Manganese, Arsenic, and Infant Mortality in Bangladesh: An Ecological Analysis

Abstract

Recent studies in Bangladesh indicate that arsenic and manganese in tube-well water may increase the incidence of infant mortality. The study reported here examined whether these findings could be replicated. Data available from some 600 villages under the care of the nongovernmental organization (NGO) Gonoshasthaya Kendra included details of 29744 live births and 934 infant deaths in a 2-year period, with age and cause. These were analyzed by mean well levels of arsenic and manganese as reported by the British Geological Survey for the 12 upazillas. Odds ratios were calculated by age at death and cause. The effect of arsenic on all-cause infant mortality, although small and not significant, was consistent with earlier reports. The previous finding of an increased risk of infant mortality at concentrations of manganese > or =0.4 mg/L was not evident.

Zinc in Well Water and Infant Mortality in Bangladesh: A Report from Gonoshasthaya Kendra

“…Pneumonia was given as the most common cause of death at all ages, accounting for 458 deaths. Most deaths assigned to prematurity (N = 262) occurred within the first seven days and most deaths from diarrhoea (N = 50) at ≥29 days [7]. Concentrations of zinc in the 114 individual wells sampled by the BGS in these 12 upazillas ranged from none detected (ND)—0.45 mg/L.…”

“…Correlations between mean zinc concentration and either arsenic (r = 0.25, p = 0.36) or manganese (r = 0.30, p = 0.28) were low. Information on each of the upazillas is given in Table 1 (which represents a correction from similar data published earlier [7]), from which it can be seen that all-cause deaths/1,000 showed no trend with zinc concentration (high 30.1/1,000: moderate 33.8/1,000: low 31.6/1,000) but that deaths/1,000 from diarrhoea were lower in the high zinc group (0.72/1,000) than in the moderate (2.13/1,000) or low (2.38/1,000). Areas with low zinc tended to have somewhat more births to women of low socioeconomic status or with no education and appeared less likely to be first births.…”

“…Deaths ascribed to prematurity tended to be somewhat higher and deaths from pneumonia somewhat lower, in areas with ‘high’ zinc. Earlier analysis [7] has suggested that diarrhoeal deaths were somewhat elevated in those with exposure to arsenic 10 < 50 µg/L (OR = 2.14; 95% CI 1.07–4.29) but with a smaller OR at ≥50 µg/L (OR = 1.57; 95% CI 0.40–6.11). Having allowed for zinc there remained no significant relation of diarrhoeal deaths to arsenic (OR 10 < 50 µg/L =1.32 95% CI 0.76–2.31; ≥50 µg/L 1.72 95% CI 0.85–3.47), with <10 µg/L as the reference).…”

“…As part of our ongoing work with Gonoshasthaya Kendra (GK), an NGO with responsibility for health care of some 600 villages, information on infant mortality was available for villages in all Divisions of Bangladesh except Khulna and Sylhet. This information, initially analysed for the relationship of infant mortality to arsenic and manganese in well water [7], has been used in the present report to examine whether higher levels of zinc in drinking water were associated with a reduction in infant mortality, overall or from diarrhoea. …”

Developmental Effects of Manganese

“…These findings are in sharp contrast with the results from a cross-sectional study, which suggested almost doubling of the risk of spontaneous abortion for women with manganese levels 40.4 mg l À1 in their drinking water, 59 and an ecological study conducted in the US state of North Carolina showing a higher rate of infant mortality in counties with higher manganese concentrations in their drinking water; 60 however, another ecological study conducted in Bangladesh found no association. 61 Therefore, more studies are needed before any definitive conclusions can be made regarding the relationship between fetal or infant mortality and manganese exposure.…”