Research Reports (2002): Health Studies, Vol - XXXIII

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Testing of tubewell water of the Community Nutrition Centres (CNC) under the Bangladesh Integrated Nutrition Project (BINP) for presence of arsenic
(BRAC Research and Evaluation Division (RED), 2002-09) Jakariya, Md.
Bangladesh faces multi-faceted problems in relation to groundwater. At present there is a new threat - arsenic contamination in groundwater. Arsenic is a shiny, grey, brittle element possessing both metallic and non-metallic properties (Train, 1979). The source of arsenic in drinking water is geological. Arsenic occurs naturally in the sediments of Bangladesh bound to amorphous iron oxyhydroxide. However, there are lots of controversies over the origin of arsenic in the groundwater. Bangladesh achieved remarkable success in providing safe drinking water to almost 97% of its rural population. But the recent discovery of arsenic in groundwater has ruined this decade-long success and the access to safe drinking water has now dropped to almost 80% (UNICEF, 1999). To mitigate the arsenic problem, a number of alternative safe water options are available in Bangladesh. Some of these options are based on surface water and some are based on treating the arsenic-contaminated water. Malnutrition, which is a serious health concern in Bangladesh and poor socio-economic conditions aggravate the hazards of arsenic toxicity. The recent remarkable strides achieved in the health sector in Bangladesh have been slow down in the reduction of malnutrition (lahan and Hossain, 1998). Fifty percent of the country's child mortality is reported to be associated directly or indirectly with malnutrition CBBS, 1994). The Bangladesh Integrated Nutrition Project (BINP) is the first major attempt of the government of Bangladesh to develop a comprehensive well coordinated inter-sectoral programme financially supported by the World Bank (The World Bank, 1995). Tubewell water is the only source of water for drinking and mixing the supplementary food at the CNCs for the pregnant women and children. Therefore, it is important to check tubewells of all the CNCs for presence of arsenic and subsequently to arrange alternative safe water options, if tubewell water is contaminated with arsenic at a dangerous level (i.e. >50~1). Accordingly, tubewell water of all the CNCs were tested with MERCK field testing kit and it was observed that only 26% tubewells found to be contaminated with arsenic more than the acceptable limit for Bangladesh. Ullfortunately, it was observed that these contaminated tubewells were using for preparing food at the CNCs. in order to develop the mitigation plan for the arsenic affected CNCs it is important to assess the average daily requirement of water by members of each CNCs to develop mitigation plans. It was observed that the daily requirement of water of almost all the CNCs was within the range of 20 litres per day, which means either small community-based option or household unit with good flow rate could be the suitable alternative safe water options for the arsenic affected CNCs. An attempt was made to check the source of drinking water of the CNC members at their home, since they spend only a few hours at CNCs. It was observed that drinking water source of more than 80% CNC members at home is tubewell water and their arsenic status was not known the owners at the time of testing. Focus group discussions were organized at the arsenic contaminated CNCs to get an idea about their preferred mitigation methods. Among the options preferred by the respondents deep hand set tubewell was found to be the most popular options (42%) followed by three-pitcher filters (25%). Since there is no curative measure for this disease except drinking arsenic-free waler (Smith 2002), alternative suitable safe water options should be made available without any delay for the exposed pregnant women and children from further exposure to arsenic contaminated water.
Experiences gained in tackling the arsenic disaster: final report on arsenic mitigation project in Sonargaon and Jhikorgachha
(BRAC Research and Evaluation Division (RED), 2002-06) Hossain, Md Zabed; Mahmud, Shah Noor; Jakariya, Md.
This report describes the experiences gained in the "action research on community-based arsenic mitigation project" implemented by BRAC in Sonargaon and Jhikorgachha upazilas of Bangladesh. The project was implemented in two phases. The first phase of the project was implemented during the period from June 1999 to December 2001 . Experiences of the phase 1 have been described in BRAC report (Chowdhury et a!. 2000). After completion of the phase 1 of the project some further works and follow-up activities were carried out during January 2001 to December 2001. The objectives of the phase 11 of the project were to: (i) assess the present status of arsenic concentration in all green, cross and at least 10% of the red tubewells marked in Phase I; (ii) involve community members in choosing, financing, implementing, and maintaining alternative sources for safe drinking water; (iii) provide alternative safe \I'later options with active participation from the communities; (iv) identify arsenic affected patients in the project areas and provide treatment or referral whichever is appropriate; (v) make community people aware of dangers of arsenic poisoning; and (vi) develop a system involving local communities and local level officials in different phases of the project activities for the long-term sustainability of the safe water implementation plan. A total of 2(),058 tubewells, 10,062 from Sonargaon and IS,<)9() from .Jhikorgachha was selected for re-testing in the Phase 11. from the monitoring of the tube wells for more than two years it was found that there was no significant change in the concentration of arsenic in the tubewell water in both the project areas.
