Chemical risks in drinking water of inhabitants in the basin of the Tonle Sap Great Lake.

The present study aimed to assess chemical risks in the drinking water of inhabitants in the basin of the Tonle Sap Great Lake. Water samples from tube wells (n = 52), dug wells (n = 13), stored rain water (n = 39), ponds/lakes (n = 19), canals/rivers (n = 24), and household pipe water (n = 45) were collected and analyzed for physicochemical properties, as well as microbial and chemical qualities using standard methods. Analytical results revealed that 42.1% of tube wells had As > 10 µg L-1 while 8.3% had Cr > 0.05 mg L-1. Concurrently, 55.2 and 11.8% of tube wells had Cd > 3.00 µg L-1 and Pb > 10 µg L-1, respectively. Moreover, 35.0% of pipe water had Fe > 0.3 mg L-1, whereas 85.7% of tube wells and 69.2% of dug wells had Mn > 0.1 mg L-1. All water sources including pipe water could pose risks of non-carcinogenic effects of chemical mixtures to all exposure groups through their drinking water pathway. Children were at a higher risk of chemical mixtures in their drinking water than adults. This study suggests that advanced treatment technologies should be applied to the current water treatment plants to provide inhabitants with safe drinking water.

Prevalence of Methylated Arsenic and Microbial Arsenic Methylation Genes in Paddy Soils of the Mekong Delta.

Microbially mediated inorganic-methylated arsenic (As) transformation in paddy soil is crucial to rice safety; however, the linkages between the microbial As methylation process and methylated As species remain elusive. Here, 62 paddy soils were collected from the Mekong River delta of Cambodia to profile As-related functional gene composition involved in the As cycle. The soil As concentration ranged from <1 to 16.6 mg kg-1, with average As contents of approximately 81% as methylated As and 54% as monomethylarsenate (MMAs(V)) in the phosphate- and oxalate-extractable fractions based on As sequential extraction analysis. Quantitative PCR revealed high arsenite-methylating gene (arsM) copy numbers, and metagenomics identified consistently high arsM gene abundance. The abundance of As-related genes was the highest in bacteria, followed by archaea and fungi. Pseudomonas, Bradyrhizobium, Burkholderia, and Anaeromyxobacter were identified as bacteria harboring the most genes related to As biotransformation. Moreover, arsM and arsI (As demethylation) gene-containing operons were identified in the metagenome-assembled genomes (MAGs), implying that arsM and arsI could be transcribed together. The prevalence of methylated As and arsM genes may have been overlooked in tropical paddy fields. The As methylation-demethylation cycle should be considered when manipulating the methylated As pool in paddy fields for rice safety.

Health risk assessment of trace elements in the Tonle Sap Great Lake and the Tonle Sap River in Cambodia during the rainy season.

To investigate the potential health risk of trace elements in the Tonle Sap Great Lake system, lake (n = 37) and river (n = 14) water samples were collected and analyzed for 19 trace elements (Ag, Al, As, B, Ba, Cd, Co, Cr, Cu, Fe, Ga, Mn, Mo, Ni, Pb, Se, Tl, U and Zn) using inductively coupled plasma mass spectrometry. As a result, Cd was not detected in any river and lake water samples. Al, Fe and Mn in lake water exceeded the regulation limits of Cambodia, USEPA and WHO. Health risk assessment using the USEPA model indicated that male and female Cambodian residents are at minimal risk of non-carcinogenic effects from single and mixed trace elements through lake and river water consumption. Nevertheless, As, Tl, Co, Ba, Mn and Cr might pose high potential health risks to consumers which requires more attention. Therefore, regular monitoring and further studies are required to investigate the pollution trends and toxic behavior of these trace elements in the Tonle Sap Great Lake system.

The Role of Micronutrients and Toxic Metals in the Management of Epidemics in Cambodia.

