Exposure In Bangladesh Research Articles

Halved mortality after reducing arsenic exposure in Bangladesh: a prospective cohort study with more than 20 years of follow-up

Halved mortality after reducing arsenic exposure in Bangladesh: a prospective cohort study with more than 20 years of follow-up

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh

ObjectivesAlthough there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. MethodsThis cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. ResultsIn our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53–2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure–child undernutrition association. ConclusionsFlood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

Children Learning About Secondhand Smoke (CLASS III): a protocol for a cluster randomised controlled trial of a school-based smoke-free intervention in Bangladesh and Pakistan

IntroductionSecondhand smoke (SHS) exposure is a major cause of premature death and disease, especially among children. Children in economically developing countries are particularly affected as smoke-free laws are typically only...

Food safety policy enforcement and associated actions reduce lead chromate adulteration in turmeric across Bangladesh

Turmeric adulterated with lead chromate pigment has been previously identified as a primary source of lead exposure in Bangladesh. This study assesses the impact of a multi-faceted intervention between 2017 and 2021 to reduce lead-tainted turmeric in Bangladesh. The intervention involved: i) disseminating findings from scientific studies via news media that identified turmeric as a source of lead poisoning, ii) educating consumers and businesspeople about the risks of lead chromate in turmeric via public notices and face-to-face meetings, and iii) collaborating with the Bangladesh Food Safety Authority to utilize a rapid lead detection technology to enforce policy disallowing turmeric adulteration. Before and after the intervention, evidence of lead chromate turmeric adulteration was assessed at the nation's largest turmeric wholesale market and at turmeric polishing mills across the country. Blood lead levels of workers at two mills were also assessed. Forty-seven interviews were conducted with consumers, businesspeople, and government officials to assess changes in supply, demand, and regulatory capacity. The proportion of market turmeric samples containing detectable lead decreased from 47% pre-intervention in 2019 to 0% in 2021 (n = 631, p < 0.0001). The proportion of mills with direct evidence of lead chromate adulteration (pigment on-site) decreased from 30% pre-intervention in 2017 to 0% in 2021 (n = 33, p < 0.0001). Blood lead levels dropped a median of 30% (IQR: 21–43%), while the 90th percentile dropped 49% from 18.2 μg/dL to 9.2 μg/dL 16 months after the intervention (n = 15, p = 0.033). Media attention, credible information, rapid lead detection tools and swift government action to enforce penalties all contributed to the intervention's success. Subsequent efforts should evaluate if this is an example of an effective intervention that can be replicated to reduce lead chromate adulteration of spices globally.

Low-cost informational intervention reduced drinking water arsenic exposure in Bangladesh.

Thirty million Bangladeshis continue to drink water with unacceptable levels of arsenic (>10 μg/L), resulting in a large public health burden. The vast majority of the Bangladeshi population relies on private wells, and less than 12% use piped water, increasing the complexity of mitigation efforts. While mass testing and informational campaigns were successful in the early 2,000 s, they have received little attention in recent years, even though the number of wells in the country has likely more than doubled. We investigated the effect of a low-cost (<USD 10/household) informational intervention on reducing arsenic exposure through a randomized control trial design. The sample size was ∼10% of the study area households, and the intervention provided exposure awareness material, the arsenic concentration of the household's drinking water, and information about alternate water sources nearby with improved water quality. The informational intervention lowered household arsenic exposure (P=0.0002), with an average reduction in arsenic levels of ∼60%. Approximately one third of the study households requested to test an additional water source at no cost. Providing the intervention a second time led to more households changing their water source but did not further reduce exposure (P=0.39). Our study establishes a causal relationship between the informational intervention and the observed reduction in household arsenic exposure. Our findings demonstrate that water testing and recommendations for accessing improved water provide an immediate, effective, and inexpensive means of reducing the public health burden of arsenic exposure in Bangladesh.

Arsenic contamination in groundwater and food chain with mitigation options in Bengal delta with special reference to Bangladesh.

