Assessment of arsenic exposure in the population of Sabalpur village of Saran District of Bihar with mitigation approach.

Arsenic poisoning through groundwater is the world's greatest normal groundwater catastrophe which got an immense effect on worldwide general wellbeing. India is confronting the outcomes of arsenic poisoning in the zone of Ganga Brahmaputra alluvial plains. In Bihar, out of 38 districts, 18 districts are exceptionally influenced with groundwater arsenic defilement. In the present study, we have assessed the current situation of arsenic exposure in Sabalpur village of Saran district of Bihar after reporting of breast, renal, skin and thyroid cancer cases from this village along with typical symptoms of arsenicosis. Such cancer patients were identified at our institute and were taken for the study. The present investigation deals with the quantification of arsenic in groundwater, hair and nail samples of subjects as well as the survey of entire village to know the overall health status of the village people. A total of n=128 household handpump water samples as well as n=128 human hair and nail samples were collected from over n=520 households. Using the graphite furnace atomic absorption spectrophotometer (GF-AAS), all the samples were analysed. The investigation resulted that the 61% of the analysed samples particularly the groundwater had the arsenic levels more than the permissible limit of WHO (> 10 µg/L) with 244.20 µg/L as the highest arsenic contamination in one of the handpump water sample. The exposure effect of hair sample was worst as 88% of all the collected samples were having high arsenic levels more than the permissible limit (> 0.2 mg/Kg). In case of nail samples, 92% of the samples were having high arsenic concentration more than the permissible limit (> 0.5 mg/Kg). The health survey study revealed high magnitude of disease burden in the exposed population with symptoms such as asthma, anaemia, hepatomegaly, diabetes, cardiac problem, skin fungal infections, breathlessness and mental disability. Few cancer cases of renal, skin, breast and cervix were also found among the exposed population of this village. The percentage of cancer cases in this village was 0.94% that was low, but it would be an aggravated situation in the near future if people will continue drinking arsenic-contaminated water. Therefore, a mitigation intervention was carried out in March 2020 by installing an arsenic filter plant. The health situation in the village in the present scenario is hope to improve in the coming years. However, motivation and awareness among the village population are still required.

Valuing health damages due to groundwater arsenic contamination in Bihar, India.

This paper estimates the health damages due to arsenicosis among people residing in two districts of Bihar, India. A primary survey of 388 households' comprises 3469 individuals from two arsenic-contaminated districts namely Patna and Bhojpur from Bihar was conducted to collect the data. Arsenic field test kits was used to test the arsenic level in drinking water of the sample households. The water test results indicate that 18.3% of the sample contained 50 ppb of arsenic, and 5.12% of the sample contained the arsenic between 300 and 500 ppb. Water source, doctor visits, work loss, and arsenic concentration levels are significant and positively related to arsenicosis, and awareness is significant but negatively related to arsenicosis. The incidence rate of arsenicosis was found to be more among females than males and children. Per-capita income, sanitation, awareness, and depth of water sources are significant and positively related to defensive activities, i.e., water purification. The annual wage loss, cost of treatment, and cost of illness for sample households are estimated as INR 2437.92 ($45.83), INR 5942.40 ($111.72) and INR 8380.32 ($157.55), respectively. The annual cost of illness for the society is estimated as INR 265.97 million ($5 million). Finally, the paper suggests policy implications of providing safe drinking water in the arsenic-affected areas in the State of Bihar, India, which can help reduce arsenicosis in sustainable manner, improve well-being and potential productivity.

Human health risks and socio-economic perspectives of arsenic exposure in Bangladesh: A scoping review.

