title: Reduction in urinary arsenic levels in response to arsenic mitigation efforts in Araihazar, Bangladesh.
abstract: BACKGROUND
  There is a need to identify and evaluate an effective mitigation program for arsenic exposure from drinking water in Bangladesh.
  
  
  OBJECTIVE
  We evaluated the effectiveness of a multifaceted mitigation program to reduce As exposure among 11,746 individuals in a prospective cohort study initiated in 2000 in Araihazar, Bangladesh, by interviewing participants and measuring changes in urinary As levels.
  
  
  METHODS
  The interventions included a) person-to-person reporting of well test results and health education; b) well labeling and village-level health education; and c) installations of 50 deep, low-As community wells in villages with the highest As exposure.
  
  
  RESULTS
  Two years after these interventions, 58% of the 6,512 participants with unsafe wells (As >/=50 microg) at baseline had responded by switching to other wells. Well labeling and village-level health education was positively related to switching to safe wells (As < 50 mug/L) among participants with unsafe wells [rate ratio (RR) = 1.84; 95% confidence interval (CI), 1.60-2.11] and inversely related to any well switching among those with safe wells (RR = 0.80; 95% CI, 0.66-0.98). The urinary As level in participants who switched to a well identified as safe (< 50 microg As/L) dropped from an average of 375 microg As/g creatinine to 200 microg As/g creatinine, a 46% reduction toward the average urinary As content of 136 microg As/g creatinine for participants that used safe wells throughout. Urinary As reduction was positively related to educational attainment, body mass index, never-smoking, absence of skin lesions, and time since switching (p for trend < 0.05).
  
  
  CONCLUSIONS
  Our study shows that testing of wells and informing households of the consequences of As exposure, combined with installation of deep community wells where most needed, can effectively address the continuing public health emergency from arsenic in drinking water in Bangladesh.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Alexander
authors.initials: A
authors.lastname: van Geen
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
authors.forename: Alexander
authors.initials: A
authors.lastname: Pfaff
authors.forename: Malgosia
authors.initials: M
authors.lastname: Madajewicz
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: A Z M Iftekhar
authors.initials: AZ
authors.lastname: Hussain
authors.forename: Vesna
authors.initials: V
authors.lastname: Slavkovich
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001151:Arsenic / Q000652:urine*; D020261:Arsenic Poisoning / Q000453:epidemiology* / Q000517:prevention & control; D001459:Bangladesh / Q000453:epidemiology; D004781:Environmental Exposure; D005260:Female; D006266:Health Education / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D014874:Water Pollutants, Chemical / Q000032:analysis*; D014881:Water Supply / Q000032:analysis*
chemical_list: D014874:Water Pollutants, Chemical; D001151:Arsenic