Bangladesh, situated in Bengal delta, is one of the worst affected countries by arsenic contamination in groundwater. Most of the people in the country are dependent on groundwater for domestic and irrigation purposes. Currently, 61 districts out of 64 districts of Bangladesh are affected by arsenic contamination. Drinking arsenic contaminated groundwater is the main pathway of arsenic exposure in the population. Additionally, the use of arsenic-contaminated groundwater for irrigation purpose in crop fields in Bangladesh has elevated arsenic concentration in surface soil and in the plants. In many arsenic-affected countries, including Bangladesh, rice is reported to be one of the significant sources of arsenic contamination. This review discussed scenario of groundwater arsenic contamination and transmission of arsenic through food chain in Bangladesh. The study further highlighted the human health perspectives of arsenic exposure in Bangladesh with possible mitigation and remediation options employed in the country.

Probabilistic Health Risk Assessment of Iodine Exposure in Bangladesh.

In this study, the concentrations of iodine in household salt samples (n = 690) were determined by following the iodometric titration method, and the health risks of Bangladeshi people were assessed based on the semi-probabilistic approach and the US Environmental Protection Agency (USEPA) deterministic model. After adjusting 20% of cooking losses, the iodine concentration (mean, range) in salt samples of Phultala, Dighalia, Terokhada, Rupsha, Batiaghata, Dumuria, Paikgacha, Koyra, Dacope, and KCC was (29.68 ± 8.67, 14.39-48.26), (31.05 ± 6.68, 15.24-43.18), (26.94 ± 5.57, 16.09-45.72), (24.33 ± 5.61, 12.70-37.26), (26.69 ± 6.73, 10.16-44.87), (27.20 ± 8.44, 9.31-53.34), (27.71 ± 8.09, 8.46-47.42), (28.39 ± 7.80, 11.01-46.57), (28.20 ± 7.97, 3.38-49.10), and (29.21 ± 6.62, 18.62-40.64) mg/kg, respectively. The iodine contents in 97.25% of samples were within the standard fortification level of Bangladesh (15-50mg/kg), while 2.61% of samples were below this limit. The semi-probabilistic risk assessment studies showed that 80.14% of samples at a low ingestion rate could provide optimal nutrition (150-299μg/day) to the whole population. Contrarily, at medium, moderate-high, and high consumption rates 34.93%, 65.22%, and 85.94% of samples, respectively, belonged to above the requirements to excessive exposure categories (300-1100μg/day), which might cause iodine-induced diseases. The target hazard quotient (THQ) values for the adults in most of the samples were within the threshold risk limit (THQ < 1.0), whereas THQ values in 6.82% to 85.97% of samples for the children at low to high ingestion rates, respectively exceeded this limit, which revealed that the adults were almost safe, but the children might face non-carcinogenic health effects. Therefore, regular monitoring of iodine concentration in iodized salts should be done to prevent iodine deficiency or iodine-induced disorders.

Estimating the Impact of the COVID-19 Pandemic on Childhood Immunization Using Subnational Exposure in Bangladesh

Estimating the Impact of the COVID-19 Pandemic on Childhood Immunization Using Subnational Exposure in Bangladesh

Well-Switching to Reduce Arsenic Exposure in Bangladesh: Making the Most of Inaccurate Field Kit Measurements.

Well‐switching programs in Bangladesh have successfully lowered arsenic exposure. In these programs, households switch from wells that are labeled “unsafe” to nearby wells labeled “safe,” but these designations are usually based on inherently inaccurate field kit measurements. Here, we (a) compare the efficacy of field‐kit measurements to accurate laboratory measurements for well switching, (b) investigate the potential impact on well switching of the chosen “safe” threshold, and (c) consider the possible benefits of providing more detailed concentration information than just “safe” and “unsafe.” We explore different hypothetical mitigation scenarios by combining two extensive data sets from Araihazar Bangladesh: a blanket survey of 6595 wells over 25 km2 based on laboratory measurements and 943 paired kit and laboratory measurements from the same area. The results indicate that the decline in average arsenic exposure from relying on kit rather than laboratory data is modest in relation to the logistical and financial challenge of delivering exclusively laboratory data. The analysis further indicates that the 50 μg/L threshold used in Bangladesh to distinguish safe and unsafe wells, rather than the WHO guideline of 10 μg/L, is close to optimal in terms of average exposure reduction. We also show that providing kit data at the maximum possible resolution rather than merely classifying wells as unsafe or safe would be even better. These findings are relevant as the government of Bangladesh is about to launch a new blanket testing campaign of millions of wells using field kits.

Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh.

BackgroundPopulation-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys.ObjectiveThis study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh.MethodsA population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness.ResultsA total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2% (1047/2006) and a co-operation rate of 89.0% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile.ConclusionsProbability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone–based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs.

Association between chronic obstructive pulmonary disease (COPD) and occupational exposures: A hospital based quantitative cross-sectional study among the Bangladeshi population.

The association between chronic obstructive pulmonary disease (COPD) and occupational exposures are less studied in Bangladeshi context, despite the fact that occupational exposures are serious public health concerns in Bangladesh. Therefore, this study aimed to evaluate this association considering demographic, health and smoking characteristics of Bangladeshi population. This was a hospital-based quantitative study including 373 participants who were assessed for COPD through spirometry testing. Assessment of occupational exposures was based on both self-reporting by respondents and ALOHA based job exposure matrix (JEM). Here, among the self-reported exposed group (n = 189), 104 participants (55%) were found with COPD compared to 23 participants (12.5%) in unexposed group (n = 184) that differed significantly (p = 0.00). Similarly, among the JEM measured low (n = 103) and high exposed group (n = 236), 23.3% and 41.5% of the participants were found with COPD respectively; compared to unexposed group (14.7%; n = 34), that differed significantly also (p = 0.00). Likewise, participants with longer self-reported occupational exposures (>8 years) showed significantly (p = 0.00) higher proportions of COPD (79.5%) compared to 40.4% in shorter exposure group (1-8 years). Similarly, significant (p = 0.00) higher cases of COPD were observed among the longer cumulative exposure years (>9 years) group than the shorter cumulative exposure years (1-9 years) group in JEM. While combining smoking and occupational exposure, the chance of developing COPD among the current, former and non-smokers of exposed group were 7.4, 7.2 and 12.7 times higher respectively than unexposed group. Furthermore, logistic analysis revealed that after adjustments for confounding risk factors, the chance of developing COPD among the self-reported exposure group was 6.3 times higher (ORs: 6.3, p = 0.00) than unexposed group; and JEM exposure group has odds of 2.8 and 1.1 respectively (p<0.05) for high and low exposures. Further studies are needed to reinforce this association between COPD and occupational exposure in Bangladesh.

Risk assessment of aflatoxin-related liver cancer in Bangladesh

ABSTRACTAflatoxins are mycotoxins (fungal toxins) produced by Aspergillus species in variety of food commodities. Consumption of aflatoxin-contaminated food can cause adverse health effects, including liver cancer. Aflatoxin exposure is usually higher in hot and humid countries. Previous biomarker-based studies have indicated significant exposure to aflatoxins among the Bangladeshi population. Recently, high aflatoxin levels were reported in dates, which are consumed in large quantities during the month of Ramadan in Bangladesh and other Muslim countries. Bangladesh has recently enacted aflatoxin regulation in foods. In this study, we determined the risk of aflatoxin-related liver cancer among the Bangladeshi population based on the average dietary intakes of different aflatoxin contaminated foods, accounting for the synergistic impacts of aflatoxin with chronic hepatitis B viral infection in inducing cancer. We also determined whether the new aflatoxin regulations in Bangladesh could significantly reduce the risk of liver cancer. The mean number of cancer cases per year caused by dietary aflatoxin exposure in Bangladesh was estimated at about 1311, or 43.9% of the total annual liver cancer cases in Bangladesh. The new aflatoxin regulations do not appear likely to significantly reduce the risk of liver cancer in the country.

Blood plasma biomarkers of citrinin and ochratoxin A exposure in young adults in Bangladesh.

Citrinin (CIT) and Ochratoxin A (OTA) are nephrotoxic mycotoxins which can co-occur in food commodities, resulting in internal exposure. Studies in many countries reported on the presence of OTA in human blood; however, such biomonitoring data for CIT is still scarce. This study was conducted to characterize both CIT and OTA biomarker levels in plasma of volunteers since food analysis data are insufficient to assess human exposure in Bangladesh. In total 104 blood samples were collected from university students in 2013 (sampling 1: n = 64, midsummer) and 2014 (sampling 2: n = 40, end winter) for analysis of CIT and OTA and their metabolites HO-CIT and OTα by LC-MS/MS and HPLC-FD techniques, respectively. CIT and HO-CIT were detected in 90% (max 2.70ng/mL) and 85% (max 1.44ng/mL) of all samples. Mean levels in sampling 2 (CIT 0.47ng/mL; HO-CIT 0.40ng/mL) were higher than in sampling 1 (0.25ng/mL; 0.37ng/mL) indicative of variable CIT exposure. OTA was present in all (max 6.63ng/mL) and OTα in 98% (max 0.99ng/mL) of the samples. In sampling 1, mean OTA (0.85ng/mL) was higher than in sampling 2 (0.51ng/mL); the reverse situation was found for OTα mean levels. The calculated dietary OTA intake among the students (mean 9.9; max 91.7ng/kg bw/week) was lower than the tolerable weekly intake for this mycotoxin (120ng/kg bw/week) set by EFSA. But frequent co-exposure to CIT should be considered, and the results of this study indicate the necessity to identify major sources of CIT and OTA intake in the Bangladeshi population.

Cost Analysis of RCC, Steel and Composite Multi-Storied Car Parking Subjected to High Wind Exposure in Bangladesh

Steel-concrete composite constructions in Bangladesh are nowadays very popular owing to their advantages over conventional concrete and steel constructions. Concrete structures are massive and allot more seismic weight and less deflection whereas steel structures instruct more deflections and ductility to the structure, which is beneficial in resisting earthquake and wind forces. Composite construction combines the better properties of both steel and concrete along with lesser cost, speedy construction, fire protection etc. The objective of this study was to analysis and design ground floor plus 19 storied R.C.C, Steel and Composite (steel-concrete) multi-storied parking structure’s frame of same plan using ETABS 2013 software and compare their structural parameters with estimated cost for required material. All frames are designed for same gravity and dynamic loadings. The RCC deck-slab is used in steel and composite frame. Beam and column sections are made of RCC, steel or steel-concrete composite sections. The composite construction option provided about 25 % and 18% less cost when compared to RCC and steel structure, respectively. Comparative study concludes that the composite frames are best suited among all the three types of constructions in terms of material cost and benefit added with better structural behaviour.

Provision of well-water treatment units to 600 households in Bangladesh: A longitudinal analysis of urinary arsenic indicates fading utility

BackgroundMillions of villagers in Bangladesh remain exposed to high levels of arsenic (As) from drinking untreated well-water even though the scale of the problem was recognized 15years ago. Water treatment at the household-level has been promoted as a viable complement but few longitudinal studies of their efficacy using an objective measure of exposure have been conducted. Participants (N=622) of a nutrition trial in Araihazar, Bangladesh were each provided with READ-F filters at the beginning of the study and encouraged to use them over the 6month duration of the intervention. Well-water As, treated water As, and urinary As were monitored periodically during the trial and measured again one year after the trial ended. ResultsThe READ-F filters were initially well received and median urinary As levels for participants declined from 117μg/L to 51μg/L within a single week. However, median urinary As levels gradually rose back to 126μg/L by the end of the trial. Fifty filters were replaced over the course of the trial because of insufficient As removal or reduced flow. With these exceptions, most of the treated water met the WHO guideline for As in drinking water of 10μg/L. One year after the nutritional trial ended, 95% of participants had abandoned their filter citing inconvenience as the primary reason. At that time, median urinary As levels for 10 participants who had switched to a nearby low-As well had declined to 63μg/L. ConclusionsParticipants were probably no longer using the READ-F filter long before the 6month nutritional intervention ended despite claiming that they were using them. Household-level treatment is likely to continue to play a minor role in the effort to reduce As exposure in Bangladesh. Understanding the limitations of such expensive interventions is important for future policy regarding As mitigation.