Arsenic contamination of drinking water, which can occur naturally or because of human activities such as mining, is the single most important public health issue in Bangladesh. Fifty out of the 64 districts in the country have arsenic concentration of groundwater exceeding 50µgL-1, the Bangladeshi threshold, affecting 35-77 million people or 21-48% of the total population. Chronic arsenic exposure through drinking water and other dietary sources is an important public health issue worldwide affecting hundreds of millions of people. Consequently, arsenic poisoning has attracted the attention of researchers and has been profiled extensively in the literature. Most of the literature has focused on characterising arsenic poisoning and factors associated with it. However, studies examining the socio-economic aspects of chronic exposure of arsenic through either drinking water or foods remain underexplored. The objectives of this paper are (i) to review arsenic exposure pathways to humans; (ii) to summarise public health impacts of chronic arsenic exposure; and (iii) to examine socio-economic implications and consequences of arsenicosis with a focus on Bangladesh. This scoping review evaluates the contributions of different exposure pathways by analysing arsenic concentrations in dietary and non-dietary sources. The socio-economic consequences of arsenicosis disease in Bangladesh are discussed in this review by considering food habits, nutritional status, socio-economic conditions, and socio-cultural behaviours of the people of the country. The pathways of arsenic exposure in Bangladesh include drinking water, various plant foods and non-dietary sources such as soil. Arsenic affected people are often abandoned by the society, lose their jobs and get divorced and are forced to live a sub-standard life. The fragile public health system in Bangladesh has been burdened by the management of thousands of arsenicosis victims in Bangladesh.

Arsenic in groundwater of West Bengal, India: A review of human health risks and assessment of possible intervention options.

This paper reviews how active research in West Bengal has unmasked the endemic arsenism that has detrimental effects on the health of millions of people and their offspring. It documents how the pathways of exposure to this toxin/poison have been greatly expanded through intensive application of groundwater in agriculture in the region within the Green Revolution framework. A goal of this paper is to compare and contrast the similarities and differences in arsenic occurrence in West Bengal with those of other parts of the world and assess the unique socio-cultural factors that determine the risks of exposure to arsenic in local groundwater. Successful intervention options are also critically reviewed with emphasis on integrative strategies that ensure safe water to the population, proper nutrition, and effective ways to reduce the transfer of arsenic from soil to crops. While no universal model may be suited for the vast areas of the world affected with by natural contamination of groundwater with arsenic, we have emphasized community-specific sustainable options that can be adapted. Disseminating scientifically correct information among the population coupled with increased community level participation and education are recognized as necessary adjuncts for an engineering intervention to be successful and sustainable.

Assessment of relationship on excess arsenic intake from drinking water and cognitive impairment in adults and elders in arsenicosis areas.

In this study, the relationships between high water arsenic exposure and cognitive impairment were investigated. A total of 483 residents aged 40 or older were randomly recruited and were divided into four groups according to the concentrations of arsenic in their water. Consumption levels (̄x¯±sd) of drinking water arsenic for normal, mild, moderate, and high exposure groups were 4±2µg/L, 25±11µg/L, 73±15µg/L, and 183±88µg/L, respectively. The average scores (̄x¯±sd) of the Chinese version Mini-Mental State Examination (MMSE) for females in each group were 21.49±3.14, 19.04±5.87, 16.18±8.14, and 15.82±7.78, and the average scores (̄x¯±sd) for males were 24.50±3.97, 23.16±4.45, 21.00±6.57, and 18.92±7.99, respectively. Significant differences among the average scores of MMSE for males or females in the four groups were found (p<0.05). The prevalence of cognitive impairment for females in each group was 10.86%, 29.63%, 53.48%, and 55.29%, and the prevalence of cognitive impairment for males was 10.71%, 12.00%, 35.71%, and 50.89%, respectively. Significant differences between all groups were observed (p<0.05). In the multivariable regress model, high water was closely associated with the MMSE score (Standardized Coefficient=-0.021) and cognitive impairment (arsenic ˃100 µg/L PR4/1=4.01). The findings of our research suggested a significant positive relationship between arsenic exposure from drinking water and cognitive impairment.

Toxic Risk Assessment of Arsenic in Males Through Drinking Water in Tharparkar Region of Sindh, Pakistan.

Humans are exposed to arsenic (As) through air, drinking water, and food. The arsenic (As) hazardous quotient was calculated on the basis of its concentration in drinking water of different origin and scalp hair of male subjects (n = 313), residents of different exposed and non-exposed areas of Sindh, Pakistan. The total As was determined in water and scalp hair samples, while As species were determined in water samples by advance extraction methodologies. The total As concentrations in drinking water of less-exposed (LE) and high-exposed (HE) areas was found to be 2.63 to 4.46 and 52 to 235, fold higher than the permissible limit, respectively, than recommended by World Health Organization (2004) for drinking water. While the levels of As in drinking water of non-exposed (NE) areas was within the permissible limit. The resulted data indicated that the dominant species was As(+5) in groundwater samples. The levels of As in scalp hair samples of male subjects of two age groups (18-30 and 31-50 years), belonging to NE, LE, and HE areas, ranged from 0.26 to 0.69, 0.58 to 1.34, and 15.6 to 60.9 µg/g, respectively. A significant correlation between As levels in drinking water and scalp hair was observed in HE area (r = 0.86-0.90, p < 0.001) as compared to those subjects belonging to LE area. A toxicity risk assessment was calculated as hazard quotient (HQ), which indicates that the study subjects of HE area have significantly higher values of HQ than LE. The population of As exposed areas is at high risk of non-carcinogenic and carcinogenesis effects.

