| 1. |
- Jakariya, Md., et al.
(author)
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Sustainable safe water options in Bangladesh : experiences from the Arsenic Project at Matlab (AsMat)
- 2005
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In: Natural Arsenic in Groundwater. - LEIDEN : A A BALKEMA PUBLISHERS. - 041536700X ; , s. 319-330
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Conference paper (peer-reviewed)abstract
- The presence of elevated levels of naturally occurring arsenic in groundwater of Bangladesh, has severely impaired the decade long effort of providing safe water to nearly 98% of its population and putting an estimated 3 5 million people-nearly one fourth of the total population at risk. In order to address this problem, a project titled "Arsenic in tubewell (TW) water and health consequences in Matlab Upazila of Chandpur district (AsMat)" is being implemented jointly by ICDDR,B and BRAC. During this study. all the TWs in Matlab have been assigned unique identification numbers, with marked GPS coordinates, depth, and age. It is estimated that nearly 65% of the about 13,000 TWs in Matlab have As concentrations above the Bangladesh drinking water standard (50 mu g/L). In order to minimize arsenic exposure, a work to provide various alternate safe drinking water options to the exposed population has been initiated. As of March 2004, about 1047 different alternate safe water options, such as Pond Sand Filter (PSF), Rainwater Harvester (RWH) and different filters to remove arsenic as well as pathogenic bacteria, were distributed among the targeted exposed population in Matlab. To ensure sustainable use, the provided options were assessed based on community acceptability, technical viability, and financial viability.
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| 2. |
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| 3. |
- Hore, Samar Kumar, et al.
(author)
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Detecting arsenic-related skin lesions : Experiences from a large community-based survey in Bangladesh
- 2007
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In: International Journal of Environmental Health Research. - : Informa UK Limited. - 0960-3123 .- 1369-1619. ; 17:2, s. 141-149
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Journal article (peer-reviewed)abstract
- A cross-sectional survey was conducted in Matlab, Bangladesh, to determine the prevalence of skin lesions (a three-step procedure) associated with arsenic exposure and discuss validity and feasibility in relation to recommended screening algorithms. Cases with skin lesions were identified by screening above 4 years of age (n = 166,934). Trained field teams conducted a careful house-to-house screening and identified 1682 individuals with skin lesions, who were referred to physicians for confirmation. Physicians diagnosed 579 cases as probable and documented all these with digital photographs. Two experts inspected all photographs for consensus agreement that was reached for 504 cases. Using the experts' opinions as reference, the positive predictive value of the physicians' diagnosis was 87% (male = 82% vs. female = 94%; p < 0.01). The physicians had difficulties in separating arsenic-induced keratosis from differential diagnoses, while probability for correct diagnosis was high for arsenic-related pigmentation changes. Including information on current arsenic concentration in drinking water (which was masked at time of skin examination) or urine in the diagnostic algorithm should have increased the number of false negative cases. In the present transition of drinking water sources these markers of current exposure levels provide no information on past exposure. A 2 - 3 step procedure with house-to-house screening and clinic-based confirmation of arsenic-induced skin lesions is a feasible approach. Information on arsenic concentration in current water sources or in urine should not have improved the precision in the diagnosis. These results may have policy implications for community screening of arsenic-related skin lesions in Bangladesh and elsewhere.
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| 4. |
- Lindberg, Anna-Lena, et al.
