public health strategies for western bangladesh that address the arsenic, manganese, uranium and...

Public Health Strategies for Western Public Health Strategies for Western Bangladesh that Address the Arsenic, Bangladesh that Address the Arsenic, Manganese, Uranium and Other Toxic Manganese, Uranium and Other Toxic

Elements in Their Drinking WaterElements in Their Drinking WaterSeth H. FrisbieSeth H. Frisbie Erika J. MitchellErika J. Mitchell Lawrence J. MasteraLawrence J. Mastera

Donald MaynardDonald Maynard Ahmad Z. YusufAhmad Z. Yusuf Mohammad Y. SiddiqMohammad Y. Siddiq

Richard OrtegaRichard Ortega Richard K. DunnRichard K. Dunn David S. WestermanDavid S. Westerman

Thomas BacquartThomas Bacquart Bibudhendra SarkarBibudhendra Sarkar

The ProblemThe Problem• The life expectancy in The life expectancy in

Bangladesh during the early-Bangladesh during the early-1970s was only 44 years.1970s was only 44 years.

• The infant mortality rate (0 to 5 The infant mortality rate (0 to 5 years) was 24%.years) was 24%.

• Many premature deaths Many premature deaths resulted from drinking surface resulted from drinking surface water that was contaminated water that was contaminated with bacteria.with bacteria.

• Approximately 10,000,000 tubewells have been installed Approximately 10,000,000 tubewells have been installed since 1971 to supply safe drinking water.since 1971 to supply safe drinking water.

• By 1995 Bangladesh had 120,000,000 people, approximately By 1995 Bangladesh had 120,000,000 people, approximately 97% of Bangladeshis drank well water, and the life 97% of Bangladeshis drank well water, and the life expectancy had increased to 55 years.expectancy had increased to 55 years.

(Photograph by Jim Monan, 1995)(Photograph by Jim Monan, 1995)

The ProblemThe Problem• Chronic arsenic (As) poisoning Chronic arsenic (As) poisoning

was first diagnosed in 1993.was first diagnosed in 1993.• In 1997 our team produced the In 1997 our team produced the

first national-scale map of As first national-scale map of As concentration in Bangladesh’s concentration in Bangladesh’s groundwater.groundwater.

• Over 28,000,000 Bangladeshis are Over 28,000,000 Bangladeshis are drinking water with As drinking water with As concentrations above the 50-µg/L concentrations above the 50-µg/L national standard.national standard.

• Over 150,000 Bangladeshis are Over 150,000 Bangladeshis are expected to die from skin, bladder, expected to die from skin, bladder, liver, or lung cancer caused by liver, or lung cancer caused by chronic As poisoning.chronic As poisoning.

Melanosis of the chestMelanosis of the chest

(Photograph by Richard Wilson, 2005)(Photograph by Richard Wilson, 2005)

Keratosis of the palmsKeratosis of the palms

Keratosis of the feetKeratosis of the feet Blackfoot diseaseBlackfoot disease

Multimetal Health EffectsMultimetal Health Effects• Over 66,000,000 Over 66,000,000

Bangladeshis are Bangladeshis are drinking water that drinking water that exceeds WHO exceeds WHO health-based health-based guidelines for As, guidelines for As, Cr, Mn, Ni, or Pb Cr, Mn, Ni, or Pb (Frisbie et al. 2002).(Frisbie et al. 2002).

• Chronic As Chronic As poisoning is the poisoning is the most significant most significant health risk.health risk.

Multimetal Health EffectsMultimetal Health Effects• Sb Sb increasesincreases As toxicity and As toxicity and was detectedwas detected in 98% in 98%

of tubewells (Frisbie et al. 2002).of tubewells (Frisbie et al. 2002).• Conversely, Se and Zn Conversely, Se and Zn decreasedecrease As toxicity and As toxicity and are are

often deficientoften deficient in Bangladesh’s diet (Ortega et al. in Bangladesh’s diet (Ortega et al. 2003).2003).

