Journal of Environmental Science and Health, Part A, 2003
To understand the magnitude of the arsenic calamity in West Bengal, a detailed study spanning 7 y... more To understand the magnitude of the arsenic calamity in West Bengal, a detailed study spanning 7 years was made in North 24-Parganas, one of the nine arsenic affected districts. Area and population of North 24-Parganas district are 4093.82 sq. km and 7.3 million, respectively. Fourty eight thousand and thirty water samples were analyzed from hand tubewells of North 24-Parganas in use for drinking, cooking and 29.2% of the tubewells were found to have arsenic above 50 microg/L, the maximum permissible limit of World Health Organization (WHO) and 52.8% have arsenic above 10 microg/L, WHO recommended value of arsenic in drinking water. Out of the 22 blocks of North 24-Parganas, in 20 blocks arsenic has been found above the maximum permissible limit and so far in 16 blocks people have been identified as suffering from arsenical skin lesions. From the generated data, it is estimated that about 2.0 million and 1.0 million people are drinking arsenic contaminated water above 10 microg/L and 50 microg/L level, respectively in North 24-Parganas alone. So far, in our preliminary study 33,000 people have been examined at random from arsenic affected villages in North 24-Parganas and 2274 people have been registered with arsenical skin lesions. Extrapolation of the available data indicates about 0.1 million people may be suffering from arsenical skin lesions from North 24-Parganas alone. A sum of 21,000 hair, nail, and urine samples analyses from arsenic affected villages show 56%, 80%, and 87% people have arsenic in biological specimen more than normal/toxic (hair) level, respectively. Thus, many may be subclinically affected. Due to use of arsenic contaminated groundwater for agricultural irrigation, rice and vegetable are getting arsenic contaminated. Hence there is an additional arsenic burden from food chain. People from arsenic affected villages are also suffering from arsenical neuropathy. A followup study indicates that many of the victims suffering from severe arsenical skin lesions for several years are now suffering from cancer or have already died of cancer.
This prospective case-control study was conducted on 105 consecutive cases admitted to the burn u... more This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.
International Journal of Environmental Health Research, 2005
Arsenicosis is presently one of the significant public health problems in Bangladesh. Employing h... more Arsenicosis is presently one of the significant public health problems in Bangladesh. Employing household screening of over 3.6 million people living in 6 arsenic-affected Upzilas of Bangladesh, 1,503 arsenicosis patients were identified at first and then blood and urine were collected from some of them and analyzed through laboratory techniques. As the relation between blood and urine chemicals with duration of having arsenicosis (DHA) is not clear, this study presented all findings by shorter versus longer DHA. Complications namely chronic bronchitis, conjunctivitis/congestions, weakness, and wasting were common, with relatively higher rates in longer group. Logistic regression analysis adjusted for age, sex, education, smoking, duration of drinking tube-well water, and whether any arsenicosis patients were in the family-indicated higher odds ratio (OR) of longer DHA (LDHA) in 3rd tertile with respect to GOT (OR = 2.12; 95%CI: 1.09-4.13), and blood glucose (OR = 2.00; 95%CI: 1.07-3.72) than 1st tertile. The OR of LDHA was significantly lower (OR = 0.48; 95%CI: 0.25-0.93) in 3rd tertile for triglycerides compared with 1st tertile. Albumin/globulin (A/G) ratio of 2nd tertile showed significantly lower OR of LDHA (OR=0.51; 95%CI: 0.28-0.95) than 1st tertile. Further epidemiological investigations based on a large sample, through cohort or case control studies, may be useful for validating and generalizing the results in Bangladesh.
We have been studying the contamination of groundwater by arsenic and the attend-ant human suffer... more We have been studying the contamination of groundwater by arsenic and the attend-ant human suffering in West Bengal, India, for a decade, and in Bangladesh for the past four years. From our analysis of thousands of ...
Methods: 1200 subjects stratified on gender and age were recruited in a case control study in Pab... more Methods: 1200 subjects stratified on gender and age were recruited in a case control study in Pabna, Bangladesh. Subjects were collected 1: 1 ratio of cases and controls. Questionnaire data, a water sample and toenail samples were collected on all subjects. ...
