Salinisation of drinking water ponds and groundwater in coastal Bangladesh linked to tropical cyclones.

Salinity is a widespread problem along the Asian coast, mainly in reclaimed lands where most people live. These low-lying areas are vulnerable to impacts from tropical cyclone induced storm surges. The role of such surges on the long-term salinity of water resources, particularly the salinisation of drinking water ponds, a key water resource, requires further investigation. Here we show, using high-resolution measurements of pond hydrology and numerical modelling, that episodic inundation events cause the widespread salinisation of surface water and groundwater bodies in coastal areas. Sudden salt fluxes in ponds cause salinity build-up in the underlying sediments and become a source of salinity. Rapid clean-up of drinking ponds immediately after a surge event can significantly minimize these salinity impacts, which are likely to increase under climate change. Our study has implications for coastal land use and water resources management in tropical deltas.

Sulfate reduction accelerates groundwater arsenic contamination even in aquifers with abundant iron oxides.

Groundwater contamination by geogenic arsenic is a global problem affecting nearly 200 million people. In South and Southeast Asia, a cost-effective mitigation strategy is to use oxidized low-arsenic aquifers rather than reduced high-arsenic aquifers. Aquifers with abundant oxidized iron minerals are presumably safeguarded against immediate arsenic contamination, due to strong sorption of arsenic onto iron minerals. However, preferential pumping of low-arsenic aquifers can destabilize the boundaries between these aquifers, pulling high-arsenic water into low-arsenic aquifers. We investigate this scenario in a hybrid field-column experiment in Bangladesh where naturally high-arsenic groundwater is pumped through sediment cores from a low-arsenic aquifer, and detailed aqueous and solid-phase measurements are used to constrain reactive transport modelling. Here we show that elevated groundwater arsenic concentrations are induced by sulfate reduction and the predicted formation of highly mobile, poorly sorbing thioarsenic species. This process suggests that contamination of currently pristine aquifers with arsenic can occur up to over 1.5 times faster than previously thought, leading to a deterioration of urgently needed water resources.

Sediment delivery to sustain the Ganges-Brahmaputra delta under climate change and anthropogenic impacts.

The principal nature-based solution for offsetting relative sea-level rise in the Ganges-Brahmaputra delta is the unabated delivery, dispersal, and deposition of the rivers' ~1 billion-tonne annual sediment load. Recent hydrological transport modeling suggests that strengthening monsoon precipitation in the 21st century could increase this sediment delivery 34-60%; yet other studies demonstrate that sediment could decline 15-80% if planned dams and river diversions are fully implemented. We validate these modeled ranges by developing a comprehensive field-based sediment budget that quantifies the supply of Ganges-Brahmaputra river sediment under varying Holocene climate conditions. Our data reveal natural responses in sediment supply comparable to previously modeled results and suggest that increased sediment delivery may be capable of offsetting accelerated sea-level rise. This prospect for a naturally sustained Ganges-Brahmaputra delta presents possibilities beyond the dystopian future often posed for this system, but the implementation of currently proposed dams and diversions would preclude such opportunities.

The Bengal Water Machine: Quantified freshwater capture in Bangladesh.

Global food security depends on the sustainability of irrigated agriculture. Rising groundwater withdrawals from seasonally humid, alluvial plains across tropical Asia have enabled dry-season rice cultivation. This groundwater pumpage increases available subsurface storage that under favorable conditions amplifies groundwater replenishment during the subsequent monsoon. We empirically quantified this nature-based solution to seasonal freshwater storage capture described as the "Bengal Water Machine," revealing its potential and limitations. On the basis of a million piezometric observations from 465 monitoring wells, we show that the collective operation of ~16 million smallholder farmers in the Bengal Basin of Bangladesh from 1988 to 2018 has induced cumulative freshwater capture that volumetrically (75 to 90 cubic kilometers) is equivalent to twice the reservoir capacity of the Three Gorges Dam.

Regional-scale hydrogeochemical evolution across the arsenic-enriched transboundary aquifers of the Ganges River Delta system, India and Bangladesh.

