Associations between urinary heavy metal concentrations and blood pressure in residents of Asian countries.

BACKGROUND: Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam). METHODS: This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index. RESULTS: The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 µg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them. CONCLUSIONS: Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.

Community clinics in Bangladesh: A unique example of public-private partnership.

BACKGROUND: Bangladesh has established more than 13,000 community clinics (CCs) to provide primary healthcare with a plan of each covering a population of around 6,000. The inception of CCs in the country has revolutionized the healthcare delivery to reach the doorstep of people. The provision of healthcare through CCs is truly participatory since the community people donate land for building infrastructure and also involve in management process. The study was conducted to assess pattern of public private partnership in healthcare delivery through participation of community people in establishment, management, monitoring and utilization of community clinics. METHODS: This quantitative study involving descriptive cross sectional design included 63 healthcare providers, 2,238 service-users and 3,285 community people as household members. Data were collected by face-to-face interview and reviewing records of CCs with the help of semi-structured questionnaire and checklist respectively. The public private partnership was assessed in this particular study by finding community participation in different activities of CCs. Data were analysed using descriptive statistics. RESULTS: Almost all (96.9%) CCs are located in easy-to-reach areas and have good infrastructure. Lands of all CCs are donated by the respective communities. The security of most of the CCs (93.7%) is maintained by community people. Cleanliness of the CCs is maintained by the cleaners or ayas who are appointed by local communities. Community Groups (CGs) of 88.9% and Community Support Groups (CSGs) of 96.8% CCs are found to be active. In most of the CCs (98.4%), monitoring is done by analysis of monthly reports. All CCs provide referral services for pregnant women. Health care delivery is found to be 'good' in more than three-fourths while health education service is 'good' in 96.7% of CCs. All CCs showed an increased trend in the utilization of services and conduction of normal child deliveries. Benefits of CCs as perceived by service users included free drugs (82.1%), free treatment (81.2%), easy access (76.3%), need-based health services (75.0%), and immunization services (68.6%). Almost all (99.0%) of the CC service users opined that CGs are involved in management of CC activities. CONCLUSION: In resource-poor settings of developing countries, public private partnership in primary healthcare delivery through community clinics may play crucial role in sustainable development of community health by providing quality health care. The study recommends public-private partnership for strengthening CCs including establishment, maintenance, utilization, monitoring and supply of essential drugs and logistics.

In-utero arsenic exposure and growth of infants from birth to 6 months of age: a prospective cohort study in rural Bangladesh.

Arsenic exposure in postnatal life impacts the growth of children, but little is known about the effect of in-utero arsenic exposure on growth very early in childhood. The aim of this study was to examine the associations between in-utero arsenic exposure and the growth of infants from birth to 6 months of age using monthly follow-up data. A prospective cohort study was conducted in rural areas of Bangladesh with 108 mother-infant pairs. This study identified a negative association between in-utero arsenic exposure and head circumference of infants 1-6 months of age (coefficient = -1.20, 95% confidence interval [CI]: -1.97, -0.42), and the effect was more pronounced in the earlier ages of 1-3 months (coefficient = -0.88, 95% CI: -1.70, -0.05). Because head circumference is considered as a surrogate of brain size, our findings suggest that in-utero arsenic exposure influences brain growth during an important developmental period.

Arsenic contamination in groundwater in Bangladesh: implications and challenges for healthcare policy.

Arsenic contamination of groundwater in Bangladesh has been recognized as a major public problem. The arsenic contamination was first identified in the tubewell water in 1993 in a northern district of Bangladesh. Tubewells are the main source of drinking water in rural areas, and except hilly and terrace upland throughout the Bangladesh, the arsenic-contaminated tube-wells are distributed. Fifty million people of Bangladesh were estimated to be at risk of exposure to arsenic through consumption of water from contaminated tubewells. Chronic exposure to arsenic causes arsenicosis and may include multi-organ pathologies. Many of the health effects of chronic toxicity are evident in Bangladesh. Besides dermatological manifestations, noncommunicable diseases including cancer, adverse pregnancy outcomes, and decreased intelligence quotient among the children are reported to be increasing. Cancer due to long-term low-dose arsenic exposure through consumption of contaminated water is now an important concern of Bangladesh as it is being increasingly reported from arsenic-exposed individuals. Stoppage of consumption of the arsenic-contaminated water is the mainstay of arsenicosis prevention and case management. At present, a higher proportion of the people are still consuming arsenic-contaminated water because of the lack of sustainable arsenic-safe water supply. In providing sustainable arsenic-safe water options, any option advocated should be cheap, easy to use, locally maintainable, and owned by the community. In addressing arsenic-related health issues, arsenic-exposed population needs to be brought under the coverage of the regular surveillance program for detection and subsequent management of noncommunicable diseases and cancers.

