A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh.
OBJECTIVE
To reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks.


METHODS
We conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks.


RESULTS
Overall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50 μg/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source. Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio = 0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased.


CONCLUSIONS
The overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public, 615 N, Wolfe Street, Room E5535, Baltimore, Maryland 21205-2103, USA. cmg2140@columbia.edu
Christine Marie
CM
George
Alexander
A
van Geen
Vesna
V
Slavkovich
Ashit
A
Singha
Diane
D
Levy
Tariqul
T
Islam
Kazi Matin
KM
Ahmed
Joyce
J
Moon-Howard
Alessandro
A
Tarozzi
Xinhua
X
Liu
Pam
P
Factor-Litvak
Joseph
J
Graziano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic; D001459:Bangladesh; D003256:Community Participation; D004781:Environmental Exposure / Q000517:prevention & control*; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D014874:Water Pollutants, Chemical; D055815:Young Adult
D014874:Water Pollutants, Chemical; D001151:Arsenic