Assessment of metal and bacterial contamination in cultivated fish and impact on human health for residents living in the Mekong Delta.

Fish is the main source of animal protein and micronutrients for inhabitants in the lower Mekong River basin. Consumption of fish in the basin ranges from 41 to 51 kg capita(-1) year(-1). Thus, concerns of human health impacts caused by daily intake of metals contained in fish, and the incidence of bacterial contamination from Listeria and Escherichia coli have been raised. This study was conducted to 1) determine concentrations of metals, fecal indicator organisms, and Listeria spp. in cultivated common diet fish, and 2) assess human health risks as results of fish consumption on a daily basis. The results showed significant impacts of metal accumulation in fish especially from the intensive aquaculture. Chemical use to promote the rapid allometric growth of fish was expected to be the explanation for this finding. Concentrations of metals contained in different fish species were not statistically different with the exceptions of Na, Mn, and Zn. This might be due to the mobility of elements in aquaculture farms. Listeria and E. coli log CFU/g were 1.36 ± 0.11 (standard error) and 1.57 ± 0.1 s.e., respectively with higher counts observed in samples collected in market sites. Lastly, for human health risk assessment via fish consumption, it was found that hazard quotients of consuming As, Cu, and Zn contained in all fish species could contribute adverse health effects to the local residents (hazard quotients higher than 1). Therefore, risk management measures must be promoted and implemented in all study areas to reduce potential risks to local Vietnamese residents.

Dietary exposure and human risk assessment of phthalate esters based on total diet study in Cambodia.

Phthalate esters are used in a wide variety of consumer products, and human exposure to this class of compounds is widespread. Nevertheless, studies on dietary exposure of human to phthalates are limited. In this study, to assess the daily intakes of phthalate esters and the possible adverse health impacts, different food samples were collected from three areas of Cambodia, one of the poorest countries in the world. The ∑phthalate ester concentrations in Kampong Cham, Kratie and Kandal provinces ranged from 0.05 to 2.34 (median 0.88) µgg(-1), 0.19-1.65 (median 0.86) µgg(-1) and 0.24-3.05 (median 0.59) µgg(-1) wet weight (ww), respectively. Di-2-Ethylhexyl phthalate (DEHP) and diisobutyl phthalate (DiBP) were the predominant compounds among all foodstuffs. The estimated daily intake (EDI) of phthalate esters for the general population in Kampong Cham, Kratie and Kandal was 34.3, 35.6 and 35.8µgkg(-1) bw d(-1), respectively. The dietary daily intake of DEHP, benzylbutyl phthalate (BBP) and di-n-butyl phthalate (DBP) in Kampong Cham, Kratie and Kandal were below the tolerable daily intakes (TDI) imposed by the European Food Safety Authority (EFSA) and reference doses (RfD) imposed by The United States Environmental Protection Agency (USEPA). Rice contributed the greatest quantity of DEHP to the daily intake in Cambodia so may deserve further exploration. To our knowledge, this is the first study to investigate the occurrence and the daily intakes of phthalate esters in Cambodia.

Bayesian modeling approach for characterizing groundwater arsenic contamination in the Mekong River basin.

In the Mekong River basin, groundwater from tube-wells is a major drinking water source. However, arsenic (As) contamination in groundwater resources has become a critical issue in the watershed. In this study, As species such as total As (AsTOT), As(III), and As(V), were monitored across the watershed to investigate their characteristics and inter-relationships with water quality parameters, including pH and redox potential (Eh). The data illustrated a dramatic change in the relationship between AsTOT and Eh over a specific Eh range, suggesting the importance of Eh in predicting AsTOT. Thus, a Bayesian change-point model was developed to predict AsTOT concentrations based on Eh and pH, to determine changes in the AsTOT-Eh relationship. The model captured the Eh change-point (∼-100±15mV), which was compatible with the data. Importantly, the inclusion of this change-point in the model resulted in improved model fit and prediction accuracy; AsTOT concentrations were strongly negatively related to Eh values higher than the change-point. The process underlying this relationship was subsequently posited to be the reductive dissolution of mineral oxides and As release. Overall, AsTOT showed a weak positive relationship with Eh at a lower range, similar to those commonly observed in the Mekong River basin delta. It is expected that these results would serve as a guide for establishing public health strategies in the Mekong River Basin.

Arsenic and Other Metals' Presence in Biomarkers of Cambodians in Arsenic Contaminated Areas.

