title: Structural violence and chronic kidney disease of unknown etiology in Sri Lanka.
abstract: Research published on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka has been undertaken largely from biomedical and epidemiological perspectives. The main objective of these studies has been to identify the etiology of the disease, which affects as much as 15-21% of the population in some regions and is associated with kidney failure. Few studies have sought to address how CKDu is socially and behaviorally situated in the affected districts. The present study, informed by structural violence theory, utilized a mixed-method approach that analyzed primary and secondary data for Medawachchiya District Secretariat Division in Anuradhapura District for 2010 and 2015, and examined CKDu as a manifestation of social inequality and exclusion and the creation of a marginalized group of agricultural laborers. Data include historical analyses, a case-control study, ecologic analysis of features of communities and CKDu prevalence, and direct observations and interviews with people in affected communities. In 2010, the most important factor associated with CKDu was private dug wells that were used for supplying water to homes. In 2015, when the number of patients had increased, CKDu was more closely linked to occupation, especially male wage labor. The male wage laborer, being the poorest of the poor, has become a particularly vulnerable social category in agricultural settlements in Medawachchiya. The co-occurrence of this social category and CKDu can be regarded as unintended consequences of the official agricultural colonization policy that started during British colonial times and has continued since independence.
authors.affiliation: Department of Behavioral and Community Health Sciences, Pitt Public Health, University of Pittsburgh, United States. Electronic address: deSilva.Amarasiri@pitt.edu.
authors.forename: M W Amarasiri
authors.initials: MW
authors.lastname: de Silva
authors.affiliation: Department of Behavioral and Community Health Sciences, Pitt Public Health, University of Pittsburgh, United States. Electronic address: smalbert@pitt.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albert
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kotelawala Defense University, Sri Lanka. Electronic address: kbjayasekara@gmail.com.
authors.forename: J M K B
authors.initials: JM
authors.lastname: Jayasekara
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D060766:Drinking Water / Q000009:adverse effects / Q000592:standards; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology; D060986:Water Wells
chemical_list: D060766:Drinking Water
keywords: Agricultural colonization; Chronic kidney disease; Epidemiology; Medical anthropology; Multimethod research; Structural violence; Wage labor