A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh

Abstract

ObjectiveTo reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks.MethodsWe conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks.ResultsOverall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50 μg/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source . Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased.ConclusionThe overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.

The Effectiveness of Educational Interventions to Enhance the Adoption of Fee-Based Arsenic Testing in Bangladesh: A Cluster Randomized Controlled Trial

“…Previous studies have found that reinforcement over time is important in encouraging households to switch to As-safe drinking water sources. 8,9 Furthermore, social and physical (distance) constraints have been found to be important barriers to well switching. 16,17 Thus, future studies should investigate if a longer health communication is more effective in increasing the proportion of households with unsafe wells that switch.…”

“…Furthermore, we had only one household visit per study respondent, although the literature suggests that reinforcement is important in facilitating well switching. 9,16 In addition, the geographic areas selected for this study were matched on the proportion of unsafe wells based on a village wide household drinking water survey conducted before the baseline survey. However, many wells at baseline were untested.…”

“…[7][8][9] In Araihazar, Bangladesh, it was found that the majority of households using As-unsafe wells that received water As testing coupled with As education and the targeted installation of wells report switching to As-safe sources. 7,8 However, well testing in Bangladesh is usually project based, without efforts to design or implement sustainable testing mechanisms.…”

Arsenic exposure in drinking water: an unrecognized health threat in Peru

“…However, the social acceptability of using a communal or neighbourhood drinking water source has to be investigated. 26 Barriers to the widespread use of arsenic removal devices in arsenic-affected countries have been related mainly to inadequate equipment maintenance, frequent clogging of the filters, difficult waste disposal, and procedures that are not user friendly. 27 The present study design has several limitations.…”

Improving Education Outcomes in South Asia: Findings from a Decade of Impact Evaluations

“…This had no effect on whether households switched from a contaminated well to a safer one (Bennear et al, 2013). However, a different and arguably more comprehensive intervention that combined water arsenic testing with education regarding health implications of chronic arsenic exposure and methods to limit exposure, reduced arsenic exposure provided there were arsenics-safe drinking water sources available (George et al, 2012).…”