Health Vulnerabilities and Resilience in a Rajshahi Slum: An Analysis

of Hygiene, Sanitation, and Information Channels

Amina Jahan, Md. Sajidur Rahman, Hina Mehak, Arif Hossain
Department of Journalism, Communication and Media Studies, Varendra University, Rajshahi- 6204, Bangladesh, 2025.

1. Introduction :

Rajshahi is among the most densely populated urban centers in Bangladesh, and its population has
been increasing at a steady pace. Within the jurisdiction of Rajshahi City Corporation, there are
estimated 45 slums of different sizes where poor people live. While the number of slum dwellers
has been rising, essential services have not kept pace.

The purpose of our study is to survey the health of the people in this region. We wanted to find out
where they get their health information, where they use toilets, where they dispose of household
waste, and various other health-related issues.

2. Literature Review :

Sanitation and public health are intrinsically linked, particularly in urban slums, where inadequate
facilities and limited awareness exacerbate health risks. Globally, studies have demonstrated that
poor sanitation contributes significantly to communicable diseases, including diarrhoea, cholera,
and respiratory infections, disproportionately affecting vulnerable populations (World Health
Organization, 2019). In densely populated slum areas, these challenges are further compounded
by high population density, lack of infrastructure, and limited access to healthcare services (UN-
Habitat,2020).

Toilet Sanitation in Slums

Research highlights that the quality and accessibility of toilet facilities in slums remain a critical
concern. Many households rely on shared or poorly maintained latrines, which increases the risk
of disease transmission (Jenkins & Curtis, 2005). Studies in South Asian urban slums indicate that
inadequate sanitation not only affects physical health but also has psychological and social
consequences, particularly for women and children who often face unsafe conditions when
accessing toilets (Cairncross et al., 2010).

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Healthcare Access and Treatment Practices

Access to healthcare in slum areas is often limited and irregular. Residents may depend on informal
providers or local pharmacies due to cost, distance, or lack of awareness (Ezeh et al., 2017). These
practices can result in delayed treatment or inappropriate medication, aggravating health issues.
The provision of health education and outreach programs has been shown to improve hygiene
practices and reduce disease incidence in similar urban settlements (Garg et al., 2015).

Health Information and Awareness

Awareness about hygiene and sanitation is closely linked to behavioral practices. Studies
emphasize that regular health education, community engagement, and targeted campaigns
significantly influence hygiene practices, such as handwashing and proper waste disposal
(WaterAid, 2018). In slums, limited literacy and socio-economic constraints can hinder the
effectiveness of these interventions, highlighting the need for culturally appropriate and accessible
programs.

Relevance to Rajshahi Slums

Although most literature focuses on South Asia broadly, limited research exists specifically on
Rajshahi. Initial studies indicate that slums in Rajshahi face challenges similar to other urban
settlements, including inadequate toilets, irregular health service usage, and low hygiene
awareness (Alam et al.,2013)These findings underscore the importance of localized studies to
inform context-specific interventions that improve sanitation and overall health outcomes.

3. Methodology :

We selected the slum area adjacent to Shiroil Colony in Rajshahi for our research, which is located
next to the disposal site in Vadra area of Rajshahi City Corporation. We selected a sample of 10
people (6 woman and 4 Man) using a cluster method. We conducted a survey through a
questionnaire for the research. The survey included open-ended, closed-ended, and mixed
questions, which are presented in shortly below:

a. What is your age?

b. What is your sex?

c. What is your occupation?

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d. What is your monthly income?

e. Have you or anyone in your family suffered from any illness in the last six months or suffering
from a long-term physical illness?

If yes, what kind?

f. Where do you go for treatment?

g. What type of toilet do you use at home?

h. When do you wash your hands with soap?

i. Where do you throw your household waste?

j. Do you vaccinate your children on time?

k. Where do you get health related information?

l. Have you received any training on health awareness?

m. What changes would you like to see in health awareness in your area?

4. Limitations:

The survey had certain limitations. The sample size was insufficient to reflect the conditions of all
slums in the Rajshahi City Corporation. Moreover, since data was gathered from just one area, the
results may not accurately represent the situation across all slums in the city.

5. Data Analysis :

5.1 Sex Ratio and Age

For this study, a sample of 10 participants was selected, comprising 6 women and 4 men
from different age groups.

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Figure 1 (5.1 Sex ratio and age)

(Based on study of participants response)

Among the participants, 2 were from the 18–30 age group, while 4 belonged to the 31–60 age
group and another 4 were aged 60 and above. The age data reveals that the majority of participants
are middle aged or older , with 80% being over the age of 30.

5.2 Education Status and Occupation

Among the 10 participants, 8 were illiterate, while the remaining 2 had completed primary
education. Which hits the rate to 80% illiteracy.

