Intended for healthcare professionals


Environmental management for vector control

BMJ 1999; 319 doi: (Published 11 September 1999) Cite this as: BMJ 1999;319:651

Is it worth a dam if it worsens malaria?

  1. David Brewster, clinical dean (
  1. Northern Territory Clinical School (Flinders University), Darwin, Australia

    Papers p 663

    The high profile of environmental issues has awakened us to the ecological dangers of global warming, pollution, destruction of tropical rainforests, overpopulation, and damming of rivers. The adverse health effects of these environmental changes are often cited but have not been as well documented. In this issue Ghebreyesus et al report a sevenfold increase in the incidence of malaria among children living close to small dams in the Tigray region of northern Ethiopia compared with children in villages distant from the dams (p663).1 Despite the weakness of a case-control design, the authors of this study have convincingly addressed in their study design the issue of confounders such as altitude, seasonality, and use of antimalarials In spite of numerous reports on the impact of water projects on malaria,27 this is the first rigorous study to document an increase in malaria incidence from dams compared with a control group. Should we conclude from this that dams are bad and should not be built, or is the lesson more complex?

    Intensity of malaria …

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