Inherited burden of disease: agricultural dams and the persistence of bloody urine (Schistosomiasis hematobium) in the Upper East Region of Ghana, 1959-1997

A major agricultural development project was commissioned to celebrate Ghana's independence in 1957. In the Upper Region along the border with Upper Volta now named Burkina Faso, a total of 185 clay-core dams were constructed in 15 years to enhance village water supplies during the 6-month dry season. In a concentrated area of N.E. Ghana (now the Upper East Region) no fewer than 104 dams were erected in only 3 years. The beneficial impacts of the dams are indisputable, and life today would be unthinkable without them, despite severe problems of neglect of maintenance. Equally undeniable has been a negative disease impact whereby the regional rate of schistosomiasis tripled in 1 or 2 years from 17% to 51% prevalence. Thus, an agriculturally induced hyperendemicity of "red water" or "bloody urine" disease was established. To test the longevity of community disease impact, a survey of hematuria (bloody urine) was conducted in the same areas in 1997. It showed a 40-year ecological entrenchment of elevated levels of schistosomiasis, that is, seemingly permanent alteration of regional disease ecology. The consequences of planning negligence have left a generational impact in that hematuria has become a "rite of passage" for young boys and girls. Unprepared and overburdened rural health care systems are ill-equipped in the face of competing demands to respond to the presence of schistosomiasis. Yet excellent medication is available to break the transmission cycle provided that there is a sufficiency of political will, accompanied by effective, inter-sectoral campaign coordination.