Non-monotonic relationships between arsenic and selenium excretion and its implication on arsenic methylation pattern in a Bangladeshi population.

The toxicity of arsenic differs markedly between individuals and populations, which might be related to the metabolism (methylation) of inorganic arsenic (As), as well as the selenium (Se) nutritional status. Urinary excretion of As (u-As) and Se (u-Se) was examined in an adult population (n=128) living in an As-contaminated area in Bangladesh. Although there was a significant negative correlation between u-Se and u-As (median 137; range 49-927 µg/g creatinine), closer examination revealed a non-monotonous relationship between them. A quadratic curve with an axis of As at 155 µg/g Cre gave a better fit, and u-As and u-Se were positively or negatively correlated depending on whether the As concentration was lower or higher than 155 µg As/g Cre, respectively. Likewise, the relationships between the As methylation pattern and glutathione-S-transferase (GST) polymorphism, body mass index (BMI), and u-Se differed depending on the u-As range; i.e., higher or lower than 155 µg/g Cre. Although we did not determine the causal mechanism for these observations, the non-monotonic relationship between As exposure and the variables examined suggested the existence of a threshold at which the handling of As by human body is qualitatively changed. The possible importance of Se nutrition for As toxicity is also discussed.

Delta-aminolevulinic acid dehydratase (ALAD) polymorphism in lead exposed Bangladeshi children and its effect on urinary aminolevulinic acid (ALA).

BACKGROUND AND OBJECTIVE: Lead has long been recognized as a harmful environmental pollutant. People in developing countries like Bangladesh still have a higher risk of lead exposure. Previous research has suggested that the delta-aminolevulinic acid dehydratase (ALAD) genotype can modify lead toxicity and individual susceptibility. As children are more susceptible to lead-induced toxicity, this study investigated whether the ALAD genotype influenced urinary excretion of delta-aminolevulinic acid (U-ALA) among children exposed to environmental lead in Bangladesh. METHODS: Subjects were elementary schoolchildren from a semi-urban industrialized area in Bangladesh. A total of 222 children were studied. Blood and urine were collected to determine ALAD genotypes, blood lead levels and urinary aminolevulinic acid (U-ALA). RESULTS: The mean BPb level was 9.7 µg/dl for the study children. BPb was significantly positively correlated with hemoglobin (p<0.01). In total, allele frequency for ALAD 1 and 2 was 0.83 and 0.17 respectively. The mean U-ALA concentration was lower in ALAD1-2/2-2 carriers than ALAD1-1 carriers for boys (p=0.001). But for girls, U-ALA did not differ significantly by genotype (p=0.26). When U-ALA was compared by genotype at the same exposure level in a multiple linear regression analysis, boys who were ALAD1-2/2-2 carriers still had a lower level of U-ALA compared to ALAD1-1 carriers. CONCLUSION: This study provides information about the influence of ALAD polymorphism and its association with U-ALA in Bangladeshi children. Our results indicate that the ALAD1-2/2-2 genotype may have a protective effect in terms of U-ALA for environmentally lead exposed boys.

Arsenic exposure increases maternal but not cord serum IgG in Bangladesh.

