Article

Responses of 6500 households to arsenic mitigation in Araihazar, Bangladesh

April 2007
Health & Place 13(1):164-72

DOI:10.1016/j.healthplace.2005.11.004

Source
PubMed

Authors:

Alexander Pfaff

Duke University

A. A. Seddique

Jatiya Kabi Kazi Nazrul Islam University

Kazi Matin Ahmed

University of Dhaka

Show all 6 authorsHide

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.

Low-cost informational intervention reduced drinking water arsenic exposure in Bangladesh

Article

Full-text available

Mar 2023

Thirty million Bangladeshis continue to drink water with unacceptable levels of arsenic (>10 μg/L), resulting in a large public health burden. The vast majority of the Bangladeshi population relies on private wells, and less than 12% use piped water, increasing the complexity of mitigation efforts. While mass testing and informational campaigns were successful in the early 2,000 s, they have received little attention in recent years, even though the number of wells in the country has likely more than doubled. We investigated the effect of a low-cost (<USD 10/household) informational intervention on reducing arsenic exposure through a randomized control trial design. The sample size was ∼10% of the study area households, and the intervention provided exposure awareness material, the arsenic concentration of the household's drinking water, and information about alternate water sources nearby with improved water quality. The informational intervention lowered household arsenic exposure (P = 0.0002), with an average reduction in arsenic levels of ∼60%. Approximately one third of the study households requested to test an additional water source at no cost. Providing the intervention a second time led to more households changing their water source but did not further reduce exposure (P = 0.39). Our study establishes a causal relationship between the informational intervention and the observed reduction in household arsenic exposure. Our findings demonstrate that water testing and recommendations for accessing improved water provide an immediate, effective, and inexpensive means of reducing the public health burden of arsenic exposure in Bangladesh.

Arsenic in Bangladesh's Drinking Water: Evaluating Factors That Have Hindered Two Decades of Mitigation Efforts, and the Opportunities to Address Them

Thesis

Jan 2020

Raghav Reddy

The discovery in the late 1990s that as many as 70 million people in Bangladesh were exposed to naturally occurring arsenic through their drinking water sources sparked widespread efforts to mitigate the risks. The intensity of these efforts declined after the mid-2000s and the limited monitoring done since has raised concerns about their long-term sustainability. The most recent Multiple Indicator Cluster Survey conducted by the Government of Bangladesh and UNICEF indicated that in 2012-2013 over 40 million people still drank water that tested above the World Health Organization (WHO) guideline for arsenic in drinking water, showing that it remains a major public health concern. This dissertation aims to elucidate barriers to reducing arsenic exposure in Bangladesh, pilot strategies to address them, and generate specific recommendations for the broad range of water supply stakeholders. The research was performed by researchers at the University of Michigan and Asia Arsenic Network, a water focused NGO in Bangladesh. The researchers worked closely with a diverse range of stakeholders to define problems and design study approaches. Field data collection was done in Phulsara and Goga unions in the southwest of Bangladesh. We investigated the state of arsenic mitigation efforts in the two study unions through an assessment of existing water supply infrastructure and surveys of rural households to understand their perceptions and behaviors regarding drinking water. The results indicate a need for better water supply planning, with mitigation strategies currently in place failing due to crumbling community water infrastructure and low levels of adoption of safe water practices. The effect of a low-cost (< USD 9/household) informational intervention on reducing arsenic exposure in arsenic affected rural households was evaluated through a randomized control trial study. The intervention consisted of sharing arsenic awareness messaging, an individual household water quality test result, and specific recommendations for alternate sources with improved water quality. The results show that the intervention led to a significant number of households changing water sources, thereby lowering arsenic exposure. This work highlights the benefit of continued well xv testing and educational programming in Bangladesh, efforts that have declined sharply since 2006. While the majority of community operated water systems fail within three years of installation, our work with the user communities of two such systems, has identified initiatives that can improve their sustainability. We documented these cases in a short video, which is intended to inform and motivate other rural communities to better manage their water infrastructure. The research further included a critical assessment of eight commercially available arsenic field test kits. While arsenic test kits are widely used in Bangladesh, an up-to-date assessment of their accuracy was lacking in the scientific literature. The results of this study show that several test kits, including the one currently most commonly used in Bangladesh, can provide variable results and often significantly underestimate arsenic levels. Finally, specific recommendations based on the work performed in this dissertation are provided for a range of water supply stakeholders in Bangladesh including government agencies, donor organizations, non-governmental organizations, and field kit manufacturers. The findings from this work are intended to draw attention to the continuing need for additional arsenic mitigation efforts and help the wide range of water supply stakeholders in Bangladesh make more informed decisions in their work.

Changes in arsenic exposure in Araihazar, Bangladesh from 2001 through 2015 following a blanket well testing and education campaign

Article

Jan 2019

Background: Concentrations of arsenic (As) are elevated in a large proportion of wells in Bangladesh but are spatially variable even within a village. This heterogeneity can enable exposed households to switch to a nearby well lower in As in response to blanket (area-wide) well As testing. Objectives: We document the evolution of As exposure in Araihazar, Bangladesh following a blanket well testing and education campaign, as well as the installation of a considerable number of low As community wells. Methods: We use well water and urinary As data collected between 2000 and 2008, along with household interviews extending through 2016, within a 25 km2 area of Araihazar upazila for nearly 12,000 participants enrolled in the Health Effects of Arsenic Longitudinal Study (HEALS). We observe changes in participants' well water and urinary As concentrations following interventions to lower their exposure and use logistic regression to determine the factors associated with participants' decisions to switch primary household wells. Results: Urinary As for participants drinking from wells with >100 μg/L As at baseline declined from a mean of 226 μg/L at baseline to 173 μg/L two years later, and further declined to 139 μg/L over 8 years. For comparison, urinary As concentrations for participants drinking from wells with ≤10 μg/L As remained close to 50 μg/L throughout. Whereas the interventions only partially reduced exposure, well status with respect to As was predictive of well-switching decisions for at least a decade after the initial testing. Participants with high-As wells were 7 times more likely to switch wells over the first two years and 1.4–1.8 times more likely to switch wells over the ensuing decade. Conclusions: Arsenic exposure gradually declined following blanket well testing, an education campaign, and the installation of community wells but remained almost three times higher than for a subgroup of the participants drinking from wells with ≤10 μg/L. In addition, the number of participants with unknown As concentrations in their primary household wells increased substantially over time, indicating the importance of additional well testing as new wells continue to be installed, in addition to other means of reducing As exposure.

Information and Persuasion: Achieving Safe Water Behaviors in Kenya

Book

Jan 2011

Changes in arsenic exposure in Araihazar, Bangladesh from 2001 through 2015 following a blanket well testing and education campaign

Article

Full-text available

Apr 2019
ENVIRON INT

Linden Huhmann

Background Concentrations of arsenic (As) are elevated in a large proportion of wells in Bangladesh but are spatially variable even within a village. This heterogeneity can enable exposed households to switch to a nearby well lower in As in response to blanket (area-wide) well As testing. Objectives We document the evolution of As exposure in Araihazar, Bangladesh following a blanket well testing and education campaign, as well as the installation of a considerable number of low As community wells. Methods We use well water and urinary As data collected between 2000 and 2008, along with household interviews extending through 2016, within a 25 km2 area of Araihazar upazila for nearly 12,000 participants enrolled in the Health Effects of Arsenic Longitudinal Study (HEALS). We observe changes in participants' well water and urinary As concentrations following interventions to lower their exposure and use logistic regression to determine the factors associated with participants' decisions to switch primary household wells. Results Urinary As for participants drinking from wells with >100 μg/L As at baseline declined from a mean of 226 μg/L at baseline to 173 μg/L two years later, and further declined to 139 μg/L over 8 years. For comparison, urinary As concentrations for participants drinking from wells with ≤10 μg/L As remained close to 50 μg/L throughout. Whereas the interventions only partially reduced exposure, well status with respect to As was predictive of well-switching decisions for at least a decade after the initial testing. Participants with high-As wells were 7 times more likely to switch wells over the first two years and 1.4–1.8 times more likely to switch wells over the ensuing decade. Conclusions Arsenic exposure gradually declined following blanket well testing, an education campaign, and the installation of community wells but remained almost three times higher than for a subgroup of the participants drinking from wells with ≤10 μg/L. In addition, the number of participants with unknown As concentrations in their primary household wells increased substantially over time, indicating the importance of additional well testing as new wells continue to be installed, in addition to other means of reducing As exposure.