Drinking no more arsenic: Switching water source through intensive awareness programme in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 2002-12) Hossain, Zabed; Gani, Md. Showkat; Jakariya, Md.; Chowdhury, AMR
The study assessed the effects of intensive awareness raising activities implemented from June 1999 to December 2001 among the arsenic exposed people to motivate towards safe water use. A total of 839 families those who used to drink arsenic contaminated water prior to intervention was selected randomly for the survey. Data revealed that 47.6% of the people switched from unsafe to safe water sources. Awareness on alternative safe water options played great role in motivating people towards safe water use. Rate of switching over was almost three times higher among the people those who were aware of alternative water options than those who were not. People with better education, high occupation and socio economic status showed the maximum rate of switching over towards safe water sources. People having the capacity to buy water options were seven times in number in changing their water source compared to those who have no capacity to buy. Integrated approach should be taken immediately to increase awareness on alternative water options, socio-economic status to increase their capacity to purchase water options.
Building community based arsenic mitigation response capacity in four upazilas of Bangladesh
(BRAC Research and Evaluation Division (RED), 2002-06) Hossain, Md Zabed; Mahmud, Shah Noor; Jakariya, Md.
BRAC in collaboration with DPHE and 'UNICEF implemented the project entitled "Building community based arsenic mitigation response capacity" during July 2001 to June 2002 in four upazilas named Barura, Haimchar, Bahanga, and Monirampur of Comilla, Chandpur, Faridpur, and Jessore districts respectively. The objectives ofthe project are to (i) raise awareness among the community (ii) determine the extent of arsenic contamination in all tubewell water in the project areas; and (iii) develop resource maps of different villages of the project area to locate safe water sources. The activities executed in the project were creation awareness among the people through training, workshop, formation of different types of arsenic mitigation committees, training for tubewell testing and blanket tubewell testing, providing technical advice on safe water and collation and dissemination of knowledge generated and lessons learnt. At the upazila level, upazila project co-ordinator ofBRAC actively participated at upazila monthly co-ordination meeting in order to appraise different stakeholders and government officials about activities and progress on arsenic mitigation. BRAe provided quarterly report to the co-ordination committee. A working committee was formed whereby local DPHE and BRAC project personnel worked together to plan and review different project activities and its progress. A total of85937 shallow tubewells, among those 21003,26339,3585 and 35010 in Bhanga, Barura, Haimchar, and Monirampur upazilas respectively were tested. Among the four upazilas the highest contamination was found in Bhanga (91 %) and the lowest was in Monirampur (51 %). A total of 378 deep hand set tubewells were tested in the project areas. Among these deep hand set tubewells only 14 (3.7%) were found to be contaminated with arsenic of above permissible 153 limit. In the four upazilas a total of 14989 irrigation wells were tested ofthose 70% were found contaminated. Field testing of the tubewells for arsenic was validated by laboratory analysis using AAS (Atomic absorption spectrophotometry). It was found that the field testers did reasonably well in testing the tubewells. The percentage of correctly tested tubewells (green-green and red-red) was 92% and 90-91 % respectively. There was no significant seasonal variation in concentration of arsenic in tubewell water. Achievement in fonnation of arsenic mitigation committees was 100% at the Upazila level to Ward level in all the four upazilas. In case of fomlation ofY AMC achievement was from 84 to 100% in the project areas. Success in fulfilling the target of organizing meeting in the committees ranged from 63 to 95% in the villages of the project areas. The following issues were encountered during the course of the project implementation below. • Number of communication materials like routine card, flash card, leaflet, posters were not adequate in number. • Although training was arranged for the communication officers of the project but there was no manual for using these materials in written fonn. • Although the Imams of the mosques were found very vital in disseminating the messages on arsenic it was not possible to give orientation and training due to inadequate logistics. • The owners of the restaurant or the teashop were found erasing red paint of the tubewells which were found arsenic and they marked those tubewells with green paints. • In few cases the members of the committees did not work spontaneously since there was no provision of incentive as they expected against their services.
Assessing the effectiveness of the Shapla arsenic removal filter
(BRAC Research and Evaluation Division (RED), 2002-12) Jakariya, Md.; Quaiyum, Md.
The study was conducted to assess the effectiveness of the Shap!a Arsenic Removal Filter. The two villages of Sonargaon Upazila were sel~cted , as the use of this filter was mainly concentrated there. A total of 50 Shapla filters were provided among the villagers by the International Development Enterprises, Bangladesh free of cost under the arsenic mitigation project, implemented by BRAC, in collaboration with Unicef and OPHE. Data were collected through interview and observation in mid - August 2002. The water of the functioning Shapla filters was tested for arsenic using Merck test kit from Gem1any during the survey. A total of 47 Shapla filters out of 50, were surveyed where about 92% of them were functioning. The arsenic concentration level in the water filtered of Shapla filters (72%) was within the tolerable limits (up to O.OSmglL). The now rate of 28% of the Shapla filters was 4 to 6 litresl Hour and it was 2.4 to 2.9 litresl Hour for another 28% of the Shapla filters. About 81 % of the respondents did not know about the interval of testing water of Shapla filter. The teaching about maintenance of the Shapla filter to the respondents was universal (93%). After the latest testing, the water of about 74% of the Shapla filters was reported arsenic free (within the tolerable limits). But some of the respondents (22%) did not know the test result. The disposal of the non-functioned media (expired media)(78%) was all over. From this study it may be concluded that the majority of the Shapla Arsenic Removal Filters provided were functioning, although some of them were found highly contaminated with arsenic. In some cases the now rate is very low and should be improved. Filter users should be informed about the result of testing in time. A proper management of disposal of expired media should be introduced.
