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Health Impacts of Climate Variability and Climate Change in Nepal
Bandana PradhanKeshav ShresthaFang Jing
Han Heijnen
Workshop on Climate Change and Healthin South- East and East Asian Countries
Kuala Lumpur, Malaysia2-5 July 2007
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
26 22' N - 30 27' N Lat.80 4'E - 88 12'E Long.
0 200 400100 Kilometers
India
China
Iran Pakistan
Myanmar
Thailand
Afghanistan
Laos
Cambodia
Bangladesh
Oman
Bhutan
Sri Lanka
Turkmenistan
Malaysia
0 130 26065 Kilometers
Country Description
Nepal
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Physiographic (Ecological) Regions, Nepal
Population growth in Nepal
Pop/km15712610279Density
100.2623.1518.4915.0211.56Country
157.7011.218.636.564.35Tarai
68.8610.258.427.166.07Hill
48.251.691.441.301.14Mountain
2001199119811971
% change 1971- 01
Population (million) by Census YearRegions
Area: 147,181 kmPop growth rate: >2% per annum since 1971 - rapid
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Mean
Temperature
Summer: 0 to 30C
Winter: -3 to 18C
Annual Precipitation
Range: from 4500mm
C
Relative
Humidity
Summer: 70 -100%
Winter: 55 90%
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
All Nepal Temperature Trend y = 0.039x + 19.335R2 = 0.5973
18.0
18.5
19.0
19.5
20.0
20.5
21.0
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Year
Tem
pera
ture
(C
)
All Nepal annual rainfall trend (1971-2005)y = 3.73x + 1516.56
R2 = 0.08
1000
1200
1400
1600
1800
2000
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Year
Rai
nfal
l (m
m)
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Ngojum
pa Gla
cier
Ngojum
pa Gla
cier
Settlement
Khumbu - largest glacier in Nepal
Economic and industrial development: features
Agriculture: Employs 66% (2001 census) of total economically active population & Contributes 41% to GDP
Manufacturing (primary production based, cement, carpet, garment, etc.): 9%
Commerce: 10%
Hydropower potential = 126,000 MW & shares 2.27% of the world water resources
Tourism: most potential/flourishing industry contributes 2.5% to GDP
Rural areas: 86% rural population & density = 139persons/km & Urban density = 985 persons/km
Rural poverty: 34.6%; Urban poverty: 9.6% (per capita $286)
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
3.023.31.924,1691004,446Nepal
4.422.71.345,74133.811,503Tarai
3.793.12.273,64252.252,323Hill
1.205.73.672,33613.95620Mountain
HSU/100 km
Area/HSU
HSU/10,000 Pop
Pop/HSU
%Units
Health ServiceUnit and Area (km)
Health ServiceUnit (HSU) and Population
Distribution of Health Services Physio
graphic Regions
Accessibility of Health Services
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Household Access to Drinking Water Sources
1.81.56.428.49.052.94,174,457Nepal
2.50.61.158.66.530.81,938,895Terai
1.22.010.12.412.072.21,950,345Hill
1.03.417.10.06.272.2285,217Mountain
OtherRivers/ Stream
Stone Spout
Tube Well
WellTap/Pipe
Percent of Total Households
TotalHouseholds
Ecological Region
Note that all water sources depend on monsoon rainfall for replenishment and sustainability .
