Arsenic Poisoning: A Public Health Concern

Arsenic poisoning is a prominent public health issue in Bangladesh, with diabetes associated with arsenic exposure, according to recent metaanalysis reports. The country's floodplains have higher soil arsenic concentrations, and paddy soils have high arsenic levels compared to non-paddy soils. Arsenic exposure through drinking water has been linked to excess mortality in rural areas among adults, and if left unaddressed, it could result in a loss of $12.5 billion over the next 20 years due to healthcare costs and diseases.

Running head: Epidemiology
Epidemiology
Name of the Student
Name of the University
Author Note

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Title
Systematic review of the arsenic poisoning in Bangladesh
Introduction:
(a) Evidence on topic
 In Bangladesh arsenic poisoning through groundwater is the major public health
issue
 In this country approximately half of the 7-11 million hand pumped tube-wells,
supply ground water with arsenic concentration greater than the 50 microgram/L,.
It is more than the maximum level of the arsenic allowed in drinking water
 According to world report, it is estimated that around 80% (19.3 million) of the
people in Bangladesh are affected by arsenic poisoning. The report highlights that
it is the neglected issue even decades after the identification of the issue
 Every one in ten has the probability of developing cancer in Bangladesh and the
risk is also found in people of West Bengal, India
 Elevated concentrations of Arsenic in vegetables, garden soil, and daily intake of
Arsenic from other vegetables was observed. It indicated potential health risks
when compared with the FAO/WHO values of metals
What motivated this review?
The issue was found to be neglected even after it was identified decades ago. Further,
there are no systematic reviews on this topic although there are many researchers who have

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explored this topic. Personal interest to learn the changes in arsenic poisoning levels, health
issues, and public responses motivated this review.
Methods:
(a) Search strategy
The data sources that are chosen for this systematic review are Google scholar, CINAHL,
PubMed, Medline and web of sciences. In all the five electronic databases, articles that are
published within 2010-2017, were considered. The time period was chosen to get latest updates
in last seven years. Additional searches include websites for collecting recent information.
The main search terms used for this purpose are – “arsenic” or “poisoning” or
“Bangladesh”. Subsequent search includes arsenic* or poisoning and health problems, cancer
risk, effected people etc.
(b) inclusion/exclusion criteria
 Articles containing the terms arsenic poisoning or contamination in Bangladesh
were considered. Arsenic poisoning in any other countries were excluded. Articles
dealing with arsenic and other trace elements such as phosphate were excluded
 Studies published in languages other than English were excluded
 Factors effecting the variability of arsenic in groundwater was excluded
 Different sources of arsenic pinioning was considered such as rice, vegetables
and other dietary components were considered

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Records from database “arsenic” or “poisoning” or “Bangladesh” n = 700 Additional searches from Google scholar n = 350
Inclusion (n= 400) and Exclusion criteria (n =84) Excluded duplicated Records
n = 350
Access eligibility for full-text papers (arsenic poisoning in Bangladesh, groundwater, health issues, effected people) n = 134 Excluded article that were not full text n=95
Full text articles on the selected search terms n = 39 Excluded articles from opinion pieces, case reports, and reviews n=29
Included articles from different sources (3 cohort, 6 mix methods, 8 cross sectional studies, n= 10 Website source
n = 1
Total articles included in this systematic review
11
The figure given below shows the PRISMA diagram on how the articles were selected for
review.

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Results
 As per longitudinal cohort study, massive mitigation efforts have reduced the
water arsenic in rural Bangladesh. However, children still have elevated arsenic
exposure from other sources such as rice. Urinary arsenic remains elevated in
children. There is a consumption of vegetables and drinking water from other
areas contaminated with arsenic
 Bangladesh is at high risk of an epidemic of arsenic poisoning The country is at
greatest risk of arsenic related diseases
 Arsenic effected people are suffering from social stigma. Mental and physical
health issue (skin, liver, lung, and bladder and impaired cognitive development in
children)
 )was profound in Bangladesh associated with arsenic
 As per the metaanalysis arsenic poisoning is associated with the adverse
pregnancy outcomes and infant mortality
 A recent metaanalysis report showed diabetes associated with arsenic exposure.
Evidence was obtained from 32 studies, R = 1.57; 95% CI 1.27–1.93
 There is a significant improvement in the awareness of the arsenic poisoning
 Many international organisations such as UNICEF, WHO, and national NGOs
are working on this issue
 There is greater human health risk due to Arsenic accumulation in rice. From the
floodplains, soils have higher soil arsenic concentrations. Arsenic concentrations
was high in paddy soil when compared to non-paddy soils

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 Excess mortality in rural areas among adults was associated with the arsenic
exposure through drinking water
 In next 20 years, there could be loss of US$ 12.5 billion if the arsenic poisoning
remains same. Economic burden due to health care cost and diseases may woren
in near future
 2.4% of the cohort’s future deaths will be attributable to arsenic, if exposure
above permissible limit is eliminated by 2030
Conclusion:
The issue of arsenic poisoning issue in Bangladesh is prominent public health issues
despite several mitigating efforts. There is need of continuous efforts and awareness programs to
avoid the terrorism of arsenic.
The objectives from the evidence are-
 Need of increase in awareness particularly in rural areas
 Collaborate with government and non-governmental bodies to formulate policies
on decreasing installation of tube wells
 Training of health care professionals on how to educate people about health issues
and when to seek intervention

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Further research
Intervention is suggested to increase the assistance to arsenicosis patients by providing
more safe alternatives, as well as improving diagnosis and care for patients. Appropriate and
robust intervention needs to be devised.

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References
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