We investigated whether primary and secondary arsenic methylation ratios were associated with ski... more We investigated whether primary and secondary arsenic methylation ratios were associated with skin lesions and whether GSTT1, GSTP1, and GSTM1 polymorphisms modify these relationships. A case-control study of 600 cases and 600 controls that were frequency matched on age and sex was conducted in Pabna, Bangladesh, in 2001-2002. Individual well water, urine, and blood samples were collected. Water arsenic concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary arsenic speciation was determined using high performance liquid chromatography hydride with generator atomic absorption spectrometry and ICP-MS. Genotyping was conducted using multiplex polymerase chain reaction and TaqMan. A 10-fold increase in primary methylation ratio [monomethylarsonic acid (MMA)/(arsenite + arsenate] was associated with a 1.50-fold increased risk of skin lesions (multivariate odds ratio = 1.50; 95% confidence interval, 1.00-2.26). We observed significant interaction on the multiplicative scale between GSTT1 wildtype and secondary methylation ratio [dimethylarsinic acid/MMA; likelihood ratio test (LRT), p = 0.01]. No significant interactions were observed for GSTM1 or GSTP1 or for primary methylation ratios. Our findings suggest that increasing primary methylation ratios are associated with an increase in risk of arsenic-related skin lesions. The interaction between GSTT1 wildtype and secondary methylation ratio modifies risk of skin lesions among arsenic-exposed individuals.
Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in ground... more Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in groundwater above the World Health Organization's maximum permissible limit of 50 microg/L. The area and population of 50 districts of Bangladesh and 9 districts in West Bengal are 118,849 km2 and 104.9 million and 38,865 km2 and 42.7 million, respectively. Our current data show arsenic levels above 50 microg/ L in 2000 villages, 178 police stations of 50 affected districts in Bangladesh and 2600 villages, 74 police stations/blocks of 9 affected districts in West Bengal. We have so far analyzed 34,000 and 101,934 hand tube-well water samples from Bangladesh and West Bengal respectively by FI-HG-AAS of which 56% and 52%, respectively, contained arsenic above 10 microg/L and 37% and 25% arsenic above 50 microg/L. In our preliminary study 18,000 persons in Bangladesh and 86,000 persons in West Bengal were clinically examined in arsenic-affected districts. Of them, 3695 (20.6% including 6.11% children) in Bangladesh and 8500 (9.8% including 1.7% children) in West Bengal had arsenical dermatological features. Symptoms of chronic arsenic toxicity developed insidiously after 6 months to 2 years or more of exposure. The time of onset depends on the concentration of arsenic in the drinking water, volume of intake, and the health and nutritional status of individuals. Major dermatological signs are diffuse or spotted melanosis, leucomelanosis, and keratosis. Chronic arsenicosis is a multisystem disorder. Apart from generalized weakness, appetite and weight loss, and anemia, our patients had symptoms relating to involvement of the lungs, gastrointestinal system, liver, spleen, genitourinary system, hemopoietic system, eyes, nervous system, and cardiovascular system. We found evidence of arsenic neuropathy in 37.3% (154 of 413 cases) in one group and 86.8% (33 of 38 cases) in another. Most of these cases had mild and predominantly sensory neuropathy. Central nervous system involvement was evident with and without neuropathy. Electrodiagnostic studies proved helpful for the diagnosis of neurological involvement. Advanced neglected cases with many years of exposure presented with cancer of skin and of the lung, liver, kidney, and bladder. The diagnosis of subclinical arsenicosis was made in 83%, 93%, and 95% of hair, nail and urine samples, respectively, in Bangladesh; and 57%, 83%, and 89% of hair, nail, and urine samples, respectively in West Bengal. Approximately 90% of children below 11 years of age living in the affected areas show hair and nail arsenic above the normal level. Children appear to have a higher body burden than adults despite fewer dermatological manifestations. Limited trials of 4 arsenic chelators in the treatment of chronic arsenic toxicity in West Bengal over the last 2 decades do not provide any clinical, biochemical, or histopathological benefit except for the accompanying preliminary report of clinical benefit with dimercaptopropanesulfonate therapy. Extensive efforts are needed in both countries to combat the arsenic crisis including control of tube-wells, watershed management with effective use of the prodigious supplies of surface water, traditional water management, public awareness programs, and education concerning the apparent benefits of optimal nutrition.