Arsenic (As) dynamics within the extensively contaminated aquifers of the Ganges River delta have been widely studied over the past few decades, but the hydrogeochemical signatures across the delta aquifers remain to be characterized. Here, we characterize the varied geochemical and isotopic (δ18O, δ2H) signatures of groundwater across the delta and interpret the hydrogeochemical evolution pathways and the driving processes on a regional-scale as a function of the delta hydrostratigraphy. Our hydrostratigraphic model identifies three major aquifer sub-systems across the delta from north-west to south-east: a single continuous unconfined aquifer (Type I); a semiconfined vertically-segregated aquifer sub-system (Type II); and a nearly confined multilayered aquifer sub-system (Type III). The Type I aquifer is dominated by Ca-Mg-HCO3-rich waters, while the aquifers to the south (Type II and Type III) exhibits increasing dominance of Na-Cl hydrogeochemical facies at shallow and intermediate depths and Na-HCO3 hydrogeochemical facies in the deep aquifers. The spatial distribution of As is also found to be heavily dictated by hydrostratigraphy, wherein the Type I aquifer sub-system yields similar concentrations across depths, while the Type II and Type III aquifer sub-systems exhibit a sharp increase in As-safe aquifers with depth. Although dominant reducing conditions occur within the delta groundwater, co-occurrence of redox-sensitive solutes from varying redox stability fields indicates to the development of overlapping redox zones. Stable isotopic signatures of groundwater exhibit a progressive depletion away from the Bay of Bengal. The Type I aquifer exhibits relatively homogenous hydrogeochemical signatures, possibly suggesting deeper infiltration of recharge under higher vertical hydraulic gradients, while the Type II and Type III aquifers exhibit variability across depth, which is possibly a reflection of horizontally stratified groundwater flows, dictated by the spatial geometry of the intervening aquitard layers.

Demand for Information on Environmental Health Risk, Mode of Delivery, and Behavioral Change: Evidence from Sonargaon, Bangladesh.

Millions of villagers in Bangladesh are exposed to arsenic by drinking contaminated water from private wells. Testing for arsenic can encourage switching from unsafe wells to safer sources. This study describes results from a cluster randomized controlled trial conducted in 112 villages in Bangladesh to evaluate the effectiveness of different test selling schemes at inducing switching from unsafe wells. At a price of about US0.60, only one in four households purchased a test. Sales were not increased by informal inter-household agreements to share water from wells found to be safe, or by visual reminders of well status in the form of metal placards mounted on the well pump. However, switching away from unsafe wells almost doubled in response to agreements or placards relative to the one in three proportion of households that switched away from an unsafe well with simple individual sales.

Prevalence of SARS-CoV-2 in Communities Through Wastewater Surveillance-a Potential Approach for Estimation of Disease Burden.

The episodic outbreak of COVID-19 due to SARS-CoV-2 is severely affecting the economy, and the global count of infected patients is increasing. The actual number of patients had been underestimated due to limited facilities for testing as well as asymptomatic nature of the expression of COVID-19 on individual basis. Tragically, for emerging economies with high population density, the situation has been more complex due to insufficient testing facilities for diagnosis of the disease. However, the recent reports about persistent shedding of viral RNA of SARS-CoV-2 in the human feces have created a possibility to track the prevalence and trends of the disease in communities, known as wastewater-based epidemiology (WBE). In this article, we highlight the current limitations and future prospects for WBE to manage pandemics.

Spatial distribution of manganese in groundwater and associated human health risk in the southern part of the Bengal Basin.

The scarcity of arsenic and iron-free safe drinking water is an alarming issue in the southern part of the Bengal Basin. The objectives of the present study were to investigate the spatial distribution of manganese (Mn) concentration in the shallow and deep groundwater and its associated health risks for the children and adults of entire southern Bengal Basin. The Mn concentration in the groundwater varied from 0 to 5.4 mg/L with an average value of 0.47 mg/L that exceeded the WHO's and Bangladesh drinking water guideline values of 0.4 and 0.1 mg/L, respectively. Mn concentration in the shallow wells overrode the deep ones. About 23% of the shallow wells and 11% of deep wells exceeded the WHO's safety limit of Mn concentration for human health. The human health risk related to Mn contamination was estimated by computing the average daily dosage (ADD) and hazard quotient (HQ) values for children and adults. The average computed HQ values found 0.108 and 0.099 for children and adults, respectively. The HQ values delimitated that children are posing a higher risk compared to the adults for the shallow wells. Deep wells were found risk-free for both children and adults. The areal coverage of shallow wells with HQ values > 1 was minimal compared to the total study area and covered only a small portion of Patuakhali and Barguna districts. The rest of the site does not pose any health risk due to Mn contamination for children and adults.