(author)
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Gender and age differences in the metabolism of inorganic arsenic in a highly exposed population in Bangladesh
- 2008
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In: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 106:1, s. 110-20
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Journal article (peer-reviewed)abstract
- Although genetic polymorphisms have been shown to explain some of the large variation observed in the metabolism of inorganic arsenic there may be several other factors playing an important role, e.g. nutrition. The objective of this study was to elucidate the influence of various factors on current arsenic exposure and metabolism in Matlab, a rural area in Bangladesh, where elevated water arsenic concentrations and malnutrition are prevalent. In total 1571 individuals, randomly selected from all inhabitants above 5 years of age, were investigated by measuring arsenic in urine and drinking water. In a subset of 526 randomly selected individuals, arsenic metabolites were speciated using HPLC coupled to inductively coupled plasma mass spectrometry (HPLC-HG-ICPMS). A significant association was observed between arsenic in urine and drinking water (R 2 = 0.41). The contribution to urinary arsenic from arsenic exposure from food and other water sources was calculated to be almost 50 mu g/L. The individuals in the present study had remarkably efficient methylation, in spite of high exposure and prevalence of malnutrition. Gender and age were major factors influencing arsenic metabolism in this population with a median of 77 mu g/L of arsenic in urine (range: 0.5-1994 mu g/L). Women had higher arsenic methylation efficiency than men, but only in childbearing age, supporting an influence of sex hormones. Overall, exposure level of arsenic, gender and age explained at most 30% of the variation in the present study, indicating that genetic polymorphisms are the most important factor influencing the metabolism of inorganic arsenic.
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| 5. |
- Lindberg, Anna-Lena, et al.
(author)
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The risk of arsenic induced skin lesions in Bangladeshi men and women is affected by arsenic metabolism and the age at first exposure
- 2008
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In: Toxicology and Applied Pharmacology. - : Elsevier BV. - 0041-008X .- 1096-0333. ; 230:1, s. 9-16
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Journal article (peer-reviewed)abstract
- It is known that a high fraction of methylarsonate (MA) in urine is a risk modifying factor for several arsenic induced health effects, including skin lesions, and that men are more susceptible for developing skin lesions than women. Thus, we aimed at elucidating the interaction between gender and arsenic metabolism for the risk of developing skin lesions. This study is part of a population-based case-referent study concerning the risk for skin lesions in relation to arsenic exposure via drinking water carried out in Matlab, a rural area 53 km south-east of Dhaka, Bangladesh. We randomly selected 526 from 1579 referents and all 504 cases for analysis of arsenic metabolites in urine using HPLC coupled to inductively coupled plasma mass spectrometry (HPLC-HG-ICPMS). The present study confirm previous studies, with the risk for skin lesions being almost three times higher in the highest tertile of %MA (adjusted OR 2.8, 95% CI: 1.9-4.2, p < 0.001) compared to the lowest tertile. The present study is the first to show that the well documented higher risk for men to develop arsenic-related skin lesions compared to women is mainly explained by the less efficient methylation of arsenic, as defined by a higher fraction of MA and lower fraction of DMA in the urine, among men. Our previously documented lower risk for skin lesions in individuals exposed since infancy, or before, was found to be independent of the observed arsenic methylation efficiency. Thus, it can be speculated that this is due to a programming effect of arsenic in utero.
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| 6. |
- Nermell, Barbro, et al.
(author)
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Urinary arsenic concentration adjustment factors and malnutrition
- 2008
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In: Environmental Research. - : Elsevier BV. - 0013-9351 .- 1096-0953. ; 106:2, s. 212-218
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Journal article (peer-reviewed)abstract
- This study aims at evaluating the suitability of adjusting urinary concentrations of arsenic, or any other urinary biomarker, for variations in urine dilution by creatinine and specific gravity in a malnourished population. We measured the concentrations of metabolites of inorganic arsenic, creatinine and specific gravity in spot urine samples collected from 1466 individuals, 5-88 years of age, in Matlab, rural Bangladesh, where arsenic-contaminated drinking water and malnutrition are prevalent (about 30% of the adults had body mass index (BMI) below 18.5 kg/m(2)). The urinary concentrations of creatinine were low; on average 0.55 g/L in the adolescents and adults and about 0.35 g/L in the 5-12 years old children. Therefore, adjustment by creatinine gave much higher numerical values for the urinary arsenic concentrations than did the corresponding data expressed as mu g/L, adjusted by specific gravity. As evaluated by multiple regression analyses, urinary creatinine, adjusted by specific gravity, was more affected by body size, age, gender and season than was specific gravity. Furthermore, urinary creatinine was found to be significantly associated with urinary arsenic, which further disqualifies the creatinine adjustment.
