Relationship of Waterborne Disease with Source of water and Sanitation facilities in Flood-affected & River Erosion Areas of Noakhali

Page | 1 Relationship of Waterborne Disease with Source of water and Sanitation Facilities in Flood-affected & River Erosion Areas of Noakhali Page | 2 Table of Content Title Page 1 Abstract Page 5 Chapter One: Introduction Page 6-10 1.1 Background of the Study Page 6 1.2 Statement of the Problem Page 7 1.3 Justification of the Study Page 7 1.4 Objective Page 8 1.4.1 General Objective Page 8 1.4.2 Specific Objective Page 8 1.5 Operational Definition Page 9 1.6 Limitation of the Study Page 9 1.7 Ethical Consideration Page 9 Chapter Two: Literature Review Page 11-13 Chapter Three: Data and Methodology Page 14-18 3.1 Introduction to Data and Methodology Page 14 3.2 Type of Data Page 14 3.3 Study Area Page 14 3.4 Geography of the Area Page 14 3.5 Study Population Page 15 3.6 Sample Design and Sample Size Page 15 3.6.1 Sampling Techniques Page 15 3.6.2 Sample Size Page 16 3.7 Field Study and Tool Development Page 16 3.8 Preparation of the Questionnaire Page 16 3.8.1 Pilot Survey Page 17 3.8.2 Data Collection Page 17 3.9 Data Processing Page 17 Page | 3 3.9.1 Editing and Coding Page 17 3.9.2 Computerization Page 18 3.10 Selection of Variable Page 18 3.10.1 Dependent Variable Page 18 3.10.2 Independent Variable Page 18 3.11 Statistical Analysis Page 18 Chapter Four: Findings Page 19-32 4.1 Demographic and Socio-economic Characteristics Page 19 4.2 Water Source and Use Page 20 4.3 Overview of Sanitation Facilities and Their Uses Practice Page 23 4.4 Hygiene Practice Page 25 4.5 Impact of Flood and River Erosion Page 28 4.6 Prevalence and Management of Waterborne Disease Page 29 4.7 Association Between Waterborne Disease and Independent Variables Page 32 Chapter Five: Discussion and Limitation Page 35-38 Chapter Six: Recommendation Page 39 Chapter Seven: Conclusion Page 40 Reference Page 41-44 Figure One: Map of Companigonj Upazila Page 15 Table One: Demographic and Socio-Economic Characteristics Page 19 Table Two: Water Source and Use Page 20 Graph One: Source of Water Page 21 Graph Two: Treatment of Water Page 22 Table Three: Overview of Sanitation Facilities and Their Uses Practice Page 23 Graph Three: Type of Toilet Page 24 Table Four: Hygiene Practice Page 25 Chart One: Bar Chart for Handwashing Habit Page 26 Graph Four: Household Waste Disposal Page 27 Table Five: Impact of Flood and River Erosion Page 28 Table Six: Prevalence and Management of Waterborne Disease Page 29 Page | 4 Table Seven: Association Between Waterborne Disease and Independent Variable Page 30 Page | 5 Abstract WASH practices are crucial for public health issue, but nearly 2 billion people lack access to safe drinking water and sanitation facilities globally. Natural disasters, such as floods, can disrupt WASH facilities, contaminate water sources, and influence hygiene practices, leading to increased water-borne diseases. The study investigates the link between WASH practices and waterborne disease prevalence in river erosion areas post-flood, identifying key risk factors and evaluating current practices and facilities. A cross-sectional quantitative study was conducted among 183 households in Companigonj Upazila from January 10 to January 14, 2025. Data were collected through structured interviews and analyzed using STATA to assess associations between water source usage, sanitation conditions, hygiene behaviors, and disease prevalence. The study shows that despite 96.7% of households using safe water for drinking, 80.3% rely on pond water for cooking, increasing disease transmission. Floods damaged 49.1% of toilets, leading 13.1% of households to open defecation. Poor hygiene practices were evident, with 78.7% not treating drinking water and 67.0% improperly disposing of waste. 56.3% reported at least one waterborne disease case, with 43.1% experiencing diarrhea, 12.0% dysentery, and 1.1% typhoid. Statistical analysis highlights significant associations between inadequate sanitation, floodinduced infrastructure damage, and the prevalence of waterborne diseases. The study underscores the urgent need for flood-resilient sanitation infrastructure, improved water treatment methods, and targeted behavioral change interventions to mitigate health risks in vulnerable areas. Keywords: WASH, waterborne diseases, sanitation, hygiene, flood-affected areas, river erosion, Noakhali, Bangladesh. Page | 6 Chapter One: Introduction 1.1 Background of The Study: Water, sanitation, and hygiene (WASH) practices are recognized as major determinants of public health. Access to clean water and proper sanitation facilities may significantly reduce the prevalence of waterborne diseases. According to the World Health Organization (WHO), nearly 2 billion people do not have access to safe drinking water worldwide and more than 4 billion do not have safe sanitation facilities(1 in 3 People Globally Do Not Have Access to Safe Drinking Water – UNICEF, WHO, 2025). This problem is more prevalent in natural disaster-prone regions such as floods, which have a significant impact on public health. Natural calamities like floods can disrupt WASH facilities, contaminate drinking water sources, and influence the basic hygiene practices of individuals who are affected by the disaster. Which may lead to an increased incidence of water-borne diseases like diarrhea, cholera, typhoid etc. Asia is in the most vulnerable state of natural calamities. Floods and other natural disasters are common events in this region. Regular occurrence of flood and other disaster significantly impact WASH facilities and practices of the people in this region. In rural and isolated areas, lack of proper facilities, and inadequate recovery process often result in public health problems as a consequence of natural