Spatiotemporal distribution of boron in the groundwater and human health risk assessment from the coastal region of Bangladesh.

High concentrations of naturally-occurring and man-accentuated boron in groundwater possess a potential threat to the health and well-being of humans worldwide. In Bangladesh, only a few studies focused on the health risks of boron-containing groundwater. Therefore, the present study investigated the spatiotemporal distribution of boron concentrations in groundwater and its associated health risks in the coastal districts of Bangladesh. A total of 268 samples from the shallow and deep wells during the wet and dry season (137 and 131 samples, respectively) were collected to determine the level of boron concentrations and health risk status. The groundwater boron concentrations ranged from 0 to 4.10 mg/L with an average concentration of 0.68 mg/L, which was much lower than the WHO and the values of Bangladesh drinking water standard guideline. The boron concentrations in the shallow wells override the deep ones with insignificant seasonal variation. Boron contamination affected 10% of the shallow wells in the wet season and only 6% of them in the dry season, whereas only 1% of deep wells exceeds the WHO guideline values of 2.40 mg/L during the wet and dry season, respectively. The human health risk of boron was determined by computing estimated daily intake (EDI) and hazard quotient (HQ) values for infants, children, teenagers, and adults. The average HQ value delimitated that children have high risk followed by teenagers, adults, and infants. About 90-95% of the studied samples were free from boron contamination because of having HQ values < 1 and the rest of the samples possess a high risk for children. For the overall study area, the deep wells were found safer than the shallow wells, which were more susceptible to boron contamination aided by localized freshwater inputs.

Recommended Sampling Intervals for Arsenic in Private Wells.

Geogenic arsenic in drinking water is a worldwide problem. For private well owners, testing (e.g., private or government laboratory) is the main method to determine arsenic concentration. However, the temporal variability of arsenic concentrations is not well characterized and it is not clear how often private wells should be tested. To answer this question, three datasets, two new and one publicly available, with temporal arsenic data were utilized: 6370 private wells from New Jersey tested at least twice since 2002, 2174 wells from the USGS NAWQA database, and 391 private wells sampled 14 years apart from Bangladesh. Two arsenic drinking water standards are used for the analysis: 10 µg/L, the WHO guideline and EPA standard or maximum contaminant level (MCL) and 5 µg/L, the New Jersey MCL. A rate of change was determined for each well and these rates were used to predict the temporal change in arsenic for a range of initial arsenic concentrations below an MCL. For each MCL and initial concentration, the probability of exceeding an MCL over time was predicted. Results show that to limit a person to below a 5% chance of drinking water above an MCL, wells that are ½ an MCL and above should be tested every year and wells below ½ an MCL should be tested every 5 years. These results indicate that one test result below an MCL is inadequate to ensure long-term compliance. Future recommendations should account for temporal variability when creating drinking water standards and guidance for private well owners.

Modeling regional-scale groundwater arsenic hazard in the transboundary Ganges River Delta, India and Bangladesh: Infusing physically-based model with machine learning.

For the last few decades, toxic levels of arsenic (As) in groundwater from the aquifers of the Ganges River delta, India and Bangladesh, have been known to cause serious public health concerns. Innumerable studies have advocated the control of geomorphologic, geologic, hydrogeologic, biogeochemical, and anthropogenic factors on arsenic mobilization, flow, and distribution patterns within the Ganges River delta. We have developed transboundary regional-scale models for computing the probability of groundwater As concentrations to exceed the WHO permissible thresholds for drinking water of 10 µg/L within the Ganges River delta as a function of the various geomorphologic-(hydro)geologic-hydrostratigraphic-anthropogenic controlling factors, using statistical methods and artificial intelligence (AI) [i.e., machine learning] techniques namely, Random Forest (RF), Boosted Regression Trees (BRT) and Logistic Regression (LR) algorithms, followed by probabilistic delineation the high As-hazard zones within the delta. A "hybrid multi-modeling approach" was adapted for this study, which involved the introduction of hydrostratigraphic parameters (aquifer connectivity and surficial aquitard thickness) derived from a high-resolution transboundary hydrostratigraphic model developed for the Ganges River delta aquifer system, as predictors for modeling groundwater As probabilities within the delta. The RF model outperforms the BRT and LR model in terms of model performance. Model outputs suggest the dominant influence of surficial aquitard thickness and groundwater-fed irrigated area (%) on groundwater As. While, the north-central and southern regions of the Ganges River delta show low As-hazard (<10 µg/L), the western and north-eastern regions demonstrate elevated hazard level (>10 µg/L). An estimated 30.3 million people are found to be exposed to elevated groundwater As within the study area. Thus, our study demonstrates that such hybrid, predictive models are not only helpful in delineating the regional-scale distribution of groundwater As-hazard zones in the areas with limited As data but is also useful in identifying the possible exogenous forcing that may have led to the worst, natural pollution in human history.