The illegal trade of wildlife in SE Asia has been identified as the likely cause of the COVID-19 pandemic. We reviewed 198 papers on the current COVID pandemic in Cambodia, diseases such as avian influenza and Nipah virus, most likely to develop into a new pandemic in Cambodia, and common features of disease that require mitigation. Artisanal goldmining uses pure mercury in the areas where wildlife is smuggled to China. Moreover, 30-40% of Cambodians are zinc deficient. High levels of arsenic in irrigation water (>1000 µg/L) are associated with very low levels of zinc in rice (5 µg/g) and rice is the primary staple food for the region. Brown rice from nine of 15 paddy fields in the arsenic zone of Cambodia had double the new guidelines of 100 µg/kg inorganic arsenic for children's food in the EU and USA. The combination of deficiencies of essential micronutrients like zinc and pervasive presence of arsenic and mercury has the potential to compromise the immunity of many Cambodians. Innovative solutions are suggested to improve micronutrient nutrition. Toxins that suppress the immune system must be better managed to reduce the virulence of pathogens. Cambodia was not likely the source of the COVID-19 but does have problems that could result in a new pandemic.

Interactions of Dimethylarsinic Acid, Total Arsenic and Zinc Affecting Rice Crop Management and Human Health in Cambodia.

BACKGROUND: In parts of Cambodia and in many other parts of the world, irrigation of rice with groundwater results in arsenic (As) accumulation in soil and rice, leading to health concerns associated with rice consumption. At times, some As is present as relatively nontoxic, non-regulated, dimethylarsinic acid (DMA). Low levels of zinc (Zn) have been found in rice from Bangladesh, Cambodia, and China where As levels in rice are high. Furthermore, there have been claims that Zn deficiency is responsible for stunting the growth of children in Cambodia and elsewhere, however in rural Asia, rice is the major source of Zn. Current data are inadequate for both Zn and DMA in Cambodian rice. OBJECTIVES: The present study aimed to provide a preliminary evaluation of the relationship between the content of Zn and DMA in rice grain in Preak Russey, an area with elevated levels of As in groundwater and to improve the management of Zn deficiency in rice. METHODS: Rice agriculture was evaluated along the Mekong River in Cambodia. Analyses for metals, total As, and As species in rice and water were conducted by inductively coupled plasma mass spectrometry. Analysis of total Zn and As in soils and total Zn in rice were analyzed using X-ray fluorescence (XRF) spectrometry. RESULTS: Rice in Preak Russey had Zn concentrations less than a third the level recommended by the United Nations World Food Programme. There was a significant (p < 0.05) negative correlation between the Zn content of rice and DMA in rice with the lowest Zn and highest DMA levels occurring near irrigation wells, the source of As. CONCLUSIONS: The highest levels of DMA in rice were associated with Zn deficiency in rice. COMPETING INTERESTS: The authors declare no competing financial interests.

Environmental and Health Implications of the Correlation Between Arsenic and Zinc Levels in Rice from an Arsenic-Rich Zone in Cambodia.

BACKGROUND: In parts of Cambodia, irrigation of rice with groundwater results in arsenic accumulation in soils and rice, leading to health concerns associated with rice consumption. In Bangladesh and China, low zinc levels in rice have been found in regions where arsenic levels in rice are high. Furthermore, there have been claims that zinc deficiency is responsible for stunting of children in Cambodia. There are limited data on zinc in Cambodian rice, but in rural Asia, rice is the major source of zinc. OBJECTIVES: To provide a preliminary evaluation of the zinc content in rice grain in Preak Russey, an area with elevated levels of arsenic. The importance of zinc in rice for infants was also assessed. METHODS: Rice cultivation was evaluated in sixty farms along the Mekong River in Cambodia. Analyses for metals, total arsenic, and arsenic species in the water and rice were conducted at the University of Ottawa, Canada by inductively coupled plasma - mass spectrometry. Analysis of total zinc and arsenic in soils were analyzed in Phnom Penh using X-ray fluorescence spectrometry (XRF). Total zinc in rice was also measured by XRF analysis. RESULTS: Rice in the Preak Russey area contained zinc with ½ to » of the 1987 Codex standard for rice in Infant Formula. Moreover, our average zinc concentration in rice samples was less than a third that recommended for zinc fortification in rice by the United Nations World Food Programme. There was a significant (α=0.05) negative correlation between the arsenic and zinc content of rice with the lowest zinc levels occurring near the irrigation wells, the source of arsenic. There was a significantly higher content of zinc in rice from farms that fertilized with cow manure. CONCLUSIONS: Handheld XRF spectrometers are useful tools for detection of zinc levels in rice. The potential for zinc deficiency in farmers in areas of Cambodia with arsenic toxicity is high. COMPETING INTERESTS: The authors declare no competing financial interests.

