Bulletin o the World Health Organization
September 2007, 85 (9)
Arsenic concentrations in 25% o tube wells in Bangladesh exceed 50μg/L, a level known to be hazardous. Levels inindividual wells vary widely. We gathered data on arsenic exposure levels and skin lesion prevalence to address the lack o knowledgeabout risks where the average arsenic concentrations was lower.
The nongovernmental organization Gonoshasthaya Kendra did three related studies o keratotic skin lesions since 2004:(1) an ecological prevalence survey among 13 705 women aged
18 in a random sample o 53 villages; (2) a case-control study o176 cases and age- and village-matched reerents; and (3) a prevalence survey o the entire population o 11 670 in two additionalvillages. We calculated prevalence as a unction o average arsenic concentrations as reported in the National Hydrochemical Survey,and measured arsenic concentrations in wells used by subjects in the case-control study.
The prevalence o skin lesions was 0.37% in people exposed to arsenic concentrations below 5μg/L, 0.63% at 6–50μg/L,and 6.84% at 81μg/L. In the case-control analysis, relative risk o skin lesions increased threeold at concentrations above 50μg/L(
Little serious skin disease is likely to occur i the arsenic concentration in drinking water is kept below 50μg/L, butensuring this water quality will require systematic surveillance and reliable testing o all wells, which may be impractical. Moreresearch is needed on easible prevention o toxic eects rom arsenic exposure in Bangladesh.
Bulletin o the World Health Organization 2007;85:668–673.
Une traduction en rançais de ce résumé fgure à la fn de l’article. Al fnal del artículo se acilita una traducción al español.
Risk of arsenic-related skin lesions in Bangladeshi villages atrelatively low exposure: a report from Gonoshasthaya Kendra
& Nicola Cherry
.ةلقا هذل مكلا لا ةين ف ةصخلا هذل ةبرعلا ةجتلا
Department o Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK. Correspondence to Corbett McDonald(e-mail: firstname.lastname@example.org).
Gonoshasthaya Kendra, Nayarhat, Savar, Dhaka, Bangladesh.
Institute o Child and Mother Health, Matuail, Dhaka, Bangladesh.
Community and Occupational Medicine Program, University o Alberta, Edmonton, Canada.doi: 10.2471/BLT.
Submitted: 19 September 2006 – Final revised version received: 9 February 2007 – Accepted: 13 February 2007
Arsenic is a human carcinogen and skinpathogen; the evidence has been docu-mented by the International Agency or Research on Cancer on several oc-casions.
A potentially serious threat topublic health that has become evidentduring the last 30–40 years is naturalarsenic contamination o drinking water,notably in South America and Asia andmore recently in Bangladesh and WestBengal (India). oxic maniestationshave been primarily keratotic skin le-sions; more threatening, however, areinternal cancers, or which there is lesscertain evidence.
A major national di-saster was evidenced by the publicationin 2001 o a systematic survey o nearly 4000 wells
showing that hal Bangla-desh’s administrative districts had aver-age arsenic concentrations above – oten well above – 50
g/L, a level known tobe hazardous. Tese averages may be apoor reection o the problem, as levelsvaried enormously within and betweenvillages by several orders o magnitude.Tus it is virtually impossible to estimate what proportion o Bangladesh’s ruralpopulation is at risk even at the nationalstandard o 50
g/L, let alone abovethe WHO recommended guideline o 10
g/L. Given this extremely variedpattern o exposure, there is need orepidemiological data over a wide rangeo concentrations.Tere have been ve recent preva-lence studies: one in West Bengal,
laterused in a case-control analysis,
and ourin Bangladesh,
where exposures esti-mated individually were related to risk o skin lesions. wo studies
reportedvery low risks below 50
g/L, rising toprevalences o 20–30% at higher con-centrations. Te two remaining studiesby Ahsan et al.
and Rahman et al.
published in 2006 were both large androm circumscribed areas south-east o Dhaka, where arsenic contaminationsare high. Te ormer study, in Araihazar,reported a systematic increase in preva-lence odds ratios (OR) compared tothose in drinking water containing<8.1
g/L, o 1.91 at 8.1–40
g/L, ris-ing to 5.39 at > 175.1
g/L. Rahman etal. did not present comparable data onexposure-response in Matlab, but theoverall prevalence in adults was only 4/1000 ater an average o some 20 years’tube-well use, and a mean exposure o 167
g/L. Te apparent dierence be-tween the ndings in these two studiesand others is addressed below.
Uncertainties over levels o risk at rela-tively low arsenic concentrations seri-ously concern Gonoshashthaya Kendra(GK), a large NGO long known interna-tionally or innovations in health care.
GK provides comprehensive services orthe entire population o over a millionin some 600 villages spread across mucho the country, excepting the divisions