EPIDEMIOLOGY III EP31EH

Student Number: 222002216

Ayanda. L Yekhethelo Mkhwanazi

[Email address]
1|Page

TABLE OF CONTENT

PAGE NUMBER CONTENT

Page 2 Abstract and Figure 1.1
Page 3 Introduction
Page 4 Sources Of Arsenic
Contamination and Figure 1.2
Page 5 Extent of Arsenic Contamination
in Bangladesh
Page 6 Health Consequences
Page 7 Discussion
Page 8 Conclusion
Page 9 Reference List
Page 10 Declaration of own work
2|Page

ABSTRACT
Arsenic contamination in drinking water includes a hindering effect on human
wellbeing which significantly impairs the quality of life. In spite of acknowledgment of
the antagonistic wellbeing suggestions of arsenic poisonous quality, there have been
few studies to date to propose measures that may well be taken to overcome arsenic
defilement. After the articulation in 2000 WHO Bulletin that Bangladesh has been
encountering the biggest mass harming of populace in history, we investigated
existing writing to evaluate the size of groundwater arsenic defilement in
Bangladesh. In this research report, we will be focusing on THREE domains:
sources of arsenic contamination, extent of contamination, and health
consequences.
The cornerstone of preventing and managing arsenicosis is ceasing to use water
tainted with arsenic. As a result of the lack of an affordable source of arsenic-safe
water, a greater proportion of people are still using polluted water at this time. Any
option that is supported when providing affordable arsenic-safe water should be
affordable, easy to use, feasible locally, and embraced by the community. The
population exposed to arsenic must be brought under the normal observation
program for the diagnosis and subsequent treatment of noncommunicable diseases
and malignancies in order to address health issues associated to arsenic exposure.

FIGURE 1.1: This is the map including the places or communities in Bangladesh that were
exposed to the arsenic contaminated water.
3|Page

INTRODUCTION
In later years the term “environmental epidemiology” has seen broad use, in spite of
the fact that it has not been well characterized. For instance, Report 27 in the
Environmental Health Criteria series, published by the joint partnership of the United
Nations Environment Program, the International Labor Organization, and the World
Health Organization, was entitled Guidelines on Studies in Environmental
Epidemiology (WHO, 1983). The report considered “[The use of] . . . epidemiological
methods for assessing the effects of environmental agents on human health.”
The Committee on Environmental Epidemiology has embraced the following
definition:
Environmental epidemiology is the study of the effect on human health of physical,
biologic, and chemical factors in the external environment, broadly conceived.
Since 3000 BC, when humans first became aware that normal arsenic was present,
they have used it for a variety of purposes, both good and bad. These include the
extraction of press from minerals using compounds containing arsenic as well as
medicinal uses. Prior to the development of modern antibiotics, people with syphilis
were advised to receive moderate dosages of arsenic (0.05 to 0.5 mg/kg/day).
William Shriveling discovered the therapeutic benefits of digitalis, an arsenic-based
medication, in the 15th century, which led to the introduction of arsenic into medicine.
Later, in the eighteenth century, Thomas Fowler created a mixture known as
"Fowler's solution," which may have been an arsenic trioxide (As2O3) arrangement
based on potassium bicarbonate. This mixture was used to treat a variety of
illnesses up until the twentieth century. There is additional evidence to suggest that
political rivals in Italy were killed with arsenic. Not until the middle of the 1800s did
people begin to learn that arsenic is dangerous, even at low dietary doses.
Groundwater arsenic poisoning first emerged as a serious health concern in
Bangladesh and India, which later gained notoriety as the world's most severely
afflicted countries in terms of population exposure to arsenic-contaminated water.
The situation in Bangladesh is thought to be the worst natural arsenic poisoning at
this time, with an estimated 50 million people at risk of exposure. Four tubewells in
Chamagram town, Nawabganj area, were identified by the Office of Open Wellbeing
Building (DPHE), Bangladesh in 1993 as producing arsenic-contaminated
groundwater. The same town also produced eight cases of arsenicosis the following
year. Shortly after it was discovered that there was arsenic contamination in tubewell
water, the government of Bangladesh launched several projects to determine the
extent of the arsenic contamination issue, with support from both national and
international non-governmental organizations (NGOs).
4|Page