Assessment of water quality and trace metal contaminations in Mondolkiri province in the Northeastern part of Cambodia.

The aim of the present study is to investigate water quality and potential trace metal contaminations in the Northeastern part of Cambodia. Tube well (n = 35), hand-dug well (n = 18), channel (n = 10) and lake/pond (n = 8) water samples were randomly collected from Mondolkiri province which is located in the Northeastern highland of Cambodia. A water sample was collected in two different bottles. One was filled in 30-mL polyethylene bottle after which was acidified to pH < 2 with concentrated HNO3. Another was filled in 250-mL polyethylene bottle. The collected water sampled was stored in a cooler during fieldwork and transferred to a fridge where they are stored at 4 °C for analysis. The measurement of pH, ORP, dissolved oxygen (DO), turbidity, conductivity, total dissolved solids (TDS) and salinity was taken at laboratory following standard procedures. All chemical measurement of trace metals were taken by inductively coupled plasma mass spectrometry (ICP-MS). Analytical results reveal that tube well (47.1%), hand-dug well (77.8%) and channel water (20%) have pH < 6.5. Turbidity of tube well (32.4%), hand-dug well (5.6%), lake water (12.5%) and all channel water samples are exceeded Cambodia regulation of 5 NTU. Mean As, Cd, Cr, Cu, Ni, Pb and Zn concentrations in Mondolkiri's water sources are below Cambodian drinking water quality standard and WHO's drinking water quality guideline. However, the upper range of Pb in tube well and channel water and Zn in tube well are exceeding Cambodia regulation. Concurrently, the mean concentrations of Fe and Mn in tube well and channel water are exceeded Cambodian aesthetic guideline of 300 µg L-1 and 100 µg L-1, respectively. This study suggests that appropriate treatment technologies are necessary for residents in the Mondolkiri province to access to clean water and minimize their potential health risks.

Groundwater Irrigation and Arsenic Speciation in Rice in Cambodia.

BACKGROUND: Arsenic bioaccumulation in rice is a global concern affecting food security and public health. OBJECTIVE: The present study examined arsenic species in rice in Cambodia to characterize health risks with rice consumption and to clarify uncertainties with Codex guidelines. METHODS: The present study collected 61 well water samples, 105 rice samples, 70 soil samples, and conducted interviews with 44 families in Preak Russey near the Bassac River and Kandal Province along the Mekong River in Cambodia. Analyses of metals, total arsenic and arsenic species were conducted in laboratories in Canada, Cambodia and Singapore. RESULTS: Unlike in Bangladesh, rice with the highest total arsenic concentrations in Cambodia contains mostly organic arsenic, dimethylarsinic acid (DMA), which is unregulated and much less toxic than inorganic arsenic. The present study found that storing surface runoff in ditches prior to irrigation can significantly reduce the arsenic concentration in rice. It is possible to remove > 95% of arsenic from groundwater prior to irrigation with natural reactions. CONCLUSIONS: The provision of high quality drinking water in 2015 to Preak Russey removed about 95% of the dietary inorganic arsenic exposure. The extremes in arsenic toxicity that are still obvious in these farmers should become less common. Rice from the site with the highest documented levels of arsenic in soils and water in Cambodia passes current Codex guidelines for arsenic. INFORMED CONSENT: Obtained. COMPETING INTERESTS: The authors declare no competing financial interests.

