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Spatial patterns of fetal loss and infant death in an arsenic-affected area in Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (nternationell barnhälsa och nutrition/Persson)
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
International Vaccine Institute, Seoul, Korea.
ICDDR,B, Dhaka, Bangladesh.
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2010 (English)In: International Journal of Health Geographics, ISSN 1476-072X, E-ISSN 1476-072X, Vol. 9, 53- p.Article in journal (Refereed) Published
Abstract [en]

Background: Arsenic exposure in pregnancy is associated with adverse pregnancy outcome and infant mortality. Knowledge of the spatial characteristics of the outcomes and their possible link to arsenic exposure are important for planning effective mitigation activities. The aim of this study was to identify spatial and spatiotemporal clustering of fetal loss and infant death, and spatial relationships between high and low clusters of fetal loss and infant death rates and high and low clusters of arsenic concentrations in tube-well water used for drinking.Methods: Pregnant women from Matlab, Bangladesh, who used tube-well water for drinking while pregnant between 1991 and 2000, were included in this study. In total 29,134 pregnancies were identified. A spatial scan test was used to identify unique non-random spatial and spatiotemporal clusters of fetal loss and infant death using a retrospective spatial and spatiotemporal permutation and Poisson probability models.Results: Two significant clusters of fetal loss and infant death were identified and these clusters remained stable after adjustment for covariates. One cluster of higher rates of fetal loss and infant death was in the vicinity of the Meghna River, and the other cluster of lower rates was in the center of Matlab. The average concentration of arsenic in the water differed between these clusters (319 μg/L for the high cluster and 174 μg/L for the low cluster). The spatial patterns of arsenic concentrations in tube-well water were found to be linked with the adverse pregnancy outcome clusters. In the spatiotemporal analysis, only one high fetal loss and infant death cluster was identified in the same high cluster area obtained from purely spatial analysis. However, the cluster was no longer significant after adjustment for the covariates.Conclusion: The finding of this study suggests that given the geographical variation in tube-well water contamination, higher fetal loss and infant deaths were observed in the areas of higher arsenic concentrations in groundwater. This illustrates a possible link between arsenic contamination in tube-well water and adverse pregnancy outcome. Thus, these areas should be considered a priority in arsenic mitigation programs.

Place, publisher, year, edition, pages
2010. Vol. 9, 53- p.
Keyword [en]
arsenic exposure, drinking-water, fetal loss, infant death, spatial clustering, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology Geology
Research subject
Epidemiology; Earth Science with specialization in Environmental Analysis; International Health
Identifiers
URN: urn:nbn:se:uu:diva-121780DOI: 10.1186/1476-072X-9-53ISI: 000284357300001PubMedID: 20977746OAI: oai:DiVA.org:uu-121780DiVA: diva2:306600
Available from: 2010-03-30 Created: 2010-03-30 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Epidemiological and Spatial Association between Arsenic Exposure via Drinking Water and Morbidity and Mortality: Population based studies in rural Bangladesh
Open this publication in new window or tab >>Epidemiological and Spatial Association between Arsenic Exposure via Drinking Water and Morbidity and Mortality: Population based studies in rural Bangladesh
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to evaluate the risk for increased morbidity and mortality due to long-term arsenic exposure via drinking water by use of epidemiological and spatial approaches in studies performed in Matlab, Bangladesh. A total of 166,934 individuals aged 4 years and above were screened for skin lesions in 2002-2003. Another sample of 115,903 adults aged 15 years or more and a third sample of 26,972 pregnancies in 1991-2000 were considered in a historical cohort and an ecological study, respectively, where risk of adult mortality and spatial clusters of foetal loss and infant death were analysed in relation to arsenic exposure.

More than 70% of the tube-wells in the study area exceeded the threshold for arsenic contamination according to the WHO guideline (10 µg/L). The prevalence of arsenic-induced skin lesions was 3/1000 and men had significantly higher prevalence of skin lesions (SMR 158, 95% CI: 133-188) compared to women. There was an increased risk for death in adulthood due to all non-accidental causes (hazards ratio = 1.16, [95% CI 1.06-1.26]) even at a low level of arsenic contamination (10-49 µg/L). Slightly lower risks were observed for death in cancers (1.44 [1.06-1.95]) and infectious diseases (1.30 [1.13-1.49]) at 50-149 µg/L, but for cardiovascular diseases, it was evident (1.23 [1.01-1.51]) from the level 150-299 µg/L. A dose-response relationship was observed for each of these causes.

We identified high and low risk clusters of foetal loss and infant death that coincided with identified high and low clusters of arsenic exposure.

Water arsenic concentration of the reported main water source was significantly correlated with arsenic concentration in urine, which reflects current arsenic intake from all sources (R2=0.41, ρ< 0.0001), and the influence of neighbouring water sources was minimal.

The study findings underlines that the ongoing arsenic exposure has resulted in a series of severe public health consequences in Bangladesh that call for reinforcement in the mitigation efforts. Knowledge about the spatial distribution of exposure and health effects may be of value in that process.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. x, 51 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 549
Keyword
Arsenic, tube-well, skin lesion, adult mortality, foetal loss, infant death, cohort, spatial model, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-121788 (URN)978-91-554-7774-5 (ISBN)
Public defence
2010-05-17, Rosénsalen, Akademiska sjukhuset, 751 85 Uppsala, Ingång 95/96 nbv, 09:15 (English)
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Supervisors
Available from: 2010-04-22 Created: 2010-03-30 Last updated: 2010-04-22Bibliographically approved

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Sohel, NazmulPersson, Lars-Åke

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