Changing environmental conditions in the Nile delta : health and policy implications with special reference to schistosomiasis

Throughout the twentieth century, the major rural health problems in Egypt have been water-related; yet environmental strategies such as water and sanitation have not been linked to health planning. A complex of interrelated environmental changes which have occurred in the Nile delta over the past 30 years, including an increase in population and domestic water use, and changing irrigation regimes, has affected patterns of transmission of water-related diseases. These changes are examined in general, as reflected in research and policy development. Current environmental health conditions are identified in two Nile delta villages in relation to the transmission of Schistosoma mansoni, which is now the predominant form of schistosomiasis in the delta; problems include canal water pollution, lack of drainage facilities for sullage and sewerage and the disposal of latrine effluent. In this article it is argued that integrated schistosomiasis control strategies, which include sanitation and drainage interventions and health and hygiene education, should be given greater prominence in schistosomiasis control in Egypt, where current strategies focus on a curative approach, diagnosis and treatment, and to a lesser extent on vector control through mollusciciding. [adapted authors' abstract].