disaster(Asia, Most at Risk for Natural Hazards, Most Vulnerable to Cyclones | PreventionWeb, 2025). Bangladesh, a riverine country, is highly susceptible to natural disasters like floods due to its low elevation from sea level and annual monsoons. This country experiences regular river erosion and flooding. Bangladesh is a densely populated country almost one-third of its population lives in flood-prone areas. It faces frequent problems of river erosion, flood, and climate migration, which eventually negatively impact WASH practices and the public health of the population(Outbreak Of Diseases After Flood | Check Spread of Waterborne Diseases in Flood-Hit Areas, 2025.; Risk of Disease Outbreak Rises as Bangladesh Floods Devastate Sanitation Infrastructure - Oxfam | Oxfam International, 2025.) Noakhali district, located in the southeastern part of Bangladesh, faces the dual challenges of river erosion and flooding throughout the year. Noakhali, one of the most vulnerable regions in the country, is significantly displaced due to erosion where communities lack access to drinking water, sanitation, and hygiene facilities. Flooding exacerbates these challenges as it contaminates water Page | 7 sources and increases the rate of waterborne diseases related to inadequate sanitation. Many communities in this district live in poverty, with limited health facilities and disaster response, making them more susceptible to the health impacts of poor WASH practices(Tusar et al., 2023). This study focuses on the impact of flood and river erosion-prone area-associated WASH practices on getting infected with waterborne diseases in Noakhali. The report examines the impact of current WASH practices and what happened next, focuses on the relationship between environmental disasters, public health issues, and WASH infrastructure, and tries to develop new disaster preparedness strategies. 1.2 Statement of the Problem Flood and River erosion-prone areas in Bangladesh, particularly in Noakhali District, are plagued by inadequate access to safe water, sanitation, and hygiene facilities. These disasters damage WASH infrastructure, leaving communities vulnerable to waterborne diseases like cholera, typhoid, and dysentery. These recurring disasters undermine long-term WASH interventions, causing displaced populations to live without reliable access, and increasing the risk of disease outbreaks. Flood-prone areas are still vulnerable to environmental disasters due to the loss of water sources and sanitation facilities. There is limited literature linking disaster-induced WASH challenges to disease burden in flood-affected regions. This Research is to assess WASH practices and the causal factors of the problem(As Floodwater Recedes, Diseases Spread | The Daily Star, 2025; Contaminated Water Endangers People’s Health Following Floods in Bangladesh - Bangladesh | ReliefWeb, 2025; Situational Overview of Noakhali District - Eastern Flash Floods 2024 (28 October 2024) - Bangladesh | ReliefWeb, 2025). 1.3 Justification of the Study The study is significant because few there are only a few studies have explored how river erosion and flooding affect WASH facilities and practices in Bangladesh, particularly in Noakhali. Most of the previous studies asses broader WASH challenges, but only a few of the studies address how both flood and river erosion has disrupted WASH practices and facilities in Noakhali. For example, Mou et al. (2023) identified the socioeconomic consequences of riverbank erosion in Chairman Ghat, Noakhali, but did not explore how it affected WASH infrastructure. Rahaman et Page | 8 al. (2020) also looked at waterlogging problems in southern Bangladesh, including Noakhali, but their emphasis was not particularly on WASH-related effects(Mou et al., 2023; Rahaman et al., 2020). This research on Water, Sanitation, and Hygiene (WASH) in the Noakhali district, affected by river erosion and flooding, offers unique insights into the relationship between these factors and waterborne diseases and sanitation issues. It has a conceptual impact by filling the knowledge gap. The research significance lies in the urgent need to improve WASH practices, rebuild disrupted WASH facilities, and decrease disease prevalence. The purpose of this study is to assess the impact of river erosion and flooding on WASH practices and facilities in Noakhali, Bangladesh, and to examine their relationship with waterborne disease prevalence. i. Public Health Issue: The study findings will have a potential say on the health burden in the population of river erosion and flood affected area ii. Policy and Planning: Findings from the study will support the development of policy to improve WASH practices and facilities and prevention of disease in the aftermath of a disaster. iii. Academic: This study will generate academic knowledge about WASH practices and facilities in the river erosion area of Bangladesh particularly Noakhali and identify determinants of the practice. 1.4 Objective The objectives of this research were divided into two-part headings: broad objectives and specific objectives. These objectives are the leading purposes of this study. 1.4.1 General Objective The main aim of the study is to investigate the relationship between WASH practices and the prevalence of waterborne diseases in river erosion areas following a recent flood, identifying key risk factors 1.4.2 Specific Objectives 1. To evaluate the current condition of water use, hygiene practices and sanitation facilities in the flood-affected river erosion area of Noakhali Page | 9 2. To describe the condition of post-flood water source and sanitation facilities in the floodaffected river erosion area of Noakhali 3. To identify post-flood waterborne disease prevalence in the flood-affected river erosion area of Noakhali. 