Abstract
Millions of villagers in Bangladesh are exposed to arsenic by drinking contaminated water from private wells. Testing for arsenic can encourage switching from unsafe wells to safer sources. This study describes results from a cluster randomized controlled trial conducted in 112 villages in Bangladesh to evaluate the effectiveness of different test selling schemes at inducing switching from unsafe wells. At a price of about US0.60, only one in four households purchased a test. Sales were not increased by informal inter-household agreements to share water from wells found to be safe, or by visual reminders of well status in the form of metal placards mounted on the well pump. However, switching away from unsafe wells almost doubled in response to agreements or placards relative to the one in three proportion of households that switched away from an unsafe well with simple individual sales.
Highlights
Poor health stands out as a common feature of life in less developed countries (LDCs)
Recall that treatment was stratified by the prevalence of unsafe wells based on Bangladesh Arsenic Mitigation and Water Supply Program (BAMWSP) data and by union
It is possible that switchers from unsafe wells in B started drinking water from wells safer than the original one, but that in C switchers were almost twice as likely as in B to change to a safe well suggests that the placards played a role in allowing better choices
Summary
Poor health stands out as a common feature of life in less developed countries (LDCs). Several studies have documented switching rates from an unsafe to a safe well after testing of between one-third and three-quarters, with higher switching rates in trials that provided information campaigns on arsenic health risks and repeat visits, in some cases with objective measures of exposure taken in the form of urine samples (Chen et al 2007; Madajewicz et al 2007; Opar et al 2007; George et al 2012; Bennear et al 2013; Balasubramanya et al 2014; Inauen et al 2014; Pfaff et al 2017) Despite these partial successes, a substantial fraction of households continues to use unsafe wells today and it is important to identify mechanisms to increase riskmitigating responses.
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