Today is our topic of discussion Arsenicosis Prevalence in Bangladesh
Arsenicosis Prevalence in Bangladesh
Department of Public Health Engineering (DPHE) at first identified arsenic in 4 tube wells in Chamagram village of Chapainawabgong district in 1993. In 1994 Occupational and Environmental Health Department of NIPSOM confirmed 8 patients with visible sign of skin lesion in the same village.
It has been estimated that 30% of shallow tube wells (wells not deeper than 150 meters) in Bangladesh are
contaminated with high level of arsenic.
Safe level:
1. National standard for arsenic in drinking water (Bangladesh) 0.05 mg/L
2. WHO provisional guideline value is 0.01 mg/L, based on concern regarding its carcinogenicity.
Epidemiological characteristics of Arsenicosis patient:
1. More prevalent in rural area and malnourished suffers more from Arsenicosis.
2. Prevalence is higher among poor socio-economic and middle age group
3. Male prevalence is higher.
4. Most patients are in mild and moderate stage.
5. Socially Arsenicosis patients are not well accepted.
Source of exposure to arsenic:
1. Eating contaminated water and food.
2. Breathing contaminated air in workplace; sawdust from wood treated with arsenic , industrial-urban pollution etc.
3. Living near uncontrolled hazardous waste sites containing arsenic.
Signs and symptoms of Arsenicosis:
Exposure to arsenic causes toxicity –
Acute Toxicity:
Ingesting 1-3 mg of arsenic / kg body wt (70-300 mg) at a time. Within 30 minutes may develop severe vomiting, passage of rice watery stool. abdominal cramp. muscular cramps, anuria, coma etc.
Chronic Toxicity:
2 – 10 years after low dose exposure to arsenic. Chronic exposure (more than 6 months) may cause development of manifestations; skin hyper-pigmentation to cancer of skin including multi-organ pathologies and increased risk of mortality.
The common manifestations are-
Skin
a. Melanosis: Fine spotted hyperpigmentation on the extremities
b. Leukomelanosis: Hypopigmented/depigmented macules
c. Keratosis – Thickening of skin: papule or nodules on the
d. Non-pitting oedema
Others –
a Gangrene of the distal organs or parts of the body
b. Cancer of the skin, lungs, bladder
c. Kidney and liver failure
d. Gastroenteritis
Factors associated with arsenic toxicity:
1. Dose and duration of exposure
2. Route of entry
3. Nutritional status
4. Age and sex
5. Body resistance and immunity
6. Genetic factor
Adaptation of arsenic to human body:
1. Most of the arsenic is transported to liver through portal circulation.
2. Arsenic crosses the placental barrier
3. Most of the toxic effects are due to inactivation of cellular respiratory enzymes.
4. The effects of low dose arsenic exposure are cumulative results of chronic prolonged exposure.
5. Urine is the primary route of excretion
Social problems with arsenicosis:
1. Taboo and stigmas to the lesions of arsenicosis especially in rural community
2. Believed to be a contagious disease
3. The disease sometimes believed as the result of sin
4. The victims are isolated and dissocialized
5. Barred from schools, community water sources, community places
6. Marriage problem and marital disharmony
7. Improvement is time consuming: patients lose their faith on available management
8. Family members sometime become fade up on the long continued suffering of the patient
9. Patients lose their economic activity and earning capability
Prevention and control:
The suggested measures are –
a. Stoppage of further intake of arsenic contaminated water
b. Supportive treatment
c. Increased intake of proteins & vitamin rich vegetables
d. Application of keratolytics for keratosis
e. Symptom/manifestation specific management
Treatment with the antioxidants is beneficial –
a. Retinol, beta-carotene, ascorbic acid & alpha-tocopherol
b. Selenium & zinc
c. Spirulina
Steps for diagnosis:
Clinical examination for skin manifestation:
Place the patient in moderate sunlight Inspect melanosis mainly on the non-exposed part of the body like front & back of the trunk Inspect leukomelanosis mainly on the thigh or trunk For keratosis- Inspect both palm and both sole for multiple corn or wart like lesions. In mild case palpate the same for thickening or unevenness.
Clinical Examination for non-dermatological manifestations – if any
H/o exposure- H/o consumption of arsenic contaminated water (>0.05mg/l) at least six months.
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