Abstract
The study broadly explores water-related disease burden, encompassing drinking-water supply, sanitation, hygiene, climate change and the management of water resources in the Maldives. There have been few studies undertaken which address the burden of water-related diseases in the Maldives.
The World Health Organization (WHO) estimates that almost ten per cent of the global disease burden is caused by unsafe water and sanitation; developing countries suffer a disproportionate share of the disease burden. For many small island states like the Maldives, availability of safe drinking water is a factor contributing towards water-related diseases. Most of these islands consist of small, flat low-lying coral islands depending on rain water as their main source of water. The Republic of Maldives consists of small coral islands stretching across 500 miles of Indian Ocean. The unique geography coupled with lack of proper infrastructure for water resources development and management have considerable implications on disease burden, and water related diseases are a major cause of concern in Maldives.
A mix of descriptive statistical and qualitative approach was used in the analysis. The quantitative analysis examines the disease burden as indicated by notification data from 1998 to 2008. This was analysed using Excel and Epi Info version 3.4. While this is a broad area of concern the focus of the analysis is on diarrhoea and typhoid as water-borne diseases, malnutrition as a consequence of diarrhoeal disease, and dengue and chikungunya as water-related diseases. Scrub typhus is also examined as a weather-related emerging disease. The findings show that water and sanitation related diseases are prevalent and widespread in both the rural islands and in the urban capital of the country, Male’. Besides, the average rainfall shows strong correlation with disease patterns for diarrhoea, dengue and typhoid. The recent increase in cases of typhoid, which has probably been present historically, the re-emergence of scrub typhus after it was probably introduced in the 1940s and recent establishment of dengue fever and chikungunya have had a considerable impact on the health and well-being of the population. Children are more vulnerable to diarrhoea and dengue while typhoid cases contrast by age of onset.
The qualitative investigation was based on semi structured key informant questionnaires. This was conducted on a sample of professionals dealing with water or health issues in the Maldives. The analysis highlights that the atoll populations are disadvantaged not only by geographic isolation, but also in their low level of access to health facilities and basic services. Furthermore, factors such as sanitation, water treatment, water sources, hygiene, extreme weather events, health education and awareness, influence and correlate strongly with disease patterns observed. In addition to this, water supply and infrastructure issues on the atolls also strongly modify the effects.
The findings highlight that there is no simple solution to these issues, a combination of multi-sector interventions through policy recognition based on evidence is crucial to reduce the disease prevalence particularly in the atolls.