Mohammad Mahmudur Rahman

Arsenic calamity in the Indian subcontinent What lessons have been learned

Groundwater arsenic (As) contamination in West Bengal (WB, India) was first reported in December 1983, when 63 people from three villages of two districts were identified by health officials as suffering from As toxicity. As of October 2001, the authors from the School of Environmental Studies (SOES) have analyzed >105 000 water samples, >25 000 urine/hair/nail/skin-scale samples, screened approximately 86 000 people in WB. The results show that more than 6 million people in 2700 villages from nine affected districts (total population approximately 42 million) of 18 total districts are drinking water containing >/=50 mug l(-1) As and >300 000 people may have visible arsenical skin lesions. The As content of the physiological samples indicates that many more may be sub-clinically affected. Children in As-affected villages may be in special danger. In 1995, we had found three villages in two districts of Bangladesh where groundwater contained >/=50 mug l(-1) As. The present situation is that in 2000 villages in 50 out of total 64 districts of Bangladesh, groundwater contains As above 50 mug l(-1) and more than 25 million people are drinking water above >/=50 mug l(-1) As. After years of research in WB and Bangladesh, additional affected villages are being identified on virtually every new survey. The present research may still reflect only the tip of iceberg in identifying the extent of As contamination. Although the WB As problem became public almost 20 years ago, there are still few concrete plans, much less achievements, to solve the problem. Villagers are probably in worse condition than 20 years ago. Even now, many who are drinking As-contaminated water are not even aware of that fact and its consequences. 20 years ago when the WB government was first informed, it was a casual matter, without the realization of the magnitude this problem was to assume. At least up to 1994, one committee after another was formed but no solution was forthcoming. None of the expert reports has suggested solutions that involve awareness campaigns, education of the villagers and participation of the people. Initially, international aid agencies working in the subcontinent simply did not consider that As could be present in groundwater. Even now, while As in drinking water is being highlighted, there have been almost no studies on how additional As is introduced through the food chain, as large amounts of As are present in the agricultural irrigation water. Past mistakes, notably the ceaseless exploitation of groundwater for irrigation, continue unabated today; at this time, more groundwater is being withdrawn than ever before. No efforts have been made to adopt effective watershed management to harness the extensive surface water and rainwater resources of this region. Proper watershed management and participation by villagers are needed for the proper utilization of water resources and to combat the As calamity. As in groundwater may just be natures initial warning about more dangerous toxins yet to come. What lessons have we really learned?

Chronic Arsenic Toxicity in Bangladesh and West Bengal, India—A Review and Commentary

Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in groundwater above the World Health Organizations maximum permissible limit of 50 μg/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 μg/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 μg/L and 37% and 25% arsenic above 50 μg/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.

Chronic exposure of arsenic via drinking water and its adverse health impacts on humans.

Worldwide chronic arsenic (As) toxicity has become a human health threat. Arsenic exposure to humans mainly occurs from the ingestion of As contaminated water and food. This communication presents a review of current research conducted on the adverse health effects on humans exposed to As-contaminated water. Chronic exposure of As via drinking water causes various types of skin lesions such as melanosis, leucomelanosis, and keratosis. Other manifestations include neurological effects, obstetric problems, high blood pressure, diabetes mellitus, diseases of the respiratory system and of blood vessels including cardiovascular, and cancers typically involving the skin, lung, and bladder. The skin seems to be quite susceptible to the effects of As. Arsenic-induced skin lesions seem to be the most common and initial symptoms of arsenicosis. More systematic studies are needed to determine the link between As exposure and its related cancer and noncancer end points.

Status of groundwater arsenic contamination in the state of West Bengal, India: a 20-year study report.

Since 1988 we have analyzed 140 150 water samples from tube wells in all 19 districts of West Bengal for arsenic; 48.1% had arsenic above 10 microg/L (WHO guideline value), 23.8% above 50 microg/L (Indian Standard) and 3.3% above 300 microg/L (concentration predicting overt arsenical skin lesions). Based on arsenic concentrations we have classified West Bengal into three zones: highly affected (9 districts mainly in eastern side of Bhagirathi River), mildly affected (5 districts in northern part) and unaffected (5 districts in western part). The estimated number of tube wells in 8 of the highly affected districts is 1.3 million, and estimated population drinking arsenic contaminated water above 10 and 50 microg/L were 9.5 and 4.2 million, respectively. In West Bengal alone, 26 million people are potentially at risk from drinking arsenic-contaminated water (above 10 microg/L). Studying information for water from different depths from 107 253 tube wells, we noted that arsenic concentration decreased with increasing depth. Measured arsenic concentration in two tube wells in Kolkata for 325 and 51 days during 2002-2005, showed 15% oscillatory movement without any long-term trend. Regional variability is dependent on sub-surface geology. In the arsenic-affected flood plain of the river Ganga, the crisis is not having too little water to satisfy our needs, it is the crisis of managing the water.