4. To assess the association between sanitation facilities and water practices with the prevalence of waterborne diseases in the flood-affected river erosion area of Noakhali. 1.5 Operational Definition WASH: Water, Sanitation, and Hygiene, which refers to the key services and practices that ensure access to clean drinking water, safe sanitation facilities, and the promotion of good hygiene practices to prevent the spread of disease(Water Sanitation and Health, 2025). Waterborne Disease: Water-borne diseases are the ones caused by pathogenic microbes spread via contaminated water(Water-Borne Diseases, 2025). Flood-affected Areas: Areas that experience frequent flooding where water covers land areas which are usually dry(Flood-Prone Area Definition | Law Insider, 2025). River Erosion: The process by which riverbanks are broken away by continuous water flow(Types of Erosion - River Processes - AQA - GCSE Geography Revision - AQA - BBC Bitesize, 2025). 1.6 Limitations of the Study: “Every study has more or less limitation in regard to timing, cost and staffing” (Karon, 1971). In short, a limitation is any defect that has a negative effect on the findings of the study. They refer to a standard feature of any study. This study has some limitations too. This study was completed in a short amount of time with some close-ended questionnaire and a small sample size. The research requires sufficient time and financial support, but obtaining financial support as a student researcher is difficult. Besides, some of the respondents were not comfortable to talk. The area of the study was remote and transportation service was not adequate. 1.7 Ethical Consideration The ethical consideration is a crucial part of any research. Researchers must maintain the ethical issue during data collection, description, analysis as well as tabulation. In this study, research assured respondents security and promised them to secure their information. Researcher also Page | 16 waterborne disease in flood-affected river erosion areas. To perform the study convenient sampling techniques were applied, and data was collected from those who were available. 3.6.2 Sample Size The formula for calculating the sample size is: n= 𝑍2.𝑝 (1−𝑝) 𝑒2 Where: • n = Required sample size. • Z = At 95% confidence interval Z = 1.96 (value corresponding to the desired confidence level confidence). • p = Estimated Prevalence 0.5 (Estimated proportion of the population with the characteristic of interest). • e = 5% or 0.05 (Margin of error) n= 1.962.(0.5) (1−0.5) 0.052 The required sample size was 384 households. Data was collected from 183 households due to time and financial limitations(Cochran, 1977). 3.7 Field Study and Tools Development Field study and tool development are one of the most important research processes. The details of the field study and tools development are discussed below: 3.8 Preparation of the Questionnaire A proper questionnaire is crucial for the success of any research study. To achieve the objectives, a written questionnaire under the close supervision honorable supervisor. The questionnaire consists of thirty-two questions divided into six domains: • Demography Page | 17 • Water source and use • Sanitation • Hygiene Practice • Disruption of WASH facilities • Waterborne Diseases 3.8.1 Pilot Survey A pilot survey was conducted between 21-23 December 2024 to test the questionnaire, identifying challenges, estimating cost and time required. The questionnaire was edited after the pilot survey removing errors and inconsistent data. 3.8.2 Data Collection Data collection was conducted between the 10th to 14th of January 2025. Data was collected from the household Companigonj Upazila. Among the various methods of data collection, the direct interview method was used for collecting the data through a structured questionnaire. During data collection, the researcher explained to respondents about the scope, purpose, and benefits. The research assured respondents security and promised them to secure their information. To ensure accurate responses and eliminate irrelevant information each question was explained clearly to respondents. 3.9 Data Processing An important part of conducting research is processing collected data in a proper way. A computer application was used to data entry, analyze, and write the final report of the study. The steps of data processing and analysis are as follows: 3.9.1 Editing and Coding Editing data is the process of evaluating acquired raw data for errors and omissions and correcting them when possible. After data collection process was done, collected data were extensively edited.. Collected data were categorized into a small number of classes or categories to simplify the process. Unorganized data was categorized to identify patterns, trends. For example, education level was coded as 0=Illiterate 1=Primary 2=Secondary 3=Higer-secondary 4=Higher Page | 18 3.9.3 Computerization Data were processed on a computer after coding and editing. Microsoft Excel was used for data entry. The entire analysis of data was performed by a computer package named STATA MP 14.2. Microsoft Word was used for completing the research. 3.10 Selection of Variables A variable is defined as a characteristic that changes over time, place, and people. Numerous factors, including Income, Education, Source of water, Treatment method, Sanitation facilities, Handwashing habits, and Waterborne diseases were taken into account to conduct the study. The researcher carefully chose a subset of dependent and independent variables. 3.10.1 Dependent Variable In this study, several variables were considered to find association. For example, education level, income of the household, type of toilet used, source and treatment of drinking water, and so on. To establish a meaningful association, make the study more reliable, perform a binary logistic regression, and obtain answers to the research question prevalence of waterborne disease was chosen as a dependent variable. 