BACKGROUND: Thousands of pregnant women are exposed to arsenic (As), which has been shown to lead to a higher risk of maternal and infant morbidity. We hypothesized that As-induced modifications to the humoral immune system may be partly responsible, and examined the relationship between As and immunoglobulin G (IgG). METHODS: Pregnant women were recruited in As-contaminated rural areas in Bangladesh. Blood and urine samples, and questionnaire data were collected. We analyzed data from 202 pregnant women and a subset of 121 mother-infant pairs. Urinary As was measured on inductively coupled plasma-mass spectrometry and adjusted with specific gravity (U-AsSG ). Maternal (IgGmat ) and cord (IgGcord ) serum total IgG were measured using immunoturbidity assay. RESULTS: The geometric mean U-AsSG (n = 202) was 69 µg/L (range, 3.1-1356 µg/L). Urinary-AsSG was significantly associated with IgGmat (n = 202; (r = 0.24; 95% confidence interval [CI]: 0.10-0.36; P < 0.001) and remained so after the inclusion of maternal-associated variables in a multiple-regression model (ß = 1.26; 95%CI: 0.47-2.05; P < 0.01). U-AsSG , however, was not significantly associated with IgGcord (n = 121), while IgGmat and IgGcord were also not associated with each other. CONCLUSIONS: Maternal As exposure was positively associated with IgGmat but not IgGcord . Elevated IgGmat may have implications as regards maternal morbidity and the placental transfer of specific IgGs. Further studies are required to better understand how As may affect maternal and child health by modifying the humoral immune system.

Nutritional Status among the Children of Age Group 5-14 Years in Selected Arsenic Exposed and Non-Exposed Areas of Bangladesh.

OBJECTIVE: To assess and compare the nutritional status of children aged 5-14 years in arsenic exposed and non- exposed areas. MATERIALS AND METHODS: It was a cross sectional study conducted on 600 children of age 5-14 years from arsenic exposed and non-exposed areas in Bangladesh. Designed questionnaire and check list were used for collection of data. To estimate BMI necessary anthropometric measurements of the studied children were done. Dietary intakes of the study children were assessed using 24-hours recall method. RESULTS: The difference of socio-economic conditions between the children of exposed area and non-exposed area was not significant. On an average the body mass index was found to be significantly (p < 0.01) lower among the children of arsenic exposed area (49%) in comparison to that of children in non-exposed area (38%). Stunting (p < 0.01), wasting (p < 0.05) and underweight (p < 0.05) were significantly higher in exposed group in comparison to non-exposed group. No significant difference of nutrition intake was found between exposed and non-exposed children as well as thin and normal children. CONCLUSION: In this study children exposed to arsenic contaminated water were found to be suffered from lower nutritional status.

Blood lead levels and health problems of lead acid battery workers in Bangladesh.

INTRODUCTION: Use of lead acid battery (LAB) in Bangladesh has risen with sharp rise of motor vehicles. As result, manufacture of LAB is increasing. Most of the lead used by these industries comes from recycling of LAB. Workers in LAB industry are at risk of exposure lead and thus development of lead toxicity. OBJECTIVE: The objective of this study was to measure the blood lead concentration and to assess the magnitude of health problems attributable to lead toxicity among the LAB manufacturing workers. METHODS: A cross-sectional study was conducted among the workers of LAB manufacturing industries located in Dhaka city. RESULT: Mean blood lead level (BLL) among the workers was found to be high. They were found to be suffering from a number of illnesses attributable to lead toxicity. The common illnesses were frequent headache, numbness of the limbs, colic pain, nausea, tremor, and lead line on the gum. High BLL was also found to be related to hypertension and anemia of the workers. CONCLUSION: High BLL and illnesses attributable to lead toxicity were prevalent amongst workers of the LAB manufacturing industries, and this requires attention especially in terms of occupational hygiene and safety.

Determinants of smoking behaviour among secondary school students in Bangladesh.

Despite established country's tobacco control law, cigarette smoking by the young people and the magnitude of nicotine dependence among the students is alarming in Bangladesh. This study was aimed to determine the prevalence of smoking and factors influencing it among the secondary school students. A two-stage cluster sampling was used for selection of schools with probability proportional to enrollment size followed by stratified random sampling of government and private schools. The 70-item questionnaire included 'core GYTS' (Global Youth Tobacco Survey) and other additional questions were used to collect relevant information. Analysis showed that the prevalence of smoking was 12.3% among boys and 4.5% among girls, respectively. The mean age at initiation of smoking was 10.8 years with standard deviation of 2.7 years. Logistic regression analysis revealed that boys are 2.282 times likely to smoked than girls and it was 1.786 times higher among the students aged 16 years and above than their younger counterparts. Smoking by teachers appeared to be the strong predictor for students smoking behaviour (OR 2.206, 95% CI: 1.576, 3.088) followed by peer influence (OR 1.988, 95% CI: 1.178, 3.356). Effective smoking prevention program should to be taken to reduce smoking behaviour. The school curricula had less impact in preventing smoking except teacher's smoking behaviour.

