Groundwater and Health: MeetingUnmet Needs in Sub-Saharan Africa

Segun Adelana, Wilson Fantong, Dessie Nedaw,and Anthony Duah

AbstractGroundwater plays a vital role in both human life and ecosystem. All over the world,industrial development, agriculture and human existence and health depend on theavailability of good quality water in sufficient quantity. In Africa groundwater isa critical resource: Nearly 80% of the continent’s population uses groundwater asits main source of drinking water – but in many parts of the region reaching basicwater requirements for health is still of concern. This is reflected by the high HumanPoverty Index, which is a function of access to adequate and potable water. There isconsiderable progress towards the Millennium Development Goals (MDGs) in Africawith regard to meeting basic water and sanitation needs; thus, the effects on humanhealth face a downward trend. However, records of health cases relating to consump-tion of groundwater in some part of Africa calls for increased attention if the MDGsare to be achieved. In this chapter, cases of groundwater quality, particularly drink-ing water supply, have been reviewed in relation to human health. Case histories aretaken mainly from West–Central Africa and East Africa to illustrate the fact that thereare unmet needs in health traceable to groundwater quality and inadequacies in watersupply.

KeywordsGroundwater quality • Fluoride • Nitrate • Health risks • Drinking water • MillenniumDevelopment Goals

Introduction

In Africa groundwater is a critical resource playinga vital role in both human life and ecosystem. Theglobal industrial development, advances in agriculture,

S. Adelana (�)Department of Geology, University of Ilorin, Ilorin, Nigeriae-mail: sadelana@gmail.com

human existence and health all depend on the availabil-ity of good quality water in sufficient quantity. Lookingat the records, regions of the world that have sustain-able groundwater balance are shrinking. Four problemsdominate groundwater use: depletion due to overdraft;waterlogging and salinization due mostly to inadequatedrainage and insufficient conjunctive use; pollutiondue to agricultural, industrial and other human activ-ities (Shah et al., 2000); and climate variability dueto global warming. In regions of the world, especially

21J.A.A. Jones (ed.), Sustaining Groundwater Resources, International Year of Planet Earth,DOI 10.1007/978-90-481-3426-7_2, © Springer Science+Business Media B.V. 2011

22 S. Adelana et al.

those with high population density, tubewell-irrigatedagriculture and insufficient surface water, many conse-quences of groundwater overdevelopment are becom-ing increasingly evident (UN-FAO, 2007; Shah et al.,2000).

The most common symptom in such cases is seculardecline in water tables. However, groundwater prob-lems in sub-Saharan Africa are not that of overdevelop-ment (per se) as it is becoming increasingly evident inother developing world. Yet it presents complexity ofissues that require technological capacity and hydro-geological information, institutional strengthening toimprove management and developmental planning ofthe groundwater resource. In the absence of these, sus-tainable use of available groundwater resources in thecause of reducing poverty and enhancing livelihoods(the target of the MDGs) can be difficult to achieve.A recent World Bank report on groundwater in ruraldevelopment presents “the problem of increasing highrates of waterwell construction failure (due to insuf-ficient yield and/or inadequate quality) in areas ofcomplex and/or unfavourable hydrogeology” (Fosteret al., 2000), aside poor construction. This remainsuntackled and represents a fundamental threat to thewell-being of the rural people as they go back to thestreams, which are in most cases polluted.

The situation in many parts of Africa, in particu-lar, may be critical and compounded with the highpopulation growth rate and increased urbanization. Inaddition to water stress and scarcity, excess nitrateconcentration due to increased agriculture; fluoridecontamination of groundwater in hard rock terrain ofwestern, central and eastern African states; and con-sequent health effects on humans and livestock are ofconcern. The approach used in this study combines theresults of both field and web-based data to illustrateprovenance of fluoride and nitrate in SSA in relationto health implications. Geochemical knowledge fromanalyses with spatial information on geology and cli-mate is in some places superimposed to give a present-day picture of pollution. The resulting effects aretraced to reported cases of illness and recurrent deaths,particularly in children. Providing safe drinking watersupply; treatment of domestic and industrial wastewa-ter; and management of solid waste generated in thetowns and cities are some of the present and futurechallenges. The health and socio-economic implica-tions of this situation cannot be over-emphasized.Nevertheless, the strategic role of groundwater is yet to

be fully understood by the governments and water pol-icy makers. The management of groundwater resourceis still a game of chance in many countries; it hasremained a poorly managed resource even in the exten-sive drought-prone areas of southeastern, eastern andnorthwestern Africa – especially where the averagerainfall is less than 1000 mm/a.