Journal of Environmental Science and Health, Part A, 2003
To understand the magnitude of the arsenic calamity in West Bengal, a detailed study spanning 7 y... more To understand the magnitude of the arsenic calamity in West Bengal, a detailed study spanning 7 years was made in North 24-Parganas, one of the nine arsenic affected districts. Area and population of North 24-Parganas district are 4093.82 sq. km and 7.3 million, respectively. Fourty eight thousand and thirty water samples were analyzed from hand tubewells of North 24-Parganas in use for drinking, cooking and 29.2% of the tubewells were found to have arsenic above 50 microg/L, the maximum permissible limit of World Health Organization (WHO) and 52.8% have arsenic above 10 microg/L, WHO recommended value of arsenic in drinking water. Out of the 22 blocks of North 24-Parganas, in 20 blocks arsenic has been found above the maximum permissible limit and so far in 16 blocks people have been identified as suffering from arsenical skin lesions. From the generated data, it is estimated that about 2.0 million and 1.0 million people are drinking arsenic contaminated water above 10 microg/L and 50 microg/L level, respectively in North 24-Parganas alone. So far, in our preliminary study 33,000 people have been examined at random from arsenic affected villages in North 24-Parganas and 2274 people have been registered with arsenical skin lesions. Extrapolation of the available data indicates about 0.1 million people may be suffering from arsenical skin lesions from North 24-Parganas alone. A sum of 21,000 hair, nail, and urine samples analyses from arsenic affected villages show 56%, 80%, and 87% people have arsenic in biological specimen more than normal/toxic (hair) level, respectively. Thus, many may be subclinically affected. Due to use of arsenic contaminated groundwater for agricultural irrigation, rice and vegetable are getting arsenic contaminated. Hence there is an additional arsenic burden from food chain. People from arsenic affected villages are also suffering from arsenical neuropathy. A followup study indicates that many of the victims suffering from severe arsenical skin lesions for several years are now suffering from cancer or have already died of cancer.
This prospective case-control study was conducted on 105 consecutive cases admitted to the burn u... more This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.
International Journal of Environmental Health Research, 2005
Arsenicosis is presently one of the significant public health problems in Bangladesh. Employing h... more Arsenicosis is presently one of the significant public health problems in Bangladesh. Employing household screening of over 3.6 million people living in 6 arsenic-affected Upzilas of Bangladesh, 1,503 arsenicosis patients were identified at first and then blood and urine were collected from some of them and analyzed through laboratory techniques. As the relation between blood and urine chemicals with duration of having arsenicosis (DHA) is not clear, this study presented all findings by shorter versus longer DHA. Complications namely chronic bronchitis, conjunctivitis/congestions, weakness, and wasting were common, with relatively higher rates in longer group. Logistic regression analysis adjusted for age, sex, education, smoking, duration of drinking tube-well water, and whether any arsenicosis patients were in the family-indicated higher odds ratio (OR) of longer DHA (LDHA) in 3rd tertile with respect to GOT (OR = 2.12; 95%CI: 1.09-4.13), and blood glucose (OR = 2.00; 95%CI: 1.07-3.72) than 1st tertile. The OR of LDHA was significantly lower (OR = 0.48; 95%CI: 0.25-0.93) in 3rd tertile for triglycerides compared with 1st tertile. Albumin/globulin (A/G) ratio of 2nd tertile showed significantly lower OR of LDHA (OR=0.51; 95%CI: 0.28-0.95) than 1st tertile. Further epidemiological investigations based on a large sample, through cohort or case control studies, may be useful for validating and generalizing the results in Bangladesh.
We have been studying the contamination of groundwater by arsenic and the attend-ant human suffer... more We have been studying the contamination of groundwater by arsenic and the attend-ant human suffering in West Bengal, India, for a decade, and in Bangladesh for the past four years. From our analysis of thousands of ...
Methods: 1200 subjects stratified on gender and age were recruited in a case control study in Pab... more Methods: 1200 subjects stratified on gender and age were recruited in a case control study in Pabna, Bangladesh. Subjects were collected 1: 1 ratio of cases and controls. Questionnaire data, a water sample and toenail samples were collected on all subjects. ...