Chemical analyses of metal (Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Mo, Ba, and Pb) concentrations in hair, nails, and urine of Cambodians in arsenic-contaminated areas who consumed groundwater daily showed elevated levels in these biomarkers for most metals of toxicological interest. The levels of metals in biomarkers corresponded to their levels in groundwater, especially for As, whose concentrations exceeded the WHO guidelines for drinking water. About 75.6% of hair samples from the population in this study contained As levels higher than the normal level in unexposed individuals (1 mg·kg(-1)). Most of the population (83.3%) showed As urinary levels exceeding the normal (<50 ng·mg(-1)). These results indicate the possibility of arsenicosis symptoms in residents of the areas studied. Among the three biomarkers tested, hair has shown to be a reliable indicator of metal exposures. The levels of As (r² = 0.633), Ba (r² = 0.646), Fe (r² = 0.595), and Mo (r² = 0.555) in hair were strongly positively associated with the levels of those metals in groundwater. In addition, significant weak correlations (p < 0.01) were found between levels of exposure to As and As concentrations in both nails (r² = 0.544) and urine (r² = 0.243).

Association between arsenic exposure and diabetes mellitus in Cambodia.

Whereas studies in Taiwan found associations between arsenic exposure from drinking water and diabetes mellitus (DM), studies in other countries yielded inconsistent results, and diet might be a confounder. We conducted a study in Cambodia, where people have non-Western style diet, to evaluate the association. We measured well water and urine samples and examined skin signs of arsenicosis to assess arsenic exposure and used questionnaires to collect data on potential risk factors. We performed a fingertip blood glucose test followed by measurement of hemoglobin A1c to assess DM. The 43-male and 99-female participants had an average age of 40.4 years. We found that participants with skin signs of arsenicosis had a higher level of arsenic in the drinking water (1101.1 versus 972.2 µ g/L, P = 0.02). Drinking water with arsenic levels above the median (907.25 µ g/L) was associated with a nearly twofold increase in the risk of DM (odds ratio [OR] = 1.7, 95% confidence interval [CI]: 0.5-5.8), so was having skin sings of arsenicosis (OR = 1.7, 95% CI: 0.5-5.6). The ORs did not reach statistical significance most likely because of the small case number. Therefore, further studies with larger study populations are needed to confirm our findings.

Human health risk assessment for ingestion exposure to groundwater contaminated by naturally occurring mixtures of toxic heavy metals in the Lao PDR.

This study constitutes the first systematic risk assessment in the Lao PDR of the safety of groundwater for consumption. Groundwater and hair samples were collected from seven Lao provinces to determine the quantitative health impact of heavy metals through ingestion exposure. Contamination levels for arsenic (As; 46.0 %) and barium (Ba; 16.2 %) exceeded World Health Organization (WHO) guidelines, especially in Mekong River floodplains. A USEPA assessment model for health risks from daily groundwater ingestion, with adjustments for local water consumption values, was applied to estimate the size of the population at risk for noncarcinogenic and carcinogenic health problems. As was the only element contributing to noncarcinogenic health risks in all contaminated areas. The populations of Bolikhamxai, Savannakhet, Saravane, Champasak, and Attapeu, moreover, were at risks of cancer. In addition to the As groundwater concentration factor, noncarcinogenic and carcinogenic risks were positively correlated with the average daily dose of As, exposure duration, and subject body weight. The level of As in hair correlated with groundwater consumption and average daily dose of As. 25.5 % of the population (n = 228) showed As levels in hair above the toxicity level.

Water quality guidelines for chemicals: learning lessons to deliver meaningful environmental metrics.

Many jurisdictions around the globe have well-developed regulatory frameworks for the derivation and implementation of water quality guidelines (WQGs) or their equivalent (e.g. environmental quality standards, criteria, objectives or limits). However, a great many more still do not have such frameworks and are looking to introduce practical methods to manage chemical exposures in aquatic ecosystems. There is a potential opportunity for learning and sharing of data and information between experts from different jurisdictions in order to deliver efficient and effective methods to manage potential aquatic risks, including the considerable reduction in the need for aquatic toxicity testing and the rapid identification of common challenges. This paper reports the outputs of an international workshop with representatives from 14 countries held in Hong Kong in December 2011. The aim of the workshop and this paper was to identify 'good practice' in the development of WQGs to deliver to a range of environmental management goals. However, it is important to broaden this consideration to cover often overlooked facets of implementable WQGs, such as demonstrable field validation (i.e. does the WQG protect what it is supposed to?), fit for purpose of monitoring frameworks (often an on-going cost) and finally how are these monitoring data used to support management decisions in a manner that is transparent and understandable to stakeholders. It is clear that regulators and the regulated community have numerous pressures and constraints on their resources. Therefore, the final section of this paper addresses potential areas of collaboration and harmonisation. Such approaches could deliver a consistent foundation from which to assess potential chemical aquatic risks, including, for example, the adoption of bioavailability-based approaches for metals, whilst reducing administrative and technical burdens in jurisdictions.