Status of groundwater arsenic contamination in Bangladesh: A 14-year study report

Since 1996, 52,202 water samples from hand tubewells were analyzed for arsenic (As) by flow injection hydride generation atomic absorption spectrometry (FI-HG-AAS) from all 64 districts of Bangladesh; 27.2% and 42.1% of the tubewells had As above 50 and 10 μg/l, respectively; 7.5% contained As above 300 μg/l, the concentration predicting overt arsenical skin lesions. The groundwater of 50 districts contained As above the Bangladesh standard for As in drinking water (50 μg/l), and 59 districts had As above the WHO guideline value (10 μg/l). Water analyses from the four principal geomorphological regions of Bangladesh showed that hand tubewells of the Tableland and Hill tract regions are primarily free from As contamination, while the Flood plain and Deltaic region, including the Coastal region, are highly As-contaminated. Arsenic concentration was usually observed to decrease with increasing tubewell depth; however, 16% of tubewells deeper than 100 m, which is often considered to be a safe depth, contained As above 50 μg/l. In tubewells deeper than 350 m, As >50 μg/l has not been found. The estimated number of tubewells in 50 As-affected districts was 4.3 million. Based on the analysis of 52,202 hand tubewell water samples during the last 14 years, we estimate that around 36 million and 22 million people could be drinking As-contaminated water above 10 and 50 μg/l, respectively. However for roughly the last 5 years due to mitigation efforts by the government, non-governmental organizations and international aid agencies, many individuals living in these contaminated areas have been drinking As-safe water. From 50 contaminated districts with tubewell As concentrations >50 μg/l, 52% of sampled hand tubewells contained As <10 μg/l, and these tubewells could be utilized immediately as a source of safe water in these affected regions provided regular monitoring for temporal variation in As concentration. Even in the As-affected Flood plain, sampled tubewells from 22 thanas in 4 districts were almost entirely As-safe. In Bangladesh and West Bengal, India the crisis is not having too little water to satisfy our needs, it is the challenge of managing available water resources. The development of community-specific safe water sources coupled with local participation and education are required to slow the current effects of widespread As poisoning and to prevent this disaster from continuing to plague individuals in the future.

Neuropathy in Arsenic Toxicity from Groundwater Arsenic Contamination in West Bengal, India

Abstract Large number of people from 9 out of 18 districts of West Bengal, India are endemically exposed to arsenic contaminated groundwater due to drinking of tubewell water containing arsenic level above World Health Organizations maximum permissible limit of 50 µg/L. From our ongoing studies on neurological involvement in patients of arsenicosis from different districts of West Bengal, we report our findings in a total of 451 patients of three districts (Murshidabad, Nadia, and Burdwan), comprising 267 males and 184 females with age ranging from 11 to 79 years. They all had arsenical skin lesions, positive biomarkers and identified source of arsenic contaminated water drinking. Peripheral neuropathy was the predominant neurological complication in these patients affecting 154 (37.3%) of 413 patients of Group 1 and 33 (86.8%) of 38 patients of Group 2. Other possible causes and alternative explanations of neuropathy were excluded. The temporal profile in most of the cases (154 of Group 1) were of chronic affection while the 33 patients of Group 2 developed both neuropathy and dermopathy subacutely. Subacutely affected Group 2 patients had much higher incidence of neuropathy. Paresthesias and pains in the distal parts of extremities were much higher in incidence in Group 2 (73.7% and 23.7% respectively) than in Group 1 (18.4% and 11.1%). Distal limb weakness or atrophy was evident in 7.3% in Group 1 and 10.5% in Group 2. Overall, sensory features were more common than motor features in patients of neuropathy and sensory neuropathy was diagnosed in 30% and 76.3% and sensorimotor in 7.3% and 10.5% respectively in Group 1 and Group 2 subjects. Nerve conduction and electromyographic studies performed in 88 cases revealed dysfunction of sensory nerve in 45% and 27% and of motor nerve in 20% and 16.7% of patients with moderate degree and mild degree of clinical neuropathies respectively. Evoked potential studies performed in 20 patients were largely normal except for two instances each of abnormal visual evoked potential and brainstem auditory evoked potential findings. Prognosis was favorable in mild and early diagnosed cases of neuropathy whereas most of the other more severe and late diagnosed cases showed slow and partial recovery or even deterioration. Outcome in neuropathic patients of arsenicosis and long term toxic neurologic effects yet unexplored and unknown remain as matters of future concern requiring close monitoring.

