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Preferences of arsenic mitigation options in Bangladesh: Stakeholder and end user perspectives
ABSTRACT
Despite access to arsenic mitigation options
millions of people drink arsenic-contaminated
water.
Discrepancies between stakeholders’ and end
users’ preferences of mitigation options may
be a reason for slow mitigation progress.
We aimed at identifying the most preferred
options by comparing both stakeholders’ and
end users’ preferences.
Results suggest installing the most preferred
options - deep tubewells, well-sharing and
piped water supply - with greater priority.
INTRODUCTION Arsenic mitigation in Bangladesh
Tubewell screening program
(2000-06): tested over half (app.
5 millions) of the wells (Johnston
and Sarker, 2007).
National policy and
implementation plan (2004):
Developed variety of arsenic
mitigation options
2000- 09: >160’000 arsenic
mitigation options were
installed (UNICEF, 2010).
Arsenic as a public health threat
Arsenic contamination of drinking water is a global
public health crisis (Naujokas et al., 2013).
Bangladesh: >20 million people are still at risk of
drinking arsenic-contaminated water (Flanagan et al., 2012).
Health effects: arsenicosis
Figure 1: Skin lesions
Mohammad Mojahidul Hossaina, b, Hans-Joachim Moslera, Jennifer Inauenc a Eawag: Swiss Federal Institute of Aquatic Science and Technology, Switzerland b Christian Commission for Development in Bangladesh (CCDB), Bangladesh c Department of Psychology, University of Zurich, Switzerland Contact: mhossain_1979@yahoo.com
Figure 2: other chronic diseases
Figure 3: Death
42,700 - 56,400
deaths per year
(Flanagan et al., 2012)
Using of arsenic mitigation options
Still many installed mitigation options
are not maintained or used regularly
(Inauen et al., 2013).
0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%
Overall
Household filter
Piped water…
Community filter
Well-sharing
Deep tubewell
Pond sand filter
Dug well
Rainwater…
62.10%
92.90%
85.60%
73.60%
71.20%
54.00%
51.60%
48.40%
36.60%
37.90%
7.10%
14.40%
26.40%
28.80%
46.00%
48.40%
51.60%
63.40%
users non-users
Figure 12: using of arsenic mitigation options (Inauen et al., 2013)
Preferences of arsenic mitigation options
End users preferences influenced by:
Technical factor (e.g., water quality)
Socio-cultural factors (e.g., religious barriers)
National policy and plan:
prioritized surface over ground water options.
Best mitigation option(s): ongoing debate
among stakeholders
Slow progress: peoples’ preferences are
neglected
Research questions
(1)Which mitigation option(s) are preferred by both?
(2)What advantages and disadvantages do both
perceive for each option?
END users surveys
Two cross-sectional surveys:
Study -1: November 2009
Study -2: December 2010
Total sample size 1268 households:
Study 1: N=872
Study 2: N=396
Study locations:
six arsenic-affected districts of Bangladesh
Study participants:
Randomly selected households
Risk of drinking arsenic-contaminated water
Access to arsenic-safe water option(s)
Face-to-face interviews:
Structured questionnaire, qualitative questions
Stakeholder interviews
Qualitative interviews:
