Economic Impacts of Chronic Kidney Disease (CKD) on

1
Economic Impacts of Chronic Kidney Disease (CKD)
on Paddy Farming Community in Anuradhapura
District of Sri Lanka
By Amaranayake, P.W.P. Department of
Agricultural Systems Faculty of
Agriculture Rajarata University of Sri Lanka
2
Introduction

• Chronic Kidney Disease (CKD)
• Condition in which the kidney function gradually
  declines until the kidneys are unable to filter
  waste from the body and maintain the proper
  balance of water and chemicals.
• 200 in every one million of the population in Sri
  Lanka, are afflicted with renal failure.
• Proportion is much higher in North Central
  Province - emerging health scourge
• Around 80 of cases from Anuradhapura district .
• 1st leading cause of death in Anuradhapura
  district
• Worrying increase of CKD in certain DS divisions

3
Prevalence of CKD cases in the NCP
Year No. of CKD cases in NCP No. of CKD cases in Sri Lanka of CKD cases in NCP out of total Sri Lanka
1996 921 5475 16.8
1997 1029 4827 21.3
1998 1390 5526 25.1
1999 1608 6194 25.9
2000 1699 5841 29.1
Source Epidemiological Unit, Colombo
Dissanayake W.
4

• Cases of CKD by districts in NCP
  1996-2003(Cases/Deaths)

Year Anuradhapura Polonnaruwa Sri Lanka
1999 1267/167 341/47 6194/1095
2000 1354/202 345/39 5841/1035
2001 1405/184 395/41 6113/1075
2002 858/137 390/52 6204/1150
2003 1098/143 291/55 6345/1170
Source Department of Health Services NCP
5
Number of CKD deaths in General Hospital
Anuradhapura from 1993 to 2002
Source Statistic division, renal clinic,
Anuradhapura
6
(General hospital, statistic division
,Anuradhapura ,2003)
7
Background of the Research problem

• Past researches on CKD mainly addressed on CKD
  of unknown etiology in Sri Lanka.
• Instances of economic Impact estimations on
  other Chronic diseases except CKD are available
  (In other countries).

8
Problem Statement

• CKD is a life threatening disease in Sri Lanka
  especially in North Central Province.
• Any of Economic impact analysis of CKD has not
  been conducted in Sri Lanka yet.
• Lack of scientific identification and estimation
  of economic burden of CKD and joint action for
  CKD prevention, from a perspective of agriculture
  and health are occurred.

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General Hypothesis
10
Specific hypotheses

• Presence of end stage CKD is likely to have
  negative impacts on natural socio-demographical
  pattern and economic performances of paddy
  farming community in Anuradhapura district.
• It may be adversely affect on family and
  exchange labor inputs, operated paddy extent,
  yield performances, income from paddy, farming
  system and labor migration.
• Prevalence of CKD likely to have association with
  source and nature of drinking water, type of
  materials used for drinking water storage and
  cooking ,habit of smoking, alcohol use and
  irrational behaviors in agrochemical use.

11
Hypothesis Statement
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Occupational distribution of CKD in Anuradhapura
district -2002
Category Number
Farmer 174 56.3
House wife 29 9.4
Laborer 15 4.9
Traders 05 1.6
Carpenters 05 1.6
Post man 03 1.0
Gramasewaka 02 0.6
Others 13 3.9
Missing data 63 20.4
Source Renal clinic, General Hospital
Anuradhapura -2002
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Age distribution of CKD in Anuradhapura district
-2002
Age Number
0 10 00 00.0
11 20 04 1.3
21 30 29 9.4
31 40 57 17.4
41 50 73 23.6
51 60 73 23.6
61 70 51 16.5
71 80 10 3.2
Data not available 12 3.9
Source Renal clinic GH Anuradhapura -2002
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• Objectives
• General objective
• To determine the economic impact of End stage
  CKD on paddy farming community in Anuradhapura
  district of Sri Lanka.
• Specific objectives
• To analyze the costs and returns of paddy farming
  for affected and non-affected samples.
• To compare the differences of costs and returns
  of paddy farming between two samples.
• To analyze the additional burden of hired labor
  due to CKD on affected paddy farmers.

