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Student of MsPH(2009-2010)
Health Services Academy

What is Arsenic (As)
• Natural and abundant element
found in soil, air, and water. It is a
notorious poisoning metalloid with
atomic no 33 in the periodic table.
• Tasteless,colorless and odorless.
• Solubility
– Insoluble in water when in natural
– Soluble in water when oxidized
• More toxic in this form
• 2 types
– Inorganic: usually with oxygen,
chlorine, or sulfur; most toxic (ex.
– Organic: usually with carbon or
hydrogen (ex. di-methyl arsonic acid)
Introduction; Arsenic is a growing
problem throughout the world.

• Globally; Argentina,,chilli, china,india,mexico,united

state,veitnam,canada hungry,peuru,Romania etc
• In Asia;
mic in Bangladesh in 1970) .35-77 Million citizens at risk of arsenic
poisoning (Out of a pop. of 125 Million).

• In pakistan;particularly in the central and southern parts of the country.

In the province of Sindh,groundwater arsenic concentration has reached up
to 1100 μg/l against WHO limits of 10 μg/l. In the province of Punjab, over
20% and in the province of Sindh, around 36% of the population isexposed
to arsenic contamination above WHO limits
• Bhawalpur,Rahimyar khan,multan, lahore,dado, khairpur,nawabshah,thatta.
• The National Water Quality Monitoring Programme (NWQMP) under the
auspices of Pakistan Council of Research in Water Resources (PCRWR) in
its ‘Fifth water quality monitoring report’ has revealed that in federal capital 3
only 26 percent of water resources are safe to drink.
Sources of Arsenic

• ; Natural sources include Weathering of rocks, Volcanic activity can

add ,Groundwater in contact with rocks that are high in
arsenic ,animals and plants make organic arsenic compounds in
oceans and Mining/smelting of copper, gold, lead and zinc ores.
Wastewater from industries , Medical use of arsenic, Wood
preservation (greenish CCA pressure treated wood is treated with
chromated copper arsenate, an arsenic and chromium containing
preservative (70% of world Arsenic pollution), Pesticide use and
Burning materials with arsenic .
• Natural and abundant element found in soil, air, and water.
• It is a known carcinogenic
• Mode of testing; for recent exposure, in urine and blood
for chronic exposure; hair nail and skin, usually
caused by water exposure

Health effects; Arsenicosis
• Various cancers: skin, lung, bladder, kidney, liver
• Heart attacks and strokes
• Melanosis: spotting of the skin, blemishes, etc.
• Keratosis: hardening of palms and soles, ulcers, Black foot.
• Hepatomegaly: liver enlargement
• Splenomegaly: spleen enlargement
• Ascitis: abdominal fluid
• Death
• Social Problems
• Arsenicosis victims are rejected from society. The impact of arsenic
extends from immediate health effect to extensive social and
economic hardship that effects especially the poor. Costs of health
care, inability of affected persons to engage in productive activities
and potential social exclusion are important factors.

Treatment option; Treatment is limited.
Consumption of only arsenic free water
can prevent
• Removal or prevention techniques;
• According to EPA coagulation filtration process. co-
precipitation, ion exchange and activated alumina filtration. The
technology for arsenic removal for piped water supply is
moderately costly and requires technical expertise.

Removal systems have been made by using locally

available housing and PCRWR developed filter
Three options were considered:
1.Clay Pitcher Arsenic Removal Filter
2.Gravity Flow Arsenic Removal Cartridge Filter
3.Arsenic Removal Cartridge Filter

“To improve the quality of water supply and prevent people from
hazards of arsenic in urban Islamabad”.

„Objectives OF THIS STUDY ARE TO:‟

1. measure the quality of drinking water in Islamabad capital
territory, by measuring the arsenic at source level, supply
and end user level.
2. prevent arsenic related health hazards
3. check the efficiency of filtration plant.

• My study will be helpful in the strengthening of health system
for surveillance and management of arsenicosis. In the
reduction of morbidity and mortality due to Arsenicosis. and
If arsenic found in drinking water advocacy campaign can be

• Operational definition;
• Cut off value;
• According to W.H.O cut off limits are 0.01mg/L.

Variable of interest;
• Arsenic level in water both at consumer and delivery
• Study design; Descriptive type of study
• Duration of study; Three month
• Sample estimation; on 50% population
• n=P(1-P)/e2
= 100

• Study area; I-8 sector.
• Study sample; 3 from the source, 3 from the pipe line
and100 from households.
• Sampling technique; simple random selection, 25 from
each 4 sub-sectors.
• Inclusion criteria; All the households agree to give
sample and using water from CDA.
• Exclusion criteria;All the households not agree to give
sample,using well water,Nestle or other.

Data collection procedure
• According to National institute no of samples %
of health guideline; They give Source
sterilized bottles which is
usually of 750ml for chemicals.
First sterilized the tap and Water
discard initial water then collect
water. supply
• Arsenic checked by a kit (by
Merc) in the field and can be Consu
sent to lab.
• Data analysis; mean, stdev, will
be calculated. Mean of the level
household level will be compare
with the mean of source and
supply. Data entry and analysis
will be performed by spss.

Proposed budget; Rs; 37,370

• Proposed timeline:
3 months

Duration: 3 months.
Person April May J une
Activity Responsible 2009 2009 2009

Proposal writing and

Questionnaire Principal
Development. Researcher

Field testing of Principal

questionnaire. Researcher

Data collection. Researcher

Data analysis. Principal


Report writing and Principal

Submission of Researcher
Ethical consideration:
• Informed consent will be obtained from all the
participants after explaining to them, the nature of

• Confidentiality of all information obtain will be


• General ethical principals including respect for

persons will be observed.

‘Expected recomentations‟
• A number of governmental technical and advisory committees should
be formed and a co-coordinating mechanism should be established
among the interested external support agencies. These committees
include the Governmental Arsenic Co-coordinating Committee headed
by the Minister of Health.
• One of the positive outcomes of this collaboration (including work
with local institutes) has been the testing of new types of treatment
• So far, many initiatives have focused on water quality testing and
control with a view to supplying arsenic-free drinking-water, thereby
reducing the risk of further arsenic-related disease.
• The amount of testing required and the need to provide effective
feedback to end users, suggest use of field testing kits.
• Only a few proven sustainable options are available to provide safe
drinking-water in our country. These include: obtaining low-arsenic
groundwater through accessing safe shallow groundwater or deeper
aquifers (greater than 200 m); rain water harvesting; pond-sand-
filtration; household chemical treatment; and piped water supply from
safe or treated sources.

Clay Pitcher Arsenic Removal Filter
Housing: Clay Pitchers
Capacity: 20 L
No. of holes: 10 -12 (1.0 mm diameter)
As contamination: 300 μg/L
Silver coated sand (2.0 kg)
Arsenic removal media developed by PCRWR
(3.0 kg)
Cast iron turnings (3.0 kg)
Plain sand

• To reduce the morbidity and mortality.

• Decrease risk factors for exposure to arsenic.
• Strengthening the health system for surviellence
and management of arsenicosis.
• Prevent people from skin diseases and cancers.

In Pakistan
 1978 water sources contained arsenic
concentration up to 10 ppb
 209 sources remained between 10-50 ppb
and 31 sources had arsenic concentration
level above 50ppb.
 Dadu, Khairpur, Nawabshah and Thatta
,multan bhawalpur districts had relatively
higher number of water sources with high
concentration of arsenic,
 Situation could be alarming as other districts
might also have arsenic contaminated water
Sources of Arsenic
• Natural sources
• Weathering of rocks
• Volcanic activity can add
• Groundwater in contact with rocks that are high in
• animals and plants make organic arsenic
compounds in oceans
• Mining/smelting of copper, gold, lead and zinc ores.
• Medical use of arsenic
• Wastewater from industries
• Pesticide use

Medical Effects of Arsenic
• Arsenic poisoning is called arsenicosis
• Mode of testing people for arsenicosis
– Recent exposure: urine
– Instant exposure: blood
– Chronic exposure: hair, nails, and skin (usually caused by water
• Illnesses resulting from arsenicosis
– Various cancers: skin, lung, bladder, kidney, liver
– Heart attacks and strokes
– Melanosis: spotting of the skin, blemishes, etc.
– Keratosis: hardening of palms and soles, ulcers
– Hepatomegaly: liver enlargement
– Splenomegaly: spleen enlargement
– Ascitis: abdominal fluid
– Death
• Social Problems
– Arsenicosis victims are rejected from society
Arsenic poisoning appears after 10 years of consumption as
Health Risks
Can lead to:

• AIM:
• “to improve the quality of water supply
in urban Islamabad"