August 2008
Total sample size:
N= 22 representatives of stakeholders
Study locations:
Dhaka and other locations in Bangladesh
Selection of stakeholders:
purposefully from different levels by their
importance, agreement and availability
Interviews:
Semi-structured personal interviews
Most available arsenic mitigation options
Figure 4: Household filters Figure 5: Communityfilter
Figure 6: Rainwater Harvesting
Figure 9: Piped water supply
Figure 7: Pond sand filter Figure 8: Dugwell
Figure 10: Deep tubewell Figure 11: Arsenic-safe
shallow tubewell
METHODS
RESULTS
Preferences of arsenic mitigation options
27.3
22.7 13.6
13.6
9.1 4.5
Piped water supply
Deep tubewells
Pond sand filters
Rainwater harvesting
Dug wells
Arsenic removal filters
Figure 13: Stakeholders’ preferences (%)
26.42
15
10.3 9.2
8.8
8.4
8.2 6.38
Deep tubewells
Well-sharing
Household filters
Community filters
Piped water supply
Pond sand filters
Rainwater harvesting
Dug wells
Figure 14: End users’ preferences (%)
Advantages & disadvantages of arsenic mitigation options
0 5 10
Peoples' WTP
Water Monitoring
easier
Long-term option
Less costly
9.1
4.5
4.5
4.5
0 5 10 15
Limited feasibility
Maintenance
No WTP for using
13.6
4.5
4.5
Figure 15: Stakeholders’ perceived advantages & disadvantages of PWS (%)
0 10 20 30 40 50
Water unavailability
Economic problem
Use/maintenance
No disadvantage
41.6
29.6
28.8
28
Figure 16: End users’ perceived advantages & disadvantages of PWS (%)
0 2 4 6 8 10
Most sustainable
Easy use &
maintenance
Preferred by GoB
9.1
9.1
4.5
0 5 10 15
Groundwater
table decline
Limited
technical…
Expensive
Risk of as.
contamina…
13.6
9.1
9.1
9.1
Figure 17: Stakeholders’ perceived advantages & disadvantages of DTW (%)
0 20 40 60 80 100
Good taste
Good temperature
Nice to meet people
Not effortful & time-
consuming
81.8
76.5
15.2
9.1
0 20 40 60 80
Distance/effort/time
Water quality
concerns
Difficult social
situations
No disadvantage
66.1
14.5
12.9
17.7
Figure 18: End users’ perceived advantages & disadvantages of DTW (%)
CONCLUSIONS
Most preferred mitigation options:
Deep tubewells
Piped water supply
Well-sharing (only by end users, but not by stakeholders)
To advance arsenic mitigation efforts:
Most preferred options: install and promote with greater emphasis
Poorly preferred options: technological improvement and promote with behavior change interventions
Collaboration between stakeholders and prioritize peoples’ preferences is urgently needed
Further research required.
REFERENCES Flanagan S.V., Johnston R.B., Zheng Y. (2012). Health and economic impact of arsenic in Bangladesh: Implications for mitigation strategy and practice. Bulletin of the World Health Organization, 90, 839–846. doi:10.2471/BLT.11.101253
Inauen J., Hossain M.M., Johnston R.B., Mosler H.J. (2013). Acceptance and use of eight arsenic-safe drinking water options in Bangladesh. PLoS ONE, 8(1), e53640. doi:10.1371/journal.pone.0053640
Johnston R.B., Sarker M.H. (2007). Arsenic mitigation in Bangladesh: National screening data and case studies in three upazilas. Journal of Environmental Science and Health, Part A: Toxic/Hazardous substances and Environmental Engineering, 42, 1889–1896.