Groundwater Situation in Sub-SaharanAfrica (SSA): Overview of Opportunitiesand Challenges

Groundwater offers a few but precious opportunitiesfor alleviating the misery of the poor, but it possesmany challenges of preserving the resource itself. InSSA, there is some action by way of a response to thegrowing scarcity of groundwater, but it may be too lit-tle, too late, since this is still experimental and thereis little approach to economizing on its use. There is ageneral perception that groundwater resources remainabundant in Africa. While some aquifers are not fullydeveloped for human use, others are over-exploitedand almost facing groundwater mining. The questionof the quantification of this “hidden” resource and thequality of what is available for domestic use requiresatisfactory answers. Groundwater is also emerging asa critical issue for cities and towns. At the heart ofthe urban groundwater problem is population density;cities are getting congested in most parts of SSA. Smalltowns rapidly develop into cities, while a number ofAfrican cities are now growing into megacities. Someof the densely populated large- and medium-sizedcities in SSA depend on groundwater. Virtually, in allthe cases the rate of expansion does not match plan-ning for water and basic sanitation services. In additionto this is that cities just do not have a large enoughrecharge area to support or meet the water supply needsof their inhabitants on a sustainable basis. These citiesmay face acute water shortages in a medium term tolong term.

Urban industrialization is also a major contribu-tor to urban groundwater problems. Although theseare interwoven, industries are sited in urban centreswhere there is sufficient labour. On the other hand,rural dwellers are on a constant move to cities in searchof white-collar jobs, thus compounding the problem ofwater supply. Industries are also known to generate lotsof wastes that contribute to surface and groundwater

Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa 23

pollution. Effluent discharge from industries is notproperly monitored in many industrial centres in SSA.Legislations and its enforcements are necessary toreduce the risk that comes back to humans throughthese activities.

Another challenging situation in SSA is over-utilization of coastal aquifers. Several of the nations’capital cities are located along the coast, most ofwhich are equally industrial centres, attracting ruraldwellers. Water supply services to meet the demandin coastal cities are complex: groundwater mixingand saline water intrusion are challenging issues forthe future. Groundwater overdraft has many nega-tive consequences. The most far-reaching impact ofgroundwater depletion and water quality deteriorationis on the health of large sections of rural populationsthat depend directly on wells as their only source ofdrinking water supply.

Generally, most of the rural communities have tra-ditionally relied mainly for their water supply needs onsources which range from dug wells, ponds, dugouts,dam impoundments, streams, rivers to rainwater har-vesting from roofs. Most of these sources particularlythose based on surface water resources are polluted andare the main sources of water-borne diseases so com-mon in the rural areas. Diseases and poverty are henceendemic in many rural communities and urban squattercamps.

In Cameroon, some 2 million city dwellers lacksafe drinking water and adequate sanitation, result-ing in outbreaks of cholera. Children living in urbanpoverty are especially vulnerable to illness, violenceand exploitation (UNICEF, 2007). Infant and under-5 mortality rates in 2005 were actually higher thantheir 1990 levels. In Ethiopia, the under-5 mortalityrate is 123 per 1000 (WASH, 2008). Sanitation andhygiene-related diseases are among the most commondeadly diseases in Ethiopia. In Nigeria, only 60% ofhouseholds have access to improved drinking watersources while access to adequate sanitation facilitiesremains low.

Presently in Ghana about 52% of the rural inhabi-tants have access to potable water mainly from ground-water sources (Gyau-Boake et al., 2008). To improvethe standard of living and boost economic activities inthe rural areas, the government has drawn up a pol-icy of supplying most of the rural communities withpotable water. The task ahead of the government ofGhana is that of achieving its goal of covering about

85% of the rural communities with potable water by2015. This is planned to be achieved by sinking moreboreholes. This is because groundwater is not only fea-sible but also the most economic source of potablewater due to the dispersed nature of the rural settle-ments. Therefore, it is imperative to see the role ofgroundwater in rural and urban supplies and the pacetowards MDGs for water and sanitation.