Arsenic contamination of Bangladesh aquifers exacerbated by clay layers.

Confining clay layers typically protect groundwater aquifers against downward intrusion of contaminants. In the context of groundwater arsenic in Bangladesh, we challenge this notion here by showing that organic carbon drawn from a clay layer into a low-arsenic pre-Holocene (>12 kyr-old) aquifer promotes the reductive dissolution of iron oxides and the release of arsenic. The finding explains a steady rise in arsenic concentrations in a pre-Holocene aquifer below such a clay layer and the repeated failure of a structurally sound community well. Tritium measurements indicate that groundwater from the affected depth interval (40-50 m) was recharged >60 years ago. Deeper (55-65 m) groundwater in the same pre-Holocene aquifer was recharged only 10-50 years ago but is still low in arsenic. Proximity to a confining clay layer that expels organic carbon as an indirect response to groundwater pumping, rather than directly accelerated recharge, caused arsenic contamination of this pre-Holocene aquifer.

Associations of drinking rainwater with macro-mineral intake and cardiometabolic health: a pooled cohort analysis in Bangladesh, 2016-2019.

This study explores the associations of drinking rainwater with mineral intake and cardiometabolic health in the Bangladeshi population. We pooled 10030 person-visit data on drinking water sources, blood pressure (BP) and 24-h urine minerals. Fasting blood glucose (FBG) was measured in 3724 person-visits, and lipids in 1118 person-visits. We measured concentrations of sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) in 253 rainwater, 935 groundwater and 130 pond water samples. We used multilevel linear or gamma regression models with participant-, household- and community-level random intercepts to estimate the associations of rainwater consumption with urine minerals and cardiometabolic biomarkers. Rainwater samples had the lowest concentrations of Na, K, Ca and Mg. Rainwater drinkers had lower urine minerals than coastal groundwater drinkers: -13.42 (95% CI: -18.27, -8.57) mmol Na/24 h, -2.00 (95% CI: -3.16, -0.85) mmol K/24 h and -0.57 (95% CI: -1.02, -0.16) mmol Mg/24 h. The ratio of median 24-hour urinary Ca for rainwater versus coastal groundwater drinkers was 0.72 (95% CI: 0.64, 0.80). Rainwater drinkers had 2.15 (95% CI: 1.02, 3.27) mm Hg higher systolic BP, 1.82 (95% CI: 1.19, 2.54) mm Hg higher diastolic BP, 0.59 (95% CI: 0.17, 1.01) mmol/L higher FBG and -2.02 (95% CI: -5.85, 0.81) mg/dl change in high-density lipoprotein cholesterol compared with the coastal groundwater drinkers. Drinking rainwater was associated with worse cardiometabolic health measures, which may be due to the lower intake of salubrious Ca, Mg and K.

Drinking Water Salinity, Urinary Macro-Mineral Excretions, and Blood Pressure in the Southwest Coastal Population of Bangladesh.

