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1349564 
Journal Article 
Abstract 
Effect of arsenic mitigation interventions on disease burden in Bangladesh 
Lokuge, K; Smith, W; Caldwell, B; Milton, AH; Dear, K 
2003 
Yes 
Epidemiology
ISSN: 1044-3983
EISSN: 1531-5487 
14 
5 
S47 
WOS:000185488600098 
Introduction: There has been growing concern about the widespread exposure of the Bangladeshi population to arsenic in tube well water. Many interventions and alternative water sources have been advocated as being appropriate solutions, on the grounds that they are effective in eliminating or reducing arsenic ingestion. However, there has been little consideration given to possible adverse effects of such interventions. This paper provides an evaluation of the possible change in overall burden of disease resulting from implementation of arsenic mitigation interventions in Bangladesh. It does so by estimating the likely impacts on both arsenic related disease and waterborne infectious disease from these interventions, and comparing the effect of projected reductions in the former with estimated increases in the latter.

Methods: To provide a basis for comparison, both mortality rates and years of life lost were calculated for disease endpoints considered likely to result from arsenic mitigation interventions. To obtain excess rates of disease due to arsenic exposure, the method used was dependant on the data available. Where incidence rates within age specific categories were available for both exposed and reference populations that were comparable to the Bangladeshi population, these were used. Where only risk estimates were available from the literature, these were applied to relevant background disease rates to obtain excess disease burden. It was assumed that interventions to water source would involve a transition from tube wells to primarily surface water sources such as dug wells, ponds and streams. In a country such as Bangladesh, where the majority of the population has limited access to sanitation, a recent study estimated such a transition corresponded to a relative risk of 1.26 for diarrhoeal disease 1. This figure was used to estimate effect on diarrhoeal disease of arsenic mitigation interventions

Results: Under the most plausible scenario, it was found that any intervention directed at arsenic mitigation would have to achieve a minimum reduction in arsenic related disease burden of 20% (in the case of all arsenic related endpoints) and 60% (if only cancer related endpoints were considered) to be effective in reducing overall burden of disease. Since maximal arsenic related reductions would be delayed for a number of years, in the initial period after intervention, there would be an overall increase in mortality. In addition, a range of scenarios was explored with varying magnitudes of effect on the considered disease endpoints.

Conclusions: This evaluation demonstrates the need for more detailed assessments of arsenic mitigation interventions. It is important that further work is done to evaluate the impact of proposed arsenic mitigation interventions on all likely disease endpoints before such interventions are recommend for widespread use in arsenic affected communities.