Sustainable Water Resource Managementand the Millennium Development Goals

Going by the UN definitions, The MillenniumDevelopment Goal 7 on Environmental Sustainabilityis to halve the proportion of people living with-out access to an improved source of drinkingwater and basic sanitation between 1990 and 2015(UN Millennium Project Task Force on Water andSanitation, 2005). The progress so far may not be atthe pace desired, and the situation with water and san-itation in SSA may even require a greater attention.Tables 1 and 2, respectively, show the position of SSAin the target for safe drinking water and basic sanita-tion. From the tables the picture is clear on the progressas to meeting the Millennium Development Goal Waterand Sanitation Target and as to what increases areneeded in developing regions? Although the worldneeds to accelerate the provision of safe drinking waterand basic sanitation services by 58% to meet the MDGtarget, SSA is lagging furthest behind (as indicated inTable 2).

According to UNICEF data on emergency of sim-ple needs, 42% of people living in SSA are drink-ing unsafe water. Based on UN projections, SSAwill need to quadruple the additional number of peo-ple served with basic sanitation (UNICEF, 2007). Ofthe 1.9 million children under 5 dying every yearof diarrhoeal diseases, some 769,000 are in sub-Saharan Africa (UNICEF/UN Data, 2007). Table 3shows children health statistics in East and West Africa(data curled and compiled from UNICEF database).Therefore, achieving the Millennium DevelopmentGoals (MDGs) in SSA anchors significantly onincreasing rural water supply coverage and improv-ing sanitation practices (which constitute threat togroundwater quality). This has a two-faced challenge:increased dependence on groundwater and protectionof aquifers to avoid further water quality degradation.

24 S. Adelana et al.

Table 1 Meeting the MDGs – progress towards the drinking water target (JMP 2008)

Drinking water coverage(percentage of population)

Annual increasein people served1990–2002:(thousands)

Annual increaseneeded to reachthe target2002–2015:(thousands)b

1990 2006 2015a

(projected)MDGtarget

Northern Africa 88 92 92 94 2383 3009

Sub-Saharan Africa 49 58 65 75 12,524 21,485

Latin America andthe Caribbean

84 92 89 92 9135 7891

Eastern Asia 68 88 78 84 16,086 15,889

South Asia 74 87 82 87 34,350 23,549

Southeast Asia 73 86 82 87 8208 9663

Western Asia 86 90 90 93 4034 4576

Oceania 51 50 67 76 93 283

World 77 87 84 89 90,836 96,568aProjected coverage in 2015 is extrapolated from rates of progress between 1990 and 2002bThe increase needed to reach the MDG water and sanitation target is based on the MDG target and the unserved population in 2002,factoring in projected population growth between 2002 and 2015. Note that the individual regions do not add up to the total due torounding.

Table 2 Meeting the MDGs – progress towards the sanitation target (JMP 2008)

Sanitation coverage(percentage of population)

Annual increasein people served1990–2002:(thousands)

Annual increaseneeded to reachthe target2002–2015:(thousands)

1990 2006 2015(projected)

MDGtarget

Northern Africa 62 76 82 81 2632 3341

Sub-Saharan Africa 26 31 40 63 7011 26,727

Latin America andthe Caribbean

68 79 82 84 8053 10,424

Eastern Asia 24 65 68 65 27,613 22,700

South Asia 20 33 55 61 25,875 41,645

Southeast Asia 48 67 75 75 9778 10,511

Western Asia 79 84 79 90 3151 5409

Oceania 58 52 52 76 80 289

World 54 62 68 777 87,164 137,796

A very large proportion of Africa’s population livein communities for which groundwater is likely tobe the only realistic option for improved water sup-ply. Groundwater will have to be given higher pri-ority and greater investment to achieving the UNMillennium Development Goals in SSA. Criticalissues for future groundwater development to achiev-ing improved rural water supplies in SSA have beenhighlighted in Foster et al. (2008). Groundwatermanagement issues in SSA with a perspective onIntegrated Water Resources Management are pre-sented in the southern Africa example (Braune andXu, 2008; Braune et al., 2008). The capacity-buildinginitiatives of Cap-Net/BGR in part of SSA are yielding

favourable results. What remains unanswered are thefuture health and well-being of African people andthe socio-economic implications of not meeting theMDGs on water and sanitation. There is an increasingneed for coordination and integrating local develop-ment efforts with investments from the internationalcommunity/organizations.