SOURCE(s) OF ARSENIC CONTAMINATION

Bangladesh is mostly located on the Bengal Bowl, which is formed by the Ganga-
Brahmaputra-Meghna (GBM) stream system. The massive amounts of silt containing
arsenic that originated mostly in the Himalayas and were transported by the strong
GBM rivers over the Pleistocene and Holocene eras have sculpted this sedimentary
bowl. Arsenic is seeping from these sediments into the Holocene alluvium and
groundwater aquifers in the fan store zones. Three processes have been put up to
explain the process of filtering arsenic within the groundwater in the GBM bowl,
despite the fact that the exact mechanism of arsenic leaching into groundwater
remains unclear:
1. The oxidation of arsenical pyrites in the alluvial dregs releases arsenic into the
groundwater. The oxidation may have occurred as a result of atmospheric
oxygen entering the aquifers and overpowering groundwater removal through
deep and shallow tubewells.
2. The subsurface microbial digesting system of natural matter leads to anoxic
conditions, which in turn reduces press oxyhydroxides (FeOOH) and
ultimately causes the release of sorbed arsenic into groundwater.
3. Due to the competitive exchange of phosphate anions, arsenic anions that
have attached themselves to aquifer minerals are being uprooted and causing
arsenic contamination in groundwater. The improper use of phosphate
fertilizer for agriculture, the deterioration of buried peat stocks and other
common natural materials, and other processes are considered to be the
sources of phosphate. Nevertheless, these suggested elements still need to
be verified.
In Bangladesh, surface water sources do not have the same concentration of arsenic
as groundwater. AsIII is the predominant form of inorganic arsenic in groundwater,
however AsV is present as well. Both inorganic and natural shapes predominate in
surface and dug well water, with arsenic's oxidized frame serving as the
transcendent species. Although AsIII and AsV are both dangerous, AsIII has been
identified as the most poisonous species. The most frequent locations for arsenic
contamination have been tubewells inserted between 15 and 50 meters below the
surface. Regardless, in certain ranges, the arsenic contamination is located in the
tubewells that were introduced at deeper depths. The presence of arsenic pollution
in the water of deep tubewells (DTWs; typically, deeper than 150 m) is uncommon.
Initially, it was believed that the Gangetic delta plain in Bangladesh was the source of
the arsenic defilement seen in tubewell water. However, subsequent research
revealed that the defilement was found in almost all of Bangladesh's sedimentary
zones, although in the Sloping and Pleistocene Uplands regions (Terrace Land).
5|Page

