diseases that the use of the swamp may expose them to. Especially unsafe water, inadequate sanitation and poor hygiene (WASH) are being perceived as responsible risk factors for diseases in the Ewaso Narok Swamp. As summarized by one pastoralist in the Ewaso Narok Swamp
‘…the quality of water is poor now, it is not as good anymore because of the water contamination. A lot of people right now are using this water and it is coming from way up there [the Aberdare Ranges]. We lack good sanitation, latrines and the bathrooms, so we have to go to the wetland for the services and we also let the animals drink from there. So this situation just contaminates the whole water. Water is the main problem in this area. It’s dirty, water is the major cause of diseases in this area. The water is so little and it’s the same water we are using for everything, for the livestock, wild animals, and with the farmers for irrigation, so it’s posing as a challenge for us.’

Moreover, the wetlands’ water resources providing mosquito breeding sites are rated as harmful. Occupational factors, such as the use of pesticides in agricultural crop production and environment- and climate-related features are widely perceived risk factors as well.
Different diseases are associated with different risk factors: Malaria is mostly associated with mosquito breeding sites, but also with flooding and rain, the proximity to rivers, as well as unsafe water and inadequate sanitation. Diarrhoea is mostly linked to unsafe water and inadequate sanitation, but also to poor hygiene. Moreover, rain is attributed as a major risk factor, as well as pesticide use. Eye diseases are first and foremost associated with the use of pesticides, but also with unsafe WASH, with swimming in wetland water and with drought. Skin diseases also are perceived to be caused especially by poor hygiene, unsafe water and inadequate sanitation, and also by the use of pesticides.
A health risk assessment relating self-reported abdominal conditions, fever, flu, skin and eye conditions of wetland users to multiple occupational and domestic WASH-related risk factors reveals that the actual risks correspond with the perceived risks. The analysis reflects the perceptions of the wetland users, demonstrating that the use of safe water, adequate sanitation and good personal hygiene and other health-protective measures such as environmental hygiene, the prevention of uncovered stagnant waters in the compound, the use of mosquito bed nets, play a key role in preventing ill-health. It also shows that in the case of the Ewaso Narok Swamp, unsafe WASH involves a higher risk than occupational factors.

CONCLUSIONS
This case study shows that wetland users are aware of water-related health risks contributing to the burden of disease. Many of the perceived risk factors, first and foremost the contamination of water, are created and exacerbated by the wetland users through their unhealthy behaviour, which originates mainly in the limited infrastructural and educational possibilities. In an area where improved water sources and sanitation facilities, as well as hygiene options are largely lacking, and where hygiene education is very limited, the perceptions of health risks can hardly motivate a change of behaviour.
However, as demonstrated here, risk perception studies are able to reflect the actual risks, as well as the shortcomings of an area, such as a WASH-wise underserved wetland. The role of wetland users as key informants should be acknowledged by wetland managers: Since the trend of increasing wetland use is unlikely to be reversed but rather most likely to be exacerbated, there is the need to capture the challenges that wetland communities are facing in order to facilitate healthy wetland use, decide on the way forward or on possible interventions. This makes risk perception studies a potential supportive tool for health-adapted sustainable wetland management that includes users as participants and actors.

ACKNOWLEDGEMENTS
This work was part of the project GlobE Wetlands in East Africa– Reconciling future food production with environmental protection, which is funded by the German Federal Ministry of Education and Research (grant number FKZ 031A250D). Ethical clearance was obtained from the Ethics Review Committee of Kenyatta University and Bonn University.

Period	5 May 2017
Event title	12th SWS Europe Chapter Meeting 2017
Event type	Conference
Conference number	12
Location	Faro, PortugalShow on map
Degree of Recognition	International