Arsenic Groundwater Contamination and Sufferings of People in North 24-Parganas, One of the Nine Arsenic Affected Districts of West Bengal, India

Abstract 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 µg/L, the maximum permissible limit of World Health Organization (WHO) and 52.8% have arsenic above 10 µg/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 µg/L and 50 µg/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.

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.

Pattern of Excretion of Arsenic Compounds [Arsenite, Arsenate, MMA(V), DMA(V)] in Urine of Children Compared to Adults from an Arsenic Exposed Area in Bangladesh

Abstract Urinary arsenic is generally considered as the most reliable indicator of recent exposure to inorganic arsenic and is used as the main bio-marker of exposure. However, due to the different toxicity of arsenic compounds, speciation of arsenic in urine is generally considered to be more convenient for health risk assessment than measuring total arsenic concentration. Additionally, it can give valuable information about the metabolism of arsenic species within the body. In our study, for exposed group—42 urine samples were collected from Datterhat (South) village of Madaripur district, Bangladesh and an average arsenic concentration in their drinking water was 376 µg/L (range 118 to 620 µg/L). For control group, 27 urine samples were collected from a non-affected district, Badhadamil village of Medinipur district, West Bengal, India, where arsenic concentration in their drinking water is below 3 µg/L. The arsenic species in the urine were separated and quantified by using HPLC-ICP-MS. The sum of inorganic arsenic and its metabolites was also determined by FI-HG-AAS. Results indicate that average total urinary arsenic metabolites in childrens urine is higher than adults and total arsenic excretion per kg body weight is also higher for children than adults. For arsenic species between adults and children, it has been observed that inorganic arsenic (In-As) in average is 2.36% and MMA is 6.55% lower for children than adults while DMA is 8.91% (average) higher in children than adults. The efficiency of the methylation process is also assessed by the ratio between urinary concentration of putative product and putative substrate of the arsenic metabolic pathway. Higher values mean higher methylation capacity. Results show the values of the MMA/In-As ratio for adults and children are 0.93 and 0.74 respectively. These results indicate that first reaction of the metabolic pathway is more active in adults than children. But a significant increase in the values of the DMA/MMA ratio in children than adults of exposed group (8.15 vs. 4.11 respectively) indicates 2nd methylation step is more active in children than adults. It has also been shown that the distribution of the values of DMA/MMA ratio to exposed group decrease with increasing age (2nd methylation process). Thus from these results we may infer that children retain less arsenic in their body than adults. This may also explain why children do not show skin lesions compared to adults when both are drinking same contaminated water.

Consumption of arsenic and other elements from vegetables and drinking water from an arsenic-contaminated area of Bangladesh.

The study assesses the daily consumption by adults of arsenic (As) and other elements in drinking water and home-grown vegetables in a severely As-contaminated area of Bangladesh. Most of the examined elements in drinking water were below the World Health Organization (WHO) guideline values except As. The median concentrations of As, cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), Mn, nickel (Ni), and zinc (Zn) in vegetables were 90 μg kg(-1), 111 μg kg(-1), 0.80 mg kg(-1), 168 μg kg(-1), 13 mg kg(-1), 2.1 mg kg(-1), 65 mg kg(-1), 1.7 mg kg(-1), and 50 mg kg(-1), respectively. Daily intakes of As, Cd, Cr, Co, Cu, Pb, manganese (Mn), Ni, and Zn from vegetables and drinking water for adults were 839 μg, 2.9 μg, 20.8 μg, 5.5 μg, 0.35 mg, 56.4 μg, 2.0mg, 49.1 μg, and 1.3mg, respectively. The health risks from consuming vegetables were estimated by comparing these figures with the WHO/FAO provisional tolerable weekly or daily intake (PTWI or PTDI). Vegetables alone contribute 0.05 μg of As and 0.008 mg of Cu per kg of body weight (bw) daily; 0.42 μg of Cd, 8.77 mg of Pb, and 0.03 mg of Zn per kg bw weekly. Other food sources and particularly dietary staple rice need to be evaluated to determine the exact health risks from such foods.