Inequitable allocation of deep community wells for reducing arsenic exposure in Bangladesh.

Community wells that extend deeper than most private wells are crucial for reducing exposure to groundwater arsenic (As) in rural Bangladesh. This study evaluates the impact on access to safe drinking water of 915 such intermediate (90-150 m) and deep (>150 m) wells across a 180 km2 area where a total of 48,790 tubewells were tested with field kits in 2012-13. Half the shallow private wells meet the Bangladesh standard of 50 µg/L for As in drinking water, whereas 92% of the intermediate and deep wells meet the more restrictive World Health Organization guideline for As in drinking water of 10 µg/L. As a proxy for water access, distance calculations show that 29% of shallow wells with >50 µg/L As are located within walking distance (100 m) of at least one of the 915 intermediate or deep wells. Similar calculations for a hypothetical more even distribution of deep wells show that 74% of shallow wells with >50 µg/L As could have been located within 100 m of the same number deep wells. These observations and well-usage data suggest that community wells in Araihazar, and probably elsewhere in Bangladesh, were not optimally allocated by the government because of elite capture.

Evaluation of an Elementary School-based Educational Intervention for Reducing Arsenic Exposure in Bangladesh.

BackgroundChronic exposure to well water arsenic (As) remains a major rural health challenge in Bangladesh and some other developing countries. Many mitigation programs have been implemented to reduce As exposure, although evaluation studies for these efforts are rare in the literature.ObjectivesIn this study we estimated associations between a school-based intervention and various outcome measures of As mitigation.MethodsWe recruited 840 children from 14 elementary schools in Araihazar, Bangladesh. Teachers from 7 schools were trained on an As education curriculum, whereas the remaining 7 schools without any training formed the control group. Surveys, knowledge tests, and well-water testing were conducted on 773 children both at baseline and postintervention follow-up. Urine samples were collected from 210 children from 4 intervention schools and the same number of children from 4 control schools. One low-As (< 10 μg/L) community well in each study village was ensured during an 18-month intervention period.ResultsAfter adjustment for the availability of low-As wells and other sociodemographic confounders, children receiving the intervention were five times more likely to switch from high- to low-As wells (p < 0.001). We also observed a significant decline of urinary arsenic (UAs) (p = < 0.001) (estimated β = –214.9; 95% CI: –301.1, –128.7 μg/g creatinine) among the children who were initially drinking from high-As wells (> Bangladesh standard of 50 μg/L) and significantly improved As knowledge attributable to the intervention after controlling for potential confounders.ConclusionsThese findings offer strong evidence that school-based intervention can effectively reduce As exposure in Bangladesh by motivating teachers, children, and parents.CitationKhan K, Ahmed E, Factor-Litvak P, Liu X, Siddique AB, Wasserman GA, Slavkovich V, Levy D, Mey JL, van Geen A, Graziano JH. 2015. Evaluation of an elementary school–based educational intervention for reducing arsenic exposure in Bangladesh. Environ Health Perspect 123:1331–1336; http://dx.doi.org/10.1289/ehp.1409462

Creatinine, arsenic metabolism, and renal function in an arsenic-exposed population in Bangladesh.