Quality of life of arsenicosis patients in an arsenic-affected rural area in Bangladesh.

The objective of this cross-sectional comparative study was to assess quality of life (QOL) of arsenicosis patients. A total of 104 arsenicosis patients, 104 arsenic-exposed individuals without arsenicosis (nonpatients), and 104 individuals not exposed to arsenic (controls) were interviewed based on a questionnaire constructed based on the WHOQOL-BREF instrument. The facets of life considered for assessing QOL were physical health domain, psychological domain, social relationships domain, and environment domain. All the domain-wise QOL scores of the arsenicosis patients were significantly smaller than those of the controls as well as of the nonpatients. The findings of the study assessing QOL of arsenicosis patients might be helpful to understand the condition and justify for the policy makers to adopt adequate measures to alleviate the sufferings through prevention, treatment, and rehabilitation.

Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, lowland Nepal.

OBJECTIVE: To reveal the inter-relationship between nutritional status and arsenic toxicity. DESIGN: Cross-sectional study. SETTING: A survey in an area of lowland Nepal, where a high prevalence of both skin manifestation and malnutrition was observed. Daily arsenic intake was estimated by measuring the arsenic concentration and daily consumption of the drinking water. PARTICIPANTS: Adult villagers (248 men and 291 women). About half were classified as "underweight" (body mass index <18.5), indicating poor nutritional status. MAIN RESULTS: Arsenic intake was negatively correlated with body mass index and substantially increased the prevalence of underweight individuals, among whom the prevalence of skin manifestations was 1.65-fold higher than normal weight individuals. When exposure level was considered, the prevalence of skin symptoms was consistently higher in the underweight than in the normal group. Although enhanced susceptibility in men was apparent by the increased prevalence of cutaneous symptoms, no sex difference was observed in the prevalence of underweight individuals related with exposure to arsenic. CONCLUSIONS: The present data suggested that exposure to arsenic is associated with an increased prevalence of underweight, a serious health problem in developing countries, which in turn is associated with increased skin manifestation of arsenic poisoning.

Arsenicosis in two villages in Terai, lowland Nepal.

Although arsenic contamination of groundwater has been detected recently in the Terai region of Nepal, scarce data have been available regarding the possible health effects of the contamination. A study was carried out in two rural villages of Nawalparasi district, where the existence of arsenic contamination has been reported. Almost all tubewells in one of the two villages (Goini, G) exceeded (ranging from 0.104 mg/L to 1.702 mg/L) the maximum permissible limit for arsenic in drinking water in Nepal (0.05 mg/L), and only a few tubewells (19.5%) in the other village (Kunuwar Big, KB) were below this level (0.004 mg/L to 0.972 mg/L). Prevalence rates of arsenicosis diagnosed on the basis of the presence of dermatological manifestations were 11.3% (56 out of 495 examined) and 6.5% (34/525) in G and KB, respectively, with an overall prevalence rate of 8.9%. In terms of gender, the prevalence rate was higher in males (11.5%; 61/531) than in females (5.9%; 29/489), supporting previous observations including our own. Most (71.1%) of the identified patients were 20-49 years old, and the prevalence rate appeared to be higher among those in their 30s or 40s in the both sexes. The youngest patient was 10 years of age. All the patients were either in the mild or moderate stage of the disease and most (78.9%) were in the mild stage. Melanosis with some other manifestations was observed in 95.6% of the patients, while keratosis was found in 57.8%. Leucomelanosis without any other manifestations, which has not been reported either in Bangladesh or India, was observed in 3.3% of the identified patients. Only one patient had Bowen's disease. To our knowledge, the current study provides for the first time quantitative information regarding the arsenicosis patients in Nepal.