3.10.2 Independent Variable In this study, several independent variables were chosen I. Socio-Demographic: Income, Education. II. WASH Practice: Source of water, Treatment method, Sanitation facilities. III. Environmental: Extent of damage to WASH facilities due to river erosion or flood. 3.11 Statistical Analysis To analyze the data several statistical tools were used and the most logical tool was selected which provided a realistic conclusion. The methodology applied for this study was: 1) Frequency distribution and percentage. 2) Data Visualization (Pie Chart, Bar Chart) 3) Bivariate distribution (Chi-Test) Page | 19 Chapter Four: Findings Frequency table is a process of organizing raw data in a tabular format. It is defined as a table where collected data for the research is arranged in a tabular format and classified into different classes. Graphical Representation is a process of data visualization of collected data to make trends, and patterns easy to understand. 4.1 Demographic and Socio-Economic Characteristics Characteristics Frequency Percentage Family Type Nuclear 124 67.7 Joint 59 32.3 Family Size Small (1-3) 18 9.8 Medium (4-6) 25 68.3 Large (7 or more) 40 21.8 Main Source of Income Agriculture 59 32.2 Job 44 24.0 Business 41 22.4 Others 39 21.3 Average Monthly Income 4000-12000 88 48.1 12001-20000 77 42.1 20001-30000 11 6.0 30001-50000 7 3.8 Education Level of Household Head Illiterate 46 25.1 Primary 61 33.3 Secondary 34 18.5 HigherSecondary 28 15.3 Higher 14 7.7 Table 1: Demographic and Socio-Economic Characteristics The table provides insights into the demographic and socio-economic characteristics of households. It includes family type, size, income sources, monthly income, and education levels. The majority of families are nuclear (67.7%) and medium-sized (68.3% have 4-6 members). Third Page | 20 of families (32.2%) e from agricultural. Other sources (21.3%), jobs (24.0%), businesses (22.4%), and other the sources (21.0%). Almost half of the families (48.1%) earn between 4000 and 12000 taka a month, and only 3.8% earn more than 30000 taka a month. The level of education is usually low; 25.1% of household heads is illiterate, and only 33.3% have finished primary school. The data shows that there are a lot of nuclear families, that household heads don't make a lot of money, and that they don't have a lot of schooling. 4.2 Water Source and Use Characteristics Frequency Percentage Primary Source of Drinking Water Tubewell 167 91.2 Tap/Supply 10 4.2 Pond/River 7 3.8 Others 0 0 Ownership of Drinking Water Source Private 107 41.3 Shared 76 58.4 Time to Bring Water <15 minutes 154 84.1 15-30 minutes 29 15.9 >30 minutes 0 0 Treatment of Drinking Water No Treatment 144 78.7 Filtration 23 12.8 Boil 16 8.7 Storage Facility Open Container 38 20.8 Covered Container 145 79.2 Table 2: Water Source and Use The table presents data on water sources and usage. Most people (91.2%) use tubewells for drinking water, while only a few rely on tap water (4.2%) or ponds/rivers (3.8%). About 58.4% share their drinking water source, while 41.3% have private access. Most people (84.1%) bring water in less than 15 minutes, and no one takes more than 30 minutes. 78.7% do not treat their drinking water, while some use filtration (12.8%) or boiling (8.7%). No one uses tablets. For storage, 79.2% use covered containers, while 20.8% store water in open containers. Page | 21 Graph 1: Source of Water The graph displays the water sources used by households. The source of drinking water used by households was merged into two categories, safe and unsafe. Water from tubewell and tap/supply was selected as safe and pond or other sources of drinking water were selected as unsafe sources of drinking water. It reveals that a significant majority, almost 96.7% of households rely on safe water, in contrast, a few rely on unsafe sources of water. Only 3.8% use unsafe water sources. This suggests that most people have access to safe water, with only a few depending on unsafe sources. It suggests that access to safe water is common in the whole population. However, the small proportion of the population still relying on unsafe water needs to be addressed to make safe water resources available and accessible to all. 96.17% 3.825% Safe Unsafe Page | 22 Graph 2: Treatment of Water The graph displays the treatment provided for drinking water. It reveals that 78.7% of households do not use any treatment for drinking water before using either purification, filtration or boiling the water. In contrast, one-fifth of the population, almost only 21.3% use any kind of treatment. This suggests that most people may have a lack of knowledge about safe water treatment. They do not know the importance of purification and filtration before use. Another factor behind not purification might be the lack of access to filtration facilities. The average monthly income of the respondents was around 13000tk, which might be a reason behind the lack of access to filtration facilities. Addressing these issues through a campaign programme can reduce the health burden and improve overall population health. 