Abstract
ObjectiveTo reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks.MethodsWe conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks.ResultsOverall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50 μg/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source . Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased.ConclusionThe overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.
Highlights
Exposure to elevated levels of inorganic arsenic (As) is associated with cancers of the skin, bladder, and lung [13], developmental effects [4,5], cardiovascular disease [6,7], and skin lesions [8,9]
Based on a previous study conducted in Araihazar, Bangladesh, we assumed that the proportion of well switching would be 0.33 in our outside tester villages and 0.66 in our community-tester villages [14,21]
In villages with less than 60% As–contaminated wells, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source
Summary
Exposure to elevated levels of inorganic arsenic (As) is associated with cancers of the skin, bladder, and lung [13], developmental effects [4,5], cardiovascular disease [6,7], and skin lesions [8,9]. Recent data suggest associations between chronic As exposure from drinking water and mortality [12]. In 2006, Ahmed et al reported that 57% of the estimated population of 28–35 million initially exposed to As above the Bangladesh standard of 50 μg/L remain exposed. The most commonly used As mitigation option is well switching (67%), followed by the use of deep tubewells (28%) [13]. Mitigation options such as piped water systems, rainwater collection, dugwells, As filters, and pond sand filters are utilized by a very small proportion of the population [13,14]
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