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Methodology

• Study area
• Padaviya and Medawachchiya (high prevalence of
  CKD) DS divisions in Anuradhapura district.
• Data and sampling
• Cross sectional type data
• Pre tested structured questionnaire survey
• Random sampling
• Affected sample size 100
• Non affected sample 100

16
Map of the Anuradhapura district
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Analytical methods

• 01) Analysis of costs returns- (objective 01
  02)
• Main costs and returns of two samples were
  calculated for an hectare of cultivation.
• The difference between estimated mean values of
  main cost and returns of two samples were
  statistically compared for any significant
  difference.
• 02) Analysis of additional burden of hired labor
  -(objective 03)
• Additional cost of hired labor for the affected
  group was compared to that of the non affected
  ones.

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Results and discussion

• 01)Analysis of costs and returns for paddy Farming

Item Affected sample Non-affected sample
Total Cost (Excluding Imputed Cost for labor) (Rs/ha) 44037.79 40234.97
Average price per acre (Rs/kg) 14.12 14.62
Gross Income from Paddy (Rs/ha) 64255.78 68171.97
Net Income Excluding Imputed Cost for labor (Rs/ha) 20217.99 27937.00
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02) Comparison of differences of cost and return
values between two samples
Variable Z calculated Z table Significance
Cost of family and exchange labor input (man days/season/ ha) 13.197 1.96 Significant
Cost of hired labor input (man days/season/ ha) 8.582 1.96 Significant
Total Cost (Excluding Imputed Cost)(Rs/ha) 3.088 1.96 Significant
Net Income Excluding Imputed Cost (Rs/ha) 3.258 1.96 Significant
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03) Analysis of Additional burden of Hired labor
due to CKD on affected paddy farmers

• The additional hired labor requirement for a
  affected farmer 11. 01 man days/ha
• Average additional burden of hired labor
  Rs 3734.40 Rs/ha/Farmer
• Additional burden of hired labor borne by the
  farmers who are affected by CKD
• Rs 2.84 millions per season
• (Rs 5.69 millions per year )
• Under estimation of severity of real burden due
  to limitations in the study

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Descriptive analysis

• a) Demographic characteristics

Majority of affected farmers, Male -
(97) Between 41- 60 age group - (76) 4-7
family members - (76) Married -
(87) Relatively less educated (1-5 years) -
(44)
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b) Information related to risk factors

• Majority of affected farmers
• - Use non-boiled and non-filtered well water
  as the main source of drinking water.
• - Use Al utensils for drinking water storage
  and cooking purposes.
• - Smokers and Alcohol users
• - Use more hired labor for agrochemical
  application after getting affected from CKD
• Majority of affected and non-affected farmers
• - Use agrochemicals for paddy farming.
• - Didnt use safety precaution in agrochemical
  application

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• Family, Exchange and hired labor inputs

Comparison of Family and Exchange and hired labor
inputs between affected and non-affected samples
24
Comparison of Family and Exchange and hired labor
inputs between affected and non-affected samples
25

• Operated and non operated paddy extents

Comparison of Operated non operated paddy
extents between affected and non-affected samples
26

• Labor migration after CKD

Comparison of Labor migration after CKD between
affected and non-affected samples
27
Comparison of yield and prices between affected
and non-affected samples

• Yield Performances

28

• Farming systems

Comparison of Farming systems between
non-affected and affected samples
Farming System Non affected Non affected Affected (Before CKD) Affected (Before CKD) Affected (After CKD) Affected (After CKD)
Farming System Number Number Number
Chena 36 36 47 47 4 4
Home gardening 68 68 61 61 39 39
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Conclusions

• Use of family and exchange labor was
  significantly less in the affected sample.
• Net income excluding imputed cost of labor of
  affected farmers was significantly less than the
  non-affected farmers.
• Value of additional burden of hired labor borne
  by the CKD affected farmers in selected DS
  divisions is Rs 2.84 millions/season.
• Presence of end stage CKD is negative impacts on
  the economic performance of the paddy farming
  community in the Anuradhapura district.