FIGURE 1.2: SOURCES OF ARSENIC CONTAMINATION

EXTENT OF ARSENIC CONTAMINATION IN BANGLADESH

Nearly 57 million individuals in Bangladesh are at chance of arsenic-induced
infection due to incessant defilement of their drinking water with arsenic
concentrations surpassing the WHO constrain. Defilement of shallow tube wells has
brought about in 80% of the Bangladeshi populace being uncovered to arsenic as
the groundwater was utilized for their everyday cooking and drinking needs. Large-
scale arsenic harming among country individuals is encourage compounded by
persistent undernutrition and destitution. Because arsenic affects public health, the
administration of water in agriculture, and agriculture, it has significant financial
ramifications. In Barisal, Bangladesh, research on the levels of arsenic in tube-well
water assessed 150 patients. Of those patients, 25% drank water from contaminated
tube wells, and 82% of those patients exhibited direct or significant lesions of the
skin that were indicative of arsenic exposure. Furthermore, arsenic contents in 31%
of water tests were 10-fold higher than Bangladesh's permissible level of 50 μg/L and
50-fold higher than the WHO's advocated threshold of 10 μg/L.
The findings in 1998, which showed that 41 out of 64 regions in Bangladesh having
groundwater concentrations of arsenic above 50 μg/L, demonstrated the widespread
proximity of arsenic pollution throughout the country. In 2005, additional research
revealed that groundwater arsenic concentrations of above 50 μg/L in 50 out of 64
sites in Bangladesh. Under anoxic circumstances, Fe- and Mn-oxyhydroxides are
reported to be the dominant source of groundwater arsenic in Bangladesh aquifer
dregs. The amount of arsenic varies depending on the depth of the ground and is
influenced by the zone's hydrogeological characteristics and surface topography. It is
discovered that the concentration is greatest at depths between 20 and 70 meters
below the surface. Numerous written publications have indicated a correlation
between the future predominance of arsenicosis and a higher groundwater arsenic
concentration. According to a researcher in the village of Eruani, Comilla, 25% of the
test subjects suffered skin damage linked to arsenic. Since an estimated 27 million
and 50 million people in Bangladesh have been exposed to arsenic by drinking water
having over 50 µg/L and 10 µg/L of arsenic, the GoB currently views this as a
national open wellness issue.
Even while it might be common knowledge that consuming groundwater
contaminated with arsenic might potentially cause harm to humans, there are other
ways as well, such as consuming food contaminated with arsenic. A study that
examined the three sequential pathways (water-soil-crop) of arsenic pollution in the
food chain discovered elevated arsenic levels in crops that are regularly grown in
Bangladesh, including a variety of rice varieties. Furthermore, this study argues that
6|Page

even in the unlikely event that pure drinking water is obtained, groundwater tainted
with arsenic would still be used for water systems, posing a serious risk to public
health. Additionally, the major food of Bangladesh, rice, exposes the people to
arsenic through its consumption.

HEALTH CONSEQUENCES
Over the last two to three decades, arsenic exposure has been acknowledged as a
major open wellbeing concern worldwide due to its devastating effects on wellbeing.
Although skin problems linked to arsenic were first identified in Bangladesh in 1995,
these problems were not given much attention until 1998. Early signs of persistent
arsenic poisoning often include skin-obscuring (diffuse or spotty melanosis) over the
back, chest, or other areas of the body. It has been shown that drinking water with a
concentration of less than 10 μg/L is associated with an increased risk of skin injury,
and these injuries do occur even after knowledge of the reduction of arsenic
introduction over time. Melanosis, or pigmentation, precedes keratosis and
hyperkeratosis as the typical cutaneous effects of arsenic presentation.
In addition to this, the severity of the skin injuries also increases the risk of lung
cancer mortality in those with arsenical skin injuries. Introduction of arsenic can
result in lesions to the hands and feet, which in certain cases can progress to
incapacity. Apart from the typical skin damage (leucomelanosis, spotted
pigmentation, body fluid layer melanosis, spotted and diffuse keratosis, and visible
knobs on the hands, feet, and legs), conjunctival clog, non-pitting foot swelling,
hepatomegaly, splenomegaly, ascites, Bowen's infection, and gangrene are among
the adverse effects of arsenic poisoning. Aside from this, it was discovered that
increased Carotid-intima Media Thickness (CMT) was connected to rising arsenic
levels in well water.
A comprehensive long-term study carried out in Bangladesh revealed that exposure
to high concentrations of arsenic appears to have both carcinogenic and non-
carcinogenic effects. Non-carcinogenic effects include chronic diseases such
diabetes mellitus, liver disease, neurotoxicity, vascular diseases, and neurotoxicity.
Elevated levels of arsenic exposure can hinder a child's development and result in
an aggressive pregnancy. Regarding carcinogenic effects, exposure to high
concentrations of arsenic increases the risk of developing cancer. This risk persists
for decades after arsenic is first introduced and then removed from the environment.
Using and being exposed to arsenic can also result in many cancer types, such as
bladder and lung cancer.
As previously mentioned, there are numerous adverse health effects linked to
arsenic exposure, ranging from terrible cardiovascular effects to cancerous effects
during pregnancy. Not only does arsenic poisoning increase gloominess, but it also
causes social problems that can result in severe segregation. Typically, arsenic-
7|Page

induced hyperkeratosis and hyperpigmentation are widely distributed over the trunk
and extremities, making it difficult for patients to engage in social activities.
Unbelievably, according to one study, 25% of all arsenic patients stopped
participating in social activities, with women being the most severely affected.