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
05848-2003-2010-131E. coli cfu/100 ml
-+Coliform bacteria (consumption point)
-++++/-Coliform bacteria (source)
0.4-5.00.10.10.10.1PO4 P (mg/l)
0.04-0.40.20.20.2ND-0.2N-NH4 (mg/l)
25023-4526-2722-4510-30Chloride mg/l
0.2NDNDNDNDChlorine mg/l
0.3 -30.30.20.2ND-0.2Iron (mg/l)
6.5-8.57.57.56.5-7.56.5-8.2pH
WHO GVS. spoutWellPu TapPr Tap
Water sourcesParameter
Water Quality Analysis
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Temperature increased by 0 to 0.5 C per decade and will increase by 1 to 3.5C over the coming century
Monsoon rainfall - less predictable and less dependable in terms of distribution and amount
Glacier retreat reduction in area and volume Over the past 50 years, 21 recorded GLOFs20 potentially dangerous glacial lakes (GLOF)Weather change fog persist until late morning in Tarai (south)winter mornings are much colder than previous years
Climate Change in Nepal
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
0
1
2
3
4
5
6Skin
ARI
Diarrhoeal
Intestinal
Worm
s
Pyrexia
Gastritis
Ear
Eye
Bronchitis
Teeth
Disease Types
% of disease
Top Ten OPD Diseases in 2005 (n=9,552,307)
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Trend of Vector Borne Diseases in Nepal
0
200
400
600
800
1000
1200
1400
1600
1800
2001 2002 2003 2004 2005
Num
ber o
f cas
es
Viral Encephalitis Filariasis Dengue Fever
Kala-azar Clinical Malaria
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Monthly Trends in OPD Visits
0
400
800
1200
J F M A M J J A S O N D
Month
Pat
ient
s vi
sits
('0
00)
2003 2004 2005
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
1. Vector Borne diseases
2. Water borne diseases
3. Natural hazards induced diseases
Diseases Burden
Malaria endemic in 65 districts Malaria eradication program in 1958 Malaria control program in 1978 Most common species is Plasmodium vivax
Malaria parasite incidence and P.falciparum.
0
0.2
0.4
0.6
0.8
2000 2001 2002 2003 2004 2005
Ann
ual P
aras
ite
inci
denc
e (A
PI/
1000
)
0
4
8
12
16
P.fa
lcip
arum
(%
)
API /1000 P. falciparum (%)
Increasing trend of P. falciparum Anopheles minimus is common vector
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Poor drainage conditions
favorable environment for mosquito breeding
Tarai
0.911.12004
0.824.62003
1.419.92002
CFR/100
Incidence/100,000
Year 2. Trend of Kala-azar (VECTOR-BORNE DISEASE)
Kala-Azar(Visceral Leishmaniasis) Endemic in 12 districts(10 Terai + 2 Hill districts)
11.750.362005
7.050.552003
3.600.462000
P. falciparum (%)API/1000Year 1. Malariometric Indicators
17,000 Kg 0.025600,000 Cypermethrin
Insecticide consumption (kg)
Dose /M2 (gm)
Target population
Insecticide used
3. Population Protected by Insecticide Spraying
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Kala-azar
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Japanese Encephalitis Endemic Districts
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Lymphatic Filariasis Elimination Activity
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Drinking Water versus Diarrhoeal Diseases
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Typhoid fever indirect effect of climate
Occurs where water supply and sanitation is substandard
Precipitation and Typhoid cases from Patan hospital
0
20
40
60
80
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Typ
hoid
cas
es
0
200
400
600
Pre
cipi
tatio
n (m
m)
Typhoid cases Precipitation
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
0
2000
4000
6000
8000
10000
12000
2001 2002 2003 2004 2005
Tot
al C
ases
0
0.4
0.8
1.2
1.6
2
Cas
e F
atal
ity R
ate
(CF
R) %
Typhoid Average CFR Typhoid CFR
Trend of total inpatient cases of Typhoid disease and comparison of average case fatality rate and Typhoid disease
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
840
1207
141 154 151
273
193
173 196441
0
200
400
600
800
1000
1200
1400
1600
1998 1999 2000 2001 2002
Number of deaths
Epidemics Avalanches Fires Flood/land slides
Earthquakes Thunderbolts Wind and hailstorm
Human Deaths due to Natural Hazards
Floods = valleys and plain
Landslides = hills
Avalanches = Himalaya
Workshop on Climate Change and Health in South- East and East Asian Countries Kuala Lumpur, Malaysia, 2-5 July 2007
Mal nutrition Status of the Children(n = 5244)
0
20
40
60
Height for age Wt for height Wt for age % o
f