PubMed · 11632229
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E Zipcy. 1976. [Not Available].. https://doi.org/10.3406/jatba.1976.3228
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A system of external reviewers was established by the World Bank Group to promote a thorough environmental and health impact assessment for the 3.5 billion US dollars Chad Oil Export Project, based on a loan request from Chad, Cameroon and a consortium of oil companies. The environmental and health assessment process showed evidence of its ability to minimize the number of deaths from malaria, traffic accidents and construction accidents and the occurrence of minor sexually transmitted diseases, diarrhoeal diseases and respiratory diseases; it also probably limited adverse impacts on wildlife and tropical ecology along the pipeline route. However, the system was unable to deal with the larger issues, which included: the intrinsic unsustainability of this kind of extraction project; its eventual contribution to large amounts of greenhouse gases in the atmosphere; the lack of equity in sharing the risks, negative impacts, benefits and decision-making among the various participants in the project; and the possible acceleration of transmission of the AIDS virus into central Africa. Unfortunately, the international panel of experts appointed by the World Bank Group was largely ignored by the project proponents, and had little success in minimizing the most serious impacts or in improving the social equity of the project.
Health impact assessments associated with large-scale infrastructure projects, such as the Chad-Cameroon Petroleum Development and Pipeline Project, monitor pre-existing conditions and new diseases associated with particular industries or changes in social organization. This paper suggests that illness self-reports constitute a complementary set of benchmarks to measure the health impacts of these projects, and presents data gathered in ongoing household and health service surveys in Ngalaba, a village near a major oilfield in Chad. In an initial 16-week period of weekly data collection, 363 people reported few of the clinically chronic or asymptomatic conditions expected according to health transition theory, and the overall level of illness reporting was low. Illnesses often were described by symptoms or lay diagnoses. Health care practitioners were consulted rarely; when they were, resources for diagnosis and treatment were limited. Clinically acute, short-duration illnesses (e.g. parasitic infections, toothaches, or hernias) were experienced as chronic conditions and were reported week after week. The low levels of illness reporting and lack of clinically chronic conditions are not taken to mean that rural Chadians are healthy. Rather, the patterns of morbidity reflect a particular local ecology in which health services are organized and care dispensed in ways that limit the possibilities for illness in terms of types of illnesses that can be diagnosed and reported, forms illnesses take, and ways in which illnesses are experienced. Illness self-reports are useful adjuncts to "harder" biological measures in HIAs, particularly in the context of large-scale infrastructure projects with explicit development goals. Rather than providing data on the extent to which harm has been mitigated by corporate, state, and donor activities, self-reports show the possibilities of illness in local contexts.
Sexually transmitted diseases (STD) are a major cause of morbidity and mortality world-wide. Because of their association with an increased risk of infection with human immunodeficiency virus, the prevention and control of STD are particularly important. Studies designed to evaluate factors associated with the transmission of STD can pose a number of statistical challenges, however. Two such concerns are the interval-censored event times that result from spacing between follow-up test visits, and an unknown proportion of study participants who are not at risk for infection. Researchers in various fields of study have used parametric mixture models to account for individuals not at risk. Owing to non-identifiability concerns within the mixture model framework, however, it is not always possible to distinguish between effects of explanatory variables on the distribution of event times for at-risk individuals and their effects on the probability of being at risk. We address these issues using data from a clinical trial designed to investigate the effectiveness of an intravaginal microbicide in preventing male-to-female transmission of STD. Factors associated with time to infection among at-risk women are initially identified by fitting right-truncated models to the interval-censored event times of participants who tested positive for STD, and hence are known to have been at risk. Subsequently, factors associated with the probability of being at risk are evaluated using mixture models that incorporate information contributed by the right-censored event-free times of uninfected study participants.