Kunal Kanti Majumdar

Arsenic Contamination of Ground Water and its Health Impact on Population of District of Nadia, West Bengal, India

Background: The global health impact and disease burden due to chronic arsenic toxicity has not been well studied in West Bengal. Objective: To ascertain these, a scientific epidemiological study was carried out in a district of the state. Materials and Methods: Epidemiological study was carried out by house-to-house survey of arsenic affected villages in the district of Nadia. A stratified multi-stage design has been adopted for this survey for the selection of the participants. A total number of 2297 households of 37 arsenic affected villages in all the 17 blocks were surveyed in the district. Result: Out of 10469 participants examined, prevalence rate of arsenicosis was found to be 15.43%. Out of 0.84 million people suspected to be exposed to arsenic, 0.14 million people are estimated to be suffering from arsenicosis in the district. Highest level of arsenic in drinking water sources was found to be 1362 μg/l, and in 23% cases it was above 100 μg/l. Majority of the population living in the arsenic affected villages were of low socio-economic condition, inadequate education and were farmers or doing physical labour. Chronic lung disease was found in 207 (12.81%) subjects among cases and 69 (0.78%) in controls. Peripheral neuropathy was found in 257 (15.9%) cases and 136 (1.5%) controls. Conclusion: Large number of people in the district of Nadia are showing arsenical skin lesion. However, insufficient education, poverty, lack of awareness and ineffective health care support are major factors causing immense plight to severely arsenic affected people.

Health impact of supplying safe drinking water containing fluoride below permissible level on flourosis patients in a fluoride-endemic rural area of West Bengal

BACKGROUND The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world. World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L. About 20 states of India, including 43 blocks of seven districts of West Bengal, were identified as endemic for fluorosis and about 66 million people in these regions are at risk of fluoride contamination. Studies showed that withdrawal of sources identified for fluoride often leads reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. OBJECTIVE To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above the permissible limit, and to assess the changes in clinical manifestations of the above participants after they started consuming safe drinking water. MATERIALS AND METHODS A longitudinal intervention study was conducted in three villages in Rampurhat Block I of Birbhum district of West Bengal to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among the study population and the impact of taking safe water from the supplied domestic and community filters on these clinical manifestations. The impact was studied by follow-up examination of the participants for 5 months to determine the changes in clinical manifestations of the above participants after they started consuming safe drinking water from supplied domestic filters and community filter with fluoride concentration below the permissible limit. The data obtained were compared with the collected data from the baseline survey. RESULTS The prevalence of signs of dental, skeletal, and non-skeletal fluorosis was 66.7%, 4.8-23.8%, and 9.5-38.1%, respectively, among the study population. Withdrawal of source(s) identified for fluoride by providing domestic and community filters supplying safe water led to 9.6% decrease in manifestation of dental fluorosis, 2.4-14.3% decrease in various manifestations of skeletal fluorosis, and 7.1-21.5% decrease in various non-skeletal manifestations within 5 months. Following repeated motivation of participants during visit, there was also 9.7-38.1% decrease in the usage of fluoride containing toothpaste, and 9.8-45.3% and 7.3-11.9% decrease in the consumption of black lemon tea and tobacco, respectively, which are known sources of fluoride ingestion in our body and have an effect on the occurrence of various manifestations of fluorosis following drinking of safe water from domestic and community filters. CONCLUSION Increased prevalence of dental, skeletal, and non-skeletal fluorosis was found among the study population. Withdrawal of source(s) identified for fluoride by supplying domestic and community filters, dietary restriction, and other nutritional interventions led to decrease in manifestation of the three types of fluorosis within 5 months.

Nutritional deficiency and arsenical manifestations: a perspective study in an arsenic-endemic region of West Bengal, India.