Estimated exposures to As, Se, and Zn from Estimated exposures to As, Se, and Zn from Bangladesh’s drinking water, rice, and soil.Bangladesh’s drinking water, rice, and soil.

MetalMetal Recommended Recommended Dietary Allowance Dietary Allowance

(μg/day)(μg/day)

Exposure from Exposure from Water, Rice, and Soil Water, Rice, and Soil

(μg/day)(μg/day)

AsAsSeSeZnZn

Not determinedNot determined5555

11,00011,000

2002004646

7,3007,300

Project GoalsProject Goals• Determine the relative distributions of As and other Determine the relative distributions of As and other

toxic elements in drinking well water from western toxic elements in drinking well water from western Bangladesh.Bangladesh.

• Use these distributions to evaluate, and possibly Use these distributions to evaluate, and possibly improve, the public health plan for this region.improve, the public health plan for this region.

Sample CollectionSample Collection• Groundwater samples Groundwater samples

were collected from 4 were collected from 4 neighborhoods in neighborhoods in western Bangladesh.western Bangladesh.

• A total of 18 random A total of 18 random samples were collected samples were collected from 17 tubewells in from 17 tubewells in each of 3 neighborhoods.each of 3 neighborhoods.

• Access was denied at 1 Access was denied at 1 sampling location; sampling location; therefore, a total of 17 therefore, a total of 17 random samples were random samples were collected from 16 collected from 16 tubewells in the fourth tubewells in the fourth neighborhood.neighborhood.

ElementElement Average Average ConcentrationConcentration

(µg/L)(µg/L)

WHO Health-WHO Health-BasedBased

Guideline (µg/L)Guideline (µg/L)

% of Unsafe% of UnsafeTubewellsTubewells

AsAsBB

BaBaCrCrFeFeMnMnMoMoNiNiPbPbSbSbSeSeUUZnZn

2929<50<501401404.74.7

2,7002,7008008001.41.411110.50.51.61.6<1<12.52.51515

10105005007007005050NANA4004007070707010102020101022

NANA

3333000011

NANA78780011110000

4848NANA

Analysis of All TubewellsAnalysis of All Tubewells

• In this neighborhood-scale study and in 2 national-scale In this neighborhood-scale study and in 2 national-scale studies of Bangladesh, As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U studies of Bangladesh, As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found above WHO health-based drinking water were found above WHO health-based drinking water guidelines (BGS/DPHE 2001; Frisbie et al. 2002).guidelines (BGS/DPHE 2001; Frisbie et al. 2002).


ElementElement ToxicityToxicityAsAs

BB

BaBa

CrCr

MnMn

MoMo

NiNi

PbPb

UU

Cancers and skin and vascular diseases in humans.Cancers and skin and vascular diseases in humans.

Developmental and reproductive diseases in animals.Developmental and reproductive diseases in animals.

Hypertension in humans.Hypertension in humans.

Inadequate evidence of carcinogenicity in humans.Inadequate evidence of carcinogenicity in humans.

Neurological and liver diseases in humans.Neurological and liver diseases in humans.

Osteoporosis and gout-like symptoms in humans.Osteoporosis and gout-like symptoms in humans.

Skin diseases in humans. Developmental and Skin diseases in humans. Developmental and reproductive diseases in rats.reproductive diseases in rats.Cancer, hypertension, and neurological, developmental, Cancer, hypertension, and neurological, developmental, and reproductive diseases in humansand reproductive diseases in humansKidney and bone diseases in humans.Kidney and bone diseases in humans.