Effects of Arsenic, Iron and Fertilizers in Soil on Rice in Cambodia.

BACKGROUND: In parts of Cambodia, irrigation with groundwater results in arsenic accumulation in soils and rice, leading to health concerns associated with rice consumption. A high concentration of iron in groundwater can precipitate arsenic and reduce its bioavailability, however high concentrations of arsenic and iron can also reduce rice production. Furthermore, concerns have been raised about chemical contamination from inorganic fertilizers used to grow rice. The relationship between soil geochemistry and arsenic concentrations in rice is not yet fully understood. OBJECTIVES: The primary objective of this project was to investigate the relationship between arsenic concentrations in irrigation water, soil and rice collected from different sites in Cambodia. A secondary objective was to explore arsenic and phosphorus levels in fertilizer samples obtained from the study area in Cambodia. METHODS: The present study collected 61 well water samples, 105 rice samples, 70 soil samples, 11 inorganic fertilizer samples and conducted interviews with 44 families along the Mekong River in Cambodia. Analyses for metals, total arsenic, and arsenic species in the water and rice were conducted in Canada by inductively coupled plasma mass spectrometry. Analyses for metals, total arsenic and phosphorus in soils and inorganic fertilizers were conducted in Cambodia and Singapore by X-ray fluorescence. RESULTS: The concentration of arsenic in rice paddy soils was highly variable and as much as 20 times higher near the irrigation wells than in more distal areas of the paddy. Two farmers in Preak Russey had integrated soil samples with arsenic levels above the concentration associated with toxicity to rice in Taiwan (40 mg/kg) and above the Dutch concentration requiring intervention or remediation (55 mg/kg). The highest total arsenic measured in soil was 95 mg/kg. In Preak Russey, the loading of arsenic from irrigation water was 3710 times greater than the loading of arsenic from inorganic fertilizers. Half of the commercial inorganic fertilizers had less than 50% of the labelled content of phosphorus. CONCLUSIONS: Emphasis should be placed on improving the management of irrigation water, not on inactivation of arsenic in soil. The high levels of iron in groundwater mitigate arsenic toxicity, but the accumulation of iron could later result in lower rice productivity. Irrigation of rice with groundwater is not likely sustainable. To improve rice productivity, the content of phosphorus in local inorganic fertilizers must be improved to world standards. X-ray fluorescence analysis can quickly identify poor quality fertilizers. INFORMED CONSENT: Obtained. COMPETING INTERESTS: The authors declare no competing financial interests.

Current status of arsenic exposure and social implication in the Mekong River basin of Cambodia.

To evaluate the current status of arsenic exposure in the Mekong River basin of Cambodia, field interview along with urine sample collection was conducted in the arsenic-affected area of Kandal Province, Cambodia. Urine samples were analyzed for total arsenic concentrations by inductively coupled plasma mass spectrometry. As a result, arsenicosis patients (n = 127) had As in urine (UAs) ranging from 3.76 to 373 µg L(-1) (mean = 78.7 ± 69.8 µg L(-1); median = 60.2 µg L(-1)). Asymptomatic villagers (n = 108) had UAs ranging from 5.93 to 312 µg L(-1) (mean = 73.0 ± 52.2 µg L(-1); median = 60.5 µg L(-1)). About 24.7 % of all participants had UAs greater than 100 µg L(-1) which indicated a recent arsenic exposure. A survey found that females and adults were more likely to be diagnosed with skin sign of arsenicosis than males and children, respectively. Education level, age, gender, groundwater drinking period, residence time in the village and amount of water drunk per day may influence the incidence of skin signs of arsenicosis. This study suggests that residents in Kandal study area are currently at risk of arsenic although some mitigation has been implemented. More commitment should be made to address this public health concern in rural Cambodia.

Environmental arsenic epidemiology in the Mekong river basin of Cambodia.