An implementation guide for the Arsenic mitigation program
(BRAC Research and Evaluation Division (RED), 2002-11) Ahmed, Munir; Jakariya, Md.; Quaiyum, Md.; Mahmud, Shah Noor
Trends and patterns in food consumption and nutrition of rural and urban poor in Bangladesh, 1991-2000
(BRAC Research and Evaluation Division (RED), 2002-12) Yusuf, Harun K.M.
A review report is prepared on the trends and patterns of food intake and nutritional status of the poor rural and urban households of Bangladesh during the decade of 1991-2000. Because agricultural production is the main determinant of the quantity and quality of meals in a poor agrarian country like Bangladesh, a thorough review of trends in gross production and gross per capita availability of commonly consumed foods was first made. The decade is marked by a commendable increase in food production, particularly rice during the second half of the decade, along with other food items like wheat, potato, vegetables, fish, meat and milk. This made the average national diet of the year 2000 richer in terms of quantity (892 g/capita/day), energy (2,112) Kcal and protein (53 g) compared to the diet of all previous survey years. However, the country is yet to acieve the desirable requirement level in any terms: the diet is still highly imbalanced, with rice and other cereals contributing nearly 80% of total energy and fruits and vegetables contributing only 3%. The diet is thus deficient in vitamins and minerals. The decade of 1991-2000 is marked by a commendable economic growth, with concomitant decline in the incidence of both absolute poverty and extreme poverty, by 9 percentage points each, more in urban than in rural areas, although the rate of decline in urban poverty slowed down in the latter years of the decade. However, in 2000, the incidence of absolute poverty was still 50% and the incidence of extreme poverty was 34%. In absolute terms, during the decade, the number of poor in rural areas decreased from 58 million to 42 million, while the number of poor in urban areas showed an appalling 100% increase from 7 million to 15 million. Since food distribution inequity is heavily weighted on the poor, the food intake of the poor in both rural and urban areas, remained inadequate in quantity (around 700 g/day), energy (1790 Kcal, 25% less than the requirement) as well as in protein (40 g/day, 30% less than required). Their diet is also precariously imbalanced, nearly 90% energy coming from cereals, 85% from rice alone, an inevitable consequence of which is malnutrition. Analysis shows that between 1991-2000, no improvement had occurred in the quantity nor in the quality of the diet of the poor and the poorest (bottom 40% expenditure category). This is true for both rural and urban areas. The urban slums are even worse. In poor households of both rural and urban areas, allocation of household expenditure for food is 70%. So, more than two-thirds of the income is spent for food which is inadequate in quantity and quality. Needless to say, the remaining 30% can barely meet the other necessities of life. Market dependence is very high in the rural areas, where nearly one-quarter of major foods like rice, vegetables and fish are procured from own production and the remainder is purchased from the market. Only in case of egg, the proportion of own production in both poor and rich households is 32-54%, indicating traditional poultry raising in rural areas. Parallel with national average economic growth, poverty reduction, increased food production and food intake. Bangladesh has achieved a commendable reduction in child malnutrition rates during the nineties. Night blindness due to vitamin A deficiency in children under 6 years of age decreased to almost nonexistence levels (0.3%) during the decade. But despite these improvements. 50% of preschool children were still stunted or underweight. 18-19% severely. in 2000. Percentage of malnourished children coming from poor families is even higher. over 60%. The prevalence is higher in rural than in urban areas and girls are more affected than boys. Over 50% children are anaemic. Chronic energy deficiency (CED) prevalence in women of child bearing age has also decreased over the years of the decade. but still. 45% of rural and 35% of urban (slum) mothers suffer from CED. Still. about half of all pregnant mothers are anaemic. Infant feeding practice (colostrum and breast milk as first food after birth and start of complementary feeding with right type of food at the right time, i.e. 5 months of age or later) are found to have strong bearing on child's nutritional status. Enriching the family food, which becomes more and more important in the infant's diet, may be enriched with egg, fish, pulse and oil. Appalling is the finding that 65% of poor families do not eat egg at all, even though they have egg in the house: they save it for hatching or sell it for hard cash. Thus, poor households, rural and urban alike, did not get the benefit of increased food production and the economic growth that the country has achieved during the nineties: in year 2000, their food intake was low and their food was imbalanced , as it was in year 1991. Those who have come out of poverty are lucky, but more pro-poor action programmes need to be taken to bring more poor out of poverty, and sooner the better.

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