Status of metal levels and their potential sources of contamination in Southeast Asian rivers.

To assess the concentration and status of metal contaminants in four major Southeast Asian river systems, water were collected from the Tonle Sap-Bassac Rivers (Cambodia), Citarum River (Indonesia), lower Chao Phraya River (Thailand), and Saigon River (Vietnam) in both dry and wet seasons. The target elements were Be, Al, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Mo, Ag, Cd, Ba, Tl, and Pb and the concentrations exceeded the background metal concentrations by 1- to 88-fold. This distinctly indicates enrichment by human urban area activities. The results of a normalization technique used to distinguish natural from enriched metal concentrations confirmed contamination by Al, Cd, Co, Mn, Ni, Pb, and Zn. Cluster analysis revealed the probable source of metals contamination in most sampling sites on all rivers studied to be anthropogenic, including industrial, commercial, and residential activities. Stable lead isotopes analyses applied to track the sources and pathways of anthropogenic lead furthermore confirmed that anthropogenic sources of metal contaminated these rivers. Discharges of wastewater from both industrial and household activities were major contributors of Pb into the rivers. Non-point sources, especially road runoff and street dust, also contributed contamination from Pb and other metals.

Assessing mixed trace elements in groundwater and their health risk of residents living in the Mekong River basin of Cambodia.

We investigated the potential contamination of trace elements in shallow Cambodian groundwater. Groundwater and hair samples were collected from three provinces in the Mekong River basin of Cambodia and analyzed by ICP-MS. Groundwater from Kandal (n = 46) and Kraite (n = 12) were enriched in As, Mn, Ba and Fe whereas none of tube wells in Kampong Cham (n = 18) had trace elements higher than Cambodian permissible limits. Risk computations indicated that 98.7% and 12.4% of residents in the study areas of Kandal (n = 297) and Kratie (n = 89) were at risk of non-carcinogenic effects from exposure to multiple elements, yet none were at risk in Kampong Cham (n = 184). Arsenic contributed 99.5%, 60.3% and 84.2% of the aggregate risk in Kandal, Kratie and Kampong Cham, respectively. Sustainable and appropriate treatment technologies must therefore be implemented in order for Cambodian groundwater to be used as potable water.

Assessment of a potential agricultural application of Bangkok-digested sewage sludge and finished compost products.

A study was conducted to investigate the levels of plant nutrients, heavy metals, parasites and fecal coliform bacteria in Bangkok-produced sewage sludge and finished compost products for potential agricultural application, as well as to compare the quality of compost under different composting conditions. The results indicated that digested sewage sludge had high fertilizing values for organic matter (19.01 ± 0.09%), total nitrogen (2.17 ± 0.07%), total phosphorus (2.06 ± 0.06%) and total potassium (1.16 ± 0.22%), but it was contaminated with human pathogens, including fecal coliform bacteria, viable helminthes egg and active forms of parasite cysts. Thus, fresh sewage sludge should not be disposed on land unless it has undergone pathogen reduction. It is proven that the quality of the sludge mixed with grass clippings at a ratio of 6:1 volume/volume after having passed a windrow composting process for 8 weeks can be classified as class A biosolids as the levels of remaining fecal coliforms were < 3 most probable number g(-1) dry solid and all human parasites were destroyed. Concentrations of organic matter, total nitrogen, total phosphorus and total potassium in the finished compost were 16.53 ± 1.25%, 1.39 ± 0.06%, 0.42 ± 0.10% and 1.53 ± 0.05% respectively. The total copper concentration was rather high (2291.31 ± 121.77 mg kg(-1)), but all heavy metal concentrations were also well below the United States Environmental Protection Agency pollutant limits for land application. The finished compost products can be considered as a soil conditioner as they have relatively low essential plant nutrient concentrations. It is recommended to be initially used for gardening and landscaping to ensure safety utilization.

