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

George, Christine Marie; Inauen, Jennifer; Rahman, Sheikh Masudur; Zheng, Yan

doi:10.4269/ajtmh.12-0664

Cited by 18 publications

(14 citation statements)

References 14 publications

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“…DPHE/UNICEF, 2011; George et al, 2013) is clearly needed to promote the testing of wells that continue to be installed not only in Araihazar but throughout Bangladesh and a halfdozen neighboring countries where groundwater can also be high in As. One possibility may be to tie testing with the decision to install a new well by disseminating at the village level the information that is available for targeting a local low-As aquifer.…”

Section: Resultsmentioning

confidence: 99%

Comparison of two blanket surveys of arsenic in tubewells conducted 12years apart in a 25km2 area of Bangladesh

Geen

Ahmed

Pitcher

et al. 2014

Science of The Total Environment

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The arsenic (As) content of groundwater pumped from all tubewells within 61 contiguous villages of Araihazar, Bangladesh, was determined a first time in 2000–01 with laboratory measurements and a second time in 2012–13 using the ITS Arsenic Econo-Quick kit. The two surveys indicate that the total number of tubewells within the area almost doubled from 5,560 to 10,879 over 12 years. The evolution of the distribution of well ages between the two surveys is consistent with a simple model that combines an annual increase of 42 wells/year in the rate of installations within the 61 villages starting in 1980 and a 7%/year rate of abandonment of wells as a function of well age. Colored placards were posted on each pumphead in 2012–2013 on the basis of the kit results relative to the WHO guideline for As and the Bangladesh standard for As in drinking water: blue for As ≤10 µg/L, green >10–50 µg/L, and red: >50 µg/L. According to quality-control samples collected from 502 tubewells for comparing the kit results with laboratory measurements, not a single well labeled blue in 2012–13 should have been labeled red and vice-versa. Field-kit testing in 2012–13 did not change the status of wells relative to the Bangladesh standard of 876 (87%) out of 1,007 wells with a placard based on laboratory measurements in 2000–01 still attached to the pumphead. The high proportion of tubewells believed by households to be unsafe (66% out of 2,041) that were still used for drinking and cooking in 2012–13 underlines the need for more widespread testing to identify low-As wells as an alternative source of drinking water.

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Section: Resultsmentioning

confidence: 99%

Comparison of two blanket surveys of arsenic in tubewells conducted 12years apart in a 25km2 area of Bangladesh

Geen

Ahmed

Pitcher

et al. 2014

Science of The Total Environment

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“…Besides the lack of institutional support, well-sharing is only moderately psychologically accepted (Inauen et al, 2013a), and well-testing services -the prerequisite for identifying arsenic-safe wells -are not readily locally available. Nevertheless, recent research has yielded encouraging results in this regard; people have been shown to pay for arsenic testing when provided with arsenic education (George et al, 2013), and behavior change interventions have been shown to successfully increase people's switching to neighboring safe wells (Inauen and Mosler, 2013). Until private or public safe water supply is extended to the entire population at risk of arsenic consumption, sharing of safe shallow tubewells will remain an important tool in reducing exposure and consequent adverse health impacts.…”

Section: Discussion and Synthesismentioning

confidence: 98%

Enhancing arsenic mitigation in Bangladesh: Findings from institutional, psychological, and technical investigations

Johnston

Hug

Inauen

et al. 2014

Science of The Total Environment

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“…Community interventions in Bangladesh have had success in motivating arsenic testing in severely affected areas, especially when coupled with household education. 6 A 2005 community-based intervention in the Quebec region succeeded at motivating more people to test for arsenic than a mass media campaign; however, while the proportion of well owners who had their water tested increased by four times, the total testing rate was only 16%. 7 Quebec residents who were already aware of problems related to drinking water (such as the need for microbiological analysis) were more likely to test for arsenic too.…”

Section: Discussionmentioning

confidence: 99%

Arsenic in private well water part 2 of 3: Who benefits the most from traditional testing promotion?

Flanagan

Spayd

Procopio

et al. 2016

Science of The Total Environment

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Arsenic, a toxic element naturally found in groundwater, is a public health concern for households drinking from wells. Private well water is not regulated to meet the federal drinking water arsenic maximum contaminant level (MCL) of 10 µg/L, or the more protective 5 µg/L New Jersey state MCL. In the absence of consistent private well regulation, public health efforts have relied on promoting testing in affected communities to various degrees of success. Few interventions publish results, and more often focus on the outcome of tested wells rather than who completed a test, and more importantly, who did not. Through our survey of randomly selected addresses (n=670) in 17 NJ towns we find higher rates of arsenic testing in areas with a history of testing promotion. However, we also see a stronger correlation of testing behavior with income and education in high promotion areas, suggesting that community engagement activities may be exacerbating socioeconomic status (SES) testing disparities. Well owners with a bachelor’s degree had ten times greater odds of participating in our direct mail testing intervention than those with less education when tests cost $40. After all households (n=255) were offered free tests to overcome many of the usual testing barriers – awareness, convenience, and cost – only 47% participated and those who chose to return water samples were of higher income and education than those who did not. Our findings highlight that while efforts to promote and provide arsenic testing succeed in testing more wells, community testing interventions risk increasing SES disparities if those with more education and resources are more likely to take advantage of testing programs. Therefore, testing interventions can benefit by better targeting socially vulnerable populations in an effort to overcome SES-patterned self-selection when individuals are left alone with the responsibility of managing their drinking water quality.

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

Cited by 18 publications

References 14 publications

Comparison of two blanket surveys of arsenic in tubewells conducted 12years apart in a 25km2 area of Bangladesh

Comparison of two blanket surveys of arsenic in tubewells conducted 12years apart in a 25km2 area of Bangladesh

Enhancing arsenic mitigation in Bangladesh: Findings from institutional, psychological, and technical investigations

Arsenic in private well water part 2 of 3: Who benefits the most from traditional testing promotion?

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