We studied a group of women of reproductive age (15-49 years) who were chronically exposed to arsenic through drinking water to identify the pregnancy outcomes in terms of live birth, stillbirth, spontaneous abortion, and preterm birth. We compared pregnancy outcomes of exposed respondents with pregnancy outcomes of women of reproductive age (15-49 years) who were not exposed to arsenic-contaminated water. In a cross-sectional study, we matched the women in both exposed and nonexposed groups for age, socioeconomic status, education, and age at marriage. The total sample size was 192, with 96 women in each group (i.e., exposed and nonexposed). Of the respondents in the exposed group, 98% had been drinking water containing [Greater and equal to] 0.10 mg/L arsenic and 43.8% had been drinking arsenic-contaminated water for 5-10 years. Skin manifestation due to chronic arsenic exposure was present in 22.9% of the respondents. Adverse pregnancy outcomes in terms of spontaneous abortion, stillbirth, and preterm birth rates were significantly higher in the exposed group than those in the nonexposed group (p = 0.008, p = 0.046, and p = 0.018, respectively).

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Arsenic contamination of groundwater in Bangladesh has been recognized as a major public problem. The arsenic contamination was first identified in the tubewell water in 1993 in a northern district of Bangladesh. Tubewells are the main source of drinking water in rural areas, and except hilly and terrace upland throughout the Bangladesh, the arsenic-contaminated tube-wells are distributed. Fifty million people of Bangladesh were estimated to be at risk of exposure to arsenic through consumption of water from contaminated tubewells. Chronic exposure to arsenic causes arsenicosis and may include multi-organ pathologies. Many of the health effects of chronic toxicity are evident in Bangladesh. Besides dermatological manifestations, noncommunicable diseases including cancer, adverse pregnancy outcomes, and decreased intelligence quotient among the children are reported to be increasing. Cancer due to long-term low-dose arsenic exposure through consumption of contaminated water is now an important concern of Bangladesh as it is being increasingly reported from arsenic-exposed individuals. Stoppage of consumption of the arsenic-contaminated water is the mainstay of arsenicosis prevention and case management. At present, a higher proportion of the people are still consuming arsenic-contaminated water because of the lack of sustainable arsenic-safe water supply. In providing sustainable arsenic-safe water options, any option advocated should be cheap, easy to use, locally maintainable, and owned by the community. In addressing arsenic-related health issues, arsenic-exposed population needs to be brought under the coverage of the regular surveillance program for detection and subsequent management of noncommunicable diseases and cancers.

Introduction. Use of lead acid battery (LAB) in Bangladesh has risen with sharp rise of motor vehicles. As result, manufacture of LAB is increasing. Most of the lead used by these industries comes from recycling of LAB. Workers in LAB industry are at risk of exposure lead and thus development of lead toxicity. Objective. The objective of this study was to measure the blood lead concentration and to assess the magnitude of health problems attributable to lead toxicity among the LAB manufacturing workers. Methods. A cross-sectional study was conducted among the workers of LAB manufacturing industries located in Dhaka city. Result. Mean blood lead level (BLL) among the workers was found to be high. They were found to be suffering from a number of illnesses attributable to lead toxicity. The common illnesses were frequent headache, numbness of the limbs, colic pain, nausea, tremor, and lead line on the gum. High BLL was also found to be related to hypertension and anemia of the workers. Conclusion. High BLL and illnesses attributable to lead toxicity were prevalent amongst workers of the LAB manufacturing industries, and this requires attention especially in terms of occupational hygiene and safety.

The study was carried out in a village in Jessore district, Bangladesh, to identify the epidemiological characteristics of arsenicosis. Eighty-seven per cent of the tubewells had arsenic concentration more than the WHO maximum permissible limit of 0.05 mg l ±1 . The mean arsenic concentration was 0.240 mg l ±1 and the maximum concentration was 1.371 mg l ±1 . Of the total 3606 villagers, 10% (363) were found to be suffering from arsenicosis. Most of the arsenicosis patients were between 10 to 39 years of age. There were more male patients (52.6%). There were no patients among villagers who consumed tubewell water having arsenic levels less than 0.082 mg l ±1 . The majority (93.4%) of the patients were in the first and second stage of arsenicosis. With increasing exposure to arsenic, a simultaneous increase in the severity of clinical manifestations of arsenicosis was observed (F = 43.699; p = 0.000). The time-weighted arsenic exposure varied from 0.248 to 5.482 mg day ±1 and the mean was 1.918 mg day ±1 . Melanosis was present in almost all the patient (99.5%) and keratosis was present in 68.9%. Cancer (basal cell epithelioma) was present in three (0.8%) patients. The duration of clinical manifestations of arsenicosis varied from 1 to 12 years and the majority were suffering for 4 ±6 years.

