1. Public Health Strategies for Western Bangladesh that Address the Arsenic, Manganese, Uranium and Other Toxic Elements in Their Drinking Water Seth H. FrisbieErika J. MitchellLawrence J. Mastera Donald MaynardAhmad Z. YusufMohammad Y. Siddiq Richard OrtegaRichard K. DunnDavid S. Westerman Thomas BacquartBibudhendra Sarkar

2. The Problem The life expectancy in Bangladesh during the early- 1970s was only 44 years.The life expectancy in Bangladesh during the early- 1970s was only 44 years. The infant mortality rate (0 to 5 years) was 24%.The infant mortality rate (0 to 5 years) was 24%. Many premature deaths resulted from drinking surface water that was contaminated with bacteria.Many premature deaths resulted from drinking surface water that was contaminated with bacteria. Approximately 10,000,000 tubewells have been installed since 1971 to supply safe drinking water.Approximately 10,000,000 tubewells have been installed since 1971 to supply safe drinking water. By 1995 Bangladesh had 120,000,000 people, approximately 97% of Bangladeshis drank well water, and the life expectancy had increased to 55 years.By 1995 Bangladesh had 120,000,000 people, approximately 97% of Bangladeshis drank well water, and the life expectancy had increased to 55 years. (Photograph by Jim Monan, 1995)

3. The Problem Chronic arsenic (As) poisoning was first diagnosed in 1993.Chronic arsenic (As) poisoning was first diagnosed in 1993. In 1997 our team produced the first national-scale map of As concentration in Bangladesh’s groundwater.In 1997 our team produced the first national-scale map of As concentration in Bangladesh’s groundwater. Over 28,000,000 Bangladeshis are drinking water with As concentrations above the 50-µg/L national standard.Over 28,000,000 Bangladeshis are drinking water with As concentrations above the 50-µg/L national standard. Over 150,000 Bangladeshis are expected to die from skin, bladder, liver, or lung cancer caused by chronic As poisoning.Over 150,000 Bangladeshis are expected to die from skin, bladder, liver, or lung cancer caused by chronic As poisoning.

4. Melanosis of the chest (Photograph by Richard Wilson, 2005) Keratosis of the palms

5. Keratosis of the feet Blackfoot disease

7. Multimetal Health Effects Over 66,000,000 Bangladeshis are drinking water that exceeds WHO health-based guidelines for As, Cr, Mn, Ni, or Pb (Frisbie et al. 2002).Over 66,000,000 Bangladeshis are drinking water that exceeds WHO health-based guidelines for As, Cr, Mn, Ni, or Pb (Frisbie et al. 2002). Chronic As poisoning is the most significant health risk.Chronic As poisoning is the most significant health risk.

8. Multimetal Health Effects Sb increases As toxicity and was detected in 98% of tubewells (Frisbie et al. 2002).Sb increases As toxicity and was detected in 98% of tubewells (Frisbie et al. 2002). Conversely, Se and Zn decrease As toxicity and are often deficient in Bangladesh’s diet (Ortega et al. 2003).Conversely, Se and Zn decrease As toxicity and are often deficient in Bangladesh’s diet (Ortega et al. 2003). Estimated exposures to As, Se, and Zn from Bangladesh’s drinking water, rice, and soil. Metal Recommended Dietary Allowance (μg/day) Exposure from Water, Rice, and Soil (μg/day) AsSeZn Not determined 5511,000200467,300

9. Project Goals Determine the relative distributions of As and other toxic elements in drinking well water from western Bangladesh.Determine the relative distributions of As and other toxic elements in drinking well water from western Bangladesh. Use these distributions to evaluate, and possibly improve, the public health plan for this region.Use these distributions to evaluate, and possibly improve, the public health plan for this region.

10. Sample Collection Groundwater samples were collected from 4 neighborhoods in western Bangladesh.Groundwater samples were collected from 4 neighborhoods in western Bangladesh. A total of 18 random samples were collected from 17 tubewells in each of 3 neighborhoods.A total of 18 random samples were collected from 17 tubewells in each of 3 neighborhoods. Access was denied at 1 sampling location; therefore, a total of 17 random samples were collected from 16 tubewells in the fourth neighborhood.Access was denied at 1 sampling location; therefore, a total of 17 random samples were collected from 16 tubewells in the fourth neighborhood.