We investigated relationship of arsenicosis symptoms with total blood arsenic (BAs) and serum albumin (SAlb) of residents in the Mekong River basin of Cambodia. We found that arsenicosis patients had significantly higher BAs and lower SAlb than asymptomatic villagers (Mann-Whitney U test, p<0.01). Arsenicosis symptoms were found to be 76.4% (1.764 times) more likely to develop among individuals having an SAlb≤44.3gL(-1) than among those who had an SAlb>44.3gL(-1) (OR=1.764, 95% CI=0.999-3.114) and 117.6% (2.176 times) as likely to occur among those with BAs>5.73µgL(-1) than for those having BAs≤5.73µgL(-1) (OR=2.176, 95% CI=1.223-3.872). Furthermore, a significant negative correlation was also found between BAs and SAlb (rs (199)=-0.354, p<0.0001). As such, this study suggests that people with low SAlb and/or high BAs are likely to rapidly develop arsenicosis symptoms.

Assessing arsenic intake from groundwater and rice by residents in Prey Veng province, Cambodia.

We investigated total daily intake of As by residents in Prey Veng province in the Mekong River basin of Cambodia. Groundwater (n = 11), rice (n = 11) and fingernail (n = 23) samples were randomly collected from the households and analyzed for total As by inductively coupled plasma mass spectrometry. Calculation indicated that daily dose of inorganic As was greater than the lower limits on the benchmark dose for a 0.5% increased incidence of lung cancer (BMDL0.5 equals to 3.0 µg d(-1) kg(-1)body wt.). Moreover, positive correlation between As in fingernail and daily dose of As from groundwater and rice and total daily dose of As were found. These results suggest that the Prey Veng residents are exposed to As in groundwater. As in rice is an additional source which is attributable to high As accumulation in human bodies in the Mekong River basin of Cambodia.

Assessing mixed trace elements in groundwater and their health risk of residents living in the Mekong River basin of Cambodia.

We investigated the potential contamination of trace elements in shallow Cambodian groundwater. Groundwater and hair samples were collected from three provinces in the Mekong River basin of Cambodia and analyzed by ICP-MS. Groundwater from Kandal (n = 46) and Kraite (n = 12) were enriched in As, Mn, Ba and Fe whereas none of tube wells in Kampong Cham (n = 18) had trace elements higher than Cambodian permissible limits. Risk computations indicated that 98.7% and 12.4% of residents in the study areas of Kandal (n = 297) and Kratie (n = 89) were at risk of non-carcinogenic effects from exposure to multiple elements, yet none were at risk in Kampong Cham (n = 184). Arsenic contributed 99.5%, 60.3% and 84.2% of the aggregate risk in Kandal, Kratie and Kampong Cham, respectively. Sustainable and appropriate treatment technologies must therefore be implemented in order for Cambodian groundwater to be used as potable water.

Hair arsenic levels and prevalence of arsenicosis in three Cambodian provinces.

Natural, inorganic arsenic contamination of groundwater threatens the health of more than 100 million people worldwide, including residents of the densely populated river deltas of South and Southeast Asia. Contaminated groundwater from tube wells in Cambodia was discovered in 2001 leading to the detection of the first cases of arsenicosis in 2006. The most affected area was the Kandal Province. The main objective of this study was to determine the prevalence of arsenicosis in Cambodia based on acceptable criteria, and to investigate the use of hair arsenic as a biomarker not only for arsenicosis-related signs but also for associated symptoms. A cross-sectional epidemiological study of 616 respondents from 3 purposely selected provinces within the Mekong River basin of Cambodia was conducted. The Kandal Province was chosen as a high arsenic-contaminated area, while the Kratie Province and Kampong Cham Province were chosen as moderate and low arsenic-contaminated areas, respectively. The most prevalent sign of arsenicosis was hypomelanosis with a prevalence of 14.5% among all respondents and 32.4% among respondents with a hair arsenic level of ≥1 µg/g. This was followed by hyperkeratosis, hyperpigmentation and mee's lines. Results also suggest a 1.0 µg/g hair arsenic level to be a practical cut off point for an indication of an arsenic contaminated individual. This hair arsenic level, together with the presence of one or more of the classical signs of arsenicosis, seems to be a practical criteria for a confirmed diagnosis. Based on these criteria, the overall prevalence of arsenicosis for all provinces was found to be 16.1%, with Kandal Province recording the highest prevalence of 35.5%. This prevalence is comparatively high when compared to that of other affected countries. The association between arsenicosis and the use of Chinese traditional medicine also needs further investigation.