Toxic Effects from Exposure in Drinking Toxic Effects from Exposure in Drinking WaterWater

ElementElement AsAsBualdaBualda FulbariaFulbaria JamjamiJamjami KomlapurKomlapur

AsAsBB

BaBaCrCrFeFeMnMnMoMoNiNiPbPbSbSbSeSeUUZnZnpHpH

DepthDepthAgeAge

UsersUsers

-0.19-0.19

-0.39-0.390.270.270.300.300.240.240.260.26

-0.30-0.300.060.060.080.08-0.03-0.030.010.01-0.26-0.26

0.600.60

0.530.53

-0.03-0.03

0.450.45

-0.04-0.04-0.24-0.24

0.390.390.470.47

0.340.340.090.09

-0.34-0.34-0.33-0.33

0.490.490.520.52

-0.55-0.55

0.180.180.140.140.230.230.210.210.330.330.090.090.250.250.200.20-0.18-0.180.140.14-0.16-0.16-0.14-0.14-0.32-0.32-0.09-0.090.030.03-0.17-0.17

0.160.16

0.210.21

0.370.370.400.400.030.03

0.270.270.070.07-0.19-0.19-0.23-0.23

0.490.49

Correlation coefficients (r) for the concentration of As versus the concentrations Correlation coefficients (r) for the concentration of As versus the concentrations of toxic elements in tubewell water from each of the 4 neighborhoods in this of toxic elements in tubewell water from each of the 4 neighborhoods in this study, the pH of this water, the depth of these tubewells, the age of these study, the pH of this water, the depth of these tubewells, the age of these tubewells, and the number of users per tubewell.tubewells, and the number of users per tubewell.

• Significant linear Significant linear relationships at the 99% relationships at the 99% confidence level are confidence level are shown in red and italics.shown in red and italics.

• Significant linear Significant linear relationships at the 95% relationships at the 95% confidence level are confidence level are shown in white and shown in white and italics.italics.

• No significant linear No significant linear relationships at either relationships at either confidence level are confidence level are shown in plain text.shown in plain text.

1.001.000.910.91

0.910.910.910.91

0.910.910.910.91

0.960.96

1.001.00 1.001.00

0.690.69

0.610.61

-0.69-0.69

1.001.00

0.740.74

0.660.66

• In this study, as the concentration of As increases there are In this study, as the concentration of As increases there are statistically significant increases in the concentrations ofstatistically significant increases in the concentrations of B, B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and ZnBa, Cr, Fe, Mn, Ni, Pb, Se, and Zn..


Analysis of Tubewells with Unsafe Analysis of Tubewells with Unsafe Concentrations of ArsenicConcentrations of Arsenic


(µg/L)(µg/L)




AsAsBB


8484<50<502202209.59.5

7,3007,3008708702.02.031311.21.22.32.3<1<10.90.92121

10105005007007005050NANA4004007070707010102020101022

NANA

100100000055

NANA59590055550000

1414NANA

SONO FilterSONO FilterAMAL FilterAMAL Filter3 Kalshi Filter3 Kalshi Filter

Analysis of Tubewells with Unsafe Analysis of Tubewells with Unsafe Concentrations of ArsenicConcentrations of Arsenic

• Almost all of the home-scale Almost all of the home-scale drinking water treatment drinking water treatment systems currently being systems currently being used in Bangladesh have used in Bangladesh have been designed to remove been designed to remove As, not these other toxic As, not these other toxic elements.elements.

• The statistically significant The statistically significant increases in toxic elements increases in toxic elements with As suggest that these with As suggest that these treatment systems should treatment systems should be further evaluated for the be further evaluated for the removal of removal of B, Ba, Cr, Mn, B, Ba, Cr, Mn, Mo, Ni, PbMo, Ni, Pb, and possibly , and possibly other elements.other elements.

Analysis of Tubewells with Safe Analysis of Tubewells with Safe Concentrations of ArsenicConcentrations of Arsenic


(µg/L)(µg/L)




AsAsBB


<7<7<50<501101102.42.44004007707701.21.21.01.0

<0.2<0.21.21.2<1<13.23.21212

10105005007007005050NANA4004007070707010102020101022

NANA

00000000

NANA87870000000000

6464NANA

• The current practice of testing every tubewell for The current practice of testing every tubewell for just As will not identify drinking water with safe just As will not identify drinking water with safe concentrations of other toxic elements.concentrations of other toxic elements.