The Joint Monitoring report (WHO–UNICEF) rec-ommends five key complementary actions to reachthe water and sanitation MDGs (over the InternationalDecade for Action on Water for Life). Crucialamong these are significantly increasing access to safedrinking water and meeting basic sanitation demand.Failure to meet these simple needs may cost many

Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa 25

Table 3 Children Health Statistics in West and East Africa (UNICEF Data 2007)

Basic indicators Countries

Cameroon Ethiopia Ghana Nigeria Uganda

Under-5 mortality rank 18 27 30 8 21

Under-5 mortality rate (1990) 139 204 120 230 175

Under-5 mortality rate (2007) 148 119 115 189 130

Infant mortality rate (under 1), 1990 85 122 76 120 106

Infant mortality rate (under 1), 2007 87 75 73 97 82

Total population (thousands), 2007 18,549 83,099 23,479 148,093 30,884

Annual no. of births (thousands), 2007 649 3201 703 5959 1445

Annual no. of under-5 deaths(thousands), 2007

96 381 81 1126 188

% of population using improveddrinking water sources, 2006, total

70 42 80 47 64

% of population using improveddrinking water sources, 2006, urban

88 96 90 65 90

% of population using improveddrinking water sources, 2006, rural

47 31 71 30 60

% of population using adequatesanitation facilities, 2006, total

51 11 10 30 33

% of population using adequatesanitation facilities, 2006, urban

58 27 15 35 29

% of population using adequatesanitation facilities, 2006, rural

42 8 6 25 34

more children their lives (WHO, 2005). In SSA, ade-quate water and sanitation infrastructure is the onlymeans possible of supporting socially, economicallyand environmentally sustainable development of urbanareas.

There are potentially powerful indirect demandmanagement strategies that are not even part of the aca-demic discussion in the developing world. These offeropportunity for new approaches, adaptation of provenmanagement schemes elsewhere in the world and theneed for closer scrutiny. There is also scope and needfor more orderly development of groundwater for irri-gation, especially in West Africa and East Africa wherepotential for groundwater development still exists.

A major barrier that prevents transition from thegroundwater development to management mode is lackof information. Many countries of sub-Saharan Africado not have any idea of how much groundwater ispresent and who withdraws how much groundwaterand where. Indeed, even in countries where ground-water is important in all uses and where there is someknowledge about water resources, systematic monitor-ing of groundwater occurrence and abstraction is stilllacking.

Cases of Aquifer Pollution and HealthEffects

The conditions under which groundwater is foundand the quantity and quality of groundwater reservesare closely related to geologic setting in the differentparts of Africa. There are quality implications on thewater flowing through or hosted within these rocks.For example, recent investigation of fluoride preva-lence in Africa (IGRAC, 2009) is shown in Fig. 1.In SSA, aquifer pollution – from both point and non-point sources – is becoming extensive. Although thereare maps and available data on aquifer distribution,the extent of pollution studies is still localized, and abroader regional assessment is scanty. However, thereis a reasonable record of publications on groundwaterpollution based on countries or basins or even relatedto specific aquifers.

Most of the exploited groundwater is generally fitfor consumption because the dissolved minerals inwater from shallow wells, particularly in the sandycoastal aquifers and weathered basement rocks ofWest Africa, are quite low. Groundwater from deeperaquifers occurs in Ethiopia and other parts of East

26 S. Adelana et al.

Fig. 1 Fluoride concentrationin groundwater in Africa(IGRAC 2009). In 2009IGRAC updated theprobability map of Fluorideoccurrence in Africa withmore recent findings. Formore information see Vasaket al. (2010)

Africa and may have a high content of dissolvedsalts. In moist, tropical countries groundwater hostedin fractured, Precambrian rocks generally contains lowdissolved minerals, whereas in the volcanic areas (forexample, of East Africa) groundwater may have sohigh a content of fluorine as to make it unfit for humanconsumption.