DISCUSSION
Since the definitive evidence of arsenic defilement in tubewell water was discovered
in 1993, the government of Bangladesh has undertaken a number of actions to
address the issue of arsenic defilement. The committee was initially formed by the
government and given the name "Committee for Looking into the Circumstance of
Arsenic in Drinking Water in Bangladesh." The committee's goal was to gather
information through fact-finding surveys in order to assess the extent of the arsenic
contamination problem and determine whether the exposed population was suffering
from deadly arsenic. In general, it was agreed that arsenic contamination would be
prohibited in Bangladesh's western border regions, particularly in the Gangetic Delta
area. As the investigation progressed, evidence of arsenic contamination of
tubewells in several regions of Bangladesh emerged.
The government formed three national committees, the "National Directing
Committee," the "Arsenic Specialized Committee," and the "Scientific Inquiry
Committee," in 1996 in response to the severe problem of arsenic defilement in
groundwater. Their purpose was to try specific and appropriate exercises to confront
and moderate the arsenic defilement issue in Bangladesh. Three specialized working
groups were formed in order to try moderation intercessions in terms of an arsenic-
safe water supply, identifiable proof, and administration of arsenicosis sufferers, and
open mindfulness. At first, two ventures were actualized all through the nation; one
extend was on testing arsenic in tubewells and supply of interchange arsenic-safe
water and another one on the distinguishing proof of arsenicosis case and their
administration and open mindfulness with respect to arsenic defilement.
8|Page

CONCLUSION
In Bangladesh, arsenicosis brought on by arsenic pollution of drinking water could
constitute a serious public health issue. Government and non-governmental
organizations have attempted various measures to stop the arsenic presentation
through drinking water since the distinguishing evidence of arsenicosis patients and
their treatment, interchangeable sources of arsenic-safe water, and widespread
mindfulness programs. As it stands, these activities might have a negligible but
enduringly good impact. It's evident that a workable arsenic-safe water supply and
an effective arsenicosis management program are inadequate, and there is a lack of
monitoring for problems, including malignancies, in people with arsenicosis and
those who have been exposed to arsenic.
Despite the fact that high-quality research in this field was carried out in the early
1990s, there has been a marked decline in this field's valuable research throughout
the latter part of the MDG period. Furthermore, a number of discussions were held
that focused on developing workable plans for monitoring arsenic contamination. To
lessen the burden of chronic infection brought on by the introduction of arsenic in
Bangladesh, stakeholders including the government, NGOs, and donors must take
prompt action in the field of wellbeing.
9|Page

References
Ahmad, S. & Khan, M., 2015. Groundwater Arsenic Contamination And It'S Health Effects In
Bangladesh. In: Flora SJS Editors Handbook Of Arsenic Toxicology. USA Academic Press
Publishers, pp. 51-72.
DPHE, n.d. aresenic contamination and mitigation in bangladesh. [Online]
Available at: http://www.dphe.gov.bd/index.php?
option=comcontent&view=artide&id=95&Itemid=104
Islam, M., 2004. Arsenic Contamination In Groundwater In Bangladesh: An Environmental And
Social Disater. [Online]
Available at: https://www.iwapublishing.com/news/arsenic-contamination-groundwater-bangladesh-
environmental-and-social-disaster
Rahman, M., 2000. Contamiantion Of Drinking-Water By Arsenic In Bangladesh: A Public Health
Emergency. Bull. World Health Organziation, pp. 1093-1103.
Rahman, M., 2002. Arsenic And Contamination Of Drinking-Water In Bangladesh: A Public Health
Perspective. J. Health Popul, pp. 193-197.
Safiuddin, M. D., Shirazi, S. M. & Yussof, S., 2011. Contamination Of Goroundwater In Bangladesh;
A Review. [Online]
Available at: http://www.academic-journals.org//IPS
World Health Organization , 1893. Guidelines On Studies In Environmental Epidemiology:
Environmental Health Criteria 27. Geneva: World Health Organization .
World Health Organization, 2001. Environmental Health Criteria 224. Arsenic And Arsenic
Compounds. WHO, Geneva: s.n.
World Health Organization, n.d. Guidelines For Drinking-Water Quality. Vol.2, Health Criteria and
other Supporting Information. [Online]
Available at: http://www.who.int/water-sanitation.health/dwq/gdwqvi/en/index.html
10 | P a g e