Demand for environmental quality information and household response: Evidence from well-water arsenic testing

Article

Aug 2017

Access to information about environmental quality may facilitate low-cost preventive measures that protect human health. In this paper, we study the demand for information about environmental quality and the behavioral response to the information provided. With a field experiment conducted in Bihar (India), we estimate the price sensitivity of demand for diagnostic testing of drinking water wells for arsenic of natural origin - a serious threat to the health of tens of millions of villagers across South and Southeast Asia. Demand is substantial but sensitive to price; uptake falls from 68% to 31% of households over our price range (Rs. 10 to Rs. 50). We further assess how households respond to information regarding the contamination level in their wells. About one-third of households with unsafe wells switch to a safer water source. Finally, we demonstrate that households that received adverse test outcomes are more likely to selectively forget test results, and proactively remove evidence of their wells' arsenic status.

Behavioral Determinants of Switching to Arsenic-Safe Water Wells: An Analysis of a Randomized Controlled Trial of Health Education Interventions Coupled With Water Arsenic Testing

Article

May 2016

More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 µg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational interventions when combined with fee-based water arsenic testing programs led to nearly all households buying an arsenic test for their drinking water sources (93%) compared with only 53% when fee-based arsenic testing alone was offered. The aim of the present study was to build on the findings of this trial by investigating prospectively the psychological factors that were most strongly associated with switching to arsenic-safe wells in response to these interventions. Our theoretical framework was the RANAS (risk, attitude, norm, ability, and self-regulation) model of behavior change. In the multivariate logistic regression model of 285 baseline unsafe well users, switching to an arsenic-safe water source was significantly associated with increased instrumental attitude (odds ratio [OR] = 9.12; 95% confidence interval [CI] = [1.85, 45.00]), descriptive norm (OR = 34.02; 95% CI = [6.11, 189.45]), coping planning (OR = 11.59; 95% CI = [3.82, 35.19]), and commitment (OR = 10.78; 95% CI = [2.33, 49.99]). In addition, each additional minute from the nearest arsenic-safe drinking water source reduced the odds of switching to an arsenic-safe well by more than 10% (OR = 0.89; 95% CI = [0.87, 0.92]). Future arsenic mitigation programs should target these behavioral determinants of switching to arsenic-safe water sources.

Theory-based promotion of safe water consumption

Article

Full-text available

Jan 2012

Jennifer Inauen

Almost 800 million people worldwide lack access to improved drinking water sources. As a consequence, water-borne diseases, including chronic illness and increased mortality from geogenic contaminants in groundwater pose severe threats to human health and well-being worldwide. The situation in developing countries is particularly dire, as central water supply is rare, and mitigation therefore more complex. In rural Bangladesh, millions of people are at risk of drinking water with elevated arsenic, despite the fact that many have gained awareness of the health risks, and over 100’000 safe water options have been installed in recent years. It is being increasingly recognized that without people’s compliance, health risks, including water-related risks cannot be mitigated. The social cognition approach proposes that behavior is best explained by an individual’s perceptions of objective reality. Moreover, these determinants are assumed to be modifiable, wherefore interventions targeting the behavioral determinants should increase behavior change effects of standard interventions that are developed without theoretical considerations. This thesis aims at applying this approach to promote safe water consumption. To identify potential behavioral determinants of safe water consumption, a review of major health behavior theories was conducted first. The identified determinants were compiled to a theoretical framework of potentially influential behavioral determinants. These were linked to behavior change techniques (BCTs) that are assumed to modify the determinants. Three empirical studies were conducted in Bangladesh that assessed arsenic-safe water consumption and the theory-derived behavioral determinants. In Study 1, a large cross-sectional survey was conducted to gain detailed knowledge about current arsenic-safe water consumption in the target population. Structured face-to-face interviews were conducted with 872 households in six districts of Bangladesh. The structured questionnaire assessed people’s acceptance and use of seven currently available arsenic-safe water options. The most influential behavioral determinants of the habitual use of arsenic-safe water options were identified by multiple linear regression analysis. Studies 2 and 3 aimed at developing theory-based interventions to enhance switching to neighboring arsenic-safe shallow wells (Study 2, N = 370), and promote the use of arsenic-safe deep tubewells (Study 3, N = 340). BCTs were developed that targeted the modification of key behavioral determinants that had been identified from baseline surveys. Thereafter, the developed BCTs were added to a standard informational intervention and compared in cluster-randomized trials regarding their effectiveness to increase the effects of the standard intervention to promote switching to arsenic-safe wells. Moreover, it was determined whether the BCTs would indeed change water consumption by changing the hypothesized behavioral determinants. Results indicated that overall, one third of the participants of Study 1 did not use the available arsenic-safe water options. Results varied greatly, with piped water supply being the most used option when people had access to it, and rainwater harvesting being the least used. More habitual use of arsenic-safe water options was foremost associated with higher self-efficacy, higher descriptive norms, and higher instrumental attitudes, i.e. when people felt more able to provide as much arsenic-safe water as they needed, when more other people also collected safe water, and when collecting safe water was perceived less time-consuming and effortful. These results were largely confirmed in Studies 2 and 3, but commitment strength emerged as a further important determinant; persons who were more committed to collect arsenic-safe water were more likely to use safe wells. Interventions that targeted increasing commitment strength were developed: reminders, implementation intentions, and public commitment. Confirming most hypotheses, these increased the behavior change effects of the informational intervention by up to 53%, leading to up to 65% well-switching at follow-up. Mediation analyses revealed that the theory-based interventions indeed changed behavior by increasing commitment strength. The empirical studies demonstrated the usefulness of the social-cognition approach for explaining, predicting, and changing yet another health behavior: safe water consumption. The results of the theory-based interventions provided strong indication that commitment is an important determinant of safe water consumption, and presumably of other behaviors as well. With relevance to health promotion, the increased effects of the theory-based interventions confirm the effectiveness of reminders, implementation intentions, and indicate the importance of more rigorous application of theory in developing and evaluating interventions. Moreover, the here developed BCTs provide promising additions to existing interventions, whereby this research hopes to make a contribution to accelerate the mitigation of arsenic contamination in Bangladesh.

Evaluation of an Elementary School–based Educational Intervention for Reducing Arsenic Exposure in Bangladesh

Article

Full-text available

May 2015
ENVIRON HEALTH PERSP

Chronic exposure to well water arsenic (As) remains a major rural health challenge in Bangladesh and some other developing countries. Many mitigation programs have been implemented to reduce As exposure although evaluation studies for these efforts are rare in the literature. This study estimates associations between a school-based intervention and various outcome measures of As mitigation. We recruited 840 children from 14 elementary schools in Araihazar, Bangladesh. Teachers from 7 schools were trained on an As education curriculum, whereas the remaining seven schools without any training formed the control group. Surveys, knowledge tests and well-water testing were conducted on 773 children both at baseline and post-intervention follow-up. Urine samples were collected from 210 children from four intervention schools and the same number of children from four control schools. One low As (<10 μg/L) community well in each study village was ensured during an 18-month intervention period. After adjustment for the availability of low As wells and other socio-demographic confounders, children receiving the intervention were five times more likely to switch from high to low As wells (p<0.001). We also observed a significant decline of urinary arsenic (UAs) (p=<0.001) (estimated b = -214.9; 95% CI: -301.1, -128.7 µg/g Cr) among the children who were initially drinking from high As wells (>Bangladesh standard of 50 μg/L) and significantly improved As knowledge attributable to the intervention after controlling for potential confounders. These findings offer strong evidence that school-based intervention can effectively reduce As exposure in Bangladesh by motivating teachers, children and parents.

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

Book

Jan 2024

Revisiting the Village Where Arsenic Contamination of Underground Water Was First Discovered in Bangladesh: Twenty-Five Years Later

Article

Full-text available

Dec 2020
Int J Environ Res Publ Health

Maiko Sakamoto

A survey was conducted in an As-affected village of Bangladesh—the first discovery of As contamination in the country—to assess the current situation and how implementation activities have worked to mitigate the problem. The As testing showed that the levels were less than the Bangladesh standard (50 µg/L) in all shallow tube-wells throughout the village. The questionnaire survey was conducted in the village as well as a neighboring As-affected village for comparison. The results revealed that there was a significant number of people using shallow tube-wells in both villages despite knowing that these wells could be contaminated with As and that safe water was available through a pipeline water supply. About 70% of responding households possessed their own water sources, mostly shallow tube-wells, and owners were less likely to choose tap water for drinking purpose than nonowners. In the village where As contamination was first reported, those individuals with a higher level of education and strong ties with neighbors were more likely to use shallow tube-well water for drinking purposes rather than tap water. This study suggests several measures to mobilize people to get safe water, namely providing subsides to install private taps, supplying public taps, and marketing and distributing handy water quality tests for households.

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

Article

Full-text available

May 2020

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.

