Preventing CKDu:Let’s act fast


A simple rainwater storage facility for a rural household

By Ranjit Mulleriyawa

Chronic Kidney Disease of Uncertain Origin (CKDu) is currently the most serious non communicable disease afflicting rural communities in many ‘dry zone’ districts in Sri Lanka. Most people living in CKDu endemic villages obtain their drinking water from open dug wells, where the water tends to contain high concentrations of Fluoride (2-4 ppm) and dissolved Calcium and Magnesium salts giving rise to the condition known as "hard water". There is widespread consensus among doctors and scientists that improving the quality of drinking water in these areas may prevent, or retard the progress of this kidney disease. This was recognized more than two years ago, but obtaining the required potable water continues to be an illusion for people in the affected areas.

The disease is also believed to be strongly linked to the life style of the people (mainly rice farmers). Long hours of work in the hot climate of the dry zone, and failing to drink enough water while engaged in field work, may result in serious dehydration leading to kidney damage, which is further aggravated by regular consumption of illicit liquor (Kassippu), cigarette smoking (indulged by male farmers) and frequent intake of highly potent painkillers for body aches and pains. Excessive fertilizer application, indiscriminate use and careless handling of pesticides may also be possible contributory factors towards the development of CKDu.

Despite all the above knowledge, our failure to address the relevant issues with a sense of urgency is causing the death of almost a thousand people each year island wide. Many times that number may be developing clinical symptoms of the disease and progressing towards end stage renal failure.

Conducive political climate

The new President of Sri Lanka hails from the North Central Province where CKDu is most severe. He is also a farmer’s son and has been a Minister of Health in the previous government. Thus, he understands the magnitude and gravity of the CKDu problem better than many others. It is also fortunate that the new Minister of Health happens to be a Doctor. There couldn’t be a more conducive climate for initiating urgent action designed to prevent CKDu.

What needs to be done?

Three main interventions are called for urgently. These are:

1. Provision of good quality drinking water to the rural population.

2. Health education.

3. Improving agricultural extension.


It is essential that the specific context of CKDu affected areas be considered in deciding appropriate interventions.

People in the disease affected areas are desperately poor. Their houses are widely scattered. The roads are dilapidated. Public services - transport, healthcare, sanitation, education, extension services and communication facilities, are poorly developed. Rural institutions (farmer organizations, rural development societies) are mostly dysfunctional. Electricity is hard to come by; even where electricity is available, voltage fluctuations and interruptions to power supply are frequent.

These areas receive an annual rainfall of 1000-1200 mm. Over 75 per cent of this rainfall occurs within four months of the year (October, Nov. Dec. and January) giving rise to frequent floods. Total annual rainfall tends to be relatively consistent. However its distribution pattern has fluctuated widely in recent years.

Providing clean drinking water through rainwater harvesting

Considering the ground situation of CKDu affected areas, the obvious solution for the drinking water problem of these rural communities is the collection and storage of rainwater- one of the purest forms of water available to man. Our ancestors had the wisdom and foresight to recognize this fact and they established a network of surface water storage reservoirs (‘tanks’) virtually in every village. These helped serve the needs of both man and beast as well as in ground water recharge. However, since the soil in the area contained minerals rich in Fluoride, Calcium and Magnesium, the ground water became laced with these elements over time and proved unsuitable for drinking. Nevertheless, it is still possible to catch the rainwater flowing off the roofs of houses and use it for drinking and cooking purposes. All that is required is a storage structure large enough to collect and store sufficient water to last through the 6-8 months of dry weather (February to September). It is estimated that a household consisting of 5 persons, would require approximately 20 liters of water per day for drinking and cooking purposes. Thus, a storage tank capable of holding 5000 liters is adequate to cope with even a severe drought. This facility (complete with a gutter and down pipe) will cost Rupees 50,000 per household. It requires no maintenance cost (except replacement of the gutter every five years or so). It will last 10 -20 years, and provide households with independent access to potable water at an affordable price (25 cents/liter). Rainwater harvesting is the most rational, cost effective, socially acceptable and ecologically sustainable method of providing clean drinking water to widely scattered rural households in the dry zone. The technology involved is simple and easy for rural people to understand, implement and sustain.

Lanka Rainwater Harvesting Forum is a local NGO possessing relevant knowledge and experience in establishing and operating rainwater storage structures in many dry zone villages over a period of 10 years or more. Last year alone it was involved in a U.S. AID funded project establishing 750 storage tanks in Vavuniya district.

Unsustainable Options

Water Filters –termed R.O. Filters are being promoted by some organizations in an attempt to provide potable water to the above areas. These are expensive (costing 8,000 to 10,000 U.S. $), complex machines heavily dependent on imported technology and require regular monitoring and maintenance by trained technicians. They require an assured supply of electricity, ground or surface water, separate housing at a centralized location, and an institutional set up to manage the operation and maintenance of equipment and ensure equitable distribution of purified water to households. People need to collect their water (costing Rs.1.50- 2.00 per liter) almost on a daily basis from the distribution point. This is both inconvenient and time consuming. These filtration plants discharge the effluent water containing toxic elements filtered out back into the ground water! Such acts violate existing environmental laws. R.O. Plants are unsustainable within the current ecological and socio-economic context of dry zone farming communities.

Health education

An effective community health education programme designed to inform rural households on the importance of drinking adequate quantities of water (at least 3liters/adult/day); refraining from smoking, intake of illicit brews (Kassippu), avoiding self medication by rushing to the nearest pharmacy or village Kade to purchase strong analgesics (pain killers) for relief of common body aches and pains, and overall improved nutrition is a vital need for residents in CKDu endemic areas. Educating school children on the above issues may help in getting the message across to their parents.

Improving agricultural extension services

Misuse of pesticides and fertilizers is largely a reflection of the ineffectiveness of agricultural extension services at village level in recent years.

Indiscriminate/excessive use and careless handling of inorganic fertilizers and pesticides by farmers has contributed to many environmental pollution problems - contamination of ground water, eutrophication (nutrient enrichment) of reservoirs leading to algal blooms etc. This unhealthy situation is due to several factors: (i). Ineffectiveness and impotency of the Agriculture Department’s extension services (II) Aggressive advertising of pesticides by chemical companies and their local agents. (III) Inadequate safeguards and regulatory measures pertaining to the import of highly toxic chemicals into the country and (IV). Huge fertilizer subsidy (amounting to over 90% at one stage) enabling farmers to resort to excessive application of cheap fertilizers.

Some action has already been initiated by the Department of Agriculture to curb advertisements pertaining to pesticides as well as banning the import of certain pesticides (Carbaryl, Chloropyrifos, Propanil and Carbofuran), in addition to strengthening regulatory mechanisms applicable to pesticide imports. Fertilizer prices have been increased by the government recently in an effort to curb excessive fertilizer application. However, there is no likelihood of any significant improvement in public sector extension services in the foreseeable future. This void needs to be filled by NGOs and CBOs.

Multi-pronged action needed

Considering the magnitude and gravity of the problem, effectively addressing CKDu needs the active participation/involvement of many agencies – Government, Non Governmental Organizations (NGOs), Private Sector, International Donor Agencies and Civil Society groups. Concerted action (similar to the handling of the Tsunami disaster) is urgently called for in addressing this kidney disease which is rapidly decimating peasant farmers in Sri Lanka’s dry zone (‘rice bowl’).

A simple rainwater storage facility for a rural household

* The writer is a researcher and rural development activist working with dry zone farmers for over thirty years. He holds a Masters’ degree in agriculture, and is currently a member of the Center for Education Research and Training on Kidney Diseases, University of Peradeniya. He may be contacted at

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