Most of the accessible published information inEthiopia is for water quality within the Rift Valley(Kloos and Haimanot, 1999; Tamene, 2006; Tekle-Haimanot et al., 2006; DFD, 2008). From this, it isevident that groundwater in the Rift zone is influ-enced by geothermal waters with abnormally highconcentrations of fluoride and/or total dissolved salts.Fluoride is therefore a recognized major problem(Fig. 2), especially for the communities living withinthe Rift valley basin (Ethiopia). From 10 millionpeople living in Ethiopia Rift zone, about 8.5 millionpeople (12% of the country’s population) are exposedto high fluoride contamination (Tamene, 2006). InEthiopian Rift Valley waters, fluoride varies from 0.5to 264 mg/l (up to 26 mg/l in drinking water sources).Over 40% of deep and shallow wells and springs in

the rift valley have fluoride levels above the optimal(WHO, 2004) level of 1.5 mg/l. More than 80% ofthe children in the rift valley have developed varyingdegrees of dental fluorosis, while crippling skeletal flu-orosis are common to old people (Tamene, 2006). Theworst cases of skeletal fluorosis are recorded at Wonji(Ethiopia) and attempts to defluoridate the water areongoing. Dental fluorosis is also recognized in somehighland communities (Kloos and Haimanot, 1999)where the water is abstracted from volcanic rocks.

Studies indicate that the volcanic rocks of EastAfrica are found to be richer in fluoride than analogousrocks in other parts of the world (Tekle-Haimanotet al., 2006; Kloos and Haimanot, 1999). The sourcesfor anomalous amounts of fluoride and sodium in sur-face and ground water have been traced to acidicrocks such as pumice deposits in the East AfricanRift Valley in Ethiopia. On the other hand, the highfluoride concentrations in the ground waters of therift valley are believed to be enhanced due to thehigh CO2 pressure, hydrothermal heating, and lowcalcium and low salinity fluids while high fluoride,salinity and alkalinity in closed-basin lakes result from

Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa 27

100.0

94.9

89.9

75.0

49.9

Deep WellsN = 415

Per

cent

ile

Shallow WellsN = 221

0 200 400 km

24.8

9.7

0.0 0.001

0.11

0.21

0.43

1.3

3.5

7.1

264mg/l

N

Fig. 2 Fluoride levels in deepand shallow wells in Ethiopia(Tekle-Haimanot et al., 2006)

evaporative concentration. Observed increased salinityin groundwater from sedimentary aquifers in the south,southeast and northeastern parts of the country arisesfrom the dissolution of evaporite minerals.

Nitrate and other pollution indicators could also behigh in Ethiopian drinking water. UN (1989) reportedthat nitrate concentrations are high in groundwaterfrom several urban areas (especially around DireDawa and Addis Ababa) as a result largely of leakingeffluent from septic tanks. Nitrate concentrations arelikely to be worst in urban areas where the watertables are reasonably close to the ground surface (i.e.within 10–15 m). Nitrate concentrations may also beincreased in some of the saline groundwaters affectedby evaporation.

In Cameroon, the various aquiferous formations arerepresented in a schematic map (Fig. 3). The cases ofgroundwater-related problems associated with each ofthese aquifers are presented in Table 4. The sources

of contamination and the reported associated healthproblems are also indicated.

The 500,000 inhabitants of Mayo Tsanaga RiverBasin (Cameroon) are vulnerable to a “silent” flu-orosis from groundwater consumption. In the studyto trace the provenance of fluoride and to estimateoptimal dose of fluoride in the Mayo Tsanaga RiverBasin a fluoride concentration range in groundwa-ter was 0.19–15.2 mg/l. Severe clinical evidence offluorosis was identified in children living in Meri vil-lage (Cameroon), through daily record in a local hospi-tal (Fantong et al., 2009). Sample with fluoride contentof less than 1.5 mg/l shows Ca-HCO3 signatures, whilethose with fluoride greater than 1.5 mg/l shows a ten-dency towards Na-HCO3 type. It was established thatpegmatitic granites were the dominant provenance ofthe fluoride, which dissolved in the groundwater asa function of alkaline medium, long residence time,sodium exchange for calcium, and anion (fluoride and

28 S. Adelana et al.

Fig. 3 Schematic map of themain aquiferous formations inCameroon (modified fromMafany et al., 2006)

OH) exchange as the groundwater interacts with flu-orapatite and micas in the granites. By the influenceof high atmospheric temperature which catalyses highconsumption rate of the groundwater, an optimal fluo-ride dose of 0.7 mg/l was estimated and is advocatedfor drinking water in the Mayo area. For the reasonthat the estimated optimal fluoride dose is about 50%less than the 1.5 mg/l set by the WHO is an indicatorthat SSA countries have another challenge of estab-lishing and implementing national/local drinking waterstandards.

