Tubewells and arsenic in Bangladesh: challenging a public health success story

Abstract

Bangladesh has seen one of the developing world's great public health successes, the conversion of the drinking water source for 94% of the rural population to`safe water', in the form of tubewells, with the aim of reducing morbidity and mortality from water-borne disease. Now, that success is being endangered by the discovery that 20 million people may be in great danger and another 20 million in lesser danger of being poisoned by arsenic contamination from tubewell water. This article reports ®ndings from the ®rst national probability sample survey of the rural population and a census of tubewells investigating the social, demographic and epidemiological context of the crisis. The survey covered 3780 households containing 20 260 people. The tubewell census covered 9174 tubewells. The article presents data on the respondents' history of drinking tubewell water, knowledge of the arsenic problem, identi®cation of arsenicosis, as well as the impact upon them of the national campaign, the testing of tubewells, and their subsequent sources of water. Eighty-seven per cent of households drank water from ordinary tubewells (at most risk from arsenic poisoning) and 7% from deep tubewells. Among males, 47.5% had heard that something may be wrong with tubewell water, compared with 39.6% of females. A much lower proportion (20.6% males, 11.3% females) had heard that the water contained a poison called arsenic. Only about 1.5% of the entire population had stopped using tubewell water. Of survey respondents, 0.5% of males and 0.4% of females reported symptoms consistent with chronic arsenicosis. Suggestions are made for a more effective programme.

Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh

“…that a) the exposed group had an overall similar age structure to the population surveyed in the 1999-2000 BDHS (National Institute of Population Research and Training 2001); b) total population numbers within each thana subunit were similar to those of the 1991 national census; and c) exposure was through use of water from shallow tube wells. Population estimates were adjusted for levels of shallow tube-well use, currently estimated at 87% (Caldwell 2003).…”

“…However, limited consideration has been given to possible adverse effects of such interventions, in particular, water-related infectious diseases such as diarrhea. Although this issue has been raised (Caldwell 2003;MacDonald 2001), there has been no evaluation published allowing a meaningful assessment of the competing risks involved in mitigation. Such an assessment is required before the development of effective policy recommendations for arsenic mitigation in Bangladesh.…”

A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh

“…Even when provided with As education, households do not always seek As-safe drinking water sources [15-18]. Testing programs typically involve a representative from an outside organization coming into a village to test the well water for As.…”

Arsenic contamination in groundwater and its proposed remedial measures

“…The top of the shallow aquifer, at depths of less than 10 m, also appears to be less contaminated than deeper down and may account in part for observation that shallow hand-dug wells are usually uncontaminated even in areas of otherwise high arsenic contamination (Geen et al, 2005;Jakariya and Bhattacharya, 2007). These wells, however, face the highest risk of microbiological contamination (Caldwell et al, 2003).…”

“…1) (BGS and MacDonald, 2000;Caldwell et al, 2003). According to the study conducted by the Department of Public Health Engineering (DPHE) and British Geological Survey (BGS) (BGS and DPHE, 2001), arsenic contents of 46 % of the shallow tubewells water exceed WHO recommended value of 0.01 mg/L and 27 % shallow tubewells water exceed Bangladesh recommended value of 0.05 mg/L (Fig.…”