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

Book

Full-text available

Mar 2020

Deep tubewell microbial water quality and access in arsenic mitigation programs in rural Bangladesh

Article

Full-text available

Dec 2018
SCI TOTAL ENVIRON

The objective of this paper is to determine whether deep tubewells installed through arsenic mitigation efforts in rural Bangladesh provide better drinking water microbial quality compared to shallow tubewells. We conducted a stratified random cross-sectional survey of 484 households to assess microbial contamination of deep tubewell water at source and at point of use (POU) compared to shallow tubewell water using the Compartment Bag Test. In addition, we measured storage time, distance, travel time and ownership status among both sets of users to assess deep tubewell efficacy and under what conditions they offer poorer or better water quality. Differences in tubewell characteristics were compared using non-parametric Mann-Whitney U tests and two-proportion Z-tests. Prevalence ratios of microbial contamination stratified by water quality, storage time and distance to tubewells and ownership were estimated using unadjusted Mantel-Haenszel tests. There was no significant difference in microbial contamination between shallow and deep tubewells at source. The presence of POU water microbial contamination in storage containers in deep tubewell households was 1.11 times the prevalence in shallow tubewell storage containers (95% CI = 0.97–1.27). Deep tubewell users stored water longer and walked significantly farther to obtain water compared to shallow tubewell users. Among deep tubewell households, those residing farther away from the source were 1.24 times as likely to drink contaminated water from storage containers compared to those located nearby (95% CI = 1.04–1.48). Our findings suggest that deep tubewells have comparable water quality to shallow tubewells at source, but increasing distance from the household exacerbates risk of microbial contamination at POU.

Evaluating Hydrogeological and Topographic Controls on Groundwater Arsenic Contamination in the Middle-Ganga Plain in India: Towards Developing Sustainable Arsenic Mitigation Models

Chapter

Aug 2016

We investigated the spatial distribution and severity of groundwater arsenic contamination in three previously un-studied villages located near the confluence of the Rivers Ganges and Sone, within the Maner block of Patna district in the Bihar State, India. We also gathered information on the demographic, socioeconomic and health issues of local residents in order to identify at-risk populations due to the exposure to elevated concentrations of arsenic. Arsenic concentrations were measured in 157 drinking water sources, which were tested using field-tests kits. Spatial patterns in arsenic distribution were compared with local physiographic and hydrogeologic parameters. Arsenic levels exceeding the WHO and the BIS standards (10 μg/L and 50 μg/L respectively) were found in all three villages, with a maximum of 300 μg/L. The shallow aquifers (≤50 m below ground surface) and older hand pumps were found to be arsenic contaminated. The deeper aquifers (>50 m) exhibited arsenic levels within permissible limits. Elevated arsenic levels are observed close to the River Ganges. However, a moderate (r = 0.240, p = 0.031) positive correlation with the surface water flow direction indicates that arsenic migrates from south to north and from west to east in the study area. This suggests that River Sone alluvium is a potential source of arsenic contamination in Bihar.

Mechanisms of behavioural maintenance: Long-term effects of theory-based interventions to promote safe water consumption

Article

Full-text available

Aug 2015
PSYCHOL HEALTH

Theory-based interventions can enhance people's safe water consumption, but the sustainability of these interventions and the mechanisms of maintenance remain unclear. We investigated these questions based on an extended theory of planned behaviour. 710 (445 analysed) randomly-selected households participated in two cluster-randomised controlled trials in Bangladesh. Study 1 promoted switching to neighbours' arsenic-safe wells, and Study 2 promoted switching to arsenic-safe deep wells. Both studies included two intervention phases. Structured interviews were conducted at baseline (T1), and at 1-month (T2), 2-month (T3), and 9-month (T4) follow-ups. In intervention phase 1 (between T1 and T2), commitment-based behaviour change techniques - reminders, implementation intentions and public commitment - were combined with information and compared to an information-only control group. In phase 2 (between T2 and T3), half of each phase-1 intervention group was randomly assigned to receive either commitment-based techniques once more, or coping planning with reminders and information. Initial well-switching rates of up to 60% significantly declined by T4: 38.3% of T2 safe-water users stopped consuming arsenic-safe water. The decline depended on the intervention. Increases in p Perceived behavioural control, intentions, commitment strength, and coping planning were associated with maintenance. In line with previous studies, the results indicate that an interplay between commitment and reminders is necessary to engender long-term behavioural change. The accepted manuscript can be downloaded here: http://www.tandfonline.com/eprint/GutuI77gmVfk4JKX348P/full

Behavioral determinants of arsenic-safe water use among Great Plains Indian Nation private well users: results from the Community-Led Strong Heart Water Study Arsenic Mitigation Program

Article

Full-text available

May 2023
ENVIRON HEALTH-GLOB

Background The objective of this study was to evaluate the behavioral determinants associated with exclusive use of arsenic-safe water in the community-led Strong Heart Water Study (SHWS) arsenic mitigation program. Methods The SHWS is a randomized controlled trial of a community-led arsenic mitigation program designed to reduce arsenic exposure among private well users in American Indian Great Plains communities. All households received point-of-use (POU) arsenic filters installed at baseline and were followed for 2 years. Behavioral determinants selected were those targeted during the development of the SHWS program, and were assessed at baseline and follow-up. Results Among participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher self-efficacy for accessing local resources to learn about arsenic (OR: 5.19, 95% CI: 1.48–18.21) and higher self-efficacy to resolve challenges related to arsenic in water using local resources (OR: 3.11, 95% CI: 1.11–8.71). Higher commitment to use the POU arsenic filter faucet at baseline was also a significant predictor of exclusive arsenic-safe water use for drinking (OR: 32.57, 95% CI: 1.42–746.70) and cooking (OR: 15.90, 95% CI: 1.33–189.52) at follow-up. From baseline to follow-up, the SHWS program significantly increased perceived vulnerability to arsenic exposure, self-efficacy, descriptive norms, and injunctive norms. Changing one’s arsenic filter cartridge after installation was associated with higher self-efficacy to obtain arsenic-safe water for drinking (OR: 6.22, 95% CI: 1.33–29.07) and cooking (OR: 10.65, 95% CI: 2.48–45.68) and higher perceived vulnerability of personal health effects (OR: 7.79, 95% CI: 1.17–51.98) from drinking arsenic-unsafe water. Conclusions The community-led SHWS program conducted a theory-driven approach for intervention development and evaluation that allowed for behavioral determinants to be identified that were associated with the use of arsenic safe water and changing one’s arsenic filter cartridge. These results demonstrate that theory-driven, context-specific formative research can influence behavior change interventions to reduce water arsenic exposure. The SHWS can serve as a model for the design of theory-driven intervention approaches that engage communities to reduce arsenic exposure. Trial registration The SHWS is registered with ClinicalTrials.gov (Identifier: NCT03725592).

Arsenic Contamination Status in Water Resources of India and Its Treatment Strategies

Article

Feb 2023

Well‐Switching to Reduce Arsenic Exposure in Bangladesh: Making the Most of Inaccurate Field Kit Measurements

Article

Full-text available

Dec 2021

Well‐switching programs in Bangladesh have successfully lowered arsenic exposure. In these programs, households switch from wells that are labeled “unsafe” to nearby wells labeled “safe,” but these designations are usually based on inherently inaccurate field kit measurements. Here, we (a) compare the efficacy of field‐kit measurements to accurate laboratory measurements for well switching, (b) investigate the potential impact on well switching of the chosen “safe” threshold, and (c) consider the possible benefits of providing more detailed concentration information than just “safe” and “unsafe.” We explore different hypothetical mitigation scenarios by combining two extensive data sets from Araihazar Bangladesh: a blanket survey of 6595 wells over 25 km² based on laboratory measurements and 943 paired kit and laboratory measurements from the same area. The results indicate that the decline in average arsenic exposure from relying on kit rather than laboratory data is modest in relation to the logistical and financial challenge of delivering exclusively laboratory data. The analysis further indicates that the 50 μg/L threshold used in Bangladesh to distinguish safe and unsafe wells, rather than the WHO guideline of 10 μg/L, is close to optimal in terms of average exposure reduction. We also show that providing kit data at the maximum possible resolution rather than merely classifying wells as unsafe or safe would be even better. These findings are relevant as the government of Bangladesh is about to launch a new blanket testing campaign of millions of wells using field kits.

Cookstove implementation and Education for Sustainable Development: A review of the field and proposed research agenda

Article

Aug 2021
RENEW SUST ENERG REV

Samantha Lindgren

This review offers a state of the field examination of cookstove implementation efforts with a focus on stakeholder engagement and persistently low rates of adoption. Literature from related fields, such as sanitation and public health, indicate that perspectives in sustainable energy are narrow, and point to a new approach for sustainable energy and development engagement, one that does not solely rely on overcoming habitualized behaviors of adult women. Should stakeholder perspectives be expanded, and coupled with partnerships that include local, youth-oriented educational institutions, better uptake of efficient cooking technologies may be realized. This paper argues that youth, current and future users of cookstoves, are systematically overlooked at all points along the cookstove value chain, and that their continued exclusion from implementation efforts is to the detriment of cookstove research and practice. This paper calls for their purposeful inclusion in development efforts through collaborations with Education for Sustainable Development providers whose work is complementary to the cookstove and sustainable development communities’ aims and aspirations. This represents a new line of research in sustainable household energy, one that includes a diversity of perspectives and the inclusion of all stakeholders.

