Economic Impacts of Chronic Kidney Disease (CKD) on Paddy Farming Community in Anuradhapura District of Sri Lanka

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 Source: Epidemiological Unit, Colombo & Dissanayake W.

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

9. Presence of end stage CKD Negative impact on Economic performances of paddy farming community Family and exchange labor Farming systems Operated paddy extent Labor migration Yield and Income Hypothesis Statement

10. 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 thecosts and returnsof paddy farming for affected and non-affected samples. • To compare thedifferences of costs and returnsof paddy farming between two samples. • To analyzethe additional burden of hired labor due to CKD on affected paddy farmers.

11. 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

12. 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.

13. Results and discussion 01)Analysis of costs and returns for paddy Farming

14. 02) Comparison of differences of cost and return values between two samples

15. 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 : Rs2.84 millions per season (Rs 5.69 millions per year ) • Under estimation of severity of real burden due to limitations in the study

16. Family, Exchange and hired labor inputs Comparison of Family and Exchange and hired labor inputs between affected and non-affected samples

17. Operated and non operated paddy extents Comparison of Operated & non operated paddy extents between affected and non-affected samples

18. Labor migration after CKD Comparison of Labor migration after CKD between affected and non-affected samples

19. Comparison of yield and prices between affected and non-affected samples • Yield Performances

20. Comparison of Farming systems between non-affected and affected samples • Farming systems

21. 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.

22. 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.

23. 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

24. 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.

25. References • Foreign medical experts to investigate rise in kidney disease”, The official government news portal of Sri Lanka,<http://www.news.lk> Accessed on 08 Feb 2008 • Grimm P. C, Ettenger R, 1992. Pediatric renal transplantation. Ad1, ances in Pediatrics, 39, 441-493. • Koch-Hattern A, Berlozheimer N, Thrower S. M, (1988). Working with, families. In P. D. Sloane, L. M. Slatt, & R. M. Baker (Eds.), Essentials offamily medicine (pp. 1-13). Baltimore: Williams & Wilkins. • Lev E. L, Owen S. V, (1998). A prospective study of adjustment to hemodialysis. American Nephrology Nursing Association Journal, 25, 495-504. • Survey done by department of Health and National Water Storage and Drainage Board on CKD, 2002. • Winsett R. P, (1999). Living with renal disease: Rehabilitation perspectives. E, rceptional Parent, 29, 26-29. • A Case Control Study of Chronic Renal Disease of Medawachchiya, North Central province, Sri Lanka, 2004, The Faculties of medicine & Sciences, University of Peradeniya & Nephrology unit, Kandy. • A Baseline Study on Early Renal Disease in a Selected Community of the North Central province of Sri Lanka , 2003 , The Faculties of medicine & Sciences , University of Peradeniya , Renal Unit , General (Teaching) Hospital Kandy , Provincial Ministry of Health , North Central Province , Sri Lanka.

26. Central Bank of Sri Lanka, 2005, Annual report. • Department of Census and Statistics, 2006 • Athuraliya T.N.C , Abeysekera T , Amarasinghe P.H , kumarasiri R , Rathnathunga N, Dissanayake D , Bandara P , Chronic Renal Disease in Medawachchiya , Sri Lanka : Some Risk factors , Bio chemical profile and Renal histology , 2004 • Patterson. J. M.. & Garwick, A. W. (1994). The impact of chronic illness on families: A family systems perspective. Annals of Behavioral Medicine, 16,131-142. • Todaro Michael. P., Stephen .C. Smith. Human Capital: Education and Health in Economic development in: Economic development – 8th Ed • A Case Control Study of Chronic Renal Disease of Medawachchiya, North Central province, Sri Lanka, 2004, The Faculties of medicine & Sciences, University of Peradeniya & Nephrology unit, Kandy. • A Baseline Study on Early Renal Disease in a Selected Community of the North Central province of Sri Lanka , 2003 , The Faculties of medicine & Sciences , University of Peradeniya , Renal Unit , General (Teaching) Hospital Kandy , Provincial Ministry of Health , North Central Province , Sri Lanka. • Dele Abegunde, Anderson Stanciole, 2006, An estimation of the economic impact of chronic noncommunicable diseases in selected countries, World Health Organization Department of Chronic Diseases and Health Promotion • Suzanne R. Smith; Elizabeth Soliday, 2001, The Effects of Parental Chronic Kidney Disease on the Family, Family Relations, Vol. 50, No. 2. pp. 171-177.

27. 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.

28. 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.

29. Thank you.