Water pollution, social construction of risk and household burden of disease: A case study of water use and abatement measures in Kampala, Uganda
Batega, Dauda Waiswa
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Water development interventions that aim at increasing access to safe water should out of necessity work out the interconnected components of human behaviour that eventually leverage the adoption of improved technology options. This is the central place of the social constructions of water safety and risk in addition to structural variable considerations in influencing choice of water source, use and adoption of abatement measures. The study was carried out in two divisions within Kampala City where 594 household respondents were interviewed and of these, 41.8 percent were from Nakawa Division, and 58.2 percent in Makindye Division. One adult respondent responsible for making decisions about water collection in each household was interviewed. Eight community focus group discussions (FGDs) and 19 key informant interviews (KIIs) were carried out, in addition to secondary sources review. A combined design involving household cross-sectional survey, qualitative methodologies, water source social mapping and water quality assessment was adopted. The study employed the cultural theory of risk perception and social constructionism in order to understand and assess exposure to water pollution, choice of water source and water use, household abatement and mitigation practices, and the related household Burden of Disease (BOD) in Kampala City, Uganda. The cultural theory of risk perception emphasises that the way people perceive and define risks associated with particular behaviour or service determines their likelihood to take precaution or avert such situations through adoption of mitigation and abatement measures. A critical aspect of social constructionism that informed this study was the end-users’ social definition of risk or lack of it in relation to choice of water source and use, and adoption of abatement and mitigation practices. The study findings indicate that the social constructions of water safety and risk influenced water use and adoption of mitigation and abatement measurers. There was an observed simultaneous use of water sources including unsafe ones. There was also an observed contested relationship between the water safety experts’ recommendations and end-users’ views in relation to the use of water from different water sources, including relatively unsafe sources. Tap water was appreciated more for its convenience and less for the health and economic benefits associated with its technological superiority. Community members reconstructed public health recommendations regarding abatement into risk factors, and continued using water from other relatively unsafe water sources such as unprotected springs, protected springs and Lake Victoria. Water safety was also socially defined in retrospective interactive relations with the water source, and if there were no imputation of disease outcomes associated with the water source, then the water source was regarded as free of putative harm attributions. Seasonality, clarity and aroma were important constructs of safety or lack of it. Particles in and change of colour of relatively safe piped water and routine chemical treatment of tap water were socially defined in putative harm dimensions and influenced choice of water source, use and adoption of abatement measures. For community members using lake water, water from a little distance inside the lake was perceived to be more ‘pure’ (matuukuvu) and therefore safer. Lake water drawn in the morning was also regarded as relatively safer “when the lake was still “peaceful” in reference to the ‘more settled nature of the water source’ at that time. Lake water harvest and abatement practices were not in tandem with recommended abatement practices for water prone to harmful algal blooms (HABs). Community members did not easily link the growth of HABs around Lake Victoria to possible contamination of water and fish that could translate up into the food chain. There is a mismatch between the level of community knowledge about HABs and the increasing leisure and recreational activities along Ggaba, Salaama and Munyonyo shorelines along Lake Victoria. The burden of disease (BOD) was related to type of water source, sanitation practices and abatement practices. Some of the abatement practices were influenced by social constructions about water safety and risk. The BOD affected the Women and children more than men. The current water and sanitation (WATSAN) policy frameworks in Kampala City are skewed towards water provision hardware with relatively little emphasis on software and sanitation; and are therefore not sufficient to constitute an effective and enabling policy environment to comprehensively meet the safe water needs – including the software for urban areas like Kampala City. This study concludes that improving access to safe water sources through the expansion of tap water systems and price regulation is essential but not sufficient without addressing the embedded nature of community social constructions of water safety. Public health information about water safety improvement should be built and considered within the multi-dimensional ways in which issues of water safety and risk are socially constructed within the local context. From a public health perspective, there is urgent need to develop and make known safety guidelines for lake water use including recreational waters. At a strategic level, there is also urgent need to step up efforts to monitor and control drivers of water pollution on Lake Victoria that lead to eutrophication and nutrient loading into the lake; otherwise fish consumption will soon translate into a silent pathway for several of the health conditions associated with HABs. There is need for strategic policy and legislative interventions that promote security of tenure through programmes like systematic demarcations. Therefore, the pathways for expansion of access to safe water technologies must out of necessity be triple carriageways that include improving access to safe water, proper sanitation facilities and relevant communication for desired abatement behaviours at household and community level. Therefore, out of the study findings and in relation to theoretical import and reflection, a fine approach to enhance the holistic understanding of water use dynamics and abatement and mitigation measures is to adopt integration theory that builds upon the relative strengths of relativism and interpretivism represented by social constructionism and the social construction of technology on one hand, and the geo-physical and economic conventional variable explanations akin to the structural perspectives on the other hand. This is because the integration model emphasizes interdependence in sociological inquiry; a structural approach to understand how society structural factors influence access to safe water; a macro-subjective approach to understand how habitualised values about water safety and risk influence water choice and abatement practice; and a micro-objective-subjective approach to understand the influence of pattern of water users behaviour in respect to water source and use, and the individual perceptions about water safety and risk.