In Ghana, concentrations of fluoride in excess of1.5 mg/l (up to 3.8 mg/l) have been observed in BongoDistrict (Upper East Region, Fig. 4) in close associ-ation with granitic rock types, called Bongo Granite(Smedley et al., 1995). According to the BritishGeological Survey reports, the occurrence of dental

fluorosis is common in these areas. Groundwaters ingranitic rocks of the southwest plateau are consideredto be less at risk because of higher rainfall and itsdiluting effect on groundwater compositions. Markedvariations in fluoride concentration with depth wereobserved in groundwaters from the problem areas ofBolgatanga (e.g. the Bongo Granite, Fig. 4). Shallowgroundwaters from dug wells had significantly lowerconcentrations than tubewell waters as a result ofdilution by recent recharge.

Hydrochemical composition of groundwater in theOffin Basin has shown that iron (Fe) poses major aes-thetic problems as approximately 46% of the boreholeshave iron concentration higher than the WHO (2004)guideline limit of 0.3 mg/l, which has sometimes ledto borehole rejection (Kortatsi et al., 2007). Fromthis work a major physiological problem is alsoposed in the basin by arsenic, as approximately 21%

Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa 29

Table 4 Groundwater-related problems and the reported associated health effects in Cameroon

Aquifer location Reported groundwatercontamination

Source of contamination Reported associatedhealth problems

Reference

Chad basin Nitrate pollution Anthropogenica Diarrhoea Fantong et al. (2009),Ngounou-Ngatcha et al.(2001)

Fluoride contamination Lithogenic Fluorosis Fantong et al. (2009,2010)

Garoua basin Fluoride contamination Not documented Not documented Mafany et al. (2006)

Mamfe basin Saline groundwater Evaporites Not documented Eseme et al. (2006)

Rio del Rey basin Saline groundwater Evaporites and seawater Diarrhoea andunpleasant taste

Fantong et al. (2001)

Iron contamination Lithogenic Cholera and badflavour

Ako et al. (2008)

Nitrate pollution Anthropogenica Gastrointestinalproblems

Fantong (1999)

Douala basin Saline groundwater Seawater intrusion Unpleasant taste UNEP/DEWAb

Nitrate and microbialpollution

Anthropogenica Diarrhoea, cholera Ndjama et al. (2008)

Aquifer material (soil)pollution by traceelements

Anthropogenica andlithogenic

Not documented Asaah et al. (2006)

Crystallineaquifers (inYaounde)

Microbiologicalpollution

Anthropogenica fromhospitals

Not documented Kuitcha et al. (2008)

Volcanic aquifers Fluoride contamination Lithogenic Not documented Tanyileke et al. (1996)aPoint sourcebUNEP/DEWA: Africa Environment Outlook (www.unep.org/dewa/africa/publications/aeo-1/165.htm)

BOLGATANGA

BOLGATANGA

10°56'N

0°37'W10°42'N

0°53'W

54

52

48

46

44

52 50 48 46 44 42 40 38

Bongo Granite

F(mg l–1)

Below 0.40.4 – 0.6

100

km

0.6 – 1.0

1.0 – 2.0

2.0 – 3.0

Above 3.0

Birimian lgneous andMetamorphic Complexes

Birimian Greenstone,Schist, Quartzite

50

Fig. 4 Distribution of fluoride in groundwater of the Bolgatanga area superimposed on geological map, Upper East Region (northernGhana). Data and Information Source: BGS, 1999

30 S. Adelana et al.

Table 5 Summary ofpotential groundwater qualityproblems in Ghana

Determinant Potential problem Geology Location

Iron (Fe) Excess, oftensignificant

All aquifers Many locations

Manganese (Mn) Excess All aquifers Several locations

Fluoride (F) Excess (up to 4 mg/l) Granites and someBirimian rocks

Upper Regions

Iodine (I) Deficiency (less than0.005 mg/l)

Birimian rocks, granites,?Voltaian

Northern Ghana(especiallyUpper Regions)

Arsenic (As) Excess (>0.01 mg/l) Birimian Especially southwestGhana (gold belt)

of the boreholes sampled have arsenic concentra-tion exceeding the maximum provisional guidelinelimits of 10 μg/l. Other potential groundwater qual-ity problems in Ghana are summarized in Table 5(BGS, 1999).

