Sociocultural aspects of arsenicosis in Bangladesh: Community perspective

Abstract

This was a cross-sectional study under taken to explore the socioeconomic perspective of the arsenicosis problem, carried out in arsenic contaminated Upazillas where at least 100 arsenicosis patients had been identified. Two of the Upazillas with significant arsenic mitigation intervention and three of the Upazillas with limited interventions were selected for the study. Seven hundred fifty respondents were included in the study from 25 villages of the 5 Upazillas. Arsenicosis became a serious problem for the affected communities. Majority (71.31%) of respondents obtained their drinking water from tubewells, almost one third (29%) of the respondents still knowingly using arsenic contaminated water. Primary reason identified for this practice was distance of safe water source. Majority (58.6%) of the respondents said to face economic and 17.9% said to face social problem of varied range. Patients of lower income group were particularly more likely to face economic problems (P< .001) as well as social problem (P< .01). About half (50.7%) of the arsenicosis patients faced difficulty whilst receiving treatment, particularly female patients were more likely to face problem than male (P< .05). Several concerns also were surfaced regarding the heath care service provider particularly to the women patients, some of which are: long waiting time for receiving treatment (15%), discrimination in service delivery (10.7%) and inadequate separate facility for female patients (14.3%). Moreover the issues of financial burden raised by the respondents seem to have emerged as significant in terms of health care access. Access to Health service was particularly difficult for poor patients, as they often had to face problems associated with accessing service like, non availability of medicines in the hospitals (50.7%), traveling long distance (26.7%), purchasing medicine in most cases (32.4%) etc. Their dissatisfaction was compounded by negligent behavior of health care staff and nature of treatment provided. Furthermore length of time needed for reversal of symptoms led to loosing faith on efficacy of treatment, which cascades to negligence of patient's part in seeking health care. Women are less likely to get treatment for arsenicosis than men (P< .01). As there appear to be specific difficulties for women particularly for poor women in accessing health care, social and cultural values make it difficult for them to attend to their own health needs and to travel to service providers. Study findings suggest that a significant proportion (79.9%) of arsenicosis patient was found to access alternative health care. This includes; Homeopath, village doctors, Kabiraj and local pharmacists. Respondents in high intervention Upazillas were significantly more likely to get treatment (P< .05), to face fewer problems and to be satisfied with the facility (P< .001). Provision of safe water options, periodic screening of water source for arsenic, availability of trained doctor, regular availability of medicine, doorstep treatment, follow up on sev...

Developing Sustainable Models of Arsenic-Mitigation Technologies in the Middle-Ganga Plain in India

“…About 70% of the population lived in sub-standard housing. Based on contingency analysis, gender, age, education level, income, occupation, housing status, time spent collecting water, distance travelled to collect water, WTP for arsenic-free sources, and awareness about arsenic and associated issues were found to be significant variables, which is in line with the previous studies 15,16 . It is important to mention here that only 17 female respondents participated in the current survey.…”

“…1). However, the operation and maintenance costs and the corruption involved in setting up and establishing such systems are issues of serious concern, as reported earlier in the literature 15,16 . The respondents in this study expressed similar concerns.…”

“…These factors include cultural background, low willingness to pay (WTP) for arsenic-mitigation technologies, lack of awareness about arsenic, lack of ownership of the arsenic-mitigation technologies, and distance and travel time required to collect arsenic-free drinking water by communities 15 . Additionally, non-cooperation of owners of safe tube wells, bad taste of water after treatment, denial of the presence of arsenic contamination, misconception that boiling water removes arsenic and lack of safe drinking water sources near houses have all contributed to the failure of arsenic-mitigation programmes 16 . Low implementation of arsenic filters is also due to lack of pictorial instructions in the operating manuals in low literacy areas, lack of transparency between the service providers and the users regarding the actual cost of arsenic filters, social knowledge, and installation of arsenic removal plants that are inaccessible to communities 13,15,17 .…”

“…For example, arsenic-affected students are barred from schools and arsenic-affected people are generally avoided by friends and colleagues and hated by others 18 . Under extreme conditions, women are abandoned, divorced or separated, or sent back to their parents by their husbands 1,16,18 . Women also suffer from overly expensive dowries, physical torture, and polygamy 16,18 .…”

“…Under extreme conditions, women are abandoned, divorced or separated, or sent back to their parents by their husbands 1,16,18 . Women also suffer from overly expensive dowries, physical torture, and polygamy 16,18 . Therefore, women affected by arsenicosis were found to be more frequent social victims than men 18 .…”