title: Evaluation of an Elementary School-based Educational Intervention for Reducing Arsenic Exposure in Bangladesh.
abstract: BACKGROUND
  Chronic exposure to well water arsenic (As) remains a major rural health challenge in Bangladesh and some other developing countries. Many mitigation programs have been implemented to reduce As exposure, although evaluation studies for these efforts are rare in the literature.
  
  
  OBJECTIVE
  In this study we estimated associations between a school-based intervention and various outcome measures of As mitigation.
  
  
  METHODS
  We recruited 840 children from 14 elementary schools in Araihazar, Bangladesh. Teachers from 7 schools were trained on an As education curriculum, whereas the remaining 7 schools without any training formed the control group. Surveys, knowledge tests, and well-water testing were conducted on 773 children both at baseline and postintervention follow-up. Urine samples were collected from 210 children from 4 intervention schools and the same number of children from 4 control schools. One low-As (< 10 μg/L) community well in each study village was ensured during an 18-month intervention period.
  
  
  RESULTS
  After adjustment for the availability of low-As wells and other sociodemographic confounders, children receiving the intervention were five times more likely to switch from high- to low-As wells (p < 0.001). We also observed a significant decline of urinary arsenic (UAs) (p = < 0.001) (estimated β = -214.9; 95% CI: -301.1, -128.7 μg/g creatinine) among the children who were initially drinking from high-As wells (> Bangladesh standard of 50 μg/L) and significantly improved As knowledge attributable to the intervention after controlling for potential confounders.
  
  
  CONCLUSIONS
  These findings offer strong evidence that school-based intervention can effectively reduce As exposure in Bangladesh by motivating teachers, children, and parents.
authors.affiliation: Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khan
authors.forename: Ershad
authors.initials: E
authors.lastname: Ahmed
authors.forename: Pam
authors.initials: P
authors.lastname: Factor-Litvak
authors.forename: Xinhua
authors.initials: X
authors.lastname: Liu
authors.forename: Abu B
authors.initials: AB
authors.lastname: Siddique
authors.forename: Gail A
authors.initials: GA
authors.lastname: Wasserman
authors.forename: Vesna
authors.initials: V
authors.lastname: Slavkovich
authors.forename: Diane
authors.initials: D
authors.lastname: Levy
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Mey
authors.forename: Alexander
authors.initials: A
authors.lastname: van Geen
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
mesh_terms: D001151:Arsenic; D020261:Arsenic Poisoning / Q000517:prevention & control*; D001459:Bangladesh; D002648:Child; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006266:Health Education / Q000379:methods; D006801:Humans; D008297:Male; D012574:Schools; D014874:Water Pollutants, Chemical; D014881:Water Supply
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic