Effectiveness of Different Approaches to Arsenic Mitigation over 18 Years in Araihazar, Bangladesh: Implications for National Policy.

About 20 million rural Bangladeshis continue to drink well water containing >50 μg/L arsenic (As). This analysis argues for reprioritizing interventions on the basis of a survey of wells serving a population of 380,000 conducted one decade after a previous round of testing overseen by the government. The available data indicate that testing alone reduced the exposed population in the area in the short term by about 130,000 by identifying the subset of low As wells that could be shared at a total cost of <US$1 per person whose exposure was reduced. Testing also had a longer term impact, as 60,000 exposed inhabitants lowered their exposure by installing new wells to tap intermediate (45-90 m) aquifers that are low in As at their own expense of US$30 per person whose exposure was reduced. In contrast, the installation of over 900 deep (>150 m) wells and a single piped-water supply system by the government reduced exposure of little more than 7000 inhabitants at a cost of US$150 per person whose exposure was reduced. The findings make a strong case for long-term funding of free well testing on a massive scale with piped water or groundwater treatment only as a last resort.