We investigated whether primary and secondary arsenic methylation ratios were associated with ski... more We investigated whether primary and secondary arsenic methylation ratios were associated with skin lesions and whether GSTT1, GSTP1, and GSTM1 polymorphisms modify these relationships. A case-control study of 600 cases and 600 controls that were frequency matched on age and sex was conducted in Pabna, Bangladesh, in 2001-2002. Individual well water, urine, and blood samples were collected. Water arsenic concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary arsenic speciation was determined using high performance liquid chromatography hydride with generator atomic absorption spectrometry and ICP-MS. Genotyping was conducted using multiplex polymerase chain reaction and TaqMan. A 10-fold increase in primary methylation ratio [monomethylarsonic acid (MMA)/(arsenite + arsenate] was associated with a 1.50-fold increased risk of skin lesions (multivariate odds ratio = 1.50; 95% confidence interval, 1.00-2.26). We observed significant interaction on the multiplicative scale between GSTT1 wildtype and secondary methylation ratio [dimethylarsinic acid/MMA; likelihood ratio test (LRT), p = 0.01]. No significant interactions were observed for GSTM1 or GSTP1 or for primary methylation ratios. Our findings suggest that increasing primary methylation ratios are associated with an increase in risk of arsenic-related skin lesions. The interaction between GSTT1 wildtype and secondary methylation ratio modifies risk of skin lesions among arsenic-exposed individuals.
Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in ground... more Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in groundwater above the World Health Organization's maximum permissible limit of 50 microg/L. The area and population of 50 districts of Bangladesh and 9 districts in West Bengal are 118,849 km2 and 104.9 million and 38,865 km2 and 42.7 million, respectively. Our current data show arsenic levels above 50 microg/ L in 2000 villages, 178 police stations of 50 affected districts in Bangladesh and 2600 villages, 74 police stations/blocks of 9 affected districts in West Bengal. We have so far analyzed 34,000 and 101,934 hand tube-well water samples from Bangladesh and West Bengal respectively by FI-HG-AAS of which 56% and 52%, respectively, contained arsenic above 10 microg/L and 37% and 25% arsenic above 50 microg/L. In our preliminary study 18,000 persons in Bangladesh and 86,000 persons in West Bengal were clinically examined in arsenic-affected districts. Of them, 3695 (20.6% including 6.11% children) in Bangladesh and 8500 (9.8% including 1.7% children) in West Bengal had arsenical dermatological features. Symptoms of chronic arsenic toxicity developed insidiously after 6 months to 2 years or more of exposure. The time of onset depends on the concentration of arsenic in the drinking water, volume of intake, and the health and nutritional status of individuals. Major dermatological signs are diffuse or spotted melanosis, leucomelanosis, and keratosis. Chronic arsenicosis is a multisystem disorder. Apart from generalized weakness, appetite and weight loss, and anemia, our patients had symptoms relating to involvement of the lungs, gastrointestinal system, liver, spleen, genitourinary system, hemopoietic system, eyes, nervous system, and cardiovascular system. We found evidence of arsenic neuropathy in 37.3% (154 of 413 cases) in one group and 86.8% (33 of 38 cases) in another. Most of these cases had mild and predominantly sensory neuropathy. Central nervous system involvement was evident with and without neuropathy. Electrodiagnostic studies proved helpful for the diagnosis of neurological involvement. Advanced neglected cases with many years of exposure presented with cancer of skin and of the lung, liver, kidney, and bladder. The diagnosis of subclinical arsenicosis was made in 83%, 93%, and 95% of hair, nail and urine samples, respectively, in Bangladesh; and 57%, 83%, and 89% of hair, nail, and urine samples, respectively in West Bengal. Approximately 90% of children below 11 years of age living in the affected areas show hair and nail arsenic above the normal level. Children appear to have a higher body burden than adults despite fewer dermatological manifestations. Limited trials of 4 arsenic chelators in the treatment of chronic arsenic toxicity in West Bengal over the last 2 decades do not provide any clinical, biochemical, or histopathological benefit except for the accompanying preliminary report of clinical benefit with dimercaptopropanesulfonate therapy. Extensive efforts are needed in both countries to combat the arsenic crisis including control of tube-wells, watershed management with effective use of the prodigious supplies of surface water, traditional water management, public awareness programs, and education concerning the apparent benefits of optimal nutrition.
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