Figure:2 (Education Status and Occupation) Education Status

(Based on study of participants response)

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Table:1 (5.2 Education Status and Occupation) Occupation

Occupation Number of participants Percentage

Beggar 05 50%
Junk Seller 03 30%
Tea Seller 01 10%
Rickshaw Puller 01 10%
(Based on study of participants response)

Five of the participants are beggars, three are junk sellers, one is a tea seller, and one is a rickshaw
puller. Six of them earn below 5,000 Taka, while four of them earn above 5,000 Taka. The data
suggests a strong link between profession and income. The majority of our participants are (60%
of the group) all into the lower income, earning below 5,000 Taka. This group includes all 5
beggars, as begging is typically a no-income or very low income activity. Tea seller and rickshaw
puller, these professions often have low and inconsistent earnings.

The remaining 40% of participants earn above 5,000 Taka. This higher earner includes 3 junk
sellers. While often considered part of the informal economy, junk sellers can sometimes earn a
significant income, particularly if they have a consistent clientele or a well-established route,
which separates them financially from the other participants.

5.3 Health Related Issues

Among the 10 participants, seven are suffering from various diseases. Which is 70% of total Ratio.
Table:2 (5.3 Health Related Issues) Types of diseases:

Diseases Number participants Percentage

Fever 2 20%
Dyspnoea 1 10%
Skin disease 1 10%
Headache 2 20%
Lower back pain 4 40%
(Based on study of participants response)

The most striking insight is that every single participant (100%) is suffering from an illness. This
highlights a critical issue of health vulnerability within this demographic. It suggests that poor

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health is not an isolated problem but a universal condition, likely tied to their living and working
circumstances, and lack of access to affordable healthcare.

Lower Back Pain: The prevalence of lower back pain (40% of the group) is likely linked to the
physically demanding nature of their work and age. This condition can severely limit their ability
to earn a living, trapping them in a cycle of pain and poverty.

Respiratory Issues (Dyspnoea): The participant with dyspnoea (difficulty breathing) suffering from
a chronic respiratory condition. This is often tied to long term exposure to poor air quality, dust,
and environmental pollution common in urban informal work settings. This serious illness gets
worse with hard work.

General Ailments (Fever & Headaches): The presence of fevers and headaches in 40% of the group
(four participants) could point to a lack of proper nutrition, dehydration, or an inability to seek
treatment for simple infections. These common ailments, when left untreated, can become more
severe and impact their ability to work, further destabilizing their already precarious financial
situation.

5.4 Treatment

Treatment in slum areas is crucial for controlling infectious diseases that thrive in overcrowded
conditions. It helps prevent localized outbreaks from spreading and becoming wider public health
crises.

Figure:3 (5.4 Treatment)

(Based on study of participants response)

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Here Eight of the ten participants seek treatment at pharmacies, while the remaining two utilize
government hospitals. Which it leads to 80% participants depends pharmacies and only 20% seek
treatment in government clinics.

Pharmacies may be seen as a more immediate and financially manageable option for minor
ailments, as they can provide medication without the added cost of a doctor's consultation or
hospital fees. The mind set of seeking care from pharmacies is a form of self-medication. It carries
serious risks, including incorrect diagnoses, improper dosage, antibiotic resistance, and delayed
treatment for more serious underlying conditions.

5.5 Sanitation

The systems for human waste disposal are a mix of different methods, including the traditional use
of bucket latrines. Most of these sanitation systems are unhygienic, which is explained by certain
environmental factors.

Table:3 (5.5 Sanitation) Types of toilets

Types of Toilet Number of participants Percentage

Public 02 20%
Kacha 04 40%
Open field 03 30%
Sanitary (Paka) 01 10%
(Based on study of participants response)

This breakdown highlights that non-sanitary options (open field, hanging, and public toilets) are
used by the vast majority of participants (90%), while a safe, sanitary toilet is used by only a small
minority (10%).

Figure:4 (5.5 Sanitation)

(Based on study of participants response)

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The vast majority of participants (90%) rely on non-sanitary options for their toilet needs. The
most common used is the "Kacha” (40%), followed by "open field" defecation (30%), and the use
of "public toilets" (20%). Only a single participant (10%) uses a sanitary toilet. This indicates a
very low adoption rate of safe and hygienic waste disposal methods.

The widespread use of methods like open field and Kacha toilets poses significant risks. Open field
defecation directly contaminates the environment, leading to the spread of diseases like cholera
and typhoid, especially during rainy seasons. Public toilets, if not properly maintained, can also be
unsanitary and contribute to the spread of infectious diseases due to high usage and poor hygiene
practices.