Arsenic contamination in the food chain and its risk assessment of populations residing in the Mekong River basin of Cambodia.

In the present study, we investigated the potential arsenic exposure of Cambodian residents from their daily food consumption. Environmental and ecological samples such as paddy soils, paddy rice (unhusked), staple rice (uncooked and cooked), fish and vegetables were collected from Kandal, Kratie and Kampong Cham provinces in the Mekong River basin of Cambodia. After acid-digestion, digestates were chemically analyzed by inductively coupled plasma mass spectrometry. Results revealed that the means of total arsenic concentration ([As]tot) in paddy soils and paddy rice from Kandal were significantly higher than those from Kampong Cham province (t-test, p<0.05). Moreover, a significant positive correlation between the [As]tot in paddy soils and paddy rice was found (r(14) = 0.826, p<0.01). Calculations of arsenic intake from food consumption indicated that the upper end of the range of the daily dose of inorganic arsenic for Kandal residents (0.089-8.386 µg d(-1) kg(-1) body wt.) was greater than the lower limits on the benchmark dose for a 0.5% increased incidence of lung cancer (BMDL0.5 is equal to 3.0 µg d(-1) kg(-1) body wt.). The present study suggests that the residents in Kandal are at risk of arsenic intake from their daily food consumption. However, the residents in Kratie and Kampong Cham provinces are less likely to be exposed to arsenic through their daily dietary intake. To the best of our knowledge, this is the first report estimating the daily intake and daily dose of inorganic arsenic from food consumption in the Mekong River basin of Cambodia.

Arsenic geochemistry of groundwater in Southeast Asia.

The occurrence of high concentrations of arsenic in the groundwater of the Southeast Asia region has received much attention in the past decade. This study presents an overview of the arsenic contamination problems in Vietnam, Cambodia, Lao People's Democratic Republic and Thailand. Most groundwater used as a source of drinking water in rural areas has been found to be contaminated with arsenic exceeding the WHO drinking water guideline of 10 µg·L(-1). With the exception of Thailand, groundwater was found to be contaminated with naturally occurring arsenic in the region. Interestingly, high arsenic concentrations (> 10 µg·L(-1)) were generally found in the floodplain areas located along the Mekong River. The source of elevated arsenic concentrations in groundwater is thought to be the release of arsenic from river sediments under highly reducing conditions. In Thailand, arsenic has never been found naturally in groundwater, but originates from tin mining activities. More than 10 million residents in Southeast Asia are estimated to be at risk from consuming arsenic-contaminated groundwater. In Southeast Asia, groundwater has been found to be a significant source of daily inorganic arsenic intake in humans. A positive correlation between groundwater arsenic concentration and arsenic concentration in human hair has been observed in Cambodia and Vietnam. A substantial knowledge gap exists between the epidemiology of arsenicosis and its impact on human health. More collaborative studies particularly on the scope of public health and its epidemiology are needed to conduct to fulfill the knowledge gaps of As as well as to enhance the operational responses to As issue in Southeast Asian countries.

Surveillance on chronic arsenic exposure in the Mekong River basin of Cambodia using different biomarkers.

