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Health and Hygiene, Knowledge, Attitude and Behavior: A Case Study at Hapania
Mauza of Atghoria Upazila in Pabna District

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International Journal of Scientific and Research Publications, Volume 7, Issue 12, December 2017 683
ISSN 2250-3153

Health and Hygiene, Knowledge, Attitude and Behavior:

A Case Study at Hapania Mauza of Atghoria Upazila in
Pabna District
Md. Zibon Ahmmed*, Sahinur Rahman*, Md. Easin Ali*, Mst. Tanzila Akter Shawon**,
Sheikh Md. Monzurul Huq***
*
Postgraduate Research Student, Department of Geography and Environment, Jahangirnagar University
**
Graduate Student, Department of Urban and Regional Planning, Jahangirnagar University
***
Professor, Department of Geography and Environment, Jahangirnagar University

Abstract- Hygiene practice, knowledge and behavior are the driving force of health. Health is considered as the physical mental
economic and social condition and satisfaction of a man and hygiene is the constitution to attain it. There are various types of diseases
which directly or indirectly depend on hygiene practice. The people of the rural areas suffer from health and hygiene related diseases.
This study attempts to assess the relationship among hygiene practice, behavior, attitude and knowledge about health. This study
conducted a questionnaire survey on 78 respondents living in Happania mauza. It was observed socio-economic and environmental
aspects were significantly associated with health. Simple statistical techniques were used for data analysis. It was found that most of
the people were engaged in business and worked as day labour and their monthly income was from 5000-10000 taka. In the study area
about 55 percent used ring slab and 52 percent of the respondents used soap for washing hand after using toilet and 61 percent people
used shoe in while using latrine. About 21 percent of the respondents suffered from diarrhoea, 35 percent from dysentery and 44
percent suffered from skin diseases. This study used cross tabulation and multiple regressions to analysis the relationships among
hygiene practice, behavior, attitude and knowledge about health. It was observed that there existed a strong relationship among
hygiene practice and health. This study observes that the methods of hygiene practice were not maintained properly. Due to the poor
level of knowledge of the respondents regarding sanitation, hygiene practices and health, the people of the study area often suffered
from various types of infectious diseases.

Index Terms- Heath, Hygiene, Sanitation practice, Diseases, Cross tabulation, Regression.

contagious diseases (Hossain, 2012). One of the main problems

I. INTRODUCTION in underdeveloped and developed countries of the world is lack

B angladesh is an over populated country. In a developing

country like Bangladesh, almost one-third of the population
lives below the poverty line. About 39 percent of the total
of safe water and sanitation. Majority of the affected population
are found in informal settlements, urban and rural parts of the
developing countries where the practice of open defecation, poor
population of South Asia lives in poverty and they have an sanitation services, and use of unsafe water persist due to
income of less than one US dollar a day. According to the knowledge gaps and improper attitude towards health and
Household Income and Expenditure survey of 2010, the rate of hygiene and make people unable to practice basic hygiene (Job,
poverty in Bangladesh has dropped to 31.5 percent. Another 2014).
report opined that 8.5 percent poverty declined in the last five
The global problem of access to safe water and sanitation
years (Kabir, 2011). Due to lack of education, knowledge and
continues to plague the poor countries of the world (Job, 2014).
basic awareness, people often have a poor understanding
According to World Health Organization an estimated 2.6 billion
regarding the relationships among health, water, sanitation and
people, comprising about 40 percent of the world’s population
hygiene. In some instances, people may still practice unhygienic
live without adequate access to safe water and proper sanitation
habits even though this understanding does exist (Das et al.
(WHO, 2010). In a developing country like Bangladesh various
2015). However maintaining good or acceptable personal
diseases are rampant due to lack of clean drinking water and
hygiene is seldom perceived and acknowledged as protection
sanitation (Amin et al, 2008). Bangladesh is a low-income
against diseases (Asha, 2013 and Farah et al, 2015). Poor health
country where round the year prevalence of waterborne diseases
and hygiene practice and inadequate sanitary condition play a
remains high. Researches indicate that washing hands without
major role in developing country like Bangladesh and increases
soap after defecation and before eating are common in
the burden of infectious diseases (Vivas et al, 2010).
Bangladesh (Rana, 2009).In Bangladesh, serving and eating
foods with bare hands is quite common (Faruque et al, 2010).
II. BACKGROUND Outbreaks of food borne disease involves poor hygiene in
Personal hygiene is very important for protecting and restaurants (Todd et al, 2008) and eating food from street
maintaining health and addressing health problems and is also vendors are considered as high risk factors (Vollaard et al, 2004).
fundamental to the prevention of many diseases, particularly
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Safe water is one of the most important felt needs in public to children without washing hands with soap, and not washing
health in developing countries in the twenty first century (Sah et hands with soap after defecation (Rana, 2009).
al, 2013). According to a World Health Organization (WHO)
estimate, 1.5 million children die from diarrheal diseases each III. AIM AND OBJECTIVES
year worldwide, with 88% of these deaths occur due to The aim of the research is to assess human knowledge, attitude
inadequate sanitation, lack of hygiene practices, and poor quality
and behavior in the study area to examine the interrelationships
drinking water (Lipson, 2010). Awareness about safe drinking
water, sanitary latrines, and of hygiene and related health issues among health, hygiene, knowledge, attitude and resulting human
are crucial factors in habituating practice in a particular context behavior.
(Nath et al, 2010). This actually indicates that washing hands
The objectives of the study are:
with soap can reduce risk of diarrhea substantially (Curtis and
Carincross, 2003; Ejemot et al. 2008) and use of sanitary latrine a) To identify the present condition of health and hygiene,
also reduces incidence of water borne diseases (GED, 2009). knowledge, attitude and behavior of human in the study
Bangladesh has been facing a number of challenges in the water, area;
sanitation, and hygiene sectors. Hygiene practice becomes b) To examine the underlying causes of diseases;
difficult in many parts of the world, including Bangladesh. This c) To analyze the behavioral aspects of the respondents in
is due to lack of safe water and proper washing materials such as this respect.
soap (Centers for Disease Control, 2011). Lack of awareness
about the benefits of using safe latrine, poverty, lack of space,
and preference for open defecation are also mentionable barriers IV. DATA SOURCES AND RESEARCH METHODOLOGY
to health and hygiene (UNDP, 2009). All these factors impede Both quantitative and qualitative data have been used in this
the universal coverage of use of sanitary latrine in the country study. Primary data were collected through questionnaire survey.
(Rana, 2009). The questionnaires contained information on household, socio-
Knowledge regarding poor hand washing practices is particularly economic information, sanitation system, hygiene practice,
important and most strongly associated with the risk of diarrhea location and situation of water sources, different diseases that
(Asha, 2013, and Farah et al, 2015). Diarrheal disease has been occurred among respondents during the last 2 years. The sample
considered as a serious global problem (WHO, 2008) and leading size was determined following the steps: Population size (N) =
cause of child mortality around the world (Boschi-Pinto, 2008)
400, Error level (e) = 10%, Confidence level= 95% and z-score
and proper hygienic behavior can play an important role in the
prevention of diseases related to water and sanitation. An average (z) =1.96. Data for the study were collected by questionnaire
of 65% of death caused by diarrheal diseases could be reduced if interview conducted on 78 respondents who lived in the study
good hygiene practice accompanies the provision of water and area. Secondary data were collected from different published and
sanitation. Diarrhoea can be significantly reduced through unpublished materials and books. Microsoft word, Microsoft
improvements of the quality of drinking water, sanitation Excel, SPSS, Arc View GIS software were used for data
facilities, hygiene knowledge and practices (Wong et al, 2007, analysis. Both descriptive and inferential statistical tools were
Fewtrell et al, 2005 and Luby et al, 2004).Around 2.4 million
used to analyze the data. To examine the relationship among
deaths could be prevented annually by good hygiene practice and
providing reliable sanitation and drinking water (Prüss-Üstün, knowledge, attitude, behavior and hygiene practice regarding
2008). Evidence shows that hand washing can reduce the health, cross tabulation and multiple linear regression were used.
occurrence of diarrheal diseases by 14-40% (Hoque, 2003). A model of the relationship between explanatory variables and a
Different studies showed that hand washing can decontaminate response variable was developed by fitting the following linear
hands and prevent cross-transmission (Kaltenthale et al, 1991, equation:
1998). The effectiveness of hand washing with soap can reduce
diarrheal risk up to 47% (Curtis and Cairncross, 2003). Many Multiple Linear Regression: Y = a + b1X1 + b2X2 + b3X3 + ... +
studies carried out in Bangladesh suggested that hand washing is btXt + u (Penn State Science, 2017)
one of the factors which decreases the incidence of diarrhea in
intervention areas significantly (Stanton and Clemens, 1987 and Where:
Alam et al, 1989).
Y = the variable are used to predict
Several underlying factors such as availability, affordability and (dependent variable)
negligence are associated with these unhygienic practices. X = the variable that are used to
Furthermore, most of the people are not much aware about the predict (independent variable)
route of transmission of waterborne diseases which increase the
a = the intercept
risk notably. Even many people lack knowledge about potential
risks of taking uncovered and inappropriately preserved food b = the slope
items, not washing hands with soap before eating, providing food u = the regression residual

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Hapania Mauza is a small administrative unit under the Atgharia of population was 871 per sq km. Average literacy rate was
Upazila in Pabna district. Total population in the study area was 26.4% male and 16.8% female. There is only a government
1989 where male was 51.41% and female 48.59%. The density primary school in the study area (BBS, 2011).

Figure 1: Map of Study Area.

(Source: BCA data and Google earth, 2016, Compiled by Author)

Table-1: Educational Status of the Population in the Study

V. SOCIO-ECONOMIC CONDITION AND KNOWLEDGE
ABOUT HEALTH Area
Education status Count Percentage
In the study area 19.23 percent respondent are illiterate, 47.44
percent have primary education, and 17.95 percent have passed Illiterate 15 19.23
SSC and only 6.41 percent completed graduation degree (Table- Primary 37 47.44
1). In Bangladesh during the year of 2014 the literature rate was SSC 14 17.95
71 percent (Bd news 24, 2015). Although the increase of per HSC 4 5.13
capita income in Bangladesh has increased significantly, the Honors 5 6.41
income of the population has hardly increased. It can be observed Masters 3 3.85
from Table-2 that 65.38 percent population income is in between
Total 78 100.00
5000-10000 taka. About 5.13 percent people have an income
Table-2: Monthly Income
below 5000 taka and 21.79 percent has income between 10000-
15000 taka. Only 5.13 percent respondents have income up to Income (Bangladeshi Taka) Count Percentage
20,000 taka (Table-2). The national per capita income of <5000 4 5.13
Bangladesh is about 125999 taka (BBS, 2017). In the study area 5001-10000 51 65.38
female are generally engaged in household activities and male 10001-15000 17 21.79
are in outside activities. Table-3 exhibits that about 29.49 percent 15001-20000 2 2.56
of the respondents are house wife, 24.36 percent are worker, 20001-25000 3 3.85
15.34 percent are engaged in small business such shop keeper,
30000+ 1 1.28
vegetable seller in local market, rice traders etc. On the other
Total 78 100.00
hand, about 21.79 percent are farmer and only 5.13 percent are
service holder (Table-3).
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Table-3: Occupational Status of Population Table-4: Different Types of Toilet

Occupation Status Count Percentage Toilet Types Count Percentage
Service Holder 4 5.13 Ring slab with fence 43 55.13
Businessman 12 15.38 Pucca 26 33.33
Worker 19 24.36 Kucha 7 8.97
Housewife 23 29.49 Others 2 2.56
Farmer 17 21.79 Total 78 100.00
Other 3 3.85 Table-5: Hand Wash Practice after Toilet
Total 78 100.00 Hand Wash by Using Count Percentage
Sources: Questionnaire Survey, 2016 Soap 41 52.56
Ash 15 19.23
VI. TOILET TYPES AND HYGIENE PRACTICE Soil 20 25.64
In the study area about 55.13 percent of the respondent use ring Only water 2 2.56
slab toilet made with fence using bamboo, straw palm leaves, Total 78 100.00
bananas leaves etc. and 33.33 percent use pucca toilet made with Table-6: Shoe Use Practice in Toilet Time
bricks and cement (Table-4). The table -1 also depicts that 8.97
Shoe Use Count Percentage
percent respondents use kuccha toilet made with soil and
Yes 48 61.54
corrugated tin. One research indicates that about 57.95% of the
households have good hygiene and sanitation system in (DPHE, No 5 6.41
2010). About 2.56 percent uses neighboring toilet and sometime Occasionally 25 32.05
defecate in open field. Among the respondents 52.56 percent use Total 78 100.00
soap, 25.64 percent use ash, 2.56 percent use only water for Sources: Questionnaire Survey, 2016
cleaning purpose (Table-5). In a study on 50 sub-districts it is
found that about 88.1% people use soap, 8.85% people use only
water and 3.15% people donot wash their hand after defecation VII. DIFFERENT DISEASES
(Rabby and Dey,2013). It can be observed that they usually use In the study area most of the people suffered from fever
damp soil or ash for cleaning their hand. Table -6 revaled that (93.59%), cold and cough (100 %), blood pressure (35.90%).
61.54 percent respondents use shoe during defecation time. Figure-2 shows that diarrhoea (21.79%), dysentery (55.13 %),
skin diseases (44.87%) acidity (55.13%) are common diseases
About 32.05 percent use shoe occasionally and 6.41 percent among the respondents in Hapania mauza. To receive treatment
never used shoe while defacating. about 53.32% of the people go to quack doctor for treatment.
People also took traditional herbal treatment. About 30% people
went to government hospital for treatment.

Figure 2: Common diseases of people in last two years at study area.

Sources: Questionnaire Survey, 2016

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suffered from this disease and they washed their hands with only
VIII. RELATIONSHIP BETWEEN TYPHOID AND HYGIENE water user. Respondents who used ash for cleaning hand suffered
PRACTICE from typhoid (6.7%) and about 50% people who used only water
Typhoid is a waterborne disease. It is intricately related with had been affected by typhoid disease and strikingly, about 10%
hygiene practice and proper sanitation system. In Hapania of the respondents who used soil for cleaning suffered from
Mauza, Kuccha toilet (14.3%) users suffered from typhoid more typhoid disease (Table -7). It can be summarized that people who
than the ring slab (2.3%) and pucca toilet users (Table-7). Table washed their hands with proper cleaning materials suffered less
7 depicts that the respondents use soap for washing hand before from the disease than the respondents who used only water for
meal intake did not suffer from typhoid and about 3% of them cleaning purpose.

Table-7:Cross Tabulation Analysis between Typhoid and Hygiene Practice

Typhoid
No Yes
Count 42 1
Ring slab
% within Toilet types 97.7% 2.3%
Count 26 0
Toilet Types

Pucca
% within Toilet types 100.0% .0%
Count 6 1
Kucha
% within Toilet types 85.7% 14.3%
Count 2 0
Others
% within Toilet types 100.0% .0%
Count 11 0
Practice before
Taking Food

Soap
Hand Wash

% within Hand wash practice before taking

100.0% .0%
food
Count 65 2
Water % within Hand wash practice before taking
97.0% 3.0%
food
Count 41 0
Hand Wash Practice after

Soap
% within hand wash practice after toilet 100.0% .0%
Count 14 1
Ash
% within hand wash practice after toilet 93.3% 6.7%
Toilet

Count 18 2
Soil
% within hand wash practice after toilet 90.0% .10%
Count 1 1
Water
% within hand wash practice after toilet 50.0% 50.0%
Count 48 0
Yes
% within shoe use 100.0% .0%
Shoe Use

Count 3 2
No
% within shoe use 60.0% 40.0%
Count 25 0
Occasionally
% within shoe use 100.0% .0%
Sources: Questionnaire Survey, 2016

Table- 8 espoused the dependency of typhoid with hygiene (0.052 unit where p = 0.078). Regular use of shoe by the
practice. One unit of increase in the number of user respectively respondents’ also decreased one unit of the probability of
“Yes” or “No” by for washing their hand increased the Typhoid (Table- 8). If the educational status is raised, then the
probability of Typhoid 0.038 unit where p = 0.215. Soap, Ash, probability of typhoid disease decreases by 0.005 units.
soil and water had higher probability of typhoid occurrence

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Table -8 : Regression Analysis between Typhoid and Hygiene Practice

Model Unstandardized Coefficients Standardized t Sig.
Coefficients
B Std. Error Beta
(Constant) -0.027 0.109 -0.252 0.802
Hand wash practice before taking 0.038 0.031 0.155 1.250 0.215
food
1 Hand wash practice after toilet 0.052 0.029 0.298 1.786 0.078
Shoe use -0.041 0.028 -0.237 -1.442 0.154
Education -0.005 0.018 -0.040 -0.285 0.776
Occupation -0.001 0.015 -0.010 -0.087 0.931
a. Dependent Variable: Typhoid

IX. RELATIONSHIP BETWEEN DYSENTERY AND HYGIENE wash practice after toilet and occurrences of dysentery disease
PRACTICE are closely related. About 36 % of the total respondents who used
Dysentery is closely related with hand wash practice before soap suffered from dysentery. About 66.7% of the respondents
eating. In Hapania Mauza 62.7% respondents suffered from used ash for cleaning purpose and they were affected by
dysentery and they used only water before taking food. And dysentery. On the other hand 80% of the respondents who used
among soap users only 9.1% suffered from dysentery (Table: 9). soil suffered from dysentery. About 100% of the people who
Table: 9 also represents the relationship between toilet types and used only water for cleaning purpose suffered from dysentery. In
dysentery. Other types of respondents such respondents who the study area, respondents who never used shoe (80%) suffered
defecated in the open space, respondents who used kuccha toilets from dysentery. Respondents who used shoe occasionally (76%)
and ring slabs and pucca toilets suffered from dysentery during and who never used suffered from dysentery on a regular basis
the last two years. It indicates that the pucca toilet users suffered 41.7% (Table-9).
less from dysentery than other types of toilet user. Types of hand

Table-9:Cross Tabulation Analysis between Dysentery and Hygiene Practice

Dysentery
No Yes
Ring slab Count 14 29
% within toilet types 32.6% 67.4%
Pucca Count 19 7
Toilet Types

% within toilet types 73.1% 26.9%

Kucha Count 2 5
% within toilet types 28.6% 71.4%
Others Count 0 2
% within toilet types .0% 100.0%
Soap Count 10 1
Hand Wash

taking food
Practice

% within Hand wash practice before taking food 90.9% 9.1%

before

Water Count 25 42
% within Hand wash practice before taking food 37.3% 62.7%
Soap Count 26 15
Hand wash Practice after

% within Hand wash practice after toilet 63.4% 36.6%

Ash Count 5 10
% within Hand wash practice after toilet 33.3% 66.7%
Toilet

Soil Count 4 16
% within Hand wash practice after toilet 20.0% 80.0%
Water Count 0 2
% within Hand wash practice after toilet .0% 100.0%

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Yes Count 28 20
% within shoe use 58.3% 41.7%
Shoe Use No Count 1 4
% within shoe use 20.0% 80.0%
Occasionally Count 6 19
% within shoe use 24.0% 76.0%
Sources: Questionnaire Survey, 2016

One unit of increase of the hand wash practice before taking food educational status had a bearing on the chance of dysentery
(respectively using soap and only water) increased the (0.225 unit where p = 0.00). Table-10 indicates that there is a
probability of Diarrhoea by 0.163 units (Table-10). Higher very low impact of toilet types on dysentery occurrence.

Table -10 : Regression Analysis among Dysentery and Hygiene Practice

Model Unstandardized Standardized t Sig.
Coefficients Coefficients
B Std. Error Beta
(Constant) 1.109 0.238 4.651 0.000
Hand wash practice before taking food 0.060 0.079 0.077 0.762 0.449
Hand wash practice after toilet 0.085 0.062 0.156 1.361 0.178
1
Education -0.225 0.045 -0.569 -5.029 0.000
Toilet types -0.002 0.061 -0.003 -0.029 0.977
Hand washing before child feeding -0.163 0.062 -0.264 -2.614 0.011
a. Dependent Variable: Dysentery

factor in hygiene practice which can help to eradicate diarrhoea

X. RELATIONSHIP BETWEEN DIARRHOEA AND HYGIENE disease in the study area and the country as a whole. Pucca toilet
PRACTICE users suffer less ((3.8%) from diarrhoea than the ring slab users
In the study area soil and ash users were less affected by diarrhea (20.9%). And kuccha toilet users suffered most 85.5% (Table-
(35% and 60%) and soap users suffered least 2.4% (Table-11). It 11).
indicates that hand washing after defecation is an important

