1.
Matlab Observatory,
Bangladesh
Dr. Md. Sirajul Islam
Emeritus Scientist, icddr,b

2.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Matlab Observatory: Objectives
To investigate:
1. The impact of water quality on diarrhoeal incidence
2. How diarrheal diseases affect household wealth
3. The effect of diarrhea-related expenditure on the household
economic burden
4. The impact of water, sanitation and hygiene practices on diarrhea
5. How these factors (water quality, WASH, diarrhea) are ultimately
related to poverty

3.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Matlab Observatory
• Complex links between different variables
– Water quality
– Health (diarrhea)
– Hygiene behavior.
– Poverty

4.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Study area: Matlab HDSS
• The world’s longest running health
project in a developing country:
Health and demographic surveillance
system
• Population 230,185
• 142 villages (184.4 sq. km)
• Meghna-Dhonagoda embankment:
Inside-outside socio-demographic
disparity
• 10 villages chosen to cover the range
of drinking water practice, distributed
inside and outside embankment and
across all wealth quintiles

5.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Survey and microbiological analysis
of water
• Baseline survey: Household demographics, WASH practices, and
socioeconomic status
• Bimonthly survey: diarrheal incidence and related expenditure
• Seasonal survey (Summer, Rainy season, Winter): Water source,
storage, use, and handwashing among household members
• Microbiology: Source and point-of-use water from 10% of the study
households analyzed for microbiological contamination (fecal
coliform and enterococci)

6.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Results
• Diarrheal incidence seen most among the
women, the children (<5), and the poor
• 76% relied on shallow tube-well as source
of drinking water, 16% on deep tube-well,
and 5% on piped water supply

7.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Very high levels of point-of use contamination,
relatively low contamination in source
0
10
20
30
40
50
60
70
80
No contamination Low risk Medium risk High risk Very high risk
Source contamination (%) POU contamination (%)
Effect of water quality on diarrhoea
Water
contamination risk
category
Base category
(no risk)
Low risk Medium risk High risk Very high risk
Co-efficient (log10) - 0.42 0.22 0.10 0.31
p-value - < 0.05 > 0.05 > 0.05 ~ 0.05

8.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Contamination of household water
in different wealth quintiles
No cfu/ml
1-10 cfu
11-100 cfu
101-1000
>1000
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
Poor 2 3 4 Rich
No cfu/ml 1-10 cfu 11-100 cfu 101-1000 >1000

9.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Diarrheal morbidity is linked to
wealth at three levels
• Water quality
• Logistic regression analysis on our data show that with the
increase of wealth quintile, the level of point-of-use water
contamination decreases
• The effect is seen to be most drastic in the case of the change
from wealth quintile 1 (poorest) to the immediately higher
quintile.

10.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
‘Expensive’ (costing >BDT 200)
diarrheal episodes are seen only in
the higher wealth quintiles
0.00
10.00
20.00
30.00
40.00
50.00
Poor 2 3 4 Rich
Expenditure below BDT 200 by wealth
quintiles
0 taka 1-50 taka 51-100 taka 101-200 taka
0.00
2.00
4.00
6.00
8.00
Poor 2 3 4 Rich
Expenditure above BDT 200 by
wealth quintiles
201-400 taka 401-800 taka >800 taka

11.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Diarrheal morbidity is linked to
wealth (contd.)
• Diarrheal morbidity
• Diarrheal morbidity is significantly associated with the poorest
wealth quintile (p < 0.05)
• Diarrhea-related expenditure
• An increase in wealth quintile was found to have an effect on
diarrheal expenditure.

12.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Inferences
• Groundwater aquifers are generally of
excellent microbiological quality, which
explains the relatively low count in source
water
• However, our results indicate high levels of
secondary contamination has taken place,
despite the sources being improved

13.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Key finding: The link between
diarrhea and poverty
• Poverty impacts diarrheal at three levels:
– Water quality (the cause of diarrheal morbidity)
– Diarrhoeal incidence
– Diarrhea-related expenditure (the economic effect of diarrheal
morbidity)
• However, our results do not indicate a linear correlation between
diarrhea and poverty
• In all three cases- the effect of poverty is seen significantly and
disproportionately on the poorest, and the effect disappears in
the immediately higher quintiles

14.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Summary

15.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Conclusions
• In order to improve water quality, hygiene education and
practices is a major point of intervention
• By ensuring safe water and providing hygiene education, it is
possible to reduce the economic burden especially on the
very poor
• This will have a positive impact on the livelihood and well-
being of the poor households

16.
REACH Water Security and Poverty Conference
27-29 March | Keble College, Oxford
Future Studies
• Detailed study with few villages to find out the critical
points for secondary contamination.
• Intervention studies to reduce the contamination of
the household stored water and see the impact on
poverty alleviation.
• How the chemical contamination influencing the water
quality and its effect on poverty in Bangladesh.

17.
Funded by: