M. Amir Hossain

Murshidabad—One of the Nine Groundwater Arsenic-Affected Districts of West Bengal, India. Part II: Dermatological, Neurological, and Obstetric Findings

Introduction. To understand the severity of related health effects of chronic arsenic exposure in West Bengal, a detailed 3-year study was carried out in Murshidabad, one of the nine arsenic-affected districts in West Bengal. Methods. We screened 25,274 people from 139 arsenic-affected villages in Murshidabad to identify patients suffering from chronic arsenic toxicity for evidence of multisystemic features and collected biological samples such as head hair, nail, and spot urine from the patients along with the tubewell water they were consuming. Results. Out of 25,274 people screened, 4813 (19%) were registered with arsenical skin lesions. A case series involving arsenical skin lesions resulting in cancer and gangrene were noted during this study. Representative histopathological pictures of skin biopsy of different types of lesions were also presented. Out of 2595 children we examined for arsenical skin lesions, 122 (4%) were registered with arsenical skin lesions, melanosis with or without keratosis. Different clinical and electrophysiological neurological features were noticed among the arsenic-affected villagers. Both the arsenic content in the drinking water and duration of exposure may be responsible in increasing the susceptibility of pregnant women to spontaneous abortions, stillbirths, preterm births, low birth weights, and neonatal deaths. Some additional multisystemic features such as weakness and lethargy, chronic respiratory problems, gastrointestinal symptoms, and anemia were also recorded in the affected population. Discussion. The findings from this survey on different health effects of arsenic exposure were compared to those from previous studies carried out on arsenic-affected populations in India and Bangladesh as well as other affected countries. Conclusion. Multisystemic disorders, including dermal effects, neurological complications, and adverse obstetric outcomes, were observed to be associated with chronic arsenic exposure in the study population in Murshidabad, West Bengal. The magnitude of severity was related to the concentration of arsenic in water as well as duration of the exposure.

Water consumption patterns and factors contributing to water consumption in arsenic affected population of rural West Bengal, India

A direct water intake study was conducted for one year, involving 423 individuals from three arsenic (As) affected villages of West Bengal, India. Average direct water intake per person and per unit body weight was found to be 3.12±1.17 L/day and 78.07±47.08 mL/kg/day (± SD), respectively. Average direct water intakes for adult males, adult females and children (age <15 years) were 3.95, 3.03 and 2.14 L/day, respectively. Significant sex differentials were observed between ages 16-55 years. For all participants, a sharp increase in water intake up to 15 years of age was observed followed by a plateau at a higher intake level. Significant monthly, seasonal, regional, and occupational variability was also observed. Another study involving 413 subjects determined the amount of indirect water intake. Average indirect water intake per person was 1.80±0.64 L/day; for adult males, adult females and children, intake was 2.15, 1.81, and 1.10 L/day, respectively. Average total (direct + indirect) water intake was 4.92 L/person/day; for adult males, adult females and children, total intake was 6.10, 4.84, and 3.24 L/person/day, respectively. The overall contribution of indirect water intake to total water consumption was 36.6% for all participants. This study additionally elucidated several factors that contribute to variable water intake, which can lead to better risk characterization of subpopulations and water contaminant ingestion. The study reveals that the water intake rates in the three studied populations in West Bengal are greater than the assumed water intake rates utilized by the World Health Organization (WHO) in the establishment of drinking water quality guidelines; therefore, these assumed intake values may be inappropriate for the study population as well as similar ones.

Murshidabad—One of the Nine Groundwater Arsenic-Affected Districts of West Bengal, India. Part I: Magnitude of Contamination and Population at Risk

Introduction. To understand the severity of the arsenic crisis in West Bengal, India, a detailed, 3-year study was undertaken in Murshidabad, one of the nine arsenic-affected districts in West Bengal. The district covers an area of 5324 km2 with a population of 5.3 million. Methods. Hand tubewell water samples and biologic samples were collected from Murshidabad and analyzed for arsenic by FI-HG-AAS method. Inter laboratory analysis and analyses of standards were undertaken for quality assurance. Results. During our survey we analyzed 29,612 hand tubewell water samples for arsenic from both contaminated and noncontaminated areas, and 26% of the tubewells were found to have arsenic above 50 µg/L while 53.8% had arsenic above 10 µg/L. Of the 26 blocks in Murshidabad, 24 were found to have arsenic above 50 µg/L. Based on our generated data we estimated that approximately 0.2 million hand tubewells are installed in all 26 blocks of Murshidabad and 1.8 million in nine arsenic-affected districts of West Bengal. It was estimated on the basis of our data that about 2.5 million and 1.2 million people were drinking arsenic-contaminated water with concentrations above 10 and 50 µg/L levels respectively in this district. The analysis of total 3800 biologic (nail, urine, and hair) samples from arsenic-affected villages revealed that 95% of the nail and 94% of the urine samples contained arsenic above the normal levels and 75% of the hair samples were found to have arsenic above the toxic level. Thus, many villagers in the affected areas of Murshidabad might be subclinically affected. Discussion and Conclusion. Comparing our extrapolated data with international dose response results, we estimated how many people may suffer from arsenical skin lesions and cancer. Finally, if the exposed population is provided safe water, better nutrition, and proper awareness about the arsenic problem, lives can be saved and countless suffering of the affected population can be avoided.

Groundwater arsenic contamination in the Sahibganj district of Jharkhand state, India in the middle Ganga plain and adverse health effects

A detailed study in the Sahibganj district of Jharkhand state in the middle Ganga plain was carried out to determine the severity of groundwater arsenic contamination and related adverse health effects due to chronic arsenic exposure. Arsenic was analyzed by flow injection hydride generation atomic absorption spectrometry (FI-HG-AAS) in water and biological samples in both contaminated and noncontaminated areas. Health effects in three villages where tubewells (n = 178) were highly contaminated (91, 79.8, and 42% above 10, 50, and 300 µg L−1) were determined. Analyses of a total of 367 biological samples (nail, hair, and urine) from affected villages revealed that an average 88% of samples contained arsenic above normal level. Out of 522 people screened from these three villages, 71 were registered with arsenical skin lesions. A case involving arsenical skin lesions resulting in cancer was noted during the study. A representative histopathological picture of skin biopsy was presented. Out of 40 children examined, nine were registered with arsenical skin lesions. A child of 18 months drinking arsenic concentration water 1150 µg L−1 displayed arsenical skin lesions, indicating arsenical skin lesions may appear earlier if arsenic concentration is high in drinking water. Different clinical and electrophysiological neurological features and abnormal quantitative sensory perception thresholds were noted amongst patients. Provision of safe water, better nutrition, and proper awareness about the arsenic danger to exposed population may save lives and avoid sufferings.

Arsenicosis and stigmatisation

Arsenicosis is believed to have debilitating effects on social relations, but with arsenic poisoning previously associated directly with economic and cognitive impacts, the degree to which stigmatisation is influenced by socio-economic or health status has not been established in the literature. Based on face-to-face interviews with 100 arsenic outpatients from specialist arsenic clinics in rural Bangladesh, this study represents an early quantitative analysis of factors predicting social impacts of arsenicosis. Physical health status, average years of schooling, family size and the presence of non-government organisation (NGO) and government-run arsenic-awareness campaigns significantly predicted social impacts. We found that the presence of awareness-raising activities was by far the most significant predictor of social impacts after other key variables, including gender and income, thus underscoring the importance of public health interventions in mitigating the impact of stigmatised diseases. The study confirms previous qualitative findings that ostracism is a pervasive problem for arsenicosis patients, and that public health interventions can be a valuable counter to such social problems.