Arsenic concentration in rice, fish, meat and vegetables in Cambodia: a preliminary risk assessment.

To assess arsenic contaminations and its possible adverse health effects, food samples were collected from Kandal, Kratie and Kampong Cham in Cambodia. The highest and the lowest concentrations were observed in fish (mean 2,832 ng g(-1), ww) collected from Kandal province and cattle stomach (1.86 ± 1.10 ng g(-1), ww) collected from Kratie, respectively. The daily intake of arsenic via food consumption was 604, 9.70 and 136 µg day(-1) in Kandal, Kratie and Kampong Cham, respectively. The arsenic dietary intake in Kandal ranked No. 1 among all the 17 compared countries or regions. Fish consumption contributed the greatest proportion of total arsenic daily intake in Kandal (about 63.0 %) and Kampong Cham (about 69.8 %). It is revealed to be a much more important exposure pathway than drinking water for residents in Kampong Cham. The results of risk assessment suggested that the residents in Cambodia, particularly for people in Kandal province, suffer high public health risks due to consuming arsenic-contaminated food.

Hair arsenic levels and prevalence of arsenicosis in three Cambodian provinces.

Natural, inorganic arsenic contamination of groundwater threatens the health of more than 100 million people worldwide, including residents of the densely populated river deltas of South and Southeast Asia. Contaminated groundwater from tube wells in Cambodia was discovered in 2001 leading to the detection of the first cases of arsenicosis in 2006. The most affected area was the Kandal Province. The main objective of this study was to determine the prevalence of arsenicosis in Cambodia based on acceptable criteria, and to investigate the use of hair arsenic as a biomarker not only for arsenicosis-related signs but also for associated symptoms. A cross-sectional epidemiological study of 616 respondents from 3 purposely selected provinces within the Mekong River basin of Cambodia was conducted. The Kandal Province was chosen as a high arsenic-contaminated area, while the Kratie Province and Kampong Cham Province were chosen as moderate and low arsenic-contaminated areas, respectively. The most prevalent sign of arsenicosis was hypomelanosis with a prevalence of 14.5% among all respondents and 32.4% among respondents with a hair arsenic level of ≥1 µg/g. This was followed by hyperkeratosis, hyperpigmentation and mee's lines. Results also suggest a 1.0 µg/g hair arsenic level to be a practical cut off point for an indication of an arsenic contaminated individual. This hair arsenic level, together with the presence of one or more of the classical signs of arsenicosis, seems to be a practical criteria for a confirmed diagnosis. Based on these criteria, the overall prevalence of arsenicosis for all provinces was found to be 16.1%, with Kandal Province recording the highest prevalence of 35.5%. This prevalence is comparatively high when compared to that of other affected countries. The association between arsenicosis and the use of Chinese traditional medicine also needs further investigation.

Prevalence of Escherichia coli in surface waters of Southeast Asian cities.

Surface water samples were collected from rivers which fed into large urban areas within Vietnam, Indonesia, Cambodia, and Thailand and were processed to enumerate Escherichia coli. Selected isolates were further characterized using PCR to detect the presence of specific virulence genes. Analyzing the four countries together, the approximate mean cfu/100 ml for E. coli counts in the dry season were log 4.3, while counts in the wet season were log 2.8. Of the 564 E. coli isolates screened for the presence of pathogenic genes, 3.9 % possessed at least one virulence gene. The most common pathogenic types found were Shiga toxin-producing E. coli isolates. These results reinforce the importance of monitoring urban surface waters for fecal contamination, that E. coli in these water environments may serve as opportunistic pathogens, and may help in determining the impact water usage from these rivers have on the public health of urban populations in Southeast Asia.

Dietary exposure and risk assessment of mercury via total diet study in Cambodia.

To assess the daily intakes of total mercury (THg) and methylmercury (MeHg) and the possible adverse health impacts, different food groups including fish, meat, vegetable and rice were collected from three areas in Cambodia. The concentrations of THg and MeHg ranged from 0.16 to 171 ng g(-1) and not detected (ND) to 82.3 ng g(-1) wet weight (ww), respectively. The concentrations of THg and MeHg in fish were approximately three to four orders of magnitude greater than that in fruit and vegetable. Fish had the highest contribution to the total daily intakes of THg and MeHg. The estimated daily intake (EDI) of THg for the general population in Kampong Cham, Kratie and Kandal was 0.24, 1.38 and 0.22 µg kg(-1) bw d(-1), and 0.11, 0.45 and 0.06 µg kg(-1) bw d(-1) for MeHg, respectively. The dietary daily intakes of MeHg in Kratie and Kampong Cham were greater than the reference dose (RfD) imposed by The United States Environmental Protection Agency (USEPA) and in Kratie was also exceed the provisional tolerable weekly intake (PTWI) imposed by World Health Organization (WHO). To our knowledge, this the first study to evaluate the daily intakes of THg and MeHg in Cambodia.