5.6 Hygiene

Hygiene is critically important in slum areas to prevent the rapid spread of diseases due to high
population density. It directly reduces the incidence of common illnesses like cholera and typhoid,
which thrive in unsanitary conditions.

Figure:5 (5.6 Hygiene)

(Based on study of participants response)

Among the 10 participants, two (20%) reported washing their hands consistently before eating,
after using the toilet, and prior to preparing food. In contrast, four participants (40%) reported a
more limited practice, washing their hands primarily before eating. The remaining four participants
(40%) engaged in reactive hand hygiene, only washing their hands when they were visibly dirty.
The participants on their hand hygiene habits, revealing three distinct behaviours:

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Comprehensive Hand Hygiene: Two participants (20%) reported practicing comprehensive hand
washing, consistently washing their hands before eating, after using the toilet, and before preparing
food.

Situational Hand Hygiene: Four participants (40%) reported washing their hands primarily before
eating, but not consistently during other critical times like after using the toilet.

Reactive Hand Hygiene: Four participants (40%) reported a limited hand washing practice, only
doing so when they perceived their hands to be visibly dirty.

The majority of participants (80%) do not practice comprehensive hand hygiene. This suggests a
significant gap in awareness or behaviour regarding the multiple critical moments for hand
washing. The data naturally segments participants into three distinct groups. This is crucial for
designing targeted interventions. For example, the "Situational Hand Hygiene" group may need
education on the importance of washing after using the toilet, while the "Reactive Hand Hygiene"
group may need a broader campaign on the existence of invisible germs. The large proportion of
participants who do not wash their hands after using the toilet or before preparing food suggests a
high-risk behaviour pattern for the spread of communicable diseases.

5.7 Vaccination

The participants(10) revealed that all respondents have ensured their children are fully vaccinated
on schedule. Participants reported receiving crucial vaccination information from "Shastho Apa"
(a local community health worker) and through announcements made via the mosque's public
address system.

5.8 Waste Dumping

Improper waste disposal has a significant negative impact on slum environments. While the natural
decomposition of waste is a necessary process, dumping it in residential areas poses serious health
risks and creates unsanitary conditions for the local population.

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Figure:6 (5.8 Waste Dumping)

(Based on study of participants response)

The 10 participants revealed varied waste disposal practices. The majority of respondents, five
participants (50%), reported dumping their waste on the roadside. In contrast, four participants
(40%) indicated that they utilize a dustbin for waste disposal. The remaining participant (10%)
stated that they dispose of their waste by throwing it into a pond.

The data indicates a significant challenge, with the majority of participants (6 out of 10, or 60%)
engaging in improper waste disposal. Tossing waste on the roadside or into a pond is the most
common practice, highlighting a major public health and environmental issue. The fact that only
40% of participants use a dustbin suggests that either there is a lack of awareness regarding the
importance of proper disposal. The habit of dumping waste on the roadside and especially into a
pond directly contributes to environmental degradation. Pond disposal can lead to water
contamination, harming aquatic life and potentially affecting local water sources. Roadside
dumping creates unsanitary conditions, attracting pests and posing health risks to the community.

5.9 Health Related Information

Health-related information is critically important for people in slum areas as it serves as a primary
tool for disease prevention and management. Due to crowded living conditions and often poor
sanitation, these communities are highly vulnerable to the rapid spread of infectious diseases.
Among the 10 participants surveyed, seven (70%) receive health-related information from mosque
announcements. Two participants (20%) rely on word of mouth from others, and only one
participant (10%) gets health information from television.

Table:4 (5.9 Health Related Information)

Type of source Number of participants Percentage

Word of mouth 02 20%

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 Mosque miking 07 70%
Television/mass medja 01 10%
(Based on study of participants response)

The overwhelming reliance on mosque announcements (70%) indicates that messages delivered
through established local networks have the greatest reach. In contrast, the low percentage of
participants who get information from mass media like television (10%) suggests that traditional
media may be an ineffective channel for disseminating health messages in this specific context.
This highlights a disconnect between common public health communication strategies and the
actual information gathering habits of the community. The reliance on word of mouth (20%)
further underscores the importance of informal social networks. This suggests that health
information, once introduced through a trusted source like the mosque, can spread and be
reinforced through personal conversations among community members.

Mass media often struggles to effectively reach residents in slum areas due to a combination of
socioeconomic barriers, inadequate infrastructure, and a preference for alternative communication
channels. Many residents in informal settlements have a low disposable income, making it difficult
to afford televisions, radios, newspapers, or internet services. Additionally, lower literacy rates in
some communities limit access to print media, such as newspapers and magazines, that require
reading proficiency. The lack of essential infrastructure is a major obstacle. Erratic or non-existent
electricity supplies make it challenging to power electronic devices like TVs and radios. Poor
network connectivity and the high cost of data plans can hinder access to online media and social
platforms.