OBJECTIVE To assess whether nutritional deficiency increases susceptibility to arsenic-related health effects. DESIGN Assessment of nutrition was based on a 24 h recall method of all dietary constituents. SETTING Epidemiological cross-sectional study was conducted in an arsenic endemic area of West Bengal with groundwater arsenic contamination. SUBJECTS The study was composed of two groups – Group 1 (cases, n 108) exhibiting skin lesions and Group 2 (exposed controls, n 100) not exhibiting skin lesions – age- and sex-matched and having similar arsenic exposure through drinking water and arsenic levels in urine and hair. RESULTS Both groups belonged to low socio-economic strata (Group 1 significantly poorer, P<0·01) and had low BMI (prevalence of BMI<18·5 kg/m2: in 38% in Group 1 and 27% in Group 2). Energy intake was below the Recommended Daily Allowance (set by the Indian Council of Medical Research) in males and females in both groups. Increased risk of arsenical skin lesions was found for those in the lowest quintile of protein intake (v. highest quintile: OR=4·60, 95% CI 1·36, 15·50 in males; OR=5·62, 95% CI 1·19, 34·57 in females). Significantly lower intakes of energy, protein, thiamin, niacin, Mg, Zn and choline were observed in both males and females of Group 1 compared with Group 2. Significantly lower intakes of carbohydrate, riboflavin, niacin and Cu were also observed in female cases with skin lesions compared with non-cases. CONCLUSIONS Deficiencies of Zn, Mg and Cu, in addition to protein, B vitamins and choline, are found to be associated with arsenical skin lesions in West Bengal.

Hypertension in chronic arsenic exposure: A case control study in West Bengal.

Various systemic manifestations are reported to be caused by chronic arsenic exposure in the population living in the Indo-Bangladesh subcontinent. This study from West Bengal assesses the likelihood of occurrence of hypertension (HTN) in individuals resident in an area of high groundwater contamination with arsenic (Nadia district) compared to those from a non-contaminated area (Hoogly district) in West Bengal, India. Two hundred and eight study participants (Group 1) were recruited from a cross-sectional study in six villages in the Nadia district and 100 controls (Group 2) from a village in the Hoogly district. The two groups were evenly matched in regard to age and sex. History taking and clinical examination including blood pressure measurement were undertaken in each participant. Water samples from current and previous drinking water sources and hair and urine samples from each participant were collected for estimation of arsenic. The present study shows evidence of increased association of HTN in individuals resident in arsenic endemic region compared to those from a non-endemic region in West Bengal. There were increased odds ratios for HTN [Adjusted Odds Ratio, OR, 2.87 (95 %CI = 1.26–4.83)] in Group- 1 participants compared to Group- 2 people. Within Group 1, there was no difference in prevalence of HTN between those with and without skin lesion. There was a dose-effect relationship seen with increasing cumulative arsenic exposure and arsenic level in hair and HTN in participants living in arsenic endemic region.The findings reported here support an association between arsenic exposure and HTN. More work is needed to characterize the link further.

Evaluation of dietary arsenic exposure and its biomarkers: A case study of West Bengal, India

Few reports are available that characterize daily arsenic exposure through water and diet among people living in groundwater-contaminated regions and correlate it with biomarkers. The present study describes the total individual arsenic exposure and arsenic level in urine and hair of such an arsenic-exposed population in West Bengal. Demographic characteristics and the total daily arsenic intake through water and diet were determined in 167 (Group-1 participants selected from arsenic endemic region) and 69 (Group-2 participants selected from arsenic non-endemic region) in West Bengal. Out of 167 Group-1 participants 78 (Group-1A) had arsenical skin lesions while 89 Group-1B) had no such lesion. Arsenic level in water samples as well as diet, urine and hair samples, collected from all the individual participants, were estimated. The mean value of estimated total arsenic content from water and diet was 349 (range: 20–1615) μg/day in 167 (Group-1) participants living in As endemic region [As in water: mean value 54 (range:BDL-326) μg/L] and 36 (range:12–120) μg/day in 69 (Group-2) participants living in As non-endemic region (As in water: below detection level (BDL), < 0.3 μg/L). Estimated mean arsenic level in urine in these two groups of participants was 116 (range: 6–526) μg/L and 17 (range: BDL-37) μg/L and in hair was 1.0 (range: 0.22–3.98) mg/Kg and 0.16 (range: 0.06–0.37) mg/Kg, respectively. Multiple regressions analysis in Group-1 participants showed that total arsenic intake was associated significantly with urinary and hair arsenic level. The estimated regression coefficient was 0.0022 (95% confidence interval, C.I: 0.0016, 0.0028; P < 0.001) and 0.0024 (95% C.I: 0.0021, 0.003; P < 0.001), respectively. In sub group analysis, higher median urinary arsenic value relative to arsenic intake through water and diet was observed in 78 Group-1A subjects with skin lesion compared to urinary arsenic value in 89 Group-1B subjects without skin lesions, though there was a marginal difference of median total arsenic intake in these two groups. This study showed that significant elevation of arsenic level in urine and hair was associated with elevated arsenic intake through water and diet in people living in arsenic endemic region (Group-1), while these values were low in people living in non-endemic region (Group-2). Those with skin lesions were found to have higher arsenic in urine and hair compared to those without skin lesion with similar arsenic intake through water and diet.

