Increasing awareness of arsenic in Bangladesh: lessons from a public education programme.

Experts are making a major effort to find technical solutions to the serious public health problems posed by arsenic in drinking water in Bangladesh, but public education strategies receive less systematic attention. This article presents the findings of a study evaluating the impact of a 1999 campaign by the 18 District Towns Project to educate the public about the arsenic problem in six Bangladesh towns, where half of the population was estimated to be using arsenic-contaminated domestic water: (1). Water users were advised not to consume arsenic-affected tube-well water; (2). A simple, temporary water treatment method was recommended for those using such water, if they had no safe alternative source; (3). Caretakers of tube-wells having arsenic-free water were advised to share their water sources with others. This evaluation study, utilizing a combination of quantitative and qualitative social research methods, found those influenced by the programme to have higher awareness levels and significantly lower levels of risk behaviour than others. Yet more than half of the at-risk, programme-influenced survey respondents were found still to be drinking (57%) or cooking with (54%) arsenic-affected water. Despite the fact that the campaign did not have a satisfactory public health impact, the experience can inform future efforts to educate the Bangladeshi public about arsenic. One finding is widespread confusion about trusted tube-well water being newly labelled as 'unsafe'. Some think the problem is in the hand pumps themselves. Awareness of life threatening danger from arsenic contamination was found to be low. Learning points from this experience are: the value of explaining together with water testing; giving people opportunities to ask questions; repeating messages; continuing to educate children about the serious risks of consuming surface water; conducting community-wide education programmes for people of all ages; and evaluating the impact of specific public education strategies. Respecting such principles in public information campaigns will greatly help the public to benefit from future technical developments.