Background Sodium (Na+) in saline water may increase blood pressure ( BP ), but potassium (K+), calcium (Ca2+), and magnesium (Mg2+) may lower BP . We assessed the association between drinking water salinity and population BP . Methods and Results We pooled 6487 BP measurements from 2 cohorts in coastal Bangladesh. We used multilevel linear models to estimate BP differences across water salinity categories: fresh water (electrical conductivity, <0.7 mS/cm), mild salinity (electrical conductivity ≥0.7 and <2 mS/cm), and moderate salinity (electrical conductivity ≥2 and <10 mS/cm). We assessed whether salinity categories were associated with hypertension using multilevel multinomial logistic models. Models included participant-, household-, and community-level random intercepts. Models were adjusted for age, sex, body mass index ( BMI ), physical activity, smoking, household wealth, alcohol consumption, sleep hours, religion, and salt consumption. We evaluated the 24-hour urinary minerals across salinity categories, and the associations between urinary minerals and BP using multilevel linear models. Compared with fresh water drinkers, mild-salinity water drinkers had lower mean systolic BP (-1.55 [95% CI : -3.22-0.12] mm Hg) and lower mean diastolic BP (-1.26 [95% CI : -2.21--0.32] mm Hg) adjusted models. The adjusted odds ratio among mild-salinity water drinkers for stage 1 hypertension was 0.60 (95% CI : 0.43-0.84) and for stage 2 hypertension was 0.56 (95% CI : 0.46-0.89). Mild-salinity water drinkers had high urinary Ca2+, and Mg2+, and both urinary Ca2+ and Mg2+ were associated with lower BP. Conclusions Drinking mild-salinity water was associated with lower BP , which can be explained by higher intake of Ca2+ and Mg2+ through saline water.

Effectiveness of Different Approaches to Arsenic Mitigation over 18 Years in Araihazar, Bangladesh: Implications for National Policy.

About 20 million rural Bangladeshis continue to drink well water containing >50 µg/L arsenic (As). This analysis argues for reprioritizing interventions on the basis of a survey of wells serving a population of 380,000 conducted one decade after a previous round of testing overseen by the government. The available data indicate that testing alone reduced the exposed population in the area in the short term by about 130,000 by identifying the subset of low As wells that could be shared at a total cost of 150 m) wells and a single piped-water supply system by the government reduced exposure of little more than 7000 inhabitants at a cost of US$150 per person whose exposure was reduced. The findings make a strong case for long-term funding of free well testing on a massive scale with piped water or groundwater treatment only as a last resort.

Sand Barriers around Latrine Pits Reduce Fecal Bacterial Leaching into Shallow Groundwater: A Randomized Controlled Trial in Coastal Bangladesh.

We evaluated the effectiveness of a sand barrier around latrine pits in reducing fecal indicator bacteria (FIB) leaching into shallow groundwater. We constructed 68 new offset single pit pour flush latrines in the Galachipa subdistrict of coastal Bangladesh. We randomly assigned 34 latrines to include a 50 cm thick sand barrier under and around the pit and 34 received no sand barrier. Four monitoring wells were constructed around each pit to collect water samples at baseline and subsequent nine follow-up visits over 24 months. Samples were tested using the IDEXX Colilert method to enumerate E. coli and thermotolerant coliforms most probable number (MPN). We determined the difference in mean log10MPN FIB counts/100 mL in monitoring well samples between latrines with and without a sand barrier using multilevel linear models and reported cluster robust standard error. The sand barrier latrine monitoring well samples had 0.38 mean log10MPN fewer E. coli (95% CI: 0.16, 0.59; p = 0.001) and 0.38 mean log10MPN fewer thermotolerant coliforms (95% CI: 0.14, 0.62; p = 0.002), compared to latrines without sand barriers, a reduction of 27% E. coli and 24% thermotolerant coliforms mean counts. A sand barrier can modestly reduce the risk presented by pit leaching.

Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater.

BACKGROUND: Recent studies found a low rate of iron deficiency in Bangladeshi non-pregnant and non-lactating women. This was attributed to high iron concentrations in drinking water. However, there are limited data on iron deficiency among pregnant women in Bangladesh. OBJECTIVES: Our aim was to investigate the prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) among rural pregnant women and explore the association of groundwater iron concentration with anemia and iron deficiency in this group. METHODS: This study used data from a baseline assessment of an intervention study on rural pregnant women (n = 522), gestational age ≤20 wk, living in areas of low and high iron in groundwater. RESULTS: Overall, 34.7% of the pregnant women had anemia, 27% had iron deficiency, and 13.4% had IDA. Prevalence of anemia, iron deficiency, and IDA among the pregnant women living in low-groundwater-iron areas was significantly higher than among the pregnant women from high-groundwater-iron areas. The odds of iron deficiency were significantly lower among pregnant women in the higher quartiles of daily iron intake from drinking water. CONCLUSIONS: This study found a differential prevalence of anemia and iron deficiency among pregnant women living in areas of high and low groundwater iron. Iron status was independently associated with daily iron intake from drinking water. However, a significant proportion of the anemia could not be attributed to iron deficiency. Further research to identify other nutritional and non-nutritional contributors to anemia in Bangladesh is needed to formulate effective prevention and control programs for anemia.

