Chen Yu, van Geen Alexander, Graziano Joseph H, Pfaff Alexander, Madajewicz Malgosia, Parvez Faruque, Hussain A Z M Iftekhar, Slavkovich Vesna, Islam Tariqul, Ahsan Habibul
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Environ Health Perspect. 2007 Jun;115(6):917-23. doi: 10.1289/ehp.9833. Epub 2007 Feb 5.
There is a need to identify and evaluate an effective mitigation program for arsenic exposure from drinking water in Bangladesh.
We evaluated the effectiveness of a multifaceted mitigation program to reduce As exposure among 11,746 individuals in a prospective cohort study initiated in 2000 in Araihazar, Bangladesh, by interviewing participants and measuring changes in urinary As levels.
The interventions included a) person-to-person reporting of well test results and health education; b) well labeling and village-level health education; and c) installations of 50 deep, low-As community wells in villages with the highest As exposure.
Two years after these interventions, 58% of the 6,512 participants with unsafe wells (As >/=50 microg) at baseline had responded by switching to other wells. Well labeling and village-level health education was positively related to switching to safe wells (As < 50 mug/L) among participants with unsafe wells [rate ratio (RR) = 1.84; 95% confidence interval (CI), 1.60-2.11] and inversely related to any well switching among those with safe wells (RR = 0.80; 95% CI, 0.66-0.98). The urinary As level in participants who switched to a well identified as safe (< 50 microg As/L) dropped from an average of 375 microg As/g creatinine to 200 microg As/g creatinine, a 46% reduction toward the average urinary As content of 136 microg As/g creatinine for participants that used safe wells throughout. Urinary As reduction was positively related to educational attainment, body mass index, never-smoking, absence of skin lesions, and time since switching (p for trend < 0.05).
Our study shows that testing of wells and informing households of the consequences of As exposure, combined with installation of deep community wells where most needed, can effectively address the continuing public health emergency from arsenic in drinking water in Bangladesh.
有必要识别并评估一项针对孟加拉国饮用水中砷暴露的有效缓解计划。
在2000年于孟加拉国阿拉伊扎尔启动的一项前瞻性队列研究中，我们通过对参与者进行访谈并测量尿砷水平的变化，评估了一项多方面缓解计划在减少11,746名个体砷暴露方面的有效性。
干预措施包括：a）个人对水井检测结果的报告及健康教育；b）水井标识及村级健康教育；c）在砷暴露最高的村庄安装50口深层、低砷社区水井。
这些干预措施实施两年后，基线时拥有不安全水井（砷含量≥50微克）的6,512名参与者中，58%已做出反应，转而使用其他水井。水井标识及村级健康教育与不安全水井的参与者转而使用安全水井（砷含量<50微克/升）呈正相关[率比（RR）=1.84；95%置信区间（CI），1.60 - 2.11]，而与安全水井的参与者更换水井呈负相关（RR = 0.80；95% CI，0.66 - 0.98）。转而使用被认定为安全的水井（砷含量<50微克/升）的参与者，其尿砷水平从平均375微克砷/克肌酐降至200微克砷/克肌酐，相较于始终使用安全水井的参与者平均尿砷含量136微克砷/克肌酐，降低了46%。尿砷降低与受教育程度、体重指数、从不吸烟、无皮肤病变以及转用新水井后的时间呈正相关（趋势p<0.05）。
我们的研究表明，水井检测并告知家庭砷暴露的后果，再加上在最需要的地方安装深层社区水井，能够有效应对孟加拉国饮用水中砷引发的持续公共卫生紧急情况。
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