11. Element Average Concentration (µg/L) WHO Health- Based Guideline (µg/L) % of Unsafe TubewellsAsBBaCrFeMnMoNiPbSbSeUZn29<501404.72,7008001.4110.51.6<12.5151050070050NA40070701020102NA33001NA780110048NA Analysis of All Tubewells

12. In this neighborhood-scale study and in 2 national-scale studies of Bangladesh, As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found above WHO health-based drinking water guidelines (BGS/DPHE 2001; Frisbie et al. 2002).In this neighborhood-scale study and in 2 national-scale studies of Bangladesh, As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found above WHO health-based drinking water guidelines (BGS/DPHE 2001; Frisbie et al. 2002). Analysis of All Tubewells

13. ElementToxicityAsBBaCrMnMoNiPbU Cancers and skin and vascular diseases in humans. Developmental and reproductive diseases in animals. Hypertension in humans. Inadequate evidence of carcinogenicity in humans. Neurological and liver diseases in humans. Osteoporosis and gout-like symptoms in humans. Skin diseases in humans. Developmental and reproductive diseases in rats. Cancer, hypertension, and neurological, developmental, and reproductive diseases in humans Kidney and bone diseases in humans. Toxic Effects from Exposure in Drinking Water

14. ElementAsBualdaFulbariaJamjamiKomlapur AsBBaCrFeMnMoNiPbSbSeUZnpHDepthAgeUsers -0.19-0.390.270.300.240.26-0.300.060.08-0.030.01-0.260.600.53-0.030.45-0.04-0.240.390.470.340.09-0.34-0.330.490.52-0.550.180.140.230.210.330.090.250.20-0.180.14-0.16-0.14-0.32-0.090.03-0.170.160.210.370.400.030.270.07-0.19-0.230.49 Correlation coefficients (r) for the concentration of As versus the concentrations of toxic elements in tubewell water from each of the 4 neighborhoods in this study, the pH of this water, the depth of these tubewells, the age of these tubewells, and the number of users per tubewell. Significant linear relationships at the 99% confidence level are shown in red and italics.Significant linear relationships at the 99% confidence level are shown in red and italics. Significant linear relationships at the 95% confidence level are shown in white and italics.Significant linear relationships at the 95% confidence level are shown in white and italics. No significant linear relationships at either confidence level are shown in plain text.No significant linear relationships at either confidence level are shown in plain text.1.000.910.910.910.910.910.961.001.000.690.61-0.691.000.740.66

15. In this study, as the concentration of As increases there are statistically significant increases in the concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and Zn.In this study, as the concentration of As increases there are statistically significant increases in the concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and Zn. Analysis of All Tubewells

16. Analysis of Tubewells with Unsafe Concentrations of Arsenic Element Average Concentration (µg/L) WHO Health- Based Guideline (µg/L) % of Unsafe TubewellsAsBBaCrFeMnMoNiPbSbSeUZn84<502209.57,3008702.0311.22.3<10.9211050070050NA40070701020102NA100005NA590550014NA

17. SONO Filter AMAL Filter 3 Kalshi Filter Analysis of Tubewells with Unsafe Concentrations of Arsenic Almost all of the home-scale drinking water treatment systems currently being used in Bangladesh have been designed to remove As, not these other toxic elements.Almost all of the home-scale drinking water treatment systems currently being used in Bangladesh have been designed to remove As, not these other toxic elements. The statistically significant increases in toxic elements with As suggest that these treatment systems should be further evaluated for the removal of B, Ba, Cr, Mn, Mo, Ni, Pb, and possibly other elements.The statistically significant increases in toxic elements with As suggest that these treatment systems should be further evaluated for the removal of B, Ba, Cr, Mn, Mo, Ni, Pb, and possibly other elements.

18. Analysis of Tubewells with Safe Concentrations of Arsenic Element Average Concentration (µg/L) WHO Health- Based Guideline (µg/L) % of Unsafe TubewellsAsBBaCrFeMnMoNiPbSbSeUZn<7<501102.44007701.21.0<0.21.2<13.2121050070050NA40070701020102NA0000NA870000064NA

19. The current practice of testing every tubewell for just As will not identify drinking water with safe concentrations of other toxic elements.The current practice of testing every tubewell for just As will not identify drinking water with safe concentrations of other toxic elements. Analysis of Tubewells with Safe Concentrations of Arsenic (Photograph by The World Bank Group, 2005)

20. The following 3-step testing program is proposed to provide safe drinking water for very little cost and without any delay:The following 3-step testing program is proposed to provide safe drinking water for very little cost and without any delay: 1.The toxicity and distribution of As relative to Mn, U, B, Ba, Cr, Mo, Ni, and Pb suggests that the current practice of sampling and testing every tubewell in Bangladesh for As to find the safest sources of drinking water stay as the highest public health priority. 2.However, if a sample meets the WHO guideline for As, then it should be retested for Mn and U. 3.If a sample meets the WHO guidelines for As, Mn and U, then it should be retested for B, Ba, Cr, Mo, Ni, and Pb. Finally, all safe tubewells should be used as public drinking water supplies. These safe tubewells must be periodically monitored for As, Mn, U, B, Ba, Cr, Mo, Ni, and Pb.Finally, all safe tubewells should be used as public drinking water supplies. These safe tubewells must be periodically monitored for As, Mn, U, B, Ba, Cr, Mo, Ni, and Pb. Analysis of Tubewells with Safe Concentrations of Arsenic

