| The Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh Kamalini M. Lokuge,1 Wayne Smith,2 Bruce Caldwell,1 Keith Dear,1 and Abul H. Milton1 1Australian National University, National Centre for Epidemiology and Population Health, Acton, Australian Capital Territory, Australia; 2University of Newcastle, Centre for Clinical Epidemiology and Biostatistics, Newcastle, New South Wales, Australia Abstract
Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs ; undiscounted) lost per year in those exposed to arsenic concentrations > 50 µg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 µg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections. Key words: arsenic/adverse effects, Bangladesh, burden of disease, diarrhea, risk assessment, water pollutants, water supply. Environ Health Perspect 112:1172-1177 (2004) . doi:10.1289/ehp.6866 available via http://dx.doi.org/ [Online 17 June 2004]
Address correspondence to K. Lokuge, National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, Australian Capital Territory, 0200 Australia. Telephone: 61-26125-2378. Fax: 61-2-61250740. E-mail: Kamalini.Lokuge@anu.edu.au The authors declare they have no competing financial interests. Received 18 November 2003 ; accepted 17 June 2004.
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