(Photograph by The World Bank Group, 2005)(Photograph by The World Bank Group, 2005)

• The following 3-step testing program is proposed to provide safe The following 3-step testing program is proposed to provide safe drinking water for very little cost and without any delay:drinking water for very little cost and without any delay:

1.1.The toxicity and distribution of As relative to Mn, U, The toxicity and distribution of As relative to Mn, U, B, Ba, Cr, Mo, B, Ba, Cr, Mo, Ni, and Pb Ni, and Pb suggests that the current practice of sampling and suggests that the current practice of sampling and testing every tubewell in Bangladesh for As to find the safest testing every tubewell in Bangladesh for As to find the safest sources of drinking water stay as the highest public health sources of drinking water stay as the highest public health priority.priority.

2.2.However, if a sample meets the WHO guideline for As, then it However, if a sample meets the WHO guideline for As, then it should be retested for Mn and U.should be retested for Mn and U.

3.3.If a sample meets the WHO guidelines for As, Mn and U, then it If a sample meets the WHO guidelines for As, Mn and U, then it should be retested for should be retested for B, Ba, Cr, Mo, Ni, and PbB, Ba, Cr, Mo, Ni, and Pb..

• Finally, all safe tubewells should be used as public drinking Finally, all safe tubewells should be used as public drinking water supplies. These safe tubewells must be periodically water supplies. These safe tubewells must be periodically monitored for As, Mn, U, monitored for As, Mn, U, B, Ba, Cr, Mo, Ni, and PbB, Ba, Cr, Mo, Ni, and Pb..


ElementElement % of % of UnsafeUnsafeTubewellsTubewells

if As is Safeif As is Safe

% of % of UnsafeUnsafeTubewellsTubewells

if As is Unsafeif As is UnsafeAsAsBB


00000000

NANA87870000000000

6464NANA

100100000055

NANA59590055550000

1414NANA


• When the concentration When the concentration of As goes from of As goes from safesafe to to unsafeunsafe, the % of , the % of tubewells with tubewells with unsafeunsafe concentrations of Cr, Ni, concentrations of Cr, Ni, and Pb increases.and Pb increases.

• When the concentration When the concentration of As goes from of As goes from unsafeunsafe to to safesafe, the % of , the % of tubewells with tubewells with unsafeunsafe concentrations of Mn, concentrations of Mn, and U increases.and U increases.

The Inverse Trend Between As and UThe Inverse Trend Between As and U• The drinking water in these neighborhoods The drinking water in these neighborhoods

generally has unsafe levels of As and Mn (19% of generally has unsafe levels of As and Mn (19% of tubewells), or U and Mn (43% of tubewells); tubewells), or U and Mn (43% of tubewells); however, it seldom (4% of tubewells) has unsafe however, it seldom (4% of tubewells) has unsafe concentrations of both As and U together.concentrations of both As and U together.

• In Jamjami the concentration of As decreases with In Jamjami the concentration of As decreases with depth (p-value = 0.002), and the concentration of U depth (p-value = 0.002), and the concentration of U increases with depth (p-value = 0.04).increases with depth (p-value = 0.04).

• Komlapur, to some extent, also shows these Komlapur, to some extent, also shows these trends.trends.

• In contrast, Bualda and Fulbaria do not show any In contrast, Bualda and Fulbaria do not show any trends between As and depth, and U and depth.trends between As and depth, and U and depth.

The Inverse Trend Between As and UThe Inverse Trend Between As and U

• Coarse grained river channel deposits at depth may be Coarse grained river channel deposits at depth may be under oxidizing conditions that remove As from under oxidizing conditions that remove As from groundwater and release U into groundwater.groundwater and release U into groundwater.