21.31% 78.69% Any Treatment No Treatment Page | 23 4.3 Overview of Sanitation Facilities and Their Usage Practices Characteristics Frequency Percentage Ownership of Toilet Used Private 144 78.6 Shared 39 21.4 Type of Toilet Used Flush Toilet 96 Pit Latrine with Slab 61 60.0 Pit Latrine without Slab 0 0 Raw/Hanging 27 14.7 Distance to Nearest Toilet Within Premises 122 66.6 <50 miters 49 26.7 >50 miters 10 5.4 Weekly 21 11.4 Monthly 68 37.1 Quarterly 80 43.7 Annually 14 7.6 Child Defection Facility Open Defection 6 8.1 Separate Raw Toilet 7 9.4 Uses a Pot 4 5.4 Uses Family Toilet 57 77.0 Table 3: Overview of Sanitation Facilities and Their Usage Practices The table provides insights into sanitation facilities and practices. The majority (78.6%) have private toilets, while 21.4% share them. Flush toilets (96 people) and pit latrines with slabs (61 people) are the most common, whereas 14.7% use raw or hanging toilets. About 66.6% have toilets within their homes, while others travel less than 50 meters (26.7%) or over 50 meters (5.4%) to access one. No one cleans toilets daily, but some clean them weekly (11.4%), monthly (37.1%), quarterly (43.7%), or annually (7.6%). Most children (77%) use family toilets, while a few uses open defecation (8.1%) or use separate raw toilets (9.4%). Page | 24 Graph 3: Type of Toilet The type of toilet used was merged into two categories, improved toiler and unimproved toilet. Flush toilets and pit latrines with slabs were levelled as improved toilets and raw/hanging or any other types of toilets were levelled as unimproved toilets. The graph displays the toilet facilities used by households. It reveals that 85.25% of households have access to improved toilets, while only 14.75% use unimproved toilets. This suggests that most people have access to better sanitation while a smaller number still rely on less developed toilet facilities. The prevalence of improved toilet use is slightly lower than data collected at the “Population and Housing Census 2022” for Companiganj Upazila, Noakhali. The prevalence for improved facility was around 90% in PHC 2022(Population and Housing Census 2022 MINISTRY OF PLANNING, 2024). 85.25% 14.75% Improved Unimporved Page | 25 4.4 Hygiene Practice Among People Characteristics Frequency Percentage Handwashing Before Eating No 0 0 Yes 183 100 Handwashing After Toilet Use No 0 0 Yes 183 100 Handwashing Before Cooking No 5 2.7 Yes 178 97.3 Handwashing Before Feeding a Child No 16 8.7 Yes 167 91.3 Handwashing After Taking Care of Sick People No 23 12.5 Yes 160 87.5 Handwashing After Touching Domestic Animals No 22 12.0 Yes 161 88.0 Handwashing Method Soap and Water 172 94.0 Ash and Water 11 6.0 Child Handwashing Before Eating and After Using Toilet Sometimes 4 2.1 Almost Always 64 35.0 Always 115 62.9 Washing Fruit and Vegetable Before Cooking Sometimes 0 0 Almost Always 47 25.7 Always 136 74.3 Water Source for Cleaning and Cooking Tubewell 36 19.7 Pond and Others 147 80.3 Household Waste Disposal Site Open Dumping 69 37.7 Burning 14 7.6 Pond/River/Cannel 24 13.1 Dustbin 76 41.5 Table 4: Hygiene Practice Page | 32 Characteristics Waterborne Disease χ² P-value Not Affected Affected Average Monthly Income 8000-16000 4 (5.0%) 40 (38.8%) 28.29 0.00* 16001-30000 49 (61.25%) 42 (40.8%) 30001-30000 27 (33.75%) 21 (20.7%) Education Level Illiterate 19 (23.75%) 27 (26.2%) 21.23 0.00* Primary 16 (20.0%) 45 (43.7%) Secondary 15(18.7%) 19 (18.45%) Higher19 (23.7%) 9 (8.7%) Higher 11(13.7%) 3 (2.9%) Source of Drinking Water Safe 79 (98.75%) (94.7%) 2.56 0.10 Unsafe 1 (1.25%) 6(5.8%) Treatment to Water No Treatment 60 (75.0%) 84(81.5 %) 1.15 0.28 Any Treatment 20 (25.0%) 19 (%) Type of Toilet Use Improved 75 (93.75%) 81(78.6%) 8.17 0.004* Unimproved 5 (6.25%) 22 (21.4%) Water for Cooking and Cleaning Safe 17 (21.25%) 19 (18.45%) 0.22 0.63 Unsafe 63 (78.75%) 84 (81.55%) Household Waste Disposal Proper 42 (52.5%) 34 (33.0%) 7.04 0.008* Improper 38 (47.5%) 69 (67.0%) Toilet Damaged Due to Flood Not Damaged 36 (45.0%) 32 (31.0%) 3.74 0.05* Damaged 44 (55.0%) 71 (69.0%) Toilet Damaged Due to River Erosion Not Damaged 70 (87.5%) 80 (77.7%) 8.49 0.08 Damaged 10 (12.5%) 23 (33.3%) Water Source Damaged Due to Flood Not Damaged 30 (%) 61 (59.2%) 8.49 0.004* Damaged 50 (62.5%) 42 (40.8%) Water Source Damaged Due to River Erosion Not Damaged 76 (95.0%) 97 (94.2%) 0.059 0.80 Damaged 4 (5.0%) 6 (5.83%) Table 7: Association Between Waterborne Diseases and Independent Variables N.B: * Indicates at 95% confidence interval value p-value (<0.05) is significant Page | 33 The table presents the association between waterborne diseases and various factors such as income, education level, water source, sanitation, and household practices. Here are the key findings: Average Monthly Income: The Table shows us the association between the dependent variable waterborne disease and the independent variable monthly income. To perform the chi-square test researcher categorized the numeric value of monthly income into three groups. Households with monthly incomes between 8000-16000 taka showed a significantly higher percentage of waterborne diseases (38.8%), with a p-value of 0.00, indicating a strong association. Education Level: The Table shows us the association between the dependent variable waterborne disease and the independent variable education level of the household head. To perform the chisquare test researcher categorized the level of education into five groups. Illiterate households had a higher percentage of waterborne diseases (26.2%) compared to those with higher education. The p-value of 0.00 suggests a significant relationship. Source of Drinking Water: The Table shows us the association between the dependent variable waterborne disease and the independent variable source of drinking water. To perform the chisquare test researcher merged the source of water into two groups, namely safe and unsafe. Safe Sources include Tubewell and Tap/Supply. Unsafe sources includes all other sources. There is a minimal association between waterborne diseases and the safety of drinking water, with a p-value of 0.10 indicating no significant relationship. Treatment of Water: The Table shows us the association between the dependent variable waterborne disease and the independent variable treatment of water. To perform the chi-square test researcher merged the source of water into two groups, namely a) no treatment and b) any treatment. No