Effect of safe water on arsenicosis: A follow-up study

Background: Arsenic pollution in groundwater, used for drinking purposes, has been envisaged as a problem of global concern. Treatment options for the management symptoms of chronic arsenicosis are limited. Mitigation option available for dealing with the health problem of ground water arsenic contamination rests mainly on supply of arsenic safe water in arsenic-endemic region of Indo-Bangladesh subcontinent. Limited information is available regarding the long-term effect of chronic arsenic toxicity after stoppage of consumption of arsenic-containing water. Objective: The current study was, therefore, done to assess, objectively, the effect of drinking arsenic safe water (<50 μg/L) on disease manifestation of arsenicosis. Results: Manifestations of various skin lesions and systemic diseases associated with chronic arsenic exposure were ascertained initially by carrying on baseline study on 208 participants in Nadia (Cohort-I, with skin lesion and Cohort-II, without skin lesion) using a scoring system, as developed by us, and compared objectively at the end of each year for 3 year follow-up period. All the participants who had arsenic contaminated drinking water source in their houses were supplied with arsenic removal filters for getting arsenic-free water during the follow-up period. In participants belonging to Cohort-I, the skin score was found to improve significantly at the end of each year, and it was found to be reduced significantly from 2.17 ± 1.09 to 1.23 ± 1.17; P < 0.001 at the end of 3 years intervention study indicating beneficial effect of safe water on skin lesions. The systemic disease symptom score was also found to improve, but less significantly, at the end of 3 years in both the cohorts. Most important observation during the follow-up study was persistence of severe symptoms of chronic lung disease and severe skin lesion including Bowens disease in spite of taking arsenic-safe water. Further, death could not be prevented to occur because of lung cancer and severe lung disease. Conclusion: It is, therefore, an urgent need to make arrangement for availability of safe water source among the arsenic-affected people in the district. Many of the people in the affected villages are not aware of contamination of their home tube wells with arsenic. Awareness generation and motivation of the people for testing their drinking water sources for arsenic and environmental interventions like rain water harvesting, ground water recharge, and restricting excessive use of ground water for domestic and agricultural purposes are also important to prevent further exposure of arsenic to these people.

Chronic lung disease and detection of pulmonary artery dilatation in high resolution computerized tomography of chest in chronic arsenic exposure

Lung affection in chronic arsenicosis developing from chronic ingestion of arsenic contaminated groundwater has been known but little is known on its effect on pulmonary arterial system. A cross sectional study was carried out at two geographically similar areas and demographically similar populations with or without evidence of chronic arsenic exposure in West Bengal, India. The willing participants in both the groups with chronic respiratory symptoms were evaluated with High Resolution Computerized Tomography (HRCT) of Chest. Evaluation of High Resolution Computerized Tomography of chest followed clinical assessment of lung disease in194 and 196 subjects from the arsenic exposed and unexposed people; the former had a higher prevalence of cough OR(Odds Ratio) 3.23 (95% CI(Confidence Interval): 1.72–6.07) and shortness of breath OR1.76 (95% CI: 0.84–3.71), respectively. The arsenic exposed individuals showed higher score for bronchiectasis [mean ± SD(Standard Deviation)] as 2.41 ± 2.32 vs. 1.22 ± 1.48 (P <0.001), pulmonary artery branch dilatation (PAD) as 2.48 ± 2.33 vs. 0.78 ± 1.56, (P <0.001) and pulmonary trunk dilatation as 0.26 ± 0.45 vs. nil. Age-adjusted prevalence odds ratio (POR) for Pulmonary Artery Dilatation Found in HRCT comparing those exposed to arsenic (Group 1) to unexposed participants (Group 2) was found to be 6.98 (CI: 2.26–16.48). There was a strong dose–response relationship between the PAD (Pulmonary Artery Dilatation) and cumulative arsenic exposure. Pulmonary trunk and branch dilatation in chronic arsenicosis is a frequent abnormality seen in HRCT Chest of arsenicosis patients. The significance of such finding needs further investigation.

