Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use

Balasubramanya, S.; Stifel, David C.; Kafle, K.; Horbulyk, T.

Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use

Abstract

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.

Title	Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use
Creator	Balasubramanya, S.
	Stifel, David C.
	Kafle, K.
	Horbulyk, T.
Publisher	Economics and Human Biology
Academic Department	Economics
Division	Social Sciences
Organization	Lafayette College
Date Issued	2020
Date Available	2020-02-24
Type	Article
Language	English
Keyword	Chronic kidney disease
	Drinking water
	Sri Lanka
	Past behaviors
	Agrochemicals
Bibliographic Citation	Balasubramanya, S., et al. (2020) "Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use." Economics and Human Biology 37: 100862.
Standard Identifier	DOI 10.1016/j.ehb.2020.100862
Standard Identifier	Handle 10385/pk02cb25z
Permalink	http://hdl.handle.net/10385/pk02cb25z
Rights Statement	Creative Commons - Attribution
Rights Holders	Balasubramanya, S.
	Stifel, David C.
	Kafle, K.
	Horbulyk, T.