Does Arsenic-Contaminated Drinking Water Limit Early Childhood Development in Bangladesh?

Book

Aug 2017

Evaluating Strategies to Reduce Arsenic Poisoning in South Asia: A View from the Social Sciences

Article

Full-text available

Sep 2020

The World Health Organization has labeled the problem of arsenic contamination of groundwater in South Asia as “the largest mass poisoning in human history.” Various technical solutions to the problem fall into one of two broad categories: (i) cleaning contaminated water before human consumption and (ii) encouraging people to switch to less contaminated water sources. In this paper, we review research on the behavioral, social, political, and economic factors that determine the field-level effectiveness of the suite of technical solutions and the complexities that arise when scaling such solutions to reach large numbers of people. We highlight the conceptual links between arsenic-mitigation policy interventions and other development projects in Bangladesh and elsewhere, as analyzed by development economists, that can shed light on the key social and behavioral mechanisms at play. We conclude by identifying the most promising policy interventions to counter the arsenic crisis in Bangladesh. We support a national well-testing program combined with interventions that address the key market failures (affordability, coordination failures, and elite and political capture of public funds) that currently prevent more deep-well construction in Bangladesh.

Why Do People Remain Attached to Unsafe Drinking Water Options? Quantitative Evidence from Southwestern Bangladesh

Article

Full-text available

Jan 2020

The acceptance of newly implemented, safe drinking water options is not guaranteed. In the Khulna and Satkhira districts, Bangladesh, pond water is pathogen-contaminated, while groundwater from shallow tubewells may be arsenic- or saline-contaminated. This study aims to determine why, as well as the extent to which, people are expected to remain attached to using these unsafe water options, compared to the following four safer drinking water options: deep tubewells, pond sand filters, vendor water, and rainwater harvesting. Through 262 surveys, this study explores whether five explanatory factors (risk, attitude, norms, reliability, and habit) pose barriers to switching from unsafe to safe drinking water options or whether they could act as facilitators of such a switch. Users’ attachment to using pond water is generally low (facilitators: risk and attitude. Barrier: norms). Users are more attached to shallow tubewells (no facilitators. Barriers: reliability and habit). The safe alternatives (deep tubewell, rain water harvesting, pond sand filter, and vendor water) score significantly better than pond water and are estimated to have the potential to be adopted by pond water users. Deep tubewell, rain water harvesting, and pond sand filter also score better than shallow tubewells and could also have the potential to replace them. These findings may be used to optimise implementation strategies for safer drinking water alternatives.

Review of processes controlling Arsenic retention and release in soils and sediments of Bengal basin and suitable iron based technologies for its removal

Article

Nov 2018

Arsenic in the soil environment has gained renewed interest because of the emerging cognizance that arsenic poisoning is a global concern. Groundwater in the Bengal Basin is significantly polluted by naturally occurring arsenic (As), a toxic metalloid, which adversely affects human health and among the countries facing As contamination problems, India and Bangladesh are the most affected. In soils and sediments, arsenic is often associated with Fe(III) (hydr)oxides and multiple processes/reactions govern its release into groundwater, including abiotic or biotically mediated oxidation-reduction and ligand exchange reactions. Reductive dissolution of arsenic-bearing Fe(III) (hydr)oxides and As(V) reduction to As(III) are the two main mechanisms controlling arsenic partitioning in soils, sediments and groundwater. Even though arsenic reduction is favourable over a wide range of conditions, Fe(III) reduction in nature is dependent on the biotic systems. This review reflects the current state of research for the understanding of arsenic in the soil environment with an emphasis on iron-based technologies for its removal. It attempts to collate all the relevant literature such that it can be a useful resource for researchers or policy makers to help recognize and explore useful treatment options.

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

Article

Full-text available

Apr 2019

About 20 million rural Bangladeshis continue to drink well-water containing >50 ug/L arsenic (As). This analysis argues for re-prioritizing 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 <US

1 per person whose exposure was reduced. Testing also had a longer term impact as 60,000 exposed inhabitants lowered their exposure by installing new wells to tap intermediate (45-90 m) aquifers that are low in As at their own expense of US

30 per person whose exposure was reduced. In contrast, the installation of over 900 deep (>150 m) wells and a single piped-water supply system by the government reduced exposure of little more than 7,000 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.

Quality Perceptions and Water Treatment Behavior at the Household Level

Article

Full-text available

Aug 2018

Contaminated drinking water is a major contributor to illnesses in low-income countries. Individuals may take measures to avoid drinking contaminated water, by boiling, filtering, or chlorinating it, or by drinking bottled water. However, lack of information about water quality in some communities may lead individuals to perceive water quality to be better than it could be and therefore not allocate sufficient resources to avoid drinking contaminated water, or to perceive water quality to be worse than it is thereby wasting resources on treating the water or buying bottled water. We build an expected utility model to demonstrate that individuals may over or under invest in improving drinking water depending on their perceptions of water quality. Perceptions depend on uncertain health outcomes as well as other potentially confounding influences (e.g., aesthetic characteristics of the water and cultural norms). Simulations demonstrate conditions under which individuals correct their perceptions over time versus when policy interventions (e.g., information campaigns) may effectively correct perceptions.

Hydrogeochemical evidences for targeting sources of safe groundwater supply in arsenic-affected multi-level aquifer systems

Article

Dec 2018
SCI TOTAL ENVIRON

Delineation of safe aquifers becomes highly imperative and challenging to ensure sustainable drinking water supply in rural areas of multi-level aquifer systems with complex water circulation under the impact of both geogenic and anthropogenic contamination. This work characterized hydrogeological and hydrogeochemical features of a multi-level Quaternary aquifer system of the central Yangtze River Basin to search for evidences of locating aquifers least contaminated. The results indicate modern hydrologic cycling is active in shallow phreatic aquifer (SPA) and in upper part of middle confined aquifer (MCA-1). The lower part of middle confined aquifer (MCA-2) and deep confined aquifer (DCA) have ages ranging from 200 to 2000 years and 4000 to >20,000 years, respectively. Vertical variations of hydrochemical compositions and Cl/Br ratios suggest the gradually decreasing and increasing contribution with depth from anthropogenic activities and natural water-mineral interactions, respectively. The SPA is characterized by high levels of anthropogenic components (Cl⁻, SO4²⁻, NO3⁻, organic pesticides and antibiotics). The MCA-1 is the main aquifer where most private tube wells were installed, typically contains geogenic As, Fe, Mn and NH4⁺ at concentration levels several hundred times higher than the national drinking water standard values. Organic-abundant geochemical and stagnant hydrogeological conditions favor their enrichment. Both MCA-2 and DCA are slightly influenced by geogenic contamination and groundwater pumping from public wells screened in MCA-2 does not or slightly perturbs the groundwater flow condition in MCA-2 and DCA. The cost-effective water supply strategy is either to maintain safe yield of groundwater from public wells screened in MCA-2, or to use the groundwater after simple filtration and aeration treatment in case that groundwater pumping in MCA-2 were over a “safe yield” or induced leakage of groundwater containing As, Fe, Mn and NH4⁺ from the overlying MCA-1. And DCA could serve as a source for water supply under emergency circumstances.

Health protective behavior following required arsenic testing under the New Jersey Private Well Testing Act

Article

Jun 2018
INT J HYG ENVIR HEAL

Exposure to naturally occurring arsenic in groundwater is a public health concern, particularly for households served by unregulated private wells. At present, one of the greatest barriers to exposure reduction is a lack of private well testing due to difficulties in motivating individual private well owners to take protective actions. Policy and regulations requiring testing could make a significant contribution towards universal screening of private well water and arsenic exposure reduction. New Jersey's Private Well Testing Act (PWTA) requires tests for arsenic during real estate transactions; however, the regulations do not require remedial action when maximum contaminant levels (MCLs) are exceeded. A follow-up survey sent to residents of homes where arsenic was measured above the state MCL in PWTA-required tests reveals a range of mitigation behavior among respondents (n = 486), from taking no action to reduce exposure (28%), to reporting both treatment use and appropriate maintenance and monitoring behavior (15%). Although 86% of respondents recall their well was tested during their real estate transaction, only 60% report their test showed an arsenic problem. Treatment systems are used by 63% of households, although half were installed by a previous owner. Among those treating their water (n = 308), 57% report that maintenance is being performed as recommended, although only 31% have tested the treated water within the past year. Perceived susceptibility and perceived barriers are strong predictors of mitigation action. Among those treating for arsenic, perceived severity is associated with recent monitoring, and level of commitment is associated with proper maintenance. Mention of a treatment service agreement is a strong predictor of appropriate monitoring and maintenance behavior, while treatment installed by a previous owner is less likely to be maintained. Though the PWTA requires that wells be tested, this study finds that not all current well owners are aware the test occurred or understood the implications of their arsenic results. Among those that have treatment installed to remove arsenic, poor monitoring and maintenance behaviors threaten to undermine intentions to reduce exposure. Findings suggest that additional effort, resources, and support to ensure home buyers pay attention to, understand, and act on test results at the time they are performed may help improve management of arsenic water problems over the long term and thus the PWTA's public health impact.

