Investments in WASH Can Help Nepal Reduce Climate Health Risks

A study was conducted to explore the qualitative and quantitative relationships between vector-borne diseases, climate change, and WASH in Nepal. It sought to understand whether investments in WASH could potentially build resilience to these diseases and climate change. Quantitative relationships between climate variables and diseases were derived from a review of literature. These were combined with climate projections specific for the country.

Two different climate change scenarios were applied to estimate increases in four different vector-borne diseases in Nepal in the short term (2011–2040) and medium term (2041–2070). The first represented a “middle of the road” scenario (SSP2-4.5) that would lead to global temperature increases of approximately 2.1°C to 3.5°C by the end of the century. The second one (SSP5-8.5) represented a “fossil-fueled,” high-growth scenario with limited progress on mitigation that could lead to global temperature rises of around 3.3°C to 5.7°C by the end of the century.

Under all climate change projections, hospitalization due to visceral leishmaniasis (also known as kala-azar) and Japanese encephalitis would slightly increase. However, the increases would be high to very high for new cases of malaria and dengue fever.

Figure 1: Maximum Increases in 4 Vector-Borne Diseases in Nepal under 2 Climate Scenarios for the Short Term (2011–2040) and Medium Term (2041–2070)

VBD = vector-borne disease.
Source: Deltares.

In the short term (2011–2040), projected consequences of climate change were similar under the two scenarios, with malaria rising by 13% to 15% and dengue by 10% to 11%, following projected 0.5°C to 0.6°C increases in mean and maximum temperatures. In the medium term (2041–2070), mean and maximum temperatures would increase by 1.4°C under the first scenario and up to 1.9°C under the second scenario. This could raise the number of malaria cases by 35% to 48% and that of dengue fever by 26% to 36%.

Increases in minimum temperature were projected to have an even stronger impact on vector-borne diseases. Increases in minimum (night) temperatures can speed up larval development and extend the transmission season.

For malaria, the forecast higher minimum temperature of 0.9°C to 1.0°C in the short term (2011–2040) could push the number of new cases up by 23% to 27% in the next 20–25 years, unless the dedicated elimination program in Nepal reaches its target and eradicates malaria from the country by 2025.

Table 1: Projected Increases in Malaria and Dengue Fever Based on the Two Climate Scenarios

Note: These are projected increases related to changes in temperature under two climate scenarios for the short term (2011–2040) and medium term (2041–2070).
Source: Deltares.

For dengue, the projections were downright alarming. The current infection rate in Nepal is about 10 times as high as that of malaria. The country also experienced dengue fever outbreaks in 2019 and in 2022. Between September and December 2022, more than 50,000 dengue cases and over 60 deaths were recorded. In the short term (2011–2040), increases in minimum temperature by 0.9°C to 1.0°C might create 38% to 44% more dengue cases with a time lag effect of 2 months. This means that the increase in cases would happen 2 months after the minimum temperature has increased.

In the medium term (2041–2070), the minimum temperature was projected to increase by 1.8°C and 2.6°C under the “middle of the road” and “fossil-fueled” scenarios, respectively, with possibly 77% and 113% more lagged cases of dengue fever. The actual impact might be worse as these projections suggested gradual trends of average values only. The forecast excluded the devastating impact of outbreaks when thousands of people get infected and fall ill within a few months or even weeks.

Investments in WASH have the potential to reduce vector-borne diseases by improving the environment of impoverished homes and eliminating mosquito-breeding sites. Continuous water supply at the household level will eliminate the need for water storage, and effective household management of solid waste will reduce the number of containers that fill up with rainwater and become mosquito-breeding sites.

Better drinking water, sanitation, and waste management at the household level have the potential to reduce disease risk. Nepal’s efforts to reach the Sustainable Development Goals (SDGs) in water and sanitation and improve waste management can reduce malaria by 17% and dengue by 41% in urban areas. This is based on the quantitative relations between changes in WASH services and diseases as derived from various studies and subsequently applied to the country setting.

Table 2: Impact of Potential WASH Interventions at Household Level on Disease Risk in Urban Areas

VBD = vector-borne disease.
Source: Deltares.

The Nepal National Adaptation Plan includes, among its priorities, improvements in water availability and quality, sustainability of sanitation and hygiene behaviours, and enhanced health benefits, such as reducing vector-borne diseases. Safe and reliable water supply—ideally continuous supply at the household level—drastically reduces the need for water storage, thereby removing important mosquito habitats.

Figure 2: Potential Compensation of Expected Dengue Cases with Investments in Urban Water Supply and Solid Waste Management at Household Level

Note: These are projected cases under two climate change scenarios (SSP2-4.5 and SSP5-8.5) for the short term (2011–2040) and the medium term (2041–2070).
Source: Deltares.

The combined effect of the planned increase in water connections and solid waste management in households could reduce dengue cases by more than 40%. Meanwhile, malaria cases could be reduced by a sixth through improved water supply and sanitation. These reductions could largely compensate for the adverse effect of climate change in the short term. Other vector-borne diseases, as well as diarrhoeal diseases, might also be lessened.

Figure 3: Possible Actions to Respond to Climate Change and Their Effects on Vector-Borne Diseases in Nepal

Source: Deltares.

WASH interventions have the potential to at least partially compensate for the negative impact of climate change on vector-borne diseases. The proposed Integrated Water Supply and Sewerage Management Project of the Government of Nepal and the Asian Development Bank aims to improve water supply, sanitation, and drainage systems in secondary and small towns. It would be supported by hygiene awareness and behavioural change campaigns. The successful implementation of this project could substantially reduce dengue fever, malaria, and other vector-borne diseases.

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