In Nigeria, the occurrence of dental fluorosis hasbeen reported in some northern communities resultingfrom drinking water (Wongdem et al., 2000; Apata,2004; Fawell et al., 2006). A total of 475 people aged5 and over, who were either born in Langtang town

(Nigeria) or had lived there for a minimum of 5 years,were examined for mottling teeth. The results revealedthere was a 26% prevalence rate of enamel fluorosis inthe Langtang area, with 21% cases classified as mildand 5.5% as severe (Wongdem et al., 2000). The high-est prevalence was reported to be among teenagers,particularly 10–19 years old. A follow-up study todetermine the fluoride concentration in Langtang townfound that levels ranged between 0.5 and 4 mg/l instreams and groundwater (Wongdem et al., 2001).

Table 6 Nitrate distribution in groundwater from various geological formations in Nigeria (Adelana, 2006)

Groundwater region Hydrostratigraphic units Lithology Maximum NO3level (mg/l)

No. ofsamples

% over45 mg/l

Basement-fluvio-volcanics

Younger granite aquifuge Weathered basalts, buriedalluvium regolith

300 120 13

Granite, metamorphicaquifuge

Fractured granite, gneiss,schists, metasediments

225.4 288 17

Sokoto basin Kalambaina aquifer Fine-coarse sand“limestone”, clay

97.1 52 33

Taloka/Wurno aquifer Coarse sand, limestone 39.1 74 18Chad basin Upper aquifer Silts, sands, gravels, clays 134.4 360 29

Lower aquifer Sands, fine-coarse sands,clay intercalations

112 12 20

Nupe basin Nupe sandstone aquifer Fine-coarse sands 88 69 <1Yola basin Alluvial aquifer Grits, sandstone, clay 72 12 16

Bima sandstone aquifer Sandstone, micaceousshale–mudstone

150 18 10

Anambra-Benin basin Ajali Sandstone aquifer Coarse/medium sands,clay interbeds

135 65 27.5

Enugu shales 472 14 25

Calabar Flank basin Coastal plain sand aquifer Red sands, thinclay interbeds

1, 101 67 80

Eastern Delta Sands, clay interbeds 3, 869 120 95Lagos-Osse basin Alluvial, coastal sand

aquiferSands, gravels, silt, clay 284.7 88 52

Ilaro/Ewekoro aquifer Clay sands, sand silt,limestone beds

107.8 112 25

Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa 31

Recent studies (Akpata et al., 2009) investigatedfluoride levels in drinking water sources from 109randomly selected local government areas (LGAs)in 6 Nigerian geopolitical zones. From the results,maps showing LGAs with fluoride concentrationsexceeding 0.3 mg/l were drawn. About 21% of theLGAs in the country had fluoride concentrationof 0.31–0.60 mg/l in their drinking water sources;the North Central geopolitical zone had the highestproportion of LGAs (45%) with this fluoride level,followed by the North West geopolitical zones (35%).Other health problems resulting from drinking waterare related to nitrate (Adelana and Olasehinde, 2003;Adelana, 2004), heavy metals and microbial coliform(Aremu et al., 2002).

The average level of nitrate in groundwater inNigeria has increased in the last 30 years due toincreased agricultural activities and the increased useof land to dispose of waste indiscriminately. This wasbased on the analyses of groundwater samples fromover 2200 wells, mostly supplying drinking water tohomes or for domestic use. The results of the surveyshow that 33% of wells produced water with a nitrateconcentration, that is, above the WHO guide limit of45 mg NO3/l (Adelana, 2006). Distribution accord-ing to hydrogeological units is illustrated in Table 6.The highest risk is for infants <3 months old who arebottlefed using groundwater with >50 mg/l NO3-N,and confounding factors (such as lack of vitamin C,gastrointestinal infections and cancer risks) are evi-dently discussed in Adelana (2005).