• In contrast, organic-rich peat and clay, regardless of depth, In contrast, organic-rich peat and clay, regardless of depth, may be under reducing conditions that release As into may be under reducing conditions that release As into groundwater and remove U from groundwater.groundwater and remove U from groundwater.


• It is important to note that in areas where drilling deeper It is important to note that in areas where drilling deeper tubewells may access water with lower concentrations of tubewells may access water with lower concentrations of As, the water from these deeper tubewells may contain As, the water from these deeper tubewells may contain increased concentrations of U.increased concentrations of U.

The Inverse Trend Between As and UThe Inverse Trend Between As and U• Despite this inverse trend, 4% of the tubewells in this study Despite this inverse trend, 4% of the tubewells in this study

had unsafe concentrations of both As and U.had unsafe concentrations of both As and U.• This is important because the home-scale drinking water This is important because the home-scale drinking water

filters that are being used in Bangladesh may not remove U.filters that are being used in Bangladesh may not remove U.• Water treatment filters typically oxidize soluble As(III) to Water treatment filters typically oxidize soluble As(III) to

insoluble As(V) to remove As by absorption or precipitation.insoluble As(V) to remove As by absorption or precipitation.• However, this oxidation may convert insoluble U(IV) to However, this oxidation may convert insoluble U(IV) to

soluble U(VI) and potentially increase the U concentration soluble U(VI) and potentially increase the U concentration of the water after treatment.of the water after treatment.

• Alternatively, this oxidation may keep dissolved U in the VI Alternatively, this oxidation may keep dissolved U in the VI oxidation state and potentially cause no change in the U oxidation state and potentially cause no change in the U concentration of the water after treatment.concentration of the water after treatment.

Conclusions and RecommendationsConclusions and Recommendations• As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found

above WHO health-based drinking water guidelines above WHO health-based drinking water guidelines in Bangladesh.in Bangladesh.

• The concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, The concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and Zn can increase as the concentration of As and Zn can increase as the concentration of As increases.increases.

• In contrast, the concentration of U can increase as In contrast, the concentration of U can increase as the concentration of As decreases.the concentration of As decreases.

• The home-scale drinking water treatment systems The home-scale drinking water treatment systems in Bangladesh have been designed to remove As. in Bangladesh have been designed to remove As. They must be evaluated for the removal of As, B, They must be evaluated for the removal of As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U.Ba, Cr, Mn, Mo, Ni, Pb, and U.

Conclusions and RecommendationsConclusions and Recommendations• The current practice of testing every tubewell for The current practice of testing every tubewell for

just As will not identify drinking water with safe just As will not identify drinking water with safe concentrations of these other toxic elements.concentrations of these other toxic elements.

• A 3-step testing program to provide safe drinking A 3-step testing program to provide safe drinking water to a large number of Bangladeshis is water to a large number of Bangladeshis is proposed.proposed.

SourcesSourcesPrimary:Primary:

• Frisbie, S.H., E.J. Mitchell, L.J. Mastera, D.M. Maynard, A.Z. Yusuf, M.Y. Siddiq, Frisbie, S.H., E.J. Mitchell, L.J. Mastera, D.M. Maynard, A.Z. Yusuf, M.Y. Siddiq, R. Ortega, R.K. Dunn, D.S. Westerman, T. Bacquart, and B. Sarkar. Arsenic, R. Ortega, R.K. Dunn, D.S. Westerman, T. Bacquart, and B. Sarkar. Arsenic, Manganese, Uranium and Other Toxic Geologic Deposits in Western Manganese, Uranium and Other Toxic Geologic Deposits in Western Bangladesh: Ramifications for Public Health and Drinking Water Supply. (Bangladesh: Ramifications for Public Health and Drinking Water Supply. ( InIn preparation.)preparation.)