Health impact of supplying safe drinking water on patients having various clinical manifestations of fluorosis in an endemic village of west bengal.

Background: Excessive fluoride in drinking water causes dental, skeletal and non-skeletal fluorosis which is encountered in endemic proportions in several parts of the world. The World Health Organization (WHO) guideline value and the permissible limit of fluoride as per the Bureau of Indian Standards (BIS) is 1.5 mg/L. Studies showed that withdrawal of sources identified for fluoride, often leads to reduction of fluoride in the body fluids (re-testing urine and serum after a week or ten days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. Objective: To determine the prevalence of signs and symptoms of suspected dental, skeletal and non-skeletal fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among participants taking water with fluoride concentration above permissible limit and to assess the changes in clinical manifestations of the above participants after consumption of safe drinking water with fluoride concentration below permissible limit. Materials and Methods: A longitudinal intervention study was conducted from October 2010 to December 2011 in a village selected randomly in Purulia District of West Bengal which is endemic for fluorosis. Thirty-six families with 104 family members in the above village having history of taking unsafe water containing high level of fluoride were selected for the study. The occurrence of various dental, skeletal and non-skeletal manifestations of fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among the study population was assessed; the impact of taking safe water with fluoride concentration below permissible limit from a supplied community filter on these clinical manifestations was studied by follow-up examination of the above participants for six months. The data obtained is compared with the collected data from the baseline survey. Results: The prevalence of signs and symptoms of dental, skeletal and non-skeletal fluorosis was (18.26%), (18.26-43.26%) and (12.49-38.46%) among the study population. Withdrawal of source(s) identified for fluoride by providing community filters supplying safe water along with nutritional interventions lead to 1.92% decrease of manifestation of dental fluorosis, 2.88-18.26% decrease of manifestations of skeletal fluorosis and 3.8-5.77% decrease in manifestations of non-skeletal fluorosis within six months. Following repeated motivation of participants during visit there was also 2.88% decrease in the usage of fluoride-containing toothpaste, 4.81% decrease in consumption of black lemon tea, supari and tobacco which are known sources of fluoride ingestion in our body. Conclusion: Increased prevalence of dental, skeletal and non-skeletal fluorosis was found among the study population. Withdrawal of sources(s) identified for fluoride by supplying community filter, dietary restriction and other nutritional interventions led to decrease of manifestations of the three types of fluorosis within six months. The government should play a vital role in ensuring drinking water safety at the household and community level by supplying domestic filters at affordable costs and community filter along with nutritional intervention to the fluorosis-affected villages on a priority basis to mitigate the problem.

Epidemiology of Diarrhea among under-five Children in a Village in Sunderbans, South 24 Parganas, West Bengal, India

Background: Though various studies have been carried out on the problem of diarrheal disease in under-five children in various parts of India, no comprehensive study has so far been done on this problem in deltaic region of West Bengal, the Sunderbans. Objectives: A study was undertaken in a prototype village, in Sunderban area to assess the prevalence of diarrheal disease in under-five children and to assess various factors which influence its occurrence. Methods: Information was collected from all households from village Hogolduri, in Sunderban area, South 24 Parganas regarding socioeconomic characteristics, water source, and sanitation status of the population. Frequency of occurrence of Diarrhea during last three months in each child under-five years of age was recorded and maternal characteristics and child’s nutrition were also noted. Results: Among the 5264 people residing in 1231 households in Hogolduri village, majority of the people were Muslims (79%). Majority (80.7%) of the families belonged to below-poverty-line (BPL). Out of 486 children living in the village, from which all the data were available, diarrhea occurred during last three months in 45.68% of children. Important contributing factors for such morbidity of children were found to be absence of toilets in households, non-use of soap for hand washing after defecation and after child’s stool cleaning by mothers, absence of vaccination against measles and low nutritional status of children. Conclusions: Multiple factors are responsible for high incidence of diarrheal disease in children in a prototype village in Sunderban area .