5.10 Health Awareness Training

Health training provides residents with practical knowledge on hygiene, sanitation, and
recognizing the early symptoms of infectious diseases like cholera and typhoid. This knowledge
empowers them to implement basic preventative measures within their homes and community,
effectively serving as the first line of defence against disease outbreaks.

Among the 10 participants surveyed, six (60%) reported having received health-related training,
while four (40%) had not received any such training.

Figure:7 (5.10 Health Awareness Training)

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 (Based on study of participants response)

The fact that six out of ten participants (60%) have received health training is a positive finding,
suggesting the presence of effective outreach or community programs. However, the remaining
four participants (40%) represent a crucial gap in knowledge. This portion of the community lacks
access to fundamental health information, which could make them more vulnerable to diseases
and less prepared to handle health emergencies.

5.11 Desired Changes

Slum residents want readily accessible and affordable healthcare. This includes having local health
clinics or community health centers with a consistent supply of essential medicines. They also
desire the presence of qualified medical professionals who can provide consultations and treatment
without the financial and logistical barriers of traveling to a distant hospital.

People want to live in a healthier environment to prevent diseases from spreading. This involves
fundamental changes to sanitation and hygiene infrastructure, such as access to safe drinking water,
a sufficient number of clean and functional toilets, and a proper waste management system to
prevent uncontrolled dumping that leads to illness.

6. Conclusion :

The data analysis of 10 participants in a slum community reveals a critical link between socio-
economic conditions, environmental factors, and public health. The findings paint a picture of a
population facing significant health vulnerabilities, largely driven by poverty, illiteracy, and
inadequate infrastructure. The study confirms that health-related issues are a universal challenge
within this demographic, with 100% of participants suffering from some form of illness. The
prevalence of specific ailments like lower back pain and respiratory issues directly reflects the
physically demanding and environmentally harsh conditions of their lives and work.

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Furthermore, the research highlights a significant reliance on informal and potentially risky
healthcare practices. With 80% of participants seeking treatment from pharmacies instead of
government hospitals, there's a clear indication that financial and logistical barriers are forcing
them toward self-medication, which poses serious health risks and could contribute to antibiotic
resistance.

The health of this community is not just a medical issue but a complex problem rooted in poverty,
a lack of sanitation, and limited access to formal healthcare. To truly address these issues, future
interventions must focus on improving basic infrastructure, providing accessible and affordable
formal healthcare, and leveraging existing, trusted community networks to disseminate vital health
information and training.

6. Reference:

1. 2. KHAN, I., ISLAM, M., & HASAN, M. Environmental Condition of the Slum Dwellers of Rajshahi City,
Bangladesh.
2. Alam, M. Z., Rahman, M. A., & Al Firoz, M. A. (2013). Water supply and sanitation facilities in urban slums:
a case study of Rajshahi City corporation slums. American Journal of Civil Engineering and
Architecture, 1(1), 1-6.
3. Hossain, M. A., Moniruzzaman, M., & Islam, M. A. (2010). Urban environmental health in Bangladesh slum:
A comparative study of two metropolitan cities. Journal of science foundation, 8(1-2), 67-76.
4. World Health Organization. (2019). Progress on household drinking water, sanitation and
hygiene 2000–2017: Special focus on inequalities. WHO.
5. UN-Habitat. (2020). Urban WASH for COVID-19 in informal settlements: Technical note.
UN-Habitat. https://unhabitat.org/sites/default/files/2020/05/un-habitat-
unicef_wash_technical_note_urban_wash_for_covid_in_informal_settlements.pdf
6. Jenkins, M. W., & Curtis, V. (2005). Achieving the “good life”: Why some people want
latrines in rural Benin. Social Science & Medicine, 61(11), 2446–2459.

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 7. Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C. H., & Schmidt,
W. P. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. International
Journal of Epidemiology, 39(Suppl_1), i193–i205.
8. WaterAid. (2018). WaterAid annual report 2018–2019. WaterAid.
https://www.wateraid.org/sites/g/files/jkxoof271/files/wateraid-global-annual-report-
2018-2019.pdf
9. Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., ... & Lilford,
R. (2017). The health of people who live in slums 1: The history, geography, and sociology
of slums and the health problems of their residents. The Lancet, 389(10068), 547–558.
10. Garg S, Sembiah S, Maharana S, Mallick N, Bhattacharya A, Biswas B. Importance of
giving health education regarding lifestyle modification and perceived barriers: focus
group discussion among community health workers of slum of Kolkata, India. Int J Res
Med Sci 2018;6:2324-3112.

Pictures of surveying :

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