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Fighting Arsenic at the Grassroots: Experience of Brac’s Community Awareness Initiative in Bangladesh

ABDULLAHEL HADI
Research and Evaluation Division, BRAC, Dhaka, Bangladesh

Abstract/ Executive Summary:

The study evaluates the arsenic mitigation project of BRAC in raising awareness of arsenic poisoning in rural communities in Bangladesh. Data came from selected project villages in south-western Bangladesh. Comparison villages were also selected from the same region. A total of 1240 randomly selected adults were interviewed in May 2000. Findings reveal that the mitigation project played a significant, positive role in raising awareness of the safe water options, signs of arsenicosis, mode of transmission and the type of treatment. Testing tube-well water for arsenic created curiosity, innovation and interest in the community, and the water treatment plant became a symbol of the arsenic campaign. The study concludes that the behavioural change aspects of the arsenic mitigation project have the potential to significantly improve the level of understanding about arsenic contamination in the traditional communities.

Keywords: Arsenic, Health promotion, Behaviour change, Bangladesh

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Program Area: Risk Management in Agriculture

Commodity: Arsenic

Objectives:

As part of the arsenic mitigation strategy, the government and several development organizations have been implementing an arsenic awareness campaign throughout the country

Methodology:

BRAC’s arsenic mitigation project Although the presence of arsenic in tube-well water was first detected in 1993 in a northwestern district of the country, the problem has attracted attention only recently. According to a report, the water of nearly 25% of hand tube-wells tested by the government was found to be contaminated with arsenic. BRAC (a non-government development organization in Bangladesh), along with the government and other development agencies, has been promoting the use of tube-wells as a safe source of drinking water. Data This study was conducted in selected villages in southwestern Bangladesh where BRAC had both the arsenic project and a demographic surveillance system (mitigation area).3 A number of comparison villages was selected from the adjacent district in the same region, where BRAC had the surveillance system but no arsenic project (comparison area). Both the sample survey and in-depth interviews were used to collect data. The surveillance system database was used to develop the sampling frame for the survey. All the adult population aged between 15 and 74 years were considered for inclusion in the sample. Two sampling frames for both men and women were constructed. Systematic random sampling was followed to select samples from both study areas. The total sample size was 1240, with 636 from the mitigation villages and 604 from the comparison villages selected. A test instrument was developed for the assessment of arsenic knowledge, comprising 12 items in the four issues of safe water options, signs of arsenicosis, mode of transmission and type of treatment. The purpose of the in-depth interviews was to gain more insight. The participants for the interviews were selected at random from the respondents of the sample survey. Both male and female respondents were included in the subsample. A total of 24 in-depth interviews were conducted. An open-ended interview schedule was developed incorporating the relevant topics for the in-depth discussion. Data were recorded, transcribed and categorized according to the discussion topics. The main findings were synthesized with the survey findings and highlighted in the analysis. Data were collected in July 2000. Analytical procedure In this study, the effects of the arsenic awareness initiative in improving the knowledge of arsenic contamination were examined. The improvement of awareness was assessed by four dichotomized dependent variables:4 safe water options, signs of treatment, mode of transmission and type of treatment. Several confounding variables such as age, education, family income source,5 media exposure and land ownership were considered to influence the knowledge of arsenic related issues. In the analysis, differences in various measures of knowledge by the mitigation project are presented. Then simple bivariate relationships between the measures of knowledge and the socioeconomic variables are discussed. To assess the net effects of the mitigation project on arsenic awareness, multivariate analysis was done. The logit model was considered appropriate because the dependent variables were dichotomous (Aldrich and Nelson 1994). One major limitation of the study was not having baseline values for the indicators of arsenic knowledge. A group of comparison villages was included in the design and comparable values were collected as the proxy baseline indicators. Initial analysis showed marked socioeconomic differences between the mitigation and comparison villages. This problem was addressed by comparing the knowledge level between the mitigation and comparison villages for each socioeconomic variable.

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Achievement/Findings:

Although this research demonstrates that perceptions on arsenic issues can be changed and argues that programme efforts can create the context for the greater behavioural change, it is clear that such intervention alone can have little significant impact in reducing the magnitude of the problem. Therefore, policy-makers, scientists and activists should come together to develop strategies and motivate the government and others to initiate innovations to properly address the problem. They should also encourage development organizations to join hands with the government to monitor and conduct systematic studies on this tragically massive public health problem in Bangladesh.

Knowledge Management: Journal