This was a cross-sectional study under taken to explore the socioeconomic perspective of the arsenicosis problem, carried out in arsenic contaminated Upazillas where at least 100 arsenicosis patients had been identified. Two of the Upazillas with significant arsenic mitigation intervention and three of the Upazillas with limited interventions were selected for the study. Seven hundred fifty respondents were included in the study from 25 villages of the 5 Upazillas. Arsenicosis became a serious problem for the affected communities. Majority (71.31%) of respondents obtained their drinking water from tubewells, almost one third (29%) of the respondents still knowingly using arsenic contaminated water. Primary reason identified for this practice was distance of safe water source. Majority (58.6%) of the respondents said to face economic and 17.9% said to face social problem of varied range. Patients of lower income group were particularly more likely to face economic problems (P< .001) as well as social problem (P< .01). About half (50.7%) of the arsenicosis patients faced difficulty whilst receiving treatment, particularly female patients were more likely to face problem than male (P< .05). Several concerns also were surfaced regarding the heath care service provider particularly to the women patients, some of which are: long waiting time for receiving treatment (15%), discrimination in service delivery (10.7%) and inadequate separate facility for female patients (14.3%). Moreover the issues of financial burden raised by the respondents seem to have emerged as significant in terms of health care access. Access to Health service was particularly difficult for poor patients, as they often had to face problems associated with accessing service like, non availability of medicines in the hospitals (50.7%), traveling long distance (26.7%), purchasing medicine in most cases (32.4%) etc. Their dissatisfaction was compounded by negligent behavior of health care staff and nature of treatment provided. Furthermore length of time needed for reversal of symptoms led to loosing faith on efficacy of treatment, which cascades to negligence of patient's part in seeking health care. Women are less likely to get treatment for arsenicosis than men (P< .01). As there appear to be specific difficulties for women particularly for poor women in accessing health care, social and cultural values make it difficult for them to attend to their own health needs and to travel to service providers. Study findings suggest that a significant proportion (79.9%) of arsenicosis patient was found to access alternative health care. This includes; Homeopath, village doctors, Kabiraj and local pharmacists. Respondents in high intervention Upazillas were significantly more likely to get treatment (P< .05), to face fewer problems and to be satisfied with the facility (P< .001). Provision of safe water options, periodic screening of water source for arsenic, availability of trained doctor, regular availability of medicine, doorstep treatment, follow up on sev...

Introduction: Since the first detection of corona virus disease (COVID-19) cases in Dhaka, Bangladesh on 8 March, 2020, numbers are rising alarmingly. Clinical data on COVID-19 in Bangladesh is lacking. We report early findings on demographic profile, clinical presentations and short-term clinical outcomes of confirmed COVID-19 patients admitted in a large teaching hospital in Dhaka, Bangladesh with preliminary analyses of their association with mortality. Materials and Methods: In this retrospective cross-sectional study, we included reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 patients aged ≥ 15 years, who were admitted in Dhaka Medical College Hospital (DMCH) between May 2 and 15, 2020, the first two weeks when DMCH started admitting COVID-19 patients. Data were collected between May 25 and 29, 2020 from patients or their attendants through telephone interview by a structured questionnaire, after having appropriate consent, irrespective of outcome. One hundred and eight consecutive patients met inclusion criteria through convenient sampling from ward registrar, 102 patients could be reached over phone and data from two patients were discarded in the data cleaning process. The statistical analysis was done by the Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Among the total participants (n=100), mean age was 41.7±16.3 years, 63% were male and 60% patients had positive contact history. Appearance of symptom to hospital admission time was a median of 6 days (range 1 to 21 days) and mean hospital stay was 7.77 ± 5.62 days. Predominant presenting symptoms were fever (69%), cough (54%), breathlessness (41%), fatigue (40%), anorexia (26%) and diarrhea (19%). Hypertension (21%), diabetes mellitus (16%), heart diseases including ischemic heart disease (IHD) (8%) and renal diseases including chronic kidney disease (CKD) (8%) were frequent comorbidities. Ten out of hundred patients died. Older age (p= 0.001), male sex (p= 0.007), smoking (p= 0.001), breathlessness (p=0.001) and presence of comorbidities (p= < 0.05) were significantly associated with mortality. Conclusion: Frequent positive contact history and significant association of breathlessness, smoking and comorbidities with mortality in our study reinforces that abiding by the prevention and containment process, smoking cessation, ensuring proper oxygen therapy and addressing comorbidities adequately are very important measures to mitigate COVID-19 in Bangladesh like the rest of the world. J Bangladesh Coll Phys Surg 2020; 38(0): 29-36

Dhaka, Bangladesh, has one of the highest air lead levels in the world. In February 2000, we evaluated children at five primary schools in Dhaka to determine blood lead (BPb) levels, sources of environmental exposure, and potential risk factors for lead poisoning. Selected schools represented a range of geographic and socioeconomic strata. A total of 779 students 4-12 years of age participated. The mean BPb level was 15.0 microg/dL (range 4.2-63.1 microg/dL). Most students (87.4%) had BPb levels above the Centers for Disease Control and Prevention's level of concern (10 microg/dL). Elevated BPb levels correlated with soil eating [odds ratio (OR) = 3.31; 95% confidence interval (CI), 1.30-8.39], low parental education (OR = 2.72; 95% CI, 1.97-3.75), living close to major roads (OR = 2.30; 95% CI, 1.23-4.29), and increasing age (OR = 1.11; 95% CI, 1.06-1.16). BPb levels measured were similar to those in other countries that use leaded gasoline. No other potential sources of lead exposure were consistently identified. Combustion of leaded gasoline is the main source of lead exposure in Dhaka, resulting in ubiquitous contamination of the environment. The increase in BPb levels with age, a finding contrary to observations in the United States and Australia, may be related to increased outdoor activities. The Bangladeshi government recently announced a plan to eliminate leaded gasoline. Baseline BPb surveys are critical to develop and evaluate intervention policies. Strategies to reduce BPb levels need to address variations in socioeconomic status, construction type and location of housing, and levels of hygiene.