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.

The global burden of disease for skin, lung, and bladder cancer caused by arsenic in food.

BACKGROUND: Arsenic is a ubiquitous, naturally occurring metalloid that poses a significant human cancer risk. While water consumption provides the majority of human exposure, millions of individuals worldwide are significantly exposed to arsenic through naturally occurring levels of arsenic in grains, vegetables, meats and fish, as well as through food processed with water containing arsenic. Thus, we estimated the global burdens of disease for bladder, lung, and skin cancers attributable to inorganic arsenic in food. METHODS: To determine foodborne inorganic arsenic exposures worldwide, we used World Health Organization estimates of food consumption in thirteen country clusters, in conjunction with reported measurements of total and inorganic arsenic in different foods. We estimated slope factors for arsenic-related bladder and lung cancers, and used the U.S. Environmental Protection Agency skin cancer slope factor, to calculate the annual risk of the cancer incidence in males and females within each country cluster. RESULTS: We estimated that each year 9,129 to 119,176 additional cases of bladder cancer, 11,844 to 121,442 of lung cancer, and 10,729 to 110,015 of skin cancer worldwide are attributable to inorganic arsenic in food. CONCLUSIONS: These estimates indicate that foodborne arsenic exposure causes a significant global burden of human disease. IMPACT: Estimating the global cancer burden caused by arsenic exposure in food will support policies that reduce exposure to disease-promoting environmental hazards.

Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation.

A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 µg/L and the World Health Organization's guideline value of 10 µg/L, respectively. From the updated exposure data and all-cause mortality hazard ratios based on local epidemiological studies, it was estimated that arsenic exposures to concentrations > 50 µg/L and 10-50 µg/L account for an annual 24,000 and perhaps as many as 19,000 adult deaths in the country, respectively. Exposure varies widely in the 64 districts; among adults, arsenic-related deaths account for 0-15% of all deaths. An arsenic-related mortality rate of 1 in every 16 adult deaths could represent an economic burden of 13 billion United States dollars (US$) in lost productivity alone over the next 20 years. Arsenic mitigation should follow a two-tiered approach: (i) prioritizing provision of safe water to an estimated 5 million people exposed to > 200 µg/L arsenic, and (ii) building local arsenic testing capacity. The effectiveness of such an approach was demonstrated during the United Nations Children's Fund 2006-2011 country programme, which provided safe water to arsenic-contaminated areas at a cost of US$ 11 per capita. National scale-up of such an approach would cost a few hundred million US dollars but would improve the health and productivity of the population, especially in future generations.

Lifetime exposure to arsenic in residential drinking water in Central Europe.

OBJECTIVE: Methods and results are presented for an arsenic exposure assessment integral to an epidemiological case-control study of arsenic and cancer-the European Commission funded ASHRAM (Arsenic Health Risk Assessment and Molecular Epidemiology) study carried out in some counties of Hungary, Romania and Slovakia. METHODS: The exposure history of each participant (N = 1,392) was constructed by taking into account how much water they consumed (as water, in drinks and in food), sources of drinking water in their various residences over their lifetime, and the concentrations of arsenic in their various water supplies measured by Hydride Generation-Atomic Absorption Spectrometry (HG-AAS). Concentrations of arsenic in previous water supplies were either derived from contemporary analyses of the same source, or from routine historical data from measurements performed by the authorities in each country. Using this approach, 80% of the recorded lifetime residential history was matched to an arsenic concentration. Seven indices of current, life time, and peak exposure were calculated. RESULTS: The exposure indices were all log-normally distributed and the mean and median lifetime average concentrations were in Hungary 14.7 and 13.3 microg l(-1), Romania 3.8 and 0.7 microg l(-1) and in Slovakia 1.9 and 0.8 microg l(-1), respectively. Overall 25% of the population had average concentrations over 10 microg l(-1) and 8% with exposure over 50 microg l(-1). CONCLUSIONS: Careful assessment of arsenic in drinking water supplies (both current and previous) enabled the majority of study participants' cumulative lifetime of potential exposure to arsenic in residential water to be characterised.

