title: Sociocultural aspects of arsenicosis in Bangladesh: community perspective.
abstract: This was a cross-sectional study under taken to explore the socioeconomic perspective of the arsenicosis problem, carried out in arsenic contaminated Upazillas where at least 100 arsenicosis patients had been identified. Two of the Upazillas with significant arsenic mitigation intervention and three of the Upazillas with limited interventions were selected for the study. Seven hundred fifty respondents were included in the study from 25 villages of the 5 Upazillas. Arsenicosis became a serious problem for the affected communities. Majority (71.31%) of respondents obtained their drinking water from tubewells, almost one third (29%) of the respondents still knowingly using arsenic contaminated water. Primary reason identified for this practice was distance of safe water source. Majority (58.6%) of the respondents said to face economic and 17.9% said to face social problem of varied range. Patients of lower income group were particularly more likely to face economic problems (P< .001) as well as social problem (P< .01). About half (50.7%) of the arsenicosis patients faced difficulty whilst receiving treatment, particularly female patients were more likely to face problem than male (P< .05). Several concerns also were surfaced regarding the heath care service provider particularly to the women patients, some of which are: long waiting time for receiving treatment (15%), discrimination in service delivery (10.7%) and inadequate separate facility for female patients (14.3%). Moreover the issues of financial burden raised by the respondents seem to have emerged as significant in terms of health care access. Access to Health service was particularly difficult for poor patients, as they often had to face problems associated with accessing service like, non availability of medicines in the hospitals (50.7%), traveling long distance (26.7%), purchasing medicine in most cases (32.4%) etc. Their dissatisfaction was compounded by negligent behavior of health care staff and nature of treatment provided. Furthermore length of time needed for reversal of symptoms led to loosing faith on efficacy of treatment, which cascades to negligence of patient's part in seeking health care. Women are less likely to get treatment for arsenicosis than men (P< .01). As there appear to be specific difficulties for women particularly for poor women in accessing health care, social and cultural values make it difficult for them to attend to their own health needs and to travel to service providers. Study findings suggest that a significant proportion (79.9%) of arsenicosis patient was found to access alternative health care. This includes; Homeopath, village doctors, Kabiraj and local pharmacists. Respondents in high intervention Upazillas were significantly more likely to get treatment (P< .05), to face fewer problems and to be satisfied with the facility (P< .001). Provision of safe water options, periodic screening of water source for arsenic, availability of trained doctor, regular availability of medicine, doorstep treatment, follow up on severe patients were the suggestions came from community for improvement.
authors.affiliation: Department of Occupational and Environmental Health, NIPSOM, Dhaka, Bangladesh. anon@bdcom.com
authors.forename: Sheikh A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Muhammad H S
authors.initials: MH
authors.lastname: Sayed
authors.forename: Manzurul H
authors.initials: MH
authors.lastname: Khan
authors.forename: Muhammad N
authors.initials: MN
authors.lastname: Karim
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Haque
authors.forename: Mohammad S A
authors.initials: MS
authors.lastname: Bhuiyan
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Rahman
authors.forename: Mahmud H
authors.initials: MH
authors.lastname: Faruquee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001151:Arsenic / Q000032:analysis*; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004784:Environmental Monitoring / Q000191:economics / Q000706:statistics & numerical data; D062665:Epidemiological Monitoring; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006801:Humans; D007642:Keratosis / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008548:Melanosis / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D012959:Socioeconomic Factors; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000506:poisoning*
chemical_list: D014874:Water Pollutants, Chemical; D001151:Arsenic