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With the identification of massive arsenic toxicity caused by consumption of arsenic-

contaminated tubewell water in Bangladesh and in West Bengal, India, arsenic contamination
was appre-hended in Nepal, particularly in the terai region having similar alluvial and fertile
plain characteristics to those encountered Bangladesh and West Bengal (Maharjan et al. 2006).

The Department of Water Supply and Sanitation conducted the first study on arsenic
contamination in the eastern terai region of Nepal in 1999, results of which indicated the
possibility for arsenic contamination in groundwater of terai (3). Findings of another preliminary
study on arsenic contamination in tubewell water in eight terai districts conducted jointly by the
Nepal Red Cross Society (NRCS) and the Environment and Public Health Organization
(ENPHO) in 2000 revealed the need for a comprehensive study on arsenic contamination in
tubewell water to find out the extent of arsenic distribution in southern Nepal. Since then,
governmental and non-governmental organizations and some researchers have tested several
thousand samples of tubewell water to identify levels of arsenic contamination and have found
that 7.4% of tubewells had arsenic concentrations more than the maximum permissible limit (50
μg/L) for Nepal (MOHP 2007).

Elevated levels of arsenic in drinking-water and its health effects have been a public-health
concern in many Asian countries, including Nepal. Based on the evidence of carcinogenicity
from human studies, arsenic has been recognized as a human carcinogen (5). Chronic exposure
to inorganic arsenic causes characteristic characteristic skin manifestations due to chronic arsenic
toxicity. Cancers of the skin, bladder, kidney, lung, and other organs also occur due to chronic
arsenic toxicity (6). The non-carcinogenic effects of chronic arsenic toxicity on the reproductive,
neurological, cardiovascular, respiratory, hepatological, nephrological, haematological problems,
diabetics, etc. are also reported in various studies (7). Skin manifestations, characterized by pig-
mentary change and keratosis, have long been considered to be the hallmark, of chronic arsenic
toxicity. Several earlier epidemiological studies in Bangladesh (8-9) and India (10) reported
manifestations in skin, these were the most common features in populations exposed to arsenic
through drinking tubewell water for a long time. Similar findings were also reported from Inner
Mongolia, China, and several other countries (11).

Although arsenic contents of hundreds of thousands of tubewells in Nepal, particularly Rautahat

district have been tested, so far no study has been done to explore the magnitude of health effects
due to chronic exposure to arsenic through tubewell water. Thus, the findings of this study will
reveal the health impact and extent of manifestation due to chronic exposure of arsenic in the
study sites. Furthermore, this study will increase awareness among the people living in the
arsenic affected areas. Therefore, I have emphasized in special need of research about prevalence
of Arsenicosis Symptomatic Patients and awareness of arsenicosis among risk group

Nepal is a land-locked nestled in the foothills of the Himalayas. It occupies an area from 26°27’
to 30°27’ north latitude and 80°4’ to 88°12’ east longitude with elevation ranging from 90 meters
to 8,848 meters. The country is sandwiched between the two populous countries of the world,
India to the east, south, and west and China to the north. Nepal is rectangular in shape and
stretches 885 kilometers in length (east to west) and 193 kilometers in width (north to south).The
total land area of the country is 147,181 square kilometers. According to the 2001 census, the
population of Nepal is just over 23 million

Topographically, Nepal is divided into 3 distinct ecological zones. These are the Mountain, Hill
and Terai (or Plains). The mountain zone, which accounts for 35 percent of the total land area,
ranges in altitude from 4,877 meters to 8,848 meters above sea level and covers a land area of
51,817 square meters. Because of the harsh terrain, transportation and communication facilities in
this zone are very limited and only about 7 percent of the total population lives here. In contrast,
the Hill ecological zone, which ranges in altitude from610 meters to 4,876 meters above sea level,
is densely populated. About 44 percent of the total population lives in the Hill zone, which covers
an area of 61,345 square kilometers and occupies 42 percent of total area. Unlike the Mountain
and Hill, the Terai zone in the southern part of the country can be regarded as an extension of the
relatively flat Gangetic plains of alluvial soil. This area, which covers 34,019 square kilometers,
is the most fertile part of the country. While it constitutes only 23 percent of the total land area in
Nepal, 48 percent of the population lives here.

For administrative purpose there are 5 Development Regions in Nepal- Eastern, Central, Western,
Mid-western and Far western. Nepal is divided into 14 Zones and 75 Administrative Districts.
Districts are further divided into smaller units, called Village Development Committee (VDCs)
and Municipalities. Currently there are 3915 VDCs and 58 Municipalities. Each VDC is
composed of nine wards, with the number of wards in each municipality ranging from 9 to 35.
Kathmandu is the capital city as well as the principal urban center of Nepal.

Nepal has not benefited fully from the rapid economic growth of its immediate neighbours China
and India, primarily due to internal conflict, political instability, and absence of a democratic
government, ineffective policies and weak implementation of progress benefiting the country. The
continued internal conflict not only stalled the criterion of new infrastructure but also destroyed
many existing ones. Thus, Nepal remains among the poorest and the least developed countries in
the world with almost one-third of its population living below the poverty line4.
Rautahat district is situated in Narayani zone and belong to central region. The total area of the
district is 1126 sq. km. Rautahat district is bordered on the north by Makawanpur district, Sarlahi
district on the east, Bara district on the west and Bihar state in India on south. The total
population of Rautahat district is 4, 14,005 were male and female population is 2, 13,994 and
200,011 respectively. Density of population is 368 per square kilometers. Road facilities and
development of semi-urban centers makes the district densely populated. Most of the people are
crowded within the urban centers where as the population density of rural areas seems
comparatively low. Agriculture is the main occupation in the rural part.

The study will be done in 12 randomly selected villages of the Rautahat district of Narayani zone.
According to the updated summary of blanket arsenic testing by Arsenic Sub-Committee under
National Drinking Water Quality Steering Committee (formerly National Arsenic Steering
Committee, NASC), of 11,20,912 water samples so far tested in 20 Terai districts of Nepal,
Rautahat district appeared to have the top 5 highest level of arsenic exceeding 500 ppb 5.7%
water samples exceeded the WHO guideline value of 10 ppb and 1.8% water samples exceeded
Nepal Standard of 50 ppb. Furthermore, the rate of prevalence of arsenic contamination (>50 ppb)
in Rautahat district of the terai region is 9.7%. So, Rautahat district is chosen for this cross-
sectional survey to determine the prevalence of arsenicosis disease.
Maharjan, M., Shrestha, R. R., Ahmad, S. A., Watanabe, C., & Ohtsuka, R. (2006). Prevalence
of Arsenicosis in Terai, Nepal. Journal of Health Population, and Nutrition, 24(2), 246-
MOHP. (2007). Nepal Demographic and Health Survey 2006. Kathmandu, Nepal: Ministry of
Health and Population (MOHP) Nepal, New Era, and Macro International Inc.