Health risk assessment of inorganic arsenic intake of Ronphibun residents via duplicate diet study.

OBJECTIVE: To assess health risk from exposure to inorganic arsenic via duplicate portion sampling method in Ronphibun residents. MATERIAL AND METHOD: A hundred and forty samples (140 subject-days) were collected from participants in Ronphibun sub-district. Inorganic arsenic in duplicate diet sample was determined by acid digestion and hydride generation-atomic absorption spectrometry. Deterministic risk assessment is referenced throughout the present paper using United States Environmental Protection Agency (U.S. EPA) guidelines. RESULTS: The average daily dose and lifetime average daily dose of inorganic arsenic via duplicate diet were 0.0021 mg/kg/d and 0.00084 mg/kg/d, respectively. The risk estimates in terms of hazard quotient was 6.98 and cancer risk was 1.26 x 10(-3). CONCLUSION: The results of deterministic risk characterization both hazard quotient and cancer risk from exposure inorganic arsenic in duplicate diets were greater than safety risk levels of hazard quotient (1) and cancer risk (1 x 10(-4)).

Arsenic contamination in groundwater in the Southeast Asia region.

The adverse impact of groundwater contaminated with arsenic (As) on humans has been reported worldwide, particularly in Asian countries. In this study, we present an overview of the As crisis in the Southeast Asian region where groundwater is contaminated with naturally occurring As and where contamination has become more widespread in recent years. In this region more than 100 million people are estimated to be at risk from groundwater As contamination, and some 700,000 people are known so far to have been affected by As-related diseases. Despite investments exceeding many millions of dollars, there are still substantial knowledge gaps about the prevalence and impact of As, notably in its epidemiology, temporal variations, social factors, patient identification, treatment, etc. Arsenic-affected people in the affected regions also face serious social problems. Of major concern is the fact that many researchers from different countries have been conducting research in SE Asia region but with a lack of coordination, thus duplicating their work. There is an urgent need to coordinate these various studies to ensure better delivery of research outcomes. Further research is needed to improve field testing and monitoring of drinking water sources, and to develop new treatments for chronic As toxicity and new sources of safe drinking water.

Human arsenic exposure and risk assessment at the landscape level: a review.

Groundwater contaminated with arsenic (As), when extensively used for irrigation, causes potentially long term detrimental effects to the landscape. Such contamination can also directly affect human health when irrigated crops are primarily used for human consumption. Therefore, a large number of humans are potentially at risk worldwide due to daily As exposure. Numerous previous studies have been severely limited by small sample sizes which are not reliably extrapolated to large populations or landscapes. Human As exposure and risk assessment are no longer simple assessments limited to a few food samples from a small area. The focus of more recent studies has been to perform risk assessment at the landscape level involving the use of biomarkers to identify and quantify appropriate health problems and large surveys of human dietary patterns, supported by analytical testing of food, to quantify exposure. This approach generates large amounts of data from a wide variety of sources and geographic information system (GIS) techniques have been used widely to integrate the various spatial, demographic, social, field, and laboratory measured datasets. With the current worldwide shift in emphasis from qualitative to quantitative risk assessment, it is likely that future research efforts will be directed towards the integration of GIS, statistics, chemistry, and other dynamic models within a common platform to quantify human health risk at the landscape level. In this paper we review the present and likely future trends of human As exposure and GIS application in risk assessment at the landscape level.

Workshop overview: arsenic research and risk assessment.