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Recommendations

• Implications to prevent CKD
• Entire population in the identified risky areas
  should undergo screening for a basic renal
  investigations.
• Community based awareness programs on CKD risk
  factors should be launched.
• Implication to increase the income from paddy
• Work out a system for encouraging use of
  exchange labor.
• 3. Implications to develop the household income
  and status
• Well organized counseling programs should be in
  place to advice and help affected farmers and
  other family members
• Home gardening should be promoted with the
  support of all family members and experiences of
  affected farmers.

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Limitations of the Research study

• Unavailability of well organized up dated
  computerized or at least a manual database.
• Difficulties in obtaining accurate facts in
  detail from end stage kidney disease patients
  since they do not keep records and suffering from
  illness.
• Time Budgetary constraints.
• Conventional objections, arguments and rules and
  regulations of some authorized people in related
  institutes as well as in farming community.
• Difficulties in contacting resource persons

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Suggestions for further research

• Further Research work to confirm the suspected
  causal factors, habits and behaviors for CKD
  (Unknown aetiology).
• Further analysis of role of hired, family and
  exchange labor inputs under the categories of
  men, women and children.
• Further research works to verify the link between
  occupation and CKD prevalence (occupational
  relationships).
• Research works which focus on the socio economic
  impact of CKD on farmers household income by
  considering all three fiscal costs.

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References

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34

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35
Acknowledgements

• Dr. Fredrick Abeyratne, Senior Programme Analyst,
  UNDP,Colombo.
• Miss. Sumali Dissanayake, Lecturer, Department of
  Agriculture, Faculty of Agriculture, Rajarata
  University of Sri Lanka,Anuradhapura.
• Mr. S. J. Herath,Department of Agricultur
  Economics and Business management, Faculty of
  Agriculture, University of Peradeniya.
• Mr. Y. M. Wickramasinghe ,Senior lecture,
  Department of Agriculture, Faculty of
  Agriculture, Rajarata University of Sri
  Lanka,Anuradhapura.
• Mr. A.M.J.B Adhikari ,Head of the Department of
  Agriculture, Faculty of Agriculture, Rajarata
  University of Sri Lanka,Anuradhapura.
• Dr. W.M. Palitha Bandara, Medical officer(
  Primary health), Officer of the PDHS (North
  Central Province), Anuradhapura.
• Dr. Navarathnasingam Janakan ,Consultant
  Epidemiologist , Epidemiological Unit/Ministry of
  Health,Colombo 10.
• Dr. Upul Karunarathne, Medical officer-
  Nephrology , Renal Care Research Centre,
  General hospital ,Anuradhapura.
• Dr. W. Athapaththu, P.D.H.S(NCP) , Office of
  PDHS,Anuraradhapura.

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• Mr. B.P.S. W. Pathirana, Assistant Director of
  Agriculture, Provincial Department of
  Agriculture, North Central province ,
  Anuradhapura.
• Dr. K.L.P.N. Samarawickrama, District Medical
  Officer ,District Hospital ,Medawachchiya.
• W.M. Karunarathna, Nursing officer, Renal Clinic
  In charge, District Hospital , Medawachchiya.
• Dr. Mahinda Uyangoda, District Medical Officer,
  District Hospital,Padaviya.
• H.G.Nimal Jayasinghe, Nursing officer, Renal
  Clinic In charge, District Hospital , Padaviya
• Mr. H.C.N.Darmapala ,Assisit. Divisional
  secretary , Medawachchiya DS office ,
  Medawachchiya.
• Mr. M.Samarathunga, Assist agriculture research
  officer ,Walpolagama.
• Mr. Nimal Abeysinghe, Assist. agriculture
  research officer , Kadawathgama.

37
Thank you.