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| 7. |
- Rahman, Mahfuzar, et al.
(author)
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Arsenic exposure and age- and sex-specific risk for skin lesions : A population-based case-referent study in Bangladesh
- 2006
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In: Journal of Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 114:12, s. 1847-1852
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Journal article (peer-reviewed)abstract
- Background: The objective of this population-based case-referent study in Matlab, Bangladesh, was to assess the susceptibility to arsenic-induced skin lesions by age and sex, in a population drinking water from As-contaminated tube wells. Methods: Identification of As-related skin lesions was carried out in three steps: a) screening of the entire population > 4 years of age (n = 166,934) by trained field teams; b) diagnosis of suspected As-related cases by physicians; and c) confirmation by experts based on physicians' records and photographs, A total of 504 cases with skin lesions were confirmed. We randomly selected 2,201 referents from the Matlab health and demographic surveillance system; 1,955 were eligible, and 1,830 (94%) were available for participation in the study. Individual history of As exposure was based on information obtained during interviews and included all drinking-water sources used since 1970 and concentrations of As (assessed by atomic absorption spectrophotometry) in all the tube wells used. Results: Cases had been exposed to As more than referents (average exposure since 1970: male cases, 200 μg/L; female cases, 211 μg/L; male referents, 143 μg/L; female referents, 155 μg/L). We found a dose-response relationship for both sexes (p < 0.001) and increased risk with increasing socioeconomic status. Males had a higher risk of obtaining skin lesions than females (odds ratio 10.9 vs. 5.78) in the highest average exposure quintile (p = 0.005). Start of As exposure (cumulative exposure) before 1 year of age was not associated with higher risk of obtaining skin lesions compared to start of As exposure later in life. Conclusions: The results demonstrate that males are more susceptible than females to develop skin lesions when exposed to As in water from tube wells.
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| 8. |
- Sohel, Nazmul, et al.
(author)
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Arsenic in Drinking Water and Adult Mortality : A Population-based Cohort Study in Rural Bangladesh
- 2009
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In: Epidemiology. - 1044-3983 .- 1531-5487. ; 20:6, s. 824-830
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Journal article (peer-reviewed)abstract
- BACKGROUND:: Arsenic is a potent human carcinogen and toxicant. Elevated concentration of arsenic in drinking water is a major public-health problem worldwide. We evaluated risks of adult mortality (due to cancer and cardiovascular and infectious diseases) in relation to arsenic exposure through drinking water. METHODS:: A cohort analysis was applied to survival data prospectively collected during 1991-2000 in a health and demographic surveillance system in Matlab, Bangladesh, where tubewells were installed beginning in the early 1970s. A total of 115,903 persons aged 15 or more years on 1 January 1991 were available for analysis. In this period, 9015 people died and 22,488 were lost to follow-up. Arsenic exposure data were derived from a survey in 2002-2003 of past and current water use and arsenic concentrations in all tubewells. We estimated risk of excess mortality in relation to arsenic exposure, using proportional hazards models. RESULTS:: Even at low levels (10-49 mug/L) of arsenic in drinking water, we observed increased risk of death due to all nonaccidental causes (hazard ratio = 1.16 [95% confidence interval = 1.06-1.26]). Increased risks at exposure of 50-149 mug/L were observed for death due to cancers (1.44 [1.06-1.95]), cardiovascular disease (1.16 [0.96-1.40]), and infectious diseases (1.30 [1.13-1.49]). We observed clear dose-response relationships for each of these causes. CONCLUSIONS:: Arsenic exposure through drinking water has generated excess adult mortality after 20-30 years of exposure.
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