Groundwater arsenic in Bangladesh: What’s new for policy research?

Article

Nov 2017

This paper provides an overview of policy responses to arsenic in groundwater in rural Bangladesh to assess their role and potential effectiveness in reducing exposure. With 97% of the country consuming groundwater for drinking, there is a continuing crisis of tens of millions of people exposed to elevated levels of arsenic. An examination of the number of people protected through two major remediation efforts suggests that recent progress may not be sufficient to keep up with the increasing population or to resolve the crisis during this century. Recent developments in remedial options are examined to identify their potential role in an evolving policy and research agenda. There appears to be growing agreement about future research and policy responses that can scale remedial options and make them widely accessible. These include: (1) the need for a reliable and affordable programme of arsenic testing and retesting; (2) attention to risks from other soluble contaminants and pathogens; (3) explicit priority setting across locations, time and to address fairness; and (4) development of value chains to ensure remedial options are supported over time.

Lessons Learned from Arsenic Mitigation among Private Well Households

Article

Full-text available

Sep 2017

Yan Zheng

Purpose of review: Many thousands of research papers have been published on the occurrence, health effects, and mitigation of arsenic in drinking water sourced from groundwater around the world. Here, an attempt is made to summarize this large body of knowledge into a small number of lessons. Recent findings: This is an opinion paper reflecting on why we are far from the goal of eliminating this silent and widespread poison to protect the health of many millions. The lessons are drawn from research in countries representing a range of economic development and cultural contexts. The replacement of household wells with centralized water supplies has reduced population level exposure to moderate (50-100 μg/L) and high (>100 μg/L) levels of arsenic in drinking water in some countries as they become wealthier. However, there remains a very large rural population in all countries where the exposure to low levels (10-50 μg/L) of arsenic continues due to its dispersed occurrence in the environment and frequent reliance on private well. A set of natural (geological and biological), socioeconomic, and behavioral barriers to progress are summarized as lessons. They range from challenges in identifying the exposed households due to spatially heterogeneous arsenic distribution in groundwater, difficulties in quantifying the exposure let alone reducing the exposure, failures in maintaining compliance to arsenic drinking water standards, to misplaced risk perceptions and environmental justice issues. Environmental health professionals have an ethical obligation to help As mitigation among private well water households, along with physicians, hydrogeologists, water treatment specialists, community organizations, and government.

Evolution of households’ responses to the groundwater arsenic crisis in Bangladesh: Information on environmental health risks can have increasing behavioral impact over time

Article

Full-text available

Jan 2014

Arsenic in Drinking Water: An Emerging Human Right Challenge in India

Chapter

Full-text available

Oct 2016

Arsenic is a dangerous contaminant that occurs naturally in the groundwater in many parts of the world, including India. The presence of this contaminant threatens enjoyment of the human right to water, negatively impacting upon people’s health, economy and social wellbeing. This in turn thwarts people’s enjoyment of the rights to health, education and development. This chapter presents the scenario of the impact of arsenic in groundwater in the Indian state of Bihar, elaborating on the health implications through detailed case studies. It further critically evaluates the measures adopted for arsenic mitigation in the state, finally suggesting that the need is to find sustainable solutions for securing safe drinking water for the people. This alone can enable enjoyment of the human right to water and other related rights in arsenic-affected areas in India and elsewhere in the world.

Groundwater arsenic and education attainment in Bangladesh

Article

Full-text available

Oct 2015
J HEALTH POPUL NUTR

Background Thousands of groundwater tube wells serving millions of Bangladeshis are arsenic contaminated. This study investigates the effect of these wells on the education attainment and school attendance of youths who rely on those wells for drinking water. Methods The analysis combines data from the 2006 Bangladesh Multiple Indicator Cluster Survey (2006 MICS) and the National Hydrochemical Survey (NHS) of Bangladeshi tube wells? contamination conducted between 1998 and 2000. The study uses multiple regression analysis to estimate the differences in education attainment and school attendance among the following: (i) youths who live where tube wells are safe, (ii) youths who live where tube wells are unsafe but who report drinking from an arsenic-free source, and (iii) youths who live where tube wells are unsafe but who do not report drinking from an arsenic-free source. Results Controlling for other determinants of education attainment and school attendance, young Bangladeshi males who live where tube wells are unsafe (by Bangladeshis standards) but who report drinking from arsenic-free sources are found to have the same education attainment (among 19- to 21-year-olds) and school attendance (among 6- to 10-year-olds), on average, as corresponding young Bangladeshi males who live where wells are safe. But young Bangladeshi males who live where tube wells are unsafe and who do not report drinking from an arsenic-free source attain, on average, a half-year less education (among 19- to 21-year-olds) and attend school, on average, five to seven fewer days a year (among 6- to 10-year-olds) than do other Bagladeshi males of those ages. The estimated effects for females are of the same sign but much smaller in magnitude. Conclusion Bangladeshi public health measures to shift drinking from unsafe to safe wells not only advance good health but also increase males? education attainment.

Groundwater Arsenic Contamination and Associated Health Risks in Bihar, India

Article

Full-text available

Jan 2014

The extent of groundwater arsenic (As) contamination and associated health-risks were studied in the four villages: Chaukia and Terahrasiya (Vaishali); Mamalkha and Masharu (Bhagalpur) in Bihar, India. Groundwater samples were tested using the standard Silverdiethyledithiocarbamate method at 520nm by Thermo UV-1 spectrophotometer. The As levels in both the districts exceeded the WHO standard of 10µg/L for drinking water with a maximum value of 20µg/L in Vaishali and 143µg/L in Bhagalpur. However, the FAO standard of 100µg/L of As for irrigation water was only exceeded in Bhagalpur. The calculated range of the hazard index (HI) for Vaishali was 0.9 to 10, and for Bhagalpur was 10.40 to 40.47. Both ranges exceed the accepted normal toxic HI of 1.00. The cancer risk was derived as 1-5/1000 people to 5-16/10,000 people in Vaishali, and 7-21/1000 and 5-16/1000 people in Bhagalpur. Prevalence of skin pigmentation was double in Vaishali in comparison to Bhagalpur. The analysis of principal components showed that only two components had a fundamental role in defining variance for cancer risk assessment. A more extensive screening of As contamination of groundwater and a follow-up clinical study are necessary to accurately assess the likelihood of As-related cancers in these districts.

Low-cost technologies based on heterogeneous photocatalysis and zerovalent iron for arsenic removal in the Chacopampean plain, Argentina

Article

Jan 2009

This chapter compiles the study of the evaluation of the effectiveness of simple and lowcost solar technologies for As removal from groundwater, based on heterogeneous photocatalysis (HP) and zerovalent iron (ZVI) technologies to remove As from laboratory water BOOK.indb 209 2/17/2010 10:06:58 PM210 M.E. Morgada de Boggio et al. solutions. For HP tests, laboratory prepared and natural samples were placed in bottles internally covered by a TiO2 layer and exposed to solar or artificial UV light. By addition of iron in different forms (iron wool, packing wire or aqueous Fe(III)), simultaneously or after the irradiation, As removal higher than 80% after 6 hours of irradiation was obtained in all cases. ZVI tests with iron wool or packing wire yielded also good removals, although iron wool demonstrated to be a better iron material. Preliminary tests with commercial zerovalent nanoparticles (NZVI) resulted in outstanding results, rendering almost total removal with very low amounts of iron in very short contact times (typically under two hours). Natural waters from two localities of the Chacopampean Plain of Argentina were also tested (Mateu 2007, Morgada et al. 2008, 2009, Morgada de Boggio et al. 2009). UV irradiation improved the results, especially in real waters. Although both methodologies, HP and ZVI yielded similar results, use of HP could be superior because simultaneous removal of As, natural organic matter, organic pollutants, toxic metals and microbiological contamination can be achieved.