The chronic exposure of humans through consumption of high levels of inorganic arsenic (iAs)-contaminated drinking water is associated with skin lesions, peripheral vascular disease, hypertension, and cancers. Additionally, humans are exposed to organic arsenicals when used as pesticides and herbicides (e.g., monomethylarsonic acid, dimethylarsinic acid (DMA(V)) also known as cacodylic acid). Extensive research has been conducted to characterize the adverse health effects that result from exposure to iAs and its metabolites to describe the biological pathway(s) that lead to adverse health effects. To further this effort, on May 31, 2006, the United States Environmental Protection Agency (USEPA) sponsored a meeting entitled "Workshop on Arsenic Research and Risk Assessment". The invited participants from government agencies, academia, independent research organizations and consultants were asked to present their current research. The overall focus of these research efforts has been to determine the potential human health risks due to environmental exposures to arsenicals. Pursuant in these efforts is the elucidation of a mode of action for arsenicals. This paper provides a brief overview of the workshop goals, regulatory context for arsenical research, mode of action (MOA) analysis in human health risk assessment, and the application of MOA analysis for iAs and DMA(V). Subsequent papers within this issue will present the research discussed at the workshop, ensuing discussions, and conclusions of the workshop.

Health risk assessment maps for arsenic groundwater content: application of national geochemical databases.

This investigation assesses the feasibility of calculating and visualizing health risk estimates from exposure to groundwater contaminated with arsenic (As) using data from national geochemical databases. The potential health risk associated with As-contaminated groundwater was assessed based on an elaboration of existing geochemical data in accordance with accepted methodological procedures established for human health risk assessment (U.S. Environmental Protection Agency methodology). A screening analysis approach was used for estimating the contribution of As to the total chronic health risk from exposure to groundwater contaminated with potentially toxic elements, including As, Ba, Cd, Cu, Hg, Pb, Sb, Se and Zn, and the results indicate that As contributes significantly (>50%) to this total health chronic risk in about 10% of Slovak territory. Based on the calculation of the potential risk level by exposure modelling, increased chronic as well as carcinogenic risk levels (medium to high) were documented in approximately 0.2 and 11% of the total Slovak area, respectively. The areas characterized by high health risk levels are mainly those geogenically contaminated. High and very high carcinogenic risk was determined in 34 of 79 districts and in 528 of 2924 municipalities.

Responses of 6500 households to arsenic mitigation in Araihazar, Bangladesh.

This study documents the response of 6500 rural households in a 25 km(2) area of Bangladesh to interventions intended to reduce their exposure to arsenic contained in well water. The interventions included public education, posting test results for arsenic on the wells, and installing 50 community wells. Sixty-five percent of respondents from the subset of 3410 unsafe wells changed their source of drinking water, often to new and untested wells. Only 15% of respondents from the subset of safe wells changed their source, indicating that health concerns motivated the changes. The geo-referenced data indicate that distance to the nearest safe well also influenced household responses.

Risk characterization and exposure assessment in arseniasis-endemic areas of Taiwan.

This paper examines the age-specific human health risks exposed to inorganic arsenic through arsenic-contaminated farmed fish/shrimp and groundwater consumptions in arseniasis-endemic areas of blackfoot disease (BFD)-endemic area and Lanyang Plain in Taiwan, based on an probabilistic integrated risk assessment framework. We employ an age-dependent predictive physiologically-based pharmacokinetic model to account for arsenic concentrations in target organs. We reconstruct age-specific dose-response profiles for arsenicosis and arsenic-induced cancers by best fitting a pharmacodynamics-based three-parameter Hill equation model to published epidemiological data from West Bengal and Taiwan. The predicted median arsenic concentrations in age group-specific skin, lung, and bladder ranged from 2.24-5.70, 3.76-9.46, and 5.11-20.71 micro g g(-1) in BFD-endemic area, whereas 4.98-12.04, 8.23-19.92, and 11.07-43.45 micro g g(-1) in Lanyang Plain, respectively. Risk analysis indicates that consumption of arsenic-contaminated farmed fish/shrimp and groundwater in arseniasis-endemic areas may increase threat to prevalence of arsenicosis for all age groups, whereas adults may undergo potential risks of arsenic-induced skin, lung and bladder cancers. We show that peoples in Lanyang Plain are more readily associated with higher morbidities for arsenicosis and skin cancer as well as fatalities for lung and bladder cancers than that of peoples in BFD-endemic area. Here we report the first case in which theoretical human health risks for consuming As-contaminated farmed fish/shrimp and groundwater in the arseniasis-endemic areas are alarming under a conservative condition based on a probabilistic risk assessment framework.