significant difference was found between treated and untreated water, as indicated by the p-value of 0.28. Type of Toilet Use: The Table shows us the association between the dependent variable waterborne disease and the independent variable toilet type. The researcher merged source of water into two groups, namely a) proper and b) improper. The proper type of toilet includes flush toilet and a pit latrine with a slab. The improper type consists of raw, hanging or pit latrines without slab. Page | 34 The use of improved toilets was linked to fewer cases of waterborne diseases, with a p-value of 0.004, showing a significant association. Water for Cooking and Cleaning: The Table shows us the association between the dependent variable waterborne disease and the independent variable cooking and cleaning water type. Safe water includes water from tubewell and rain. Unsafe water includes Ponds, River or any other source of water No significant relationship between the safety of water for cooking and cleaning and the prevalence of waterborne diseases, with a p-value of 0.63. Household Waste Disposal: The Table shows us the association between the dependent variable waterborne disease and the independent variable household waste disposal practice. Disposing into a designated dustbin indicates proper and safe disposal. While burning, open dumping or duping in pond/river/channel indicates improper disposal. Improper waste disposal was strongly associated with waterborne diseases, as seen with a p-value of 0.008. Toilet Facility Damage Due to Flood: The Table shows us the association between the dependent variable waterborne disease and the independent variable toilet facility damages due to flood. If the toilet was fully or partially damaged it goes into the damaged category otherwise in the notdamaged category. Households with damaged toilets due to flooding had more waterborne diseases, with a p-value of 0.05, indicating a moderate association. Toilet Facility Damage Due to River Erosion: The Table shows us the association between the dependent variable waterborne disease and the independent variable toilet facility damage due to river erosion. If the toilet was fully or partially damaged it goes into the damaged category otherwise in the not-damaged category. No significant association was found between toilet damage due to river erosion and waterborne diseases, with a p-value of 0.08. Water Source Damage Due to Flood: The Table shows us the association between the dependent variable waterborne disease and the independent variable damage to the water source due to flooding. Researcher categorized completely damaged or partially damaged as “Damaged” and fully functional. It was strongly linked to waterborne diseases, with a p-value of 0.004. Water Source Damage Due to River Erosion: No significant relationship was found between water source damage due to river erosion and waterborne diseases, with a p-value of 0.80 Page | 35 Chapter Five: Discussion and Limitations The objective of this study was to review water source use, sanitation practices and prevalence of waterborne diseases. These findings show us how households manage their water sources and how these arrangements impact health and well-being. Independent and dependent variable was chosen carefully for the study. In the study, the waterborne disease was the dependent and several other socio-demographic and WASH practices and facilities were the independent variable. A key finding of the study is that most households use two separate sources of water: one for drinking and one for cooking. 96.7% of households use safe water for drinking, but they prefer to use pond water most of the time for cooking. This indicates that although people are concerned about water safety, their perception of the safety of water used for cooking is somewhat lower, which may be due to limited safe water sources. This study also found that most people (91.2%) use tubewells for drinking water, and ponds/rivers (3.8%). These findings align with (M. Islam et al., 2017). M.Islam et al found that 88% of the population from river banks use tubewells for collecting their drinking water. But while using water for cooking, pond water is the primary source (80.3%). In terms of water treatment, 78.9% of households do not treat their water, which may be responsible for the outbreak of waterborne diseases. While(Jube Gore et al., 2021) found that in rural areas of South-Sudan, 66% of the community uses chlorine for drinking water treatment, 19% use boiling, 10% use filtration, and 5% do not know water treatment. Differences in study results may be due to a variety of factors, including differences in study populations, differences in data collection methods, or the influence of additional variables such as hygiene practices, sanitation infrastructure, and immune status. Despite safe water use, lack of treatment in cooking water and use of pond water can spread diseases.(Rana, 2010) found that water, sanitation, and hygiene (WASH) programs decreased the prevalence of waterborne diseases from 10% to 7% overall and among under-five children it reduced from 22% to 13% (p<0.001), which underlines that to reduce waterborne disease water, sanitation and hygiene intervention plays important role However, the association table shows that there is almost no association between water source or treatment and waterborne diseases. There was a minimal association between waterborne diseases and the safety of drinking water, with a p-value of 0.10 indicating no significant relationship. No significant difference was found between treated and untreated water, as indicated by the p-value of 0.28 Page | 36 The study findings indicate that sanitation has a significant impact on human health and the spread of waterborne diseases. Although most households use safe