Groundwater arsenic contamination and associated health risks in Bihar, India

Article

Full-text available

Jan 2014

Arsenic mitigation measures in Bangladesh

Article

Mar 2012

Mohammad Zaved Kaiser Khan

The scale of arsenic toxicity of the groundwater in Bangladesh is greater than any environmental debacle in the history of human civilization. The main route of arsenic accumulation in the human body is the ingestion of arsenic tainted water. Because of the undetectable nature of arsenic poisoning at the early stage and lack of awareness due to mass illiteracy, poverty and malnutrition, arsenic related ailments may cause death. However, this paper mainly discusses arsenic mitigation measures in Bangladesh. Although a piped surface water supply after treatment is the absolute solution to get rid of this crisis, the weak economic background of Bangladesh does not support supplying such water to every corner of rural areas. Hence research groups have developed their own methods to suit the local environment, using locally available materials and approaches based on the common method of arsenic removal: use of oxidizing agents, followed by flocculation and precipitation. Again, among different alternative water supply options, deep tubewells, which have been used by the communities in Bangladesh during the past few decades, appear to be a more suitable alternate option. Moreover, household-based arsenic filters can be a good choice if proper maintenance can be done.

Nudges, Time Poverty, and the Friction of Distance: Three Factors Explaining Arsenic Exposure in Rural India

Article

Mar 2025

Demographic and socioeconomic determinants of urinary arsenic concentration for elementary school children in Bangladesh

Article

Aug 2024

Developing a safe water atlas for sustainable drinking water supply in Sonargaon Upazila, Bangladesh

Article

Feb 2024

16Evaluation of MOF Applications for Groundwater Arsenic Mitigation of the Middle Ganga Plains of Bihar, India

Chapter

Sep 2023

A System for Providing Safe Water

Chapter

Dec 2017

Wardatul Akmam

The aim of this chapter is to develop a system through which it would be possible to provide safe water to the people of the study area (Taranagar) through the most appropriate and optimal option available. At first a general system of seven stages is developed, followed by a relatively more detailed decision-making and implementation sub-systems.

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

Article

Aug 2017

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.

A Safe Depth Forecasting Model for Insuring Tubewell Installations Against Arsenic Risk in Bangladesh

Conference Paper

Jul 2017
Lect Notes Comput Sci

Nowadays large spatial databases are available to help analysts facing a variety of environmental risk problems. Statistically accurate and computationally efficient algorithms and models are then needed to extract knowledge from these, for inference and prediction of the studied phenomenon, and, ultimately for decision both at country-wide policy and local level. Arsenic concentrations are naturally elevated in groundwater pumped from millions of shallow tubewells distributed across rural Bangladesh. Deeper tubewells often make access to groundwater with lower arsenic levels. Thereby, also thanks to a relatively low installation cost, they have proven to be an effective method to reduce arsenic exposure. Relying on a large database of well tests conducted in thousands of villages, we propose a supervised learning technique to estimate the probability that a new well will be low in arsenic based on its location and depth. For villages lacking direct information to make a local prediction, our technique, that we call the Sister-Village method, combines data from villages with similar characteristics. To further promote safe well installations and to help disseminate the information resulting from our method, we also propose and price a simple insurance model.

Reduction in exposure to arsenic from drinking well-water in Bangladesh limited by insufficient testing and awareness

Article

Mar 2017

This study considers potential policy responses to the still very high levels of exposure to arsenic (As) caused by drinking water from shallow tubewells in rural Bangladesh. It examines a survey of 4,109 households in 76 villages of Araihazar upazila conducted two years after a national testing campaign swept through the area. The area is adjacent to the region where a long-term study was initiated in 2000 and where households are periodically reminded of health risks associated with well-water elevated in As. Results confirm that testing spurs switching away from unsafe wells, although the 27% fraction who switched was only about half of that in the long-term study area. By village, the fraction of households that switched varied with the availability of safe wells and the distance from the long-term study area. Lacking follow-up testing, two years only after the campaign 21% of households did not know the status of their well and 21% of households with an unsafe well that switched did so to an untested well. Well testing is again urgently needed in Bangladesh and should be paired with better ways to raise awareness and the installation of additional deep community wells.

Water Quality Awareness and Breastfeeding: Evidence of Health Behavior Change in Bangladesh

Article

Aug 2016

Decades of campaigns have cautioned households in Bangladesh about waterborne contaminants such as arsenic. In addition to switching water sources, mothers can protect young children from contaminated water by breastfeeding longer. We exploit time series variation in whether children were born before or after a nationwide information campaign and geographic variation in exposure to arsenic. We find that mothers breast-feed children longer in response to the campaign, especially when they have less access to uncontaminated wells, and that infants are more likely to be exclusively breast-fed. We find consistent evidence of lower mortality rates and diarrheal incidence for infants. © 2017 The President and Fellows of Harvard College and the Massachusetts Institute of Technology.

Inequitable allocation of deep community wells for reducing arsenic exposure in Bangladesh.

Data

Full-text available

Aug 2016

Inequitable allocation of deep community wells for reducing arsenic exposure in Bangladesh

Article

Full-text available

Dec 2015

Community wells that extend deeper than most private wells are crucial for reducing exposure to groundwater arsenic (As) in rural Bangladesh. This study evaluates the impact on access to safe drinking water of 915 such intermediate (90-150 m) and deep (>150 m) wells across a 180 km(2) area where a total of 48,790 tubewells were tested with field kits in 2012-13. Half the shallow private wells meet the Bangladesh standard of 50 µg/L for As in drinking water, whereas 92% of the intermediate and deep wells meet the more restrictive World Health Organization guideline for As in drinking water of 10 µg/L. As a proxy for water access, distance calculations show that 29% of shallow wells with >50 µg/L As are located within walking distance (100 m) of at least one of the 915 intermediate or deep wells. Similar calculations for a hypothetical more even distribution of deep wells show that 74% of shallow wells with >50 µg/L As could have been located within 100 m of the same number deep wells. These observations and well-usage data suggest that community wells in Araihazar, and probably elsewhere in Bangladesh, were not optimally allocated by the government because of elite capture.

Green Practices to Save Our Precious “Water Resource”

Chapter

Aug 2014

Population explosion and increasing urbanization and industrialization are the major reasons behind the increasing water pollution causing a major threat to the quality of water content. To a large extent, due to human activities and to some extent due to natural processes, a large number of organic toxicants such as petroleum hydrocarbons, halogenated and nitroaromatic compounds, phthalate esters, solvents, and pesticides pollute the aquatic environments. Conventional methods used for water purification can be costly and cumbersome leading to secondary pollution. Eco-friendly and cheaper alternates are always the need of the day. In this chapter, the properties and behavior of water, the pollutants responsible for water borne illness and the precautions and preventions against water pollution are discussed in the frame of new Green technologies which are being actively researched on and applied at larger scale to clean up the polluted water resources. The focus here is on Green practices to save this precious resource. © 2012 Springer Science+Business Media Dordrecht. All rights reserved.

Piloting Improved Cookstoves in India

Article

Mar 2015
J HEALTH COMMUN

Despite the potential of improved cookstoves to reduce the adverse environmental and health impacts of solid fuel use, their adoption and use remains low. Social marketing-with its focus on the marketing mix of promotion, product, price, and place-offers a useful way to understand household behaviors and design campaigns to change biomass fuel use. We report on a series of pilots across 3 Indian states that use different combinations of the marketing mix. We find sales varying from 0% to 60%. Behavior change promotion that combined door-to-door personalized demonstrations with information pamphlets was effective. When given a choice amongst products, households strongly preferred an electric stove over improved biomass-burning options. Among different stove attributes, reduced cooking time was considered most valuable by those adopting a new stove. Households clearly identified price as a significant barrier to adoption, while provision of discounts (e.g., rebates given if households used the stove) or payments in installments were related to higher purchase. Place-based factors such as remoteness and nongovernmental organization operations significantly affected the ability to supply and convince households to buy and use improved cookstoves. Collectively, these pilots point to the importance of continued and extensive testing of messages, pricing models, and different stove types before scale-up. Thus, we caution that a one-size-fits-all approach will not boost improved cookstove adoption.

Arsenic contamination of groundwater in Bangladesh: A review

Article

Full-text available

Nov 2011
INT J PHYS SCI

Md Safiuddin

The groundwater arsenic contamination in Bangladesh is known as the largest natural calamity in the world in terms of the affected population. The millions of tube-wells that had been sunk for drinking water supply are now dispensing poisonous arsenic. Consequently, about 80 million people are at risk and another 30 million are potentially exposed to arsenic poisoning. Most of the recognized stages of arsenic poisoning such as melanosis, keratosis, and hyper-keratosis have been identified in Bangladesh. In addition to the health crisis, the arsenic poisoning is affecting the agricultural crops and causing many social problems. The present study is an overview of the groundwater arsenic contamination in Bangladesh. The severity, sources, and causes of arsenic contamination are discussed in this paper. The health, agricultural, and social effects of the arsenic poisoning are highlighted. In addition, a number of urgent needs are given for combating the arsenic disaster.

