Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka.
Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka; Lafayette College, Easton, PA, United States.
Econ Hum Biol. 2020 May;37:100862. doi: 10.1016/j.ehb.2020.100862. Epub 2020 Feb 13.
This paper examines whether there are systematic differences in the historical behaviors of households that are affected and unaffected by chronic kidney disease (CKD) in Sri Lanka pertaining to their water source choices, water treatment practices, and agrochemical use. This analysis is motivated by the Sri Lankan government's largest policy response to this epidemic - to encourage communities to switch from untreated well water to publicly provided alternatives. We use recall methods to elicit information on the drinking water source and treatment choices of households over an 18-year period from 2000-2017. Our analysis is based on a survey of 1497 rural ground-water dependent households in the most CKD-affected areas of the 10 districts of Sri Lanka with the highest prevalence of CKD. Our main findings are that (a) households that have ever used a pump to extract (typically deep) drinking water from a household well are more likely to be affected by CKD; (b) we fail to find a relationship between disease status and households' use of buckets to extract (typically shallow) groundwater from their wells; and (c) those who have ever treated their shallow well water by boiling it are less likely to be affected by CKD. We also find that a greater share of CKD affected households historically used agrochemicals, used wells that were geographically removed from surface water sources, and displayed lower proxies of wealth. The implications of these findings are fourfold. First, since the systematic differences in the historical patterns of water sources and treatments used by CKD affected and non-affected households are modest, the sources of water and the treatment practices themselves may not be the sole risk factors in developing CKD. Second, although we find a negative association between boiling water and the probability of CKD, it is not obvious that a public policy campaign to promote boiling water is an appropriate response. Third, the hydrochemistry of deep and shallow well water needs to be better understood in order to shed light on the positive relationship between deep well water and disease status, and on why boiling shallow but not deep well water is associated with a lower probability of CKD. Fourth, there is a need for a deeper understanding of other risk factors and of the efficacy of preventative programs that provide alternative sources of household drinking water.
本文考察了斯里兰卡受慢性肾脏病（CKD）影响和未受影响的家庭在水源选择、水处理实践和农用化学品使用方面的历史行为是否存在系统性差异。这一分析的动机是，斯里兰卡政府对这一流行病的最大政策反应是鼓励社区从未经处理的井水转向公共提供的替代水源。我们使用回忆方法来获取 2000 年至 2017 年 18 年间家庭饮用水源和处理选择的信息。我们的分析基于对斯里兰卡 10 个受 CKD 影响最大的地区的 1497 个农村地下水依赖家庭的调查，这些地区的 CKD 患病率最高。我们的主要发现是：（a）曾经使用水泵从家庭水井中抽取（通常是深水井）饮用水的家庭更有可能受到 CKD 的影响；（b）我们没有发现疾病状况与家庭使用桶从水井中抽取（通常是浅水井）地下水之间的关系；（c）曾经将浅井水煮沸处理的家庭更不容易受到 CKD 的影响。我们还发现，历史上有更多的 CKD 受影响家庭使用农用化学品，使用的水井与地表水来源的地理位置相隔更远，并且显示出较低的财富代理指标。这些发现有四重意义。首先，由于 CKD 受影响和未受影响家庭在历史上使用的水源和处理方式存在系统性差异较小，因此水源和处理方式本身可能不是导致 CKD 的唯一风险因素。其次，尽管我们发现煮沸水与 CKD 发生概率之间存在负相关关系，但推广煮沸水的公共政策运动是否是一个恰当的应对措施尚不清楚。第三，需要更好地了解深水井和浅水井水的水化学性质，以便阐明深水井水与疾病状况之间的正相关关系，以及为什么煮沸浅水井水而不是深水井水与 CKD 发生概率较低有关。第四，需要更深入地了解其他风险因素和提供家庭饮用水替代水源的预防计划的效果。