DECLARATION
This is merely a checklist serving as a guide for submitting academic papers (assignments)
to lecturers for evaluation. Please tick (√) your answers on the following statements in the
appropriate blocks. Sign the declaration and supplement it as part of your assignment
before submitting it to your lecturer. No assignment will be evaluated without
completing the declaration and checklist.

Statements About My Assignment: I do hereby declare that I have: Yes No

Done research and visited the library 

Checked that my topic is correctly formulated as given by the lecturer 

Consulted guidelines for writing academic and scientific papers 

Compiled a table of contents 

Written an introduction outlining the scope and approach of the assignment 

Structured my paper into suitable paragraph headings 

Read, edited, checked, and double-checked my paper for typing, morphology, and 
other technical errors
Made use of relevant figures, tables, maps, and other appropriate visual expositions 

Made use of the Harvard system of reference throughout my paper, in the text 

Compiled a bibliography that meets the criteria of academic and scientific writing 

Written a concise summary/conclusion at the end of my paper 

Not committed plagiarism 

Submitted my assignment on/before the due date 

Learnt more about the subject matter as a result of conducting scientific research 

Established confidence in myself 

I, Ayanda Londiwe Yekhethelo Mkwanazi

(Full name/s and surname) hereby certify that:

 The content of this academic paper is my own original work,

11 | P a g e

 I have properly acknowledged all sources which I have used in my text, references,
and bibliography,
 The information contained in this document has been submitted in the form of an
academic paper to this or any other department,
 I am aware that by handing in a paper that is not my own original work I may be
subjected to disciplinary action.

Student Number: 222002216 Date: 25 February 2024

Signature: Ayanda Mkhwanazi

Written Assignment Rubric

Poor - Fair – Good - Excellent – highly Student

Mark Allocation incompetent improvement competent competent Mark
(100%) possible (%)
Major typing Intermittent typing Minimal typing Neat, well presented
errors errors errors Logical layout and
PRESENTATION Poor grammar Poor spacing Layout needs style
(10%) and spelling Several some attention Written in own words
grammatical Mostly written in
errors own words

0 – 2% 3 – 5% 6-8% 9 – 10%
Information is Meets some of Meets most of Meets all criterion set
sparse / the criterion set the criterion set out
CONTENT incorrect out out Original, practically
(50%) Lacking Minimal Partial relevant
important investigation of investigation of In-depth investigation
detail the topic the topic of topic
Lack of initiative Shows some Shows initiative and
and insight initiative and insight
insight Personal enquiry
evident

0 – 12% 13 – 24% 25 – 38% 39 – 50%

No practical Some practical A fair degree of Practical information
application application but of practical work is unique and of value
evident no real value done which is of Clearly relevant
RELEVANCE & Of no use to Some of the value to industry Can be understood
PRACTICAL industry in information is of Information and applied
APPLICATION terms of use to industry mostly relevant Is presentable at all
information, but most Some areas are levels
(25%) content or irrelevant or impractical and Will be of immediate
data collected impractical not workable in and long-term value
Of no practical the true sense to industry
value

0 – 5% 6 – 12% 13 – 19% 20 – 25%

12 | P a g e

Main points Not clear but can Understood but Clear and concise
CONCLUSION poorly be understood could improve summation of points
(5%) summarized Irrelevant or
incorrect
summary
1% 2% 3% 4 – 5%
Non-existent / Mostly irrelevant Completed but Completed, correct
REFERENCING minimal Not done in not totally correct through text and list
(10%) accordance with through text and
set standards list

0 – 2% 3 – 4% 5 – 7% 8 – 10%
TOTAL %