Impact of an Information Campaign about Arsenic in Drinking Water in Bangladesh

Article

Full-text available

Spatial Variability of Arsenic in 6000 Tube Wells in a 25 km2 Area of Bangladesh

Article

Full-text available

May 2003

1] Arsenic concentrations measured by graphite furnace atomic absorption range from < 5 to 900 mg/L in groundwater pumped from 6000 wells within a 25 km 2 area of Bangladesh. The proportion of wells that exceed the Bangladesh standard for drinking water of 50 mg/L arsenic increases with depth from 25% between 8 and 10 m to 75% between 15 and 30 m, then declines gradually to less than 10% at 90 m. Some villages within the study area do not have a single well that meets the standard, while others have wells that are nearly all acceptable. In contrast to the distribution of arsenic in the 8–30 m depth range which does not follow any obvious geological feature, the arsenic content of groundwater associated with relatively oxic Pleistocene sand deposits appears to be consistently low. The depth of drilling necessary to reach these low-As aquifers ranges from 30 to 120 m depth within the study area. INDEX TERMS: 1030 Geochemistry: Geochemical cycles (0330); 1045 Geochemistry: Low-temperature geochemistry; 1806 Hydrology: Chemistry of fresh water; 1831 Hydrology: Groundwater quality; 1884 Hydrology: Water supply; KEYWORDS: arsenic, groundwater, Bangladesh, tube well Citation: van Geen, A., et al., Spatial variability of arsenic in 6000 tube wells in a 25 km 2 area of Bangladesh, Water Resour. Res., 39(5), 1140, doi:10.1029/2002WR001617, 2003.

Promotion of well-switching to mitigate the arsenic crisis in Bangladesh

Article

Full-text available

Feb 2002
B WORLD HEALTH ORGAN

To survey tube wells and households in Araihazar upazila, Bangladesh, to set the stage for a long-term epidemiological study of the consequences of chronic arsenic exposure. Water samples and household data were collected over a period of 4 months in 2000 from 4997 contiguous tube wells serving a population of 55000, the position of each well being determined to within +/- 30 m using Global Positioning System receivers. Arsenic concentrations were determined by graphite-furnace atomic-absorption spectrometry. In addition, groundwater samples collected every 2 weeks for an entire year from six tube wells were analysed for arsenic by high-resolution inductively coupled plasma-mass spectrometry. Half of the wells surveyed in Araihazar had been installed in the previous 5 years; 94% were privately owned. Only about 48% of the surveyed wells supplied water with an arsenic content below 50 micro g/l, the current Bangladesh standard for drinking-water. Similar to other regions of Bangladesh and West Bengal, India, the distribution of arsenic in Araihazar is spatially highly variable (range: 5-860 micro g/l) and therefore difficult to predict. Because of this variability, however, close to 90% of the inhabitants live within 100 m of a safe well. Monitoring of six tube wells currently meeting the 50 micro g/l standard showed no indication of a seasonal cycle in arsenic concentrations coupled to the hydrological cycle. This suggests that well-switching is a viable option in Araihazar, at least for the short term. Well-switching should be more systematically encouraged in Araihazar and many other parts of Bangladesh and West Bengal, India. Social barriers to well-switching need to be better understood and, if possible, overcome.

Increasing awareness of arsenic in Bangladesh: Lessons from a public education programme

Article

Full-text available

Jan 2003

Experts are making a major effort to find technical solutions to the serious public health problems posed by arsenic in drinking water in Bangladesh, but public education strategies receive less systematic attention. This article presents the findings of a study evaluating the impact of a 1999 campaign by the 18 District Towns Project to educate the public about the arsenic problem in six Bangladesh towns, where half of the population was estimated to be using arsenic-contaminated domestic water: (1). Water users were advised not to consume arsenic-affected tube-well water; (2). A simple, temporary water treatment method was recommended for those using such water, if they had no safe alternative source; (3). Caretakers of tube-wells having arsenic-free water were advised to share their water sources with others. This evaluation study, utilizing a combination of quantitative and qualitative social research methods, found those influenced by the programme to have higher awareness levels and significantly lower levels of risk behaviour than others. Yet more than half of the at-risk, programme-influenced survey respondents were found still to be drinking (57%) or cooking with (54%) arsenic-affected water. Despite the fact that the campaign did not have a satisfactory public health impact, the experience can inform future efforts to educate the Bangladeshi public about arsenic. One finding is widespread confusion about trusted tube-well water being newly labelled as 'unsafe'. Some think the problem is in the hand pumps themselves. Awareness of life threatening danger from arsenic contamination was found to be low. Learning points from this experience are: the value of explaining together with water testing; giving people opportunities to ask questions; repeating messages; continuing to educate children about the serious risks of consuming surface water; conducting community-wide education programmes for people of all ages; and evaluating the impact of specific public education strategies. Respecting such principles in public information campaigns will greatly help the public to benefit from future technical developments.

Community wells to mitigate the arsenic crisis in Bangladesh

Article

Full-text available

Feb 2003
B WORLD HEALTH ORGAN

To monitor the effectiveness of deep community wells in reducing exposure to elevated levels of arsenic in groundwater pumped from shallower aquifers. Six community wells ranging in depth from 60 m to 140 m were installed in villages where very few of the wells already present produced safe water. By means of flow meters and interviews with villagers carrying water from the community wells, a study was made of the extent to which these were used during one year. The results were compared with household and well data obtained during a previous survey in the same area. The mean arsenic concentration in water pumped from wells already in use in the villages where the community wells, were installed was 180 +/- 140 micrograms/l (n = 956). Monthly sampling for 4-11 months showed that arsenic levels in groundwater from five of the six newly installed wells were consistently within the WHO guideline value of 10 micrograms/l for drinking-water. One of these wells met the Bangladesh standard of 50 micrograms/l arsenic but failed to meet the WHO guideline values for manganese and uranium in drinking-water. The community wells were very popular. Many women walked hundreds of metres each day to fetch water from them. On average, 2200 litres were hand-pumped daily from each community well, regardless of the season. A single community well can meet the needs of some 500 people residing within a radius of 150 m of it in a densely populated village. Properly monitored community wells should become more prominent in campaigns to reduce arsenic exposure in Bangladesh. Between 8000 and 10,000 deep community wells are needed to provide safe water for the four to five million people living in the most severely affected parts of the country.

Can information alone change behavior? Response to arsenic contamination of groundwater in Bangladesh

Article

Full-text available

Nov 2007
J DEV ECON

This paper provides a survey on studies that analyze the macroeconomic effects of intellectual property rights (IPR). The first part of this paper introduces different patent policy instruments and reviews their effects on R&D and economic growth. This part also discusses the distortionary effects and distributional consequences of IPR protection as well as empirical evidence on the effects of patent rights. Then, the second part considers the international aspects of IPR protection. In summary, this paper draws the following conclusions from the literature. Firstly, different patent policy instruments have different effects on R&D and growth. Secondly, there is empirical evidence supporting a positive relationship between IPR protection and innovation, but the evidence is stronger for developed countries than for developing countries. Thirdly, the optimal level of IPR protection should tradeoff the social benefits of enhanced innovation against the social costs of multiple distortions and income inequality. Finally, in an open economy, achieving the globally optimal level of protection requires an international coordination (rather than the harmonization) of IPR protection.

Contamination of drinking water by arsenic in Bangladesh: A public health emergency

Article

Jan 2000
B WORLD HEALTH ORGAN

The contamination of groundwater by arsenic in Bangladesh is the largest poisoning of a population in history, with millions of people exposed. This paper describes the history of the discovery of arsenic in drinking-water in Bangladesh and recommends intervention strategies. Tube-wells were installed to provide "pure water" to prevent morbidity and mortality from gastrointestinal disease. The water from the millions of tube-wells that were installed was not tested for arsenic contamination. Studies in other countries where the population has had long-term exposure to arsenic in groundwater indicate that 1 in 10 people who drink water containing 500 mu g of arsenic per litre may ultimately die from cancers caused by arsenic, including lung, bladder and skin cancers. The rapid allocation of funding and prompt expansion of current interventions to address this contamination should be facilitated. The fundamental intervention is the identification and provision of arsenic-free drinking water. Arsenic is rapidly excreted in urine, and for early or mild cases, no specific treatment is required. Community education and participation are essential to ensure that interventions are successful; these should be coupled with follow-up monitoring to confirm that exposure has ended. Taken together with the discovery of arsenic in groundwater in other countries, the experience in Bangladesh shows that groundwater sources throughout the world that are used for drinking-water should be tested for arsenic.

