Drinking Water and CKD of Unknown Etiology in Sri Lanka: A Community Perspective.

People's belief that polluted drinking water is the principal medium through which environmental toxins are absorbed into the bodies of CKD of unknown etiology (CKDu) patients in the CKDu-endemic areas in Sri Lanka has been the subject of extensive epidemiological and medical research. This study examines (a) the people's perception and experience that polluted drinking water is the cause of CKDu, (b) how the government responded to people's demands for potable water, and (c) the impact of the use of alternative drinking water sources on the health of CKDu patients and their families, and on the progression of the disease in CKDu patients. Data were collected in 2013 and 2019 in Anuradhapura and Polonnaruwa districts in North Central Province of Sri Lanka. People's agitation, activism, and lobbying, together with the media's work in bringing the issue of polluted water to the forefront of political discourse, have prompted the government, private sector agencies, and community organizations to supply clean water to affected communities. A massive change in drinking water behaviors has occurred following the government's decision to supply reverse osmosis (RO) water to the affected communities. Informants perceived the provision of RO water as having brought about many positive outcomes in the health and disease progression of CKDu patients.

Drinking water and chronic kidney disease of unknown aetiology in Anuradhapura, Sri Lanka.

This paper examines how people in Anuradhapura District in Sri Lanka affected by endemic chronic kidney disease of unknown aetiology (CKDu) explain the factors causing the illness and their cultural meanings. The research found that the issue of contaminated water raised by the local community and the cultural meaning of water have influenced the government policy, health programmes, research agendas and the work of the media. Media reports on sociocultural, biomedical and epidemiological research into the aetiology of kidney disease have strengthened the perspective of the villagers who believe that polluted water has a direct relationship to kidney disease. This new understanding among villagers in Anuradhapura District has led to changes in their behaviours relating to the use and consumption of water, an important factor that has reinforced existing social hierarchies.

Bio-media Citizenship and Chronic Kidney Disease of Unknown Etiology in Sri Lanka.

In this article, I examine the crucial role of the biomedical industry, epidemiological and biomedical research, and the media in forming attitudes to and the understanding of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Local conceptions of CKDu have been shaped by the circulation in the media of epidemiological research findings pertaining to the disease, biomedical interventions in the management of the disease in hospitals and clinics, community programs involving mass blood surveys and the testing of well water, and local food and health education programs carried out through village health committees. This process of circulation I identify as bio-media citizenship.

Structural violence and chronic kidney disease of unknown etiology in Sri Lanka.

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.