Quantitative drinking water arsenic concentrations in field environments using mobile phone photometry of field kits.

Arsenic (As) groundwater contamination is common yet spatially heterogeneous within most environments. It is therefore necessary to measure As concentrations to determine whether a water source is safe to drink. Measurement of As in the field involves using a test strip that changes color in the presence of As. These tests are relatively inexpensive, but results are subjective and provide binned categorical data rather than exact determinations of As concentration. The goal of this work was to determine if photos of field kit test strips taken on mobile phone cameras could be used to extract more precise, continuous As concentrations. As concentrations for 376 wells sampled from Araihazar, Bangladesh were analyzed using ICP-MS, field kit and the new mobile phone photo method. Results from the field and lab indicate that normalized RGB color data extracted from images were able to accurately predict As concentrations as measured by ICP-MS, achieving detection limits of 9.2µg/L, and 21.9µg/L for the lab and field respectively. Data analysis is most consistent in the laboratory, but can successfully be carried out offline following image analysis, or on the mobile phone using basic image analysis software. The accuracy of the field method was limited by variability in image saturation, and variation in the illumination spectrum (lighting) and camera response. This work indicates that mobile phone cameras can be used as an analytical tool for quantitative measures of As and could change how water samples are analyzed in the field more widely, and that modest improvements in the consistency of photographic image collection and processing could yield measurements that are both accurate and precise.

Microbial Community Structure and Arsenic Biogeochemistry in Two Arsenic-Impacted Aquifers in Bangladesh.

Long-term exposure to trace levels of arsenic (As) in shallow groundwater used for drinking and irrigation puts millions of people at risk of chronic disease. Although microbial processes are implicated in mobilizing arsenic from aquifer sediments into groundwater, the precise mechanism remains ambiguous. The goal of this work was to target, for the first time, a comprehensive suite of state-of-the-art molecular techniques in order to better constrain the relationship between indigenous microbial communities and the iron and arsenic mineral phases present in sediments at two well-characterized arsenic-impacted aquifers in Bangladesh. At both sites, arsenate [As(V)] was the major species of As present in sediments at depths with low aqueous As concentrations, while most sediment As was arsenite [As(III)] at depths with elevated aqueous As concentrations. This is consistent with a role for the microbial As(V) reduction in mobilizing arsenic. 16S rRNA gene analysis indicates that the arsenic-rich sediments were colonized by diverse bacterial communities implicated in both dissimilatory Fe(III) and As(V) reduction, while the correlation analyses involved phylogenetic groups not normally associated with As mobilization. Findings suggest that direct As redox transformations are central to arsenic fate and transport and that there is a residual reactive pool of both As(V) and Fe(III) in deeper sediments that could be released by microbial respiration in response to hydrologic perturbation, such as increased groundwater pumping that introduces reactive organic carbon to depth.IMPORTANCE The consumption of arsenic in waters collected from tube wells threatens the lives of millions worldwide and is particularly acute in the floodplains and deltas of southern Asia. The cause of arsenic mobilization from natural sediments within these aquifers to groundwater is complex, with recent studies suggesting that sediment-dwelling microorganisms may be the cause. In the absence of oxygen at depth, specialist bacteria are thought able to use metals within the sediments to support their metabolism. Via these processes, arsenic-contaminated iron minerals are transformed, resulting in the release of arsenic into the aquifer waters. Focusing on a field site in Bangladesh, a comprehensive, multidisciplinary study using state-of-the-art geological and microbiological techniques has helped better understand the microbes that are present naturally in a high-arsenic aquifer and how they may transform the chemistry of the sediment to potentially lethal effect.

Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale.

INTRODUCTION: Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. METHODS AND ANALYSIS: The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02746003; Pre-results.