Response to Comments on “Limited Temporal Variability of Arsenic Concentration in 20 Wells Monitored for 3 Years in Araihazar, Bangladesh”

Article

Jan 2006

Tubewells and arsenic in Bangladesh: Challenging a public health success story

Article

Jan 2003
Int J Popul Geogr

Bangladesh has seen one of the developing world's great public health successes, the conversion of the drinking water source for 94% of the rural population to ‘safe water’, in the form of tubewells, with the aim of reducing morbidity and mortality from water-borne disease. Now, that success is being endangered by the discovery that 20 million people may be in great danger and another 20 million in lesser danger of being poisoned by arsenic contamination from tubewell water. This article reports findings from the first national probability sample survey of the rural population and a census of tubewells investigating the social, demographic and epidemiological context of the crisis. The survey covered 3780 households containing 20260 people. The tubewell census covered 9174 tubewells. The article presents data on the respondents' history of drinking tubewell water, knowledge of the arsenic problem, identification of arsenicosis, as well as the impact upon them of the national campaign, the testing of tubewells, and their subsequent sources of water. Eighty-seven per cent of households drank water from ordinary tubewells (at most risk from arsenic poisoning) and 7% from deep tubewells. Among males, 47.5% had heard that something may be wrong with tubewell water, compared with 39.6% of females. A much lower proportion (20.6% males, 11.3% females) had heard that the water contained a poison called arsenic. Only about 1.5% of the entire population had stopped using tubewell water. Of survey respondents, 0.5% of males and 0.4% of females reported symptoms consistent with chronic arsenicosis. Suggestions are made for a more effective programme. Copyright © 2003 John Wiley & Sons, Ltd.

Searching for an optimum solution to the Bangladesh arsenic crisis

Article

Jun 2003

Searching for an optimum solution to the Bangladesh arsenic crisis: Thirty years ago Bangladesh experienced very high levels of infant and child mortality, much of it due to water-borne disease in deltaic conditions where surface water was highly polluted. In what appeared to be one of the great public health achievements, 95% of the population were converted to drinking bacteria-free tubewell water from underground aquifers. Recently, it has been shown that perhaps 20% of this water is arsenic contaminated and alternatives to tubewell water have been sought. This paper reports on two national surveys collaboratively carried out in 2000 by the Health Transition Centre, Australian National University and Mitra and Associates, Dhaka: A census of tubewells and a household survey of tubewell use and arseniosis. The study found that the tubewell revolution has been promoted not only by health considerations but also by the demand for a household water facility and the desire by women to reduce workloads associated with using surface water. Because of this, and because the population had absorbed the message about safe tubewell water, it is argued that the movement away from the use of tubewell water should be as limited as possible, even if this means using safe tubewells which are often found in the neighbourhood. To enable such a move the most urgent need is not changing the source of water but comprehensive national water testing providing essential information to households about which wells are safe and which are not.

Performance of a Household-Level Arsenic Removal System during 4-Month Deployments in Bangladesh

Article

Jul 2004

A simple arsenic removal system was used in Bangladesh by six households for 4 months to treat well water containing 190-750 microg/L As as well as 0.4-20 mg/L Fe and 0.2-1.9 mg/L P. The system removes As from a 16-L batch of water in a bucket by filtration through a sand bed following the addition of about 1.5 g of ferric sulfate and 0.5 g of calcium hypochlorite. Arsenic concentrations in all but 1 of 72 samples of treated water were below the Bangladesh drinking water standard of 50 microg/L for As. Approximately half of the samples also met the World Health Organization (WHO) guideline of 10 microg/L. At the two wells that did not meet the WHO guideline, observations were confirmed by additional experiments in one case ([P] = 1.9 mg/L) but not in the other, suggesting that the latter household was probably not following the instructions. Observed residual As levels are consistent with predictions from a surface complexation model only if the site density is increased to 2 mol/mol of Fe. With the exception of Mn, the average concentrations of other inorganic constituents of health concern (Cr, Ni, Cu, Se, Mo, Cd, Sb, Ba, Hg, Pb, and U) in treated water were below their respective WHO guideline for drinking water.

Direct Data Manipulation for Local Decision Analysis as Applied to the Problem of Arsenic in Drinking Water from Tube Wells in Bangladesh

Article

Jan 2005

A wide variety of tools are available, both parametric and nonparametric, for analyzing spatial data. However, it is not always clear how to translate statistical inferences into decision recommendations. This article explores the possibilities of estimating the effects of decision options using very direct manipulation of data, bypassing formal statistical analysis. We illustrate with the application that motivated this research, a study of arsenic in drinking water in nearly 5,000 wells in a small area in rural Bangladesh. We estimate the potential benefits of two possible remedial actions: (1) recommendations that people switch to nearby wells with lower arsenic levels; and (2) drilling new community wells. We use simple nonparametric clustering methods and estimate uncertainties using cross-validation.

Reliability of a Commercial Kit To Test Groundwater for Arsenic in Bangladesh

Article

Feb 2005

A comparison of field and laboratory measurements of arsenic in groundwater of Araihazar, Bangladesh, indicates that the most widely used field kit correctly determined the status of 88% of 799 wells relative to the local standard of 50 microg/L As. Additional tests showthatthe inconsistencies, mainly underestimates in the 50-100 microg/L As range, can be avoided by increasing the reaction time from 20 to 40 min. Despite this limitation, the field data already compiled for millions of wells by the Bangladesh Arsenic Mitigation and Water Supply Project, in combination with information on well location and depth, should prove to be extremely useful to prioritize interventions in thousands of affected villages.

Limited Temporal Variability of Arsenic Concentrations in 20 Wells Monitored for 3 Years in Araihazar, Bangladesh

Article

Aug 2005

Millions of people in Bangladesh have probably switched their water consumption to wells that meet the local standard for As in drinking water of 50 microg/L as a result of blanket field testing throughout the country. It is therefore important to know if As concentrations in those wells could change over time. To address this issue, we report here precise groundwater As analyses for time-series samples collected from a suite of 20 tube wells containing < or =50 microg/L As and ranging from 8 to 142 m in depth. For 17 out of 20 wells, the standard deviation of groundwater As concentrations was <10 microg/L over the 3-year monitoring period (n = 24-44 per well). Six of the 17 wells are community wells, each of which serves the needs of several hundred people in particularly affected villages. Of the three wells showing larger fluctuations in chemical composition including As, two are very shallow (8 and 10 m). Variations in As concentrations for one of these wells (50 +/- 32 microg/L, n = 36), as well as another shallow well showing smaller variations (48 +/- 5 microg/L, n = 36), appear to be coupled to seasonal precipitation and recharge linked to the monsoon. The other shallow well showing larger variations in composition indicates a worrisome and steady increase in As concentrations from 50 to 70 microg/L (n = 36) over 3 years. The time series of As (30 +/- 11 microg/L, n = 24) and other constituents in one deep community well (59 m) show large fluctuations that suggest entrainment of shallow groundwater through a broken PVC pipe. Even though the majority of wells that were initially safe remained so for 3 years, our results indicate that tube wells should be tested periodically.

and switching to an undetermined source (8%) Fighting arsenic, listening to rural communities: willingness to pay for arsenic-free, safe drinking water in rural Bangladesh. Water and Sanitation Program Study Arsenic contamination of groundwater in Bangladesh

Jan 2001

J Ahmad
B N Goldar
S Misra
M Jakariya

(21%), switching to the 50 community wells (16%), and switching to an undetermined source (8%). In References Ahmad, J., Goldar, B.N., Misra, S., Jakariya, M., 2003. Fighting arsenic, listening to rural communities: willingness to pay for arsenic-free, safe drinking water in rural Bangladesh. Water and Sanitation Program Study. BGS and DPHE, 2001. Arsenic contamination of groundwater in Bangladesh. In: Kinniburgh, D.G., Smedley, P.L. (Eds.), Final Report, BGS Technical Report WC/00/19. British Geological Survey, Keyworth, UK.

Fighting arsenic, listening to rural communities: willingness to pay for arsenic-free, safe drinking water in rural Bangladesh

Jan 2003

J Ahmad
B N Goldar
S Misra
M Jakariya

Ahmad, J., Goldar, B.N., Misra, S., Jakariya, M., 2003. Fighting arsenic, listening to rural communities: willingness to pay for arsenic-free, safe drinking water in rural Bangladesh. Water and Sanitation Program Study.

Arsenic contamination of groundwater in Bangladesh

Jan 2001

Dphe Bgs

BGS and DPHE, 2001. Arsenic contamination of groundwater in Bangladesh. In: Kinniburgh, D.G., Smedley, P.L. (Eds.), Final Report, BGS Technical Report WC/00/19. British Geological Survey, Keyworth, UK.

Reliability of a commercial kit to test groundwater for arsenic in Bangladesh

Jan 2005
299

van Geen

Fighting arsenic, listening to rural communities: willingness to pay for arsenic-free, safe drinking water in rural Bangladesh

Jan 2003

Ahmad

Responses of 6500 households to arsenic mitigation in Araihazar, Bangladesh

Abstract

No full-text available

Recommended publications

Increasing awareness of arsenic in Bangladesh: Lessons from a public education programme