Table-11:Cross Tabulation Analysis between Diarrhoea and Hygiene Practice

Diarrhoea
No Yes
Soap Count 40 1
Hand Wash Practice after

% within Hand wash practice after toilet 97.6% 2.4%

Ash Count 6 9
% within Hand wash practice after toilet 40.0% 60.0%
Toilet

Soil Count 13 7
% within Hand wash practice after toilet 65.0% 35.0%
Water Count 2 0
% within Hand wash practice after toilet 100.0% .0%
Ring slab Count 34 9
Toilet Types

% within toilet types 79.1% 20.9%

Pucca Count 25 1
% within toilet types 96.2% 3.8%
Kucha Count 1 6

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% within toilet types 14.3% 85.7%

Others Count 1 1
% within toilet types 50.0% 50.0%
Soap Count 11 0
Element use for

before taking
hand wash
% within use Hand wash practice before taking food 100.0% .0%
food Water Count 50 17
74.6% 25.4%
% within Hand wash practice before taking food
Sources: Questionnaire Survey, 2016

There is a strong relation between diarrhea and socio- economic one unit of personal hygiene practice of mother after children
conditions and hygiene practice. Table- 12 depicts that one unit cleaning (respectively soap, ash, soil, only water) decreases
increase in hand wash practice after defecation (only water, soil, 0.120 unit probability of diarrhea. It can be observed that hand
ash and soap) increases 0.05 probability of diarrhea diseases and wash practices decreases diarrhea significantly.
it is statistically significant (p = 0.0.456). With the increase of

Table -12 : Regression Analysis among Diarrhea and Hygiene Practice

Model Unstandardized Standardized T Sig.
Coefficients Coefficients
B Std. Error Beta
(Constant) 0.200 0.250 0.798 0.427
Hand wash practice before taking food 0.163 0.070 0.252 2.314 0.024
Hand wash practice after toilet -0.050 0.066 -0.110 -0.750 0.456
1
Shoe use 0.126 0.064 0.281 1.953 0.055
Education -0.085 0.040 -0.260 -2.117 0.038
Occupation -0.028 0.034 -0.084 -0.825 0.412
a. Dependent Variable: Diarrhoea

diseases in the study area are sanitation and hygiene practice

XI. CONCLUSIONS related. To avoid these diseases it is indispensable to aware
Hygiene practice is the precondition of good health. But hygiene people and disseminates the ideas of proper ways of hygiene
means not only follow the rule of sanitation system but also practices. The ideas related to hygiene practices may be
gaining awareness and knowledge about the rule of maintaining disseminated in the study area through mass education and
hygiene. There is a lack of proper knowledge among the training. Local governments and people of the area of the study
respondents in the study area. People have little knowledge about area may work hand in hand to speared health and hygiene
the adoption of proper methods of hygiene practice. Therefore related disease and eradicate infectious diseases from the study
treatment facilities are not available in the study area. Most of the area.

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Authors Mst. Tanzila Akter Shawon

Md. Zibon Ahmmed Graduate Student,

Department of Urban and Regional Planning,
Postgraduate Research Student, Jahangirnagar University,
Department of Geography and Environment, Savar, Dhaka, Bangladesh.
Jahangirnagar University, E-mail: shaonurp@gmail.com
Savar, Dhaka, Bangladesh.
E-mail: zibonahmmed@gmail.com Sheikh Md. Monzurul Huq

Sahinur Rahman Professor,

Department of Geography and Environment,
Postgraduate Research Student,
Jahangirnagar University;
Department of Geography and Environment,
Savar, Dhaka, Bangladesh
Jahangirnagar University,
E-mail: monzurulh@gmail.com
Savar, Dhaka, Bangladesh.
E-mail: rahmansahinju@gmail.com
Correspondence Author
Md. Easin Ali Sahinur Rahman
Postgraduate Research Student, Postgraduate Research Student,
Department of Geography and Environment, Department of Geography and Environment,
Jahangirnagar University, Jahangirnagar University,
Savar, Dhaka, Bangladesh. Savar, Dhaka, Bangladesh.
E-mail: easinju@gmail.com Cell no: +8801923336352
E-mail: rahmansahinju@gmail.com

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