According to the United Nations Chil- dren Fund (UNICEF) and the World Health Organization (WHO), Bangladesh has recorded the highest number of child deaths due to diarrhea, with approximately 50,800 children under the age of 5 years dying from diarrheal illnesses each year. Therefore, access to safe drinking water is essential to good health and is necessary for infant and child survival and development, in particu- lar (Parvez et al., 2019). Waterborne diseases are common through- out Bangladesh, but these diseases are espe- cially common in suburban areas of cities where poverty and poor living conditions worsen the situation. Whether in big or small cities, these diseases affect almost all of these poorer areas. For example, in the so-called slums of Dhaka, waterborne deaths accounted for 27% of all recorded deaths (Jorgenson & Rice, 2012). The situation is the same in other districts such as Rajshahi, Chittagong, and Khulna. In view of this reality, we selected poor suburban areas of the Khulna District as the study area for our research study. Mothers play a key role in protecting their children’s health, and thus improving moth- ers’ knowledge, attitudes, and practices is crucial to improving their children’s health (Workie et al., 2018). A variety of health issues can affect children throughout their early childhood years, and changes in a child’s health can manifest through sudden changes in behavior. By increasing parental awareness and attentiveness, a large improvement can be made for children, which will help with these challenges. Previous research in different countries has explored the linkages between parental awareness and children’s physical and mental well-being (Nasrin et al., 2021). Children are vulnerable to infection from many sources such as contaminated food and water, flies, fomites, and polluted environments. The major role played by mothers in urban areas of India, for example, in preventing water- borne diseases is due to the fact that women are mainly responsible for caring for the children (Kutwal, 2019). In Bangladesh, few research studies have specifically addressed parental awareness in relation to reducing waterborne diseases among children ages 5–9 years, particularly in poorer suburban areas. In light of this knowledge gap, our study aimed to investigate parental behaviors that
contribute to reducing waterborne diseases in children and to quantify each head of household’s willingness to pay (WTP) for decreasing such disease incidence using the stated preference approach of the contingent valuation method (CVM). Our study find- ings can serve as essential baseline informa- tion for improving household water security, promoting healthier water-use behaviors, and enhancing child health outcomes within the study area as well as more broadly. Theoretical Framework A person’s water, sanitation, and hygiene (WASH) practices are shaped by various beliefs and cultural norms. The health belief model (HBM), one of the earliest frameworks for understanding health-related behav- ior, was created in the 1950s by social psy- chologists Godfrey M. Hochbaum, Irwin M. Rosenstock, and S. Stephen Kegeles at the U.S. Public Health Service. This model offers a psychological explanation for why people adopt or fail to adopt particular health behav- iors under specific circumstances. Over time, HBM has been widely applied in different fields to examine psychosocial influences on adherence to health recommendations and has become one of the most frequently refer- enced theories in health education (Sajaud- din et al., 2017). In our study, the concept and factors asso- ciated with HBM have been used to interpret the range of water- and sanitation-related practices among residents of poorer areas of six suburban regions of Khulna District in Bangladesh. Our analysis focuses on two broad clusters of behavior within HBM: indi- viduals’ perceptions and the factors that mod- ify or trigger their actions. Perception-related elements include how people view the risk and seriousness of illness, as well as the per- sonal value they place on maintaining good health. Modifying factors, on the other hand, cover demographic characteristics, perceived threats, and the cues that prompt individuals to take action (Yamauchi et al., 2022).
In Rupsha Upazila, water resources are highly susceptible to environmental stress, which poses major risks to public health. The water supply is primarily provided by a government-owned water supplier, the Khulna Water Supply & Sewerage Authority (KWASA), which distributes treated surface water through a piped network. The water supply, however, remains insufficient to meet the population’s needs, and Rupsha Upazila faces major challenges due to high water salinity and industrial contamination. We selected six villages within Rupsha Upazila (Rajapur, Aichhgati, Jogihati, Diara, Nandanpur, and Milky-Diara). We prepared a list of 500 household heads in six villages whose children had been affected by water- borne diseases more than one time in a year. From this population, a sample of 300 house- holds was selected using a random sam- pling technique across 6 villages. Our study focuses on two individual segments at the same time. We investigated 1) the probability of waterborne diseases affecting children in these poorer areas and 2) WTP of household heads to reduce the probability of spreading waterborne diseases in these areas. Model Specification We estimated the probability of affecting waterborne diseases by using the logit model. Additionally, we estimated the number of affected waterborne diseases as count data using the Poisson regression model, for children ages 5–9 years who had had waterborne diseases during 2024. According to the local government office, most of primary school-age children are negatively affected by waterborne diseases. Alam (2009) considered the cost of water- borne diseases for children living in these poorer areas, whereas we considered a set of independent variables including some engineering variables, behavioral variables, and socioeconomic variables to arrive at our estimation. We considered these types of variables to estimate the exact effect of independent variables on the dependent variable (i.e., the affecting number of water- borne diseases [WDN] in 2024): WDN = β 0 + β 1 CAG + β 2 CSX + β 3 PED + β 4 SLY+ β 5 PYI + β 6 HFM + β 7 HNP + β 8 RNT + β 9 FWA + β 10 PLF + β 11 NNC + β 12 HWB + β 13 CCW+ ui (1)
Methods
Case Study We chose Rupsha Upazila of Khulna District, a southwestern coastal region of Bangladesh, as the study area because it is one of Ban- gladesh’s most climate-vulnerable regions.
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October 2026 • Journal of Environmental Health
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