doi:10.1080/10934520701567155
Naujokas M.F., Anderson B., Ahsan H., Aposhian H.V., Graziano J.H., Thompson C., Suk W.A. (2013). The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem. Environmental Health Perspectives, 121(3), 295–302
UNICEF. (2010). Arsenic mitigation in Bangladesh. UNICEF, Dhaka, Bangladesh. Available at: http://www.unicef.org/bangladesh/Arsenic_Mitigation_in_Bangladesh.pdf. Accessed 10 December 2013
For more information:
Hossain M.M. and Inauen J. (2014). Differences in stakeholders’ and end users’ preferences of arsenic mitigation options in Bangladesh. Journal of Public Health, 22, 335–350. DOI 10.1007/s10389-014-0625-8
0 50 100
Distance/effort/time
Difficult social
situations
Water quality concerns
No disadvantage
64
38.4
12.8
6.4
Figure 19: End users’ perceived advantages & disadvantages of well-sharing (%)
Stakeholders did not name well-sharing
Past studies identified some major problems:
collecting water as more time-consuming
normative problems
lower confidence and commitment to use (Inauen et al., 2013)
0 2 4 6 8 10
9.1
For emergency response
0 5 10 15
Not sustainable
High cost
Maintenance
13.6
4.5
4.5
Figure 20: Stakeholders’ perceived advantages & disadvantages
of arsenic removal filters (%)
0 20 40 60 80
Arsenic-safe
No/less iron
Good taste/smell/
color/temperature
Good water quality
(unspecific)
74.6
65.9
61.9
37.3
0 20 40 60
Use/maintenance
dissatisfaction
Distance/effort/ time
Economic problem
No disadvantage
41.3
34.9
11.1
30.2
Figure 21: End users’ perceived advantages & disadvantages of HH filters (%)
0 20 40 60 80
Arsenic-safe
No/less iron
Good taste/smell/
color/temperature
Good water quality
(unspecific)
79.2
68.8
47.2
39.2
0 20 40 60 80
Arsenic-safe
Good taste/smell/
color/temperature
No/less iron
No/less illness
Good water quality
(unspecific)
70.4
56
48
25.6
20.8
0 2 4 6 8 10
9.1
For emergency response
0 5 10 15
Not sustainable
High cost
Maintenance
13.6
4.5
4.5
Figure 20: Stakeholders’ perceived advantages & disadvantages
of arsenic removal filters (%)
0 20 40 60 80
Arsenic-safe
No/less iron
No/less illness
Good taste/smell/
color/temperature
Good water quality
(unspecific)
79.2
56
41.6
40
40
0 20 40 60 80
Distance/effort/time
Economic problem
Water unavailability
Water quality concerns
Difficult social situations
No disadvantage
60.8
24
14.4
9.6
9.6
28
Figure 22:End users’ perceived advantages & disadvantages of community filters(%)
0 1 2 3 4 5
4.5
Feasible in the coastal area
0 5 10
Microbial contamination
Maintenance problem
People prefer simpler
solution
Unknown to rural people
9.1
4.5
4.5
4.5
Figure 23: Stakeholders’ perceived advantages & disadvantages of PSF (%)
0 20 40 60 80
Arsenic-safe
No/less iron
Good taste/smell/
color/temperature
No/less illness
Good water
quality…
68.5
43.5
37.9
36.3
31.5
0 50 100
Distance/effort/time
Water quality
concerns
Difficult social
situations
No disadvantage
66.1
14.5
12.9
17.7
Figure 24: End users’ perceived advantages & disadvantages of PSF (%)
0 1 2 3 4 5
Main safe option for the
coastal regions
There's enough rain
4.5
4.5
0 5 10
Limited feasibility
Unknown to people
Only one family can use
Not preferred by people
9.1
4.5
4.5
4.5
Figure 25: Stakeholders’ perceived advantages & disadvantages of RWHS (%)
0 50 100
Arsenic-safe
No/less iron
Good taste/smell/
color/temperature
Good water
quality…
91.1
90.2
41.5
30.9
0 20 40
Use/maintenance
dissatisfaction
Water unavailability
Distance/effort/time
No disadvantage
26.8
23.6
16.3
30.9
Figure 26: End users’ perceived advantages & disadvantages of RWHS (%)
0 2 4 6
Similar in traditional
usage culture
Require less space
Easy maintenance
Very sustainable
4.5
4.5
4.5
4.5
0 1 2 3 4 5
4.5
Often contaminated with arsenic
Figure 27: Stakeholders’ perceived advantages & disadvantages of dug-wells (%)
0 20 40 60 80
Arsenic-safe
No/less iron
No/less illness
Good taste/smell/
color/temperature
67.7
46
46
37.1
0 20 40 60
Distance/effort/time
Bad taste/smell/…
Water quality…
Difficult social…
Water unavailability
55.6
35.5
22.6
12.9
9.7
Figure 28: End users’ perceived advantages & disadvantages of dug-wells (%)
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