Kidney disease is emerging as an arsenic (As)-linked disease outcome, however further evidence of this association is warranted. Our first objective for this paper was to examine the potential renal toxicity of As exposure in Bangladesh. Our second objective relates to examining whether the previously reported positive association between urinary creatinine (uCrn) and As methylation may be explained by renal function. We had hypothesized that these associations relate to supply and demand for s-adenosylmethionine, the methyl donor for both creatine synthesis and As methylation. Alternatively, renal function could influence both As and creatinine excretion, or the As metabolites may influence renal function, which in turn influences uCrn. We conducted a cross-sectional study (N = 478) of adults, composed of a sample recruited in 2001 and a sample recruited in 2003. We assessed renal function using plasma cystatin C, and calculated the estimated glomerular filtration rate (eGFR). Consistent with renal toxicity of As, log-uAs had a marginal inverse association with eGFR in the 2003 sample (b = −5.6, p = 0.07), however this association was not significant in the 2001 sample (b = −1.9, p = 0.24). Adjustment for eGFR did not alter the associations between uCrn and the %uAs metabolites, indicating that GFR does not explain these associations. Increased eGFR was associated with increased odds of having %uInAs >12.2% (2001: OR = 1.01, 95%CI (1.00,1.03); 2003: OR = 1.04, 95%CI (1.01,1.07)). In the 2003 sample only, there was a negative association between eGFR and %uDMA (b = −0.08, p = 0.02). These results may indicate differential effects of renal function on excretion of InAs and DMA. Alternatively, a certain methylation pattern, involving decreased %InAs and increased %DMA, may reduce renal function. Given that these studies were cross-sectional, we cannot distinguish between these two possibilities. Discrepancies between the samples may be due to the higher As exposure, poorer nutrition, and lower As methylation capacity in the 2003 sample.

Randomized Controlled Trials of Community Based Arsenic Interventions to Reduce Arsenic Exposure in Bangladesh

Background: Millions of villagers in Bangladesh drink water which exceeds the Bangladesh Arsenic (As) standard of 50 micrograms per liter. Exposure to elevated levels of inorganic As is associated with cancers of the skin, bladder, and lung, developmental effects, cardiovascular disease, and skin lesions. As mitigation typically involves testing the well water without providing resources to address health concerns or give advice on mitigation options. We sought to evaluate community level intervention strategies for As mitigation in Bangladesh. Method: We conducted two randomized controlled trials (RCT) in Singair and Shibalaya, Bangladesh. In the first cluster of 1000 households, we evaluated the effectiveness of having community members versus outside representatives disseminate As education and conduct water As testing using urinary As at baseline and follow-up. In the second cluster RCT of 450 households, we evaluated the effectiveness of community and household level As educational interventions on increasing the adoption of a fee-based As testing program. Our primary outcome in this RCT was a household purchasing As test for their primary drinking water source. Results: In the first RCT, we found that overall 53% of respondent using As contaminated wells (&gt;50?g/L), at baseline switched after receiving the intervention. When we stratified by those residing in a village where less than 60% of wells in use were As unsafe, UNICEF cutoff for well switching as a mitigation option, 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. These results were confirmed by a 30% reduction in urinary As between baseline and follow-up for those who reported switching to safe wells (p&lt;0.0001). In the RCT of the fee-based As testing program, we found that 93% of households that received the community and household level As interventions purchased an As test, in comparison to only 53% in the control group. Finding: These low cost easily to implement community based arsenic educational interventions were effective in reducing arsenic exposure and promoting the use of a fee-based arsenic testing program in communities in rural Bangladesh.

Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation

A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 µg/L and the World Health Organization's guideline value of 10 µg/L, respectively. From the updated exposure data and all-cause mortality hazard ratios based on local epidemiological studies, it was estimated that arsenic exposures to concentrations > 50 µg/L and 10-50 µg/L account for an annual 24,000 and perhaps as many as 19,000 adult deaths in the country, respectively. Exposure varies widely in the 64 districts; among adults, arsenic-related deaths account for 0-15% of all deaths. An arsenic-related mortality rate of 1 in every 16 adult deaths could represent an economic burden of 13 billion United States dollars (US$) in lost productivity alone over the next 20 years. Arsenic mitigation should follow a two-tiered approach: (i) prioritizing provision of safe water to an estimated 5 million people exposed to > 200 µg/L arsenic, and (ii) building local arsenic testing capacity. The effectiveness of such an approach was demonstrated during the United Nations Children's Fund 2006-2011 country programme, which provided safe water to arsenic-contaminated areas at a cost of US$ 11 per capita. National scale-up of such an approach would cost a few hundred million US dollars but would improve the health and productivity of the population, especially in future generations.