Urinary cadmium concentrations in a population downstream: from a zinc mining area in Mae Sot District, Tak Province, Thailand.

Urinary cadmium (UCd) is a good indicator of long-term exposure to cadmium. UCd concentrations resulting from juvenile cadmium exposure in 3 sub-districts of Tak Province, Thailand, were investigated. The target population was divided by gender and into 2 age subgroups: 9-12 and 13-15 years. A total of 748 urine samples were collected and analyzed by spectrophotometer. All samples had UCd of more than 1.0 µg/g creatinine (Cr). Total UCd means among the 3 sub-districts were 1.31, 1.01, and 0.87 µg/g Cr; the Thai population mean is 0.5 µg/g. The difference among the three sub-districts was statistically significant (p < 0.05). Total means for UCd were 1.13 µg/g Cr for boys, 1.00 for girls, 1.01 µg/g Cr for those 9-12 years old, and 1.18 for those 13-15. UCd concentrations were not significantly different between genders and age groups. Likely dietary sources of cadmium exposure for the subject population were surveyed.

Handling e-waste in developed and developing countries: initiatives, practices, and consequences.

Discarded electronic goods contain a range of toxic materials requiring special handling. Developed countries have conventions, directives, and laws to regulate their disposal, most based on extended producer responsibility. Manufacturers take back items collected by retailers and local governments for safe destruction or recovery of materials. Compliance, however, is difficult to assure, and frequently runs against economic incentives. The expense of proper disposal leads to the shipment of large amounts of e-waste to China, India, Pakistan, Nigeria, and other developing countries. Shipment is often through middlemen, and under tariff classifications that make quantities difficult to assess. There, despite the intents of national regulations and hazardous waste laws, most e-waste is treated as general refuse, or crudely processed, often by burning or acid baths, with recovery of only a few materials of value. As dioxins, furans, and heavy metals are released, harm to the environment, workers, and area residents is inevitable. The faster growth of e-waste generated in the developing than in the developed world presages continued expansion of a pervasive and inexpensive informal processing sector, efficient in its own way, but inherently hazard-ridden.

Arsenic contamination in the food chain and its risk assessment of populations residing in the Mekong River basin of Cambodia.

In the present study, we investigated the potential arsenic exposure of Cambodian residents from their daily food consumption. Environmental and ecological samples such as paddy soils, paddy rice (unhusked), staple rice (uncooked and cooked), fish and vegetables were collected from Kandal, Kratie and Kampong Cham provinces in the Mekong River basin of Cambodia. After acid-digestion, digestates were chemically analyzed by inductively coupled plasma mass spectrometry. Results revealed that the means of total arsenic concentration ([As]tot) in paddy soils and paddy rice from Kandal were significantly higher than those from Kampong Cham province (t-test, p<0.05). Moreover, a significant positive correlation between the [As]tot in paddy soils and paddy rice was found (r(14) = 0.826, p<0.01). Calculations of arsenic intake from food consumption indicated that the upper end of the range of the daily dose of inorganic arsenic for Kandal residents (0.089-8.386 µg d(-1) kg(-1) body wt.) was greater than the lower limits on the benchmark dose for a 0.5% increased incidence of lung cancer (BMDL0.5 is equal to 3.0 µg d(-1) kg(-1) body wt.). The present study suggests that the residents in Kandal are at risk of arsenic intake from their daily food consumption. However, the residents in Kratie and Kampong Cham provinces are less likely to be exposed to arsenic through their daily dietary intake. To the best of our knowledge, this is the first report estimating the daily intake and daily dose of inorganic arsenic from food consumption in the Mekong River basin of Cambodia.

Arsenic geochemistry of groundwater in Southeast Asia.