Possible negative health effects of increased nitrateconcentrations are methaemoglobinaemia, especiallyfor infants; in which the body development, nervousand heart systems of children can be affected. The pres-ence of the nutrients nitrogen (in the form of nitrate andammonia) and phosphorus in water is generally con-sidered to be a manifestation of pollution. In the caseof groundwater, pollution is more difficult to trace andthe effects are not as obvious. Due to lack of clinicaldata it was difficult to link the infant mortality rate withnitrate ingestion through bottlefeeding, as was done inthe southern part of Africa (Colvin, 1999).

ConclusionsIn this chapter, groundwater resources in sub-Saharan Africa have been reviewed in terms ofquality in the bid towards Millennium Development

Goals. This has been driven by the targets for drink-ing water and sanitation, which were the primewater-related outcome of the World Summit onSustainable Development in Johannesburg in 2002.The status of sub-Saharan Africa (SSA) as com-pared to other developing world in the journeytowards the target is of concern. Many issues stillneed to be addressed in the light of experiences inrural water supply across the countries. The casesdiscussed in this chapter demonstrate evidence ofhealth problems traceable to natural and anthro-pogenic sources. The ingestion of high fluoride andnitrate through drinking water illustrated the silentepidemics that are not yet fully addressed. Asidegeologic factors, there is a list of human activitiesin the region that contaminate water sources, i.e.,agriculture, sanitation practices, industry, mining,military and burial sites, waste disposal and traffic.

Groundwater offers precious opportunities foralleviating the misery of the poor, but it possessesmany and daunting challenges for preserving theresource itself. In SSA, there is some action by wayof a response to the growing scarcity of groundwa-ter, but it is too little, too late, still experimentaland there is precious little on approaches to econ-omizing on its use. Groundwater interventions inwater supply often tend to be too local and restrictedto the rural areas. Like surface water, groundwaterresources too need to be planned and managed formaximum basin-level efficiency.

Understanding health aspects of groundwater iscrucial to developing management strategies andopens the door to potential management actions thatmay be taken to protect drinking water sources. Itis a useful approach to analyse hazards to ground-water quality, characterizing and/or assessing therisk these may cause for a specific supply is crucialand calls for comprehensive research. Setting prior-ities in addressing these may be the beginning of acomprehensive water safety plan for rural and urbancommunities in sub-Saharan Africa. Propagation oflaws and regulations for the control of risks asso-ciated with these activities is an issue in manycountries in SSA. The water laws and regulationsare not weak in themselves, where they exist, buttheir implementation has defects. The political willneeded to implement these regulations must begeared up, primarily at the local level involving the

32 S. Adelana et al.

people, local governments and non-governmentalorganizations but with responsive participation andcontributions of the international community. Thereis a long-term profit in being able to set and enforcethe laws governing water and environmental pollu-tion in the various countries of Africa. This will,obviously, set the stage for the protection of ground-water in specific regions averting future healthproblems.

There are a number of strategies which haveproven results of success in other parts of theworld that may be adopted in some of the coun-tries in SSA. The countermeasures to control waterpollution may include (i) proper siting and improv-ing well construction in rural areas; (ii) increasingthe consciousness of water resources protection;(iii) integrated management of water resources; (iv)adopting effective measures and establishing water-saving approaches to avoid overdraft and industrialwaste reduction; and (v) perfecting/implementingthe existing laws and regulations on water quality.

There are potentially powerful indirect demandmanagement strategies that are not even part ofthe academic discussion in the developing world.These offer opportunity for new approaches, adap-tation of proven management schemes elsewhere inthe world and the need for closer scrutiny. Thereis also scope and need for more orderly develop-ment of groundwater for irrigation, especially inWest Africa and East Africa where potential forgroundwater development still exists.

A major barrier that prevents transition from thegroundwater development to management mode islack of information. Many countries of sub-SaharanAfrica do not have any idea of how much groundwa-ter is present and who withdraws how much ground-water and where. Indeed, even in countries wheregroundwater is important in all uses and wherethere is some knowledge about water resources, sys-tematic monitoring of groundwater occurrence andabstraction is still lacking.

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