Allan H. Smith,1 Elena O. Lingas,2 &
1 Professor of Epidemiology, 140 Warren
Hall, School of Public Health, University of California, Berkeley, Berkeley, CA
94720-7360, USA (email: firstname.lastname@example.org). Correspondence should be
addressed to this author.
2 Doctoral Research Student, School of Public Health,
University of California, Berkeley, USA.
3 International Fellow, Public Health Sciences
Division, International Centre for Diarrheal Disease Research in Bangladesh,
Dhaka, Bangladesh; Division of Occupational and Environmental Medicine, Faculty
of Health Sciences, Linko¨ ping University, Sweden.
Ref. No. 00-0751
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 µg 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.
Keywords: Bangladesh; arsenic poisoning, prevention and
control; arsenic poisoning, therapy; water pollution, chemical, prevention and
control; water treatment; environmental monitoring.