water for drinking, their sanitation practices are not hygienic, which plays a significant role in the spread of waterborne diseases. In terms of the use of improved toilets, 85.25% of households follow a hygienic sanitation system, but some households have damaged toilets due to floods or river erosion. Such infrastructural problems are hindering the improvement of proper sanitation systems and increasing the spread of diseases. The use of improved toilets was linked to fewer cases of waterborne diseases, with a pvalue of 0.004, showing a significant association. (John T. Watson et al., 2007) found similar result, the found Flooding contaminates drinking water sources, damages sanitation infrastructure, and displaces populations, forcing them to rely on unsafe water sources. Research has found that awareness about sanitation is directly related to the level of education. Uneducated households have lower levels of proper use of sanitation, which makes them more susceptible to water-borne diseases. Increasing education can help increase awareness about sanitation and help households develop healthy habits. Illiterate households had a higher percentage of waterborne diseases (26.2%) compared to those with higher education. The p-value of 0.00 suggests a significant relationship.(Azizur R. Molla, 1999)found that the level of education and prevalence of diarrhea has no significant association with a p-value of 0.744. However, another study has found that Children whose mothers have no formal education are more likely to experience diarrhea compared to those whose mothers have higher levels of education. For example, in Nigeria, the prevalence of diarrhea among children aged 0-24 months was 15.5% for children of women with no formal education, compared to 6.4% for those whose mothers had tertiary education(Desmennu et al., 2017). When floods hit, many families face problems accessing their toilets. Floods can damage or move toilets away from homes, making it impossible to defecate properly. In this situation, 69% of household faces deterioration of their toilets due to flood and 40.8% experienced disruption of water supply. In another study (Rafa et al., 2021) found that only 20% of the population had proper access to WASH2 facilities. Households with damaged toilets due to flooding had more waterborne diseases, with a p-value of 0.05, indicating a moderate association which was also found by (Rafa et al., 2021). Anotherstudy by (Ahmed, 2009) found that flood was the primary reason behind disruption of toilet. Page | 37 During floods, when it is not possible to use water sources, local people try to collect water in various ways. About 16.8% of households use safe water by boiling water, which helps prevent the spread of waterborne diseases. In addition, 46% of households collect water from distant places, which is the only way, although time-consuming. Some households are collecting rainwater and using it. It was strongly linked to waterborne diseases, with a p-value of 0.004. (Ahmed et al., 2020) had found that communities affected by river erosion often experience WASH infrastructure collapse, leading to increased exposure to contaminated water sources. However, no significant relationship was found in this study between water source damage due to river erosion and waterborne diseases, with a p-value of 0.80. A report by WHO revels that open defecation and improper waste disposal contribute to the spread of fecal-oral diseases. This study also found strong association between with a significant p-value of 0.008 (Progress on Household Drinking Water, Sanitation and Hygiene 2000-2020 Five Years into the SDGs, 2021) Poverty and waterborne diseases are strongly interconnected as found in this study. In 2016 Hutton & Chase found that many developing nations, access to safe drinking water depends on financial ability, forcing the poor to rely on unsafe water sources.(Hutton G & Chase C, 2016.) Limitations i. Cross-sectional studies collect data only at a specific point in time, which cannot assess any changes or continuity related to changes over time. As a result, the study did not allow for analysis of long-term trends or cause-and-effect relationships. ii. The study required a total of 384 samples to be collected, but only 183 samples were collected. This created data gaps and somewhat reduced the generalizability of the study results. iii. Due to late data collection, some important data or statistics may be missed, which may cause deficiencies in subsequent analysis. This gap has created some obstacles in presenting the research results completely and accurately. iv. The regression odds ratio was not used in the study, which limited the ability to analyze the relationship between different variables and their effects. Page | 38 v. The transportation system in the study area was not good, it took some time and effort to collect accurate data. In particular, it was difficult to reach the area at times due to the damage to roads and communication systems in the post-flood situation. vi. Due to the lack of adequate funding for the research, there were problems in procuring some of the necessary materials or equipment. Due to the lack of funds, it became difficult to make full arrangements for data collection and fieldwork. Page | 39 Chapter Six: Recommendation Based on this study, some recommendations have been made for the river erosion and floodaffected areas of the Noakhali district, which can help improve the health and livelihood of the local people: Improvement of sanitation system: Initiatives by the government and local authorities are necessary to improve the sanitation system in the flood-affected areas. Construction of new toilets, promotion of cleanliness and proper waste disposal system should be implemented. It is very important to install tubewells in