Images:Images:

• Ahmed F., K. Minnatullah, A. Talbi. Arsenic Mitigation Technologies in South Ahmed F., K. Minnatullah, A. Talbi. Arsenic Mitigation Technologies in South and East Asia. Available: and East Asia. Available: http://siteresources.worldbank.org/INTSAREGTOPWATRES/Resources/ArsenicVolII_PaperIII.pdf [cited 13 May 2008]. [cited 13 May 2008].

• GlobeXplorer ™ 2005. GlobeXplorer ™ Aerial Photos Satellite Images and Maps. GlobeXplorer ™ 2005. GlobeXplorer ™ Aerial Photos Satellite Images and Maps. Available: Available: http://www.globexplorer.com/ [cited 17 October 2005]. [cited 17 October 2005].

• Hussam A. 2008. Household Arsenic Filter. Available: Hussam A. 2008. Household Arsenic Filter. Available: http://www.drinking-water.org/html/en/Treatment/Household-Arsenic-Filter.html [cited [cited 13 May 2008].13 May 2008].

• Integrated Regional Information Networks. 2008. Bangladesh: New Water Filter Integrated Regional Information Networks. 2008. Bangladesh: New Water Filter to Combat Arsenic Poisoning. Available: http://www.irinnews.org/Report.aspx?to Combat Arsenic Poisoning. Available: http://www.irinnews.org/Report.aspx?ReportId=76176 [cited 13 May 2008].ReportId=76176 [cited 13 May 2008].

• Monan, J. 1995. Bangladesh the Strength to Succeed. Oxford, UK:Oxfam, 39.Monan, J. 1995. Bangladesh the Strength to Succeed. Oxford, UK:Oxfam, 39.

http://siteresources.worldbank.org/INTSAREGTOPWATRES/Resources/ArsenicVolII_PaperIII.pdf

http://siteresources.worldbank.org/INTSAREGTOPWATRES/Resources/ArsenicVolII_PaperIII.pdf

http://www.globexplorer.com/

http://www.drinking-water.org/html/en/Treatment/Household-Arsenic-Filter.html

SourcesSourcesImages:Images:

• Mukherjee P., J. Greenleaf. 2005. Arsenic Crisis in Indian Subcontinent: An Mukherjee P., J. Greenleaf. 2005. Arsenic Crisis in Indian Subcontinent: An Indigenous Solution. Available: http://www.lehigh.edu/~aks0/arsenic.html [cited Indigenous Solution. Available: http://www.lehigh.edu/~aks0/arsenic.html [cited 13 May 2008].13 May 2008].

• SOS-Arsenic.Net. 2008. Arsenic Poisoning in Bangladesh/India. Available: SOS-Arsenic.Net. 2008. Arsenic Poisoning in Bangladesh/India. Available: http://www.sos-arsenic.net/english/groundwater/index.html [cited 13 May 2008]http://www.sos-arsenic.net/english/groundwater/index.html [cited 13 May 2008]

• The World Bank Group. 2005. Available: http://wbln1018.worldbank.org [cited 22 The World Bank Group. 2005. Available: http://wbln1018.worldbank.org [cited 22 February 2005].February 2005].

• Water and Sanitation Program. 2000. Arsenic Mitigation in West Bengal and Water and Sanitation Program. 2000. Arsenic Mitigation in West Bengal and Bangladesh. Available: http://www.wsp.org/filez/pubs/sa_arsenic.pdf [cited 13 Bangladesh. Available: http://www.wsp.org/filez/pubs/sa_arsenic.pdf [cited 13 May 2008].May 2008].

• Wilson R. Pictures of Sufferers (Chronic Arsenic Poisoning). Available: Wilson R. Pictures of Sufferers (Chronic Arsenic Poisoning). Available: http://phys4.harvard.edu/%7Ewilson/arsenic/pictures/arsenic_project_pictures2.http://phys4.harvard.edu/%7Ewilson/arsenic/pictures/arsenic_project_pictures2.html [cited 13 May 2008].html [cited 13 May 2008].

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