Reddy Raghav R, van Velden Grace A, Abedin Md Joynul, Karim Md Rezaul, Hayes Kim F, Agrawal Arun, Raskin Lutgarde
Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI 48109,US.
School of Public Health, University of Michigan, Ann Arbor, MI 48109,US.
PNAS Nexus. 2023 Mar 27;2(3):pgac284. doi: 10.1093/pnasnexus/pgac284. eCollection 2023 Mar.
Thirty million Bangladeshis continue to drink water with unacceptable levels of arsenic (>10 μg/L), resulting in a large public health burden. The vast majority of the Bangladeshi population relies on private wells, and less than 12% use piped water, increasing the complexity of mitigation efforts. While mass testing and informational campaigns were successful in the early 2,000 s, they have received little attention in recent years, even though the number of wells in the country has likely more than doubled. We investigated the effect of a low-cost (<USD 10/household) informational intervention on reducing arsenic exposure through a randomized control trial design. The sample size was ∼10% of the study area households, and the intervention provided exposure awareness material, the arsenic concentration of the household's drinking water, and information about alternate water sources nearby with improved water quality. The informational intervention lowered household arsenic exposure ( = 0.0002), with an average reduction in arsenic levels of ∼60%. Approximately one third of the study households requested to test an additional water source at no cost. Providing the intervention a second time led to more households changing their water source but did not further reduce exposure ( = 0.39). Our study establishes a causal relationship between the informational intervention and the observed reduction in household arsenic exposure. Our findings demonstrate that water testing and recommendations for accessing improved water provide an immediate, effective, and inexpensive means of reducing the public health burden of arsenic exposure in Bangladesh.
三千万孟加拉国人仍在饮用砷含量超过可接受水平（>10μg/L）的水，这导致了巨大的公共卫生负担。绝大多数孟加拉国人口依赖私人水井，使用自来水的比例不到12%，这增加了缓解措施的复杂性。虽然大规模检测和宣传活动在21世纪初取得了成功，但近年来却很少受到关注，尽管该国的水井数量可能增加了一倍多。我们通过随机对照试验设计，研究了低成本（<10美元/家庭）的信息干预对减少砷暴露的影响。样本量约为研究区域家庭的10%，干预措施提供了暴露意识材料、家庭饮用水中的砷浓度，以及附近水质改善的替代水源信息。信息干预降低了家庭的砷暴露（P = 0.0002），砷水平平均降低了约60%。约三分之一的研究家庭要求免费检测额外的水源。再次提供干预措施导致更多家庭更换水源，但并未进一步降低暴露水平（P = 0.39）。我们的研究确立了信息干预与观察到的家庭砷暴露减少之间的因果关系。我们的研究结果表明，水质检测和获取优质水的建议为减轻孟加拉国砷暴露的公共卫生负担提供了一种即时、有效且廉价的方法。