Thousands of Cambodia populations are currently at high risks of both toxic and carcinogenic effects through drinking arsenic-rich groundwater. In order to determine and assess the use of arsenic contents in different biological samples as biomarkers of chronic arsenic exposure from drinking arsenic-rich groundwater in Cambodia, individual scalp hair, fingernail and toenail were collected from three different provinces in the Mekong River basin of Cambodia. After washing and acid-digestion, digestate was analyzed for total arsenic by an inductively coupled plasma mass spectrometry. Chemical analysis of the acid-digested hair revealed that among 270 hair samples cut from Kandal, 78.1% had arsenic content in scalp hair (As(h)) greater than the typical As(h) (1.00 µg g(-1)), indicating possible arsenic toxicity. Concurrently, 1.2% and 0.6% were found elevated in Kratie (n=84) and Kampong Cham (n=173), respectively. Similarly, the upper end of the ranges for arsenic contents in fingernail (As(fn)) and toenail (As(tn)) clipped from Kandal (fingernail n=241; toenail n=187) were higher than the normal arsenic content in nail (0.43-1.08 µg g(-1)), however, none was observed elevated in both Kratie (fingernail n=76, toenail n=42) and Kampong Cham (fingernail n=83; toenail n=52). Significant positive intercorrelations between groundwater arsenic concentration (As(w)), average daily dose (ADD) of arsenic, As(h), As(fn) and As(tn) suggest that As(h), As(fn) and As(tn) can be used as biomarkers of chronic arsenic exposure from drinking arsenic-rich groundwater, in which As(h) is more favorable than As(fn) and As(tn) due to the ease of sample processing and analytical measurements, respectively.

Health risk assessment of inorganic arsenic intake of Cambodia residents through groundwater drinking pathway.

In order to compare the magnitudes and health impacts of arsenic and other toxic trace elements in well water, groundwater and hair samples were collected from three areas with different arsenic exposure scenarios in the Mekong River basin of Cambodia. Ampil commune in Kampong Cham province was selected as an uncontaminated area, Khsarch Andaet commune in Kratie province was selected as a moderately contaminated area, and Kampong Kong commune in Kandal Province was selected as an extremely contaminated area. Results of ICP-MS analyses of the groundwater samples revealed that As, Mn, Fe and Ba concentrations were significantly different among the three study areas (Kruskal-Wallis test, p < 0.0001). Out of 46 observed wells in the Kandal province study area, 100% detected As > 50 µg L(-1) and Fe > 300 µg L(-1); 52.17% had Mn > 400 µg L(-1) and 73.91% found Ba > 700 µg L(-1). In the Kratie province study area (n = 12), 25% of wells showed elevated arsenic levels above 10 µg L(-1) and 25% had Mn > 400 µg L(-1), whereas samples from Kampong Cham province study area (n = 18) were relatively clean, with As < 10 µg L(-1). A health risk assessment model derived from the USEPA was applied to calculate individual risks resulting from drinking groundwater. Computational results indicated that residents from Kandal Province study area (n = 297) confronted significantly higher non-carcinogenic and carcinogenic risks than those in Kratie (n = 89) and Kampong Cham (n = 184) province study areas (Kruskal-Wallis test, p < 0.0001). 98.65% of respondents from the Kandal province study area were at risk for the potential non-cancer effect and an average cancer risk index was found to be 5 in 1000 exposure. The calculations also indicated that, in the Kratie province study area, 13.48% of respondents were affected by non-cancer health risks and 33.71% were threatened by cancer, whereas none of respondents in the Kampong Cham province study area appeared to have non-carcinogenic effect. Positively significant correlations of the arsenic content in scalp hair (As(h)) with both arsenic levels in groundwater (As(w)) (r(s) (304) = 0.757, p < 0.0001) and individual average daily doses (ADD) of arsenic (r(s) (304) = 0.763, p < 0.0001) undoubtedly indicated that arsenic accumulation in the bodies of Cambodia residents in the Mekong River basin was mainly through a groundwater drinking pathway. To the best of our knowledge, this is the first comprehensive report comparing individual health risk assessments of arsenic exposure through a groundwater drinking pathway to enriched arsenic levels from groundwater in the Mekong River basin, Cambodia. This study indicates that elevated arsenic concentrations in groundwater may lead to thousands of cases of arsenicosis in the near future if mitigating actions are not taken.