local areas. In the current situation, due to the lack of safe water, people are using pond water, which is creating sanitation problems and spreading water-borne diseases. By providing tubewells, the local people will be able to get safe water, which will play an important role in protecting their health. Especially after floods, tubewells will act as a permanent source of water, which will help in dealing with the water crisis. For this, it is necessary to take measures to install and maintain tubewells at the initiative of the local government. Development of permanent water sources: Permanent and safe water sources must be created for this region so that there is no water shortage even after the floods. Arrangements should be made to install and maintain tubewells through local governments and other supporting organizations to ensure long-term water security. Increase sanitation awareness among the people: Training and awareness programs should be conducted among the local people on sanitation and safe water use. Raising public awareness for sanitation and safe water use is essential. Sanitation awareness should be raised through local community centers, schools, mosques and other social platforms. Training, workshops and awareness camps can educate the local population about the importance of safe water use. By instilling proper sanitation habits among the population, it will be possible to reduce the risk of waterborne diseases. If these recommendations are implemented, the risk of waterborne diseases for the people of Noakhali district will be greatly reduced and they will be able to lead a healthy life. The quality of life of the local people will be improved through the development of safe water supply and sanitation systems, post-flood health care systems, and increased awareness among the people. Page | 40 Chapter: Seven: Conclusion The objective of this study was to analyze the current situation of water, sanitation and hygiene (WASH) in Noakhali district, which has been affected by river erosion and floods, and to determine its relationship with waterborne diseases. According to the results of the study, most households use two different water sources: on the one hand, safe water used for drinking, and on the other hand, pond water used for cooking and other purposes. Although people use safe water only for drinking, the use of pond water for cooking is causing various sanitation-related problems, which has been identified as a major factor in the increase in the incidence of waterborne diseases. The most important finding of the study is that the outbreak of waterborne diseases is mainly due to the weakness of the sanitation system rather than the water source. According to our observations, the sanitation practices of the local population are not proper and there are serious problems with cleanliness and waste management. As a result, the pond water, which is usually used for cooking, can cause outbreaks of various diseases. In addition, the health situation in the area is getting worse due to the destruction of sanitation infrastructure in the post-flood situation. It is clear that ensuring the safety of water sources alone is not enough; waterborne diseases can be prevented by improving sanitation systems, healthy waste management, and increasing sanitation awareness among the population. Sanitation and hygiene activities should be accelerated after a flood or river erosion situation so that the population of the affected areas can be free from health risks. Page | 41 Reference 1 in 3 people globally do not have access to safe drinking water – UNICEF, WHO. (n.d.). Retrieved February 14, 2025, from https://www.who.int/news/item/1806-2019-1-in-3-people-globally-do-not-have-access-to-safe-drinking-waterunicef-who Ahmed, S. (2009). An Assessment of the Impacts of Floods on Sanitation in Rural Bangladesh. As floodwater recedes, diseases spread | The Daily Star. (n.d.). Retrieved February 19, 2025, from https://www.thedailystar.net/news/bangladesh/news/floodwater-recedesdiseases-spread-3691341 Asia, most at risk for natural hazards, most vulnerable to cyclones | PreventionWeb. (n.d.). Retrieved February 19, 2025, from https://www.preventionweb.net/news/asia-most-risk-natural-hazards-mostvulnerable-cyclones Azizur R. Molla. (n.d.). Pond Water Contamination And Incidence of Disease in Rural Bangladesh. Cochran, W. G. (1977). Sampling techniques (3rd ed.). Companiganj Upazila, Noakhali - Wikipedia. (n.d.). Retrieved February 16, 2025, from https://en.wikipedia.org/wiki/Companiganj_Upazila,_Noakhali Contaminated water endangers people’s health following floods in Bangladesh - Bangladesh | ReliefWeb. (n.d.). Retrieved February 19, 2025, from https://reliefweb.int/report/bangladesh/contaminated-water-endangers-peopleshealth-following-floods-bangladesh Desmennu, A. T., Oluwasanu, M. M., John-Akinola, Y. O., Opeyemi, O., & Ayo, A. S. (2017). Maternal education and diarrhea among children aged 0-24 months in Nigeria. African Journal of Reproductive Health, 21(3), 27–36. https://doi.org/10.29063/AJRH2017/V21I3.2 Elvis Fon, T., Atanga Mary, B. S., & Fonyuy Emmanuel, B. (2024). Emergency Preparedness for Waterborne Diseases in the Wake of Floods in Northern Cameroon: A Call for Immediate Action. International Journal of Science and Healthcare Research, 9(4), 23–29. https://doi.org/10.52403/ijshr.20240404 Page | 48 েমদ আপনার পমরিায়র স্বকউ পামনিামহত স্বরায়ে আক্রান্ত হয়ল, তায়দর মচমকৎসার জনয মকভায়ি িযিিা স্বনয়া হয়? ক. িানীয় মিমনক/হাসপাতাল ে. মচমকৎসক/পরািশথক ে. িামিয়ত মনয়জ মচমকৎসা ঘ. মচমকৎসা স্বনয়মন আপনার পমরিায়রর সদসযরা মক পামনিামহত স্বরায়ে আক্রান্ত হওয়ার পর পামন িযিহায়রর ধ্রন পমরিতথন কয়র র্ায়কন? ক. হযাাঁ, পামন ফ ুমিয়য় োওয়া ে. হযাাঁ, পামন মফল্টার িা পমরয়শাধ্ন কয়র িযিহার ে. হযাাঁ, নতুন স্বকায়না মনরাপদ পামন উৎস িযিহার ঘ. স্বকান পমরিতথন কমরমন