The occurrence of high concentrations of arsenic in the groundwater of the Southeast Asia region has received much attention in the past decade. This study presents an overview of the arsenic contamination problems in Vietnam, Cambodia, Lao People's Democratic Republic and Thailand. Most groundwater used as a source of drinking water in rural areas has been found to be contaminated with arsenic exceeding the WHO drinking water guideline of 10 µg·L(-1). With the exception of Thailand, groundwater was found to be contaminated with naturally occurring arsenic in the region. Interestingly, high arsenic concentrations (> 10 µg·L(-1)) were generally found in the floodplain areas located along the Mekong River. The source of elevated arsenic concentrations in groundwater is thought to be the release of arsenic from river sediments under highly reducing conditions. In Thailand, arsenic has never been found naturally in groundwater, but originates from tin mining activities. More than 10 million residents in Southeast Asia are estimated to be at risk from consuming arsenic-contaminated groundwater. In Southeast Asia, groundwater has been found to be a significant source of daily inorganic arsenic intake in humans. A positive correlation between groundwater arsenic concentration and arsenic concentration in human hair has been observed in Cambodia and Vietnam. A substantial knowledge gap exists between the epidemiology of arsenicosis and its impact on human health. More collaborative studies particularly on the scope of public health and its epidemiology are needed to conduct to fulfill the knowledge gaps of As as well as to enhance the operational responses to As issue in Southeast Asian countries.

Prediction of contamination potential of groundwater arsenic in Cambodia, Laos, and Thailand using artificial neural network.

The arsenic (As) contamination of groundwater has increasingly been recognized as a major global issue of concern. As groundwater resources are one of most important freshwater sources for water supplies in Southeast Asian countries, it is important to investigate the spatial distribution of As contamination and evaluate the health risk of As for these countries. The detection of As contamination in groundwater resources, however, can create a substantial labor and cost burden for Southeast Asian countries. Therefore, modeling approaches for As concentration using conventional on-site measurement data can be an alternative to quantify the As contamination. The objective of this study is to evaluate the predictive performance of four different models; specifically, multiple linear regression (MLR), principal component regression (PCR), artificial neural network (ANN), and the combination of principal components and an artificial neural network (PC-ANN) in the prediction of As concentration, and to provide assessment tools for Southeast Asian countries including Cambodia, Laos, and Thailand. The modeling results show that the prediction accuracy of PC-ANN (Nash-Sutcliffe model efficiency coefficients: 0.98 (traning step) and 0.71 (validation step)) is superior among the four different models. This finding can be explained by the fact that the PC-ANN not only solves the problem of collinearity of input variables, but also reflects the presence of high variability in observed As concentrations. We expect that the model developed in this work can be used to predict As concentrations using conventional water quality data obtained from on-site measurements, and can further provide reliable and predictive information for public health management policies.

Surveillance on chronic arsenic exposure in the Mekong River basin of Cambodia using different biomarkers.

Thousands of Cambodia populations are currently at high risks of both toxic and carcinogenic effects through drinking arsenic-rich groundwater. In order to determine and assess the use of arsenic contents in different biological samples as biomarkers of chronic arsenic exposure from drinking arsenic-rich groundwater in Cambodia, individual scalp hair, fingernail and toenail were collected from three different provinces in the Mekong River basin of Cambodia. After washing and acid-digestion, digestate was analyzed for total arsenic by an inductively coupled plasma mass spectrometry. Chemical analysis of the acid-digested hair revealed that among 270 hair samples cut from Kandal, 78.1% had arsenic content in scalp hair (As(h)) greater than the typical As(h) (1.00 µg g(-1)), indicating possible arsenic toxicity. Concurrently, 1.2% and 0.6% were found elevated in Kratie (n=84) and Kampong Cham (n=173), respectively. Similarly, the upper end of the ranges for arsenic contents in fingernail (As(fn)) and toenail (As(tn)) clipped from Kandal (fingernail n=241; toenail n=187) were higher than the normal arsenic content in nail (0.43-1.08 µg g(-1)), however, none was observed elevated in both Kratie (fingernail n=76, toenail n=42) and Kampong Cham (fingernail n=83; toenail n=52). Significant positive intercorrelations between groundwater arsenic concentration (As(w)), average daily dose (ADD) of arsenic, As(h), As(fn) and As(tn) suggest that As(h), As(fn) and As(tn) can be used as biomarkers of chronic arsenic exposure from drinking arsenic-rich groundwater, in which As(h) is more favorable than As(fn) and As(tn) due to the ease of sample processing and analytical measurements, respectively.