21. Element % of Unsafe Tubewells if As is Safe % of Unsafe Tubewells if As is Unsafe AsBBaCrFeMnMoNiPbSbSeUZn0000NA870000064NA100005NA590550014NA Analysis of All Tubewells When the concentration of As goes from safe to unsafe, the % of tubewells with unsafe concentrations of Cr, Ni, and Pb increases.When the concentration of As goes from safe to unsafe, the % of tubewells with unsafe concentrations of Cr, Ni, and Pb increases. When the concentration of As goes from unsafe to safe, the % of tubewells with unsafe concentrations of Mn, and U increases.When the concentration of As goes from unsafe to safe, the % of tubewells with unsafe concentrations of Mn, and U increases.

22. The Inverse Trend Between As and U The drinking water in these neighborhoods generally has unsafe levels of As and Mn (19% of tubewells), or U and Mn (43% of tubewells); however, it seldom (4% of tubewells) has unsafe concentrations of both As and U together.The drinking water in these neighborhoods generally has unsafe levels of As and Mn (19% of tubewells), or U and Mn (43% of tubewells); however, it seldom (4% of tubewells) has unsafe concentrations of both As and U together. In Jamjami the concentration of As decreases with depth (p-value = 0.002), and the concentration of U increases with depth (p-value = 0.04).In Jamjami the concentration of As decreases with depth (p-value = 0.002), and the concentration of U increases with depth (p-value = 0.04). Komlapur, to some extent, also shows these trends.Komlapur, to some extent, also shows these trends. In contrast, Bualda and Fulbaria do not show any trends between As and depth, and U and depth.In contrast, Bualda and Fulbaria do not show any trends between As and depth, and U and depth.

23. The Inverse Trend Between As and U Coarse grained river channel deposits at depth may be under oxidizing conditions that remove As from groundwater and release U into groundwater.Coarse grained river channel deposits at depth may be under oxidizing conditions that remove As from groundwater and release U into groundwater.

24. The Inverse Trend Between As and U In contrast, organic-rich peat and clay, regardless of depth, may be under reducing conditions that release As into groundwater and remove U from groundwater.In contrast, organic-rich peat and clay, regardless of depth, may be under reducing conditions that release As into groundwater and remove U from groundwater.

25. The Inverse Trend Between As and U It is important to note that in areas where drilling deeper tubewells may access water with lower concentrations of As, the water from these deeper tubewells may contain increased concentrations of U.It is important to note that in areas where drilling deeper tubewells may access water with lower concentrations of As, the water from these deeper tubewells may contain increased concentrations of U.

26. The Inverse Trend Between As and U Despite this inverse trend, 4% of the tubewells in this study had unsafe concentrations of both As and U.Despite this inverse trend, 4% of the tubewells in this study had unsafe concentrations of both As and U. This is important because the home-scale drinking water filters that are being used in Bangladesh may not remove U.This is important because the home-scale drinking water filters that are being used in Bangladesh may not remove U. Water treatment filters typically oxidize soluble As(III) to insoluble As(V) to remove As by absorption or precipitation.Water treatment filters typically oxidize soluble As(III) to insoluble As(V) to remove As by absorption or precipitation. However, this oxidation may convert insoluble U(IV) to soluble U(VI) and potentially increase the U concentration of the water after treatment.However, this oxidation may convert insoluble U(IV) to soluble U(VI) and potentially increase the U concentration of the water after treatment. Alternatively, this oxidation may keep dissolved U in the VI oxidation state and potentially cause no change in the U concentration of the water after treatment.Alternatively, this oxidation may keep dissolved U in the VI oxidation state and potentially cause no change in the U concentration of the water after treatment.

27. Conclusions and Recommendations As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found above WHO health-based drinking water guidelines in Bangladesh.As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U were found above WHO health-based drinking water guidelines in Bangladesh. The concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and Zn can increase as the concentration of As increases.The concentrations of B, Ba, Cr, Fe, Mn, Ni, Pb, Se, and Zn can increase as the concentration of As increases. In contrast, the concentration of U can increase as the concentration of As decreases.In contrast, the concentration of U can increase as the concentration of As decreases. The home-scale drinking water treatment systems in Bangladesh have been designed to remove As. They must be evaluated for the removal of As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U.The home-scale drinking water treatment systems in Bangladesh have been designed to remove As. They must be evaluated for the removal of As, B, Ba, Cr, Mn, Mo, Ni, Pb, and U.

28. Conclusions and Recommendations The current practice of testing every tubewell for just As will not identify drinking water with safe concentrations of these other toxic elements.The current practice of testing every tubewell for just As will not identify drinking water with safe concentrations of these other toxic elements. A 3-step testing program to provide safe drinking water to a large number of Bangladeshis is proposed.A 3-step testing program to provide safe drinking water to a large number of Bangladeshis is proposed.

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