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There are no easy community solutions for high natural arsenic contamination in
Bangladesh because of the co-existing socio-economic and infrastructure problems.
If arsenic contamination is recognised, relatively inexpensive water treatment can
remove it, for example with candle filtration systems for use for a short period in
the home or with a sachet of chemicals. Arsenic can also be removed before water
distribution, but this requires a fairly sophisticated water treatment system.
Arsenic compounds have been known since ancient times and the metallic form was
isolated over 700 years ago. Inorganic arsenic is acutely toxic. Murderers have used
its ability to slowly kill a victim from apparently natural causes: large doses—far
higher than are found in water—cause rapid deterioration and death. Slow
exposure, as in low-level water contamination causes several long-term effects. The
effects of this arsenic poisoning, known as arsenicosis, can take a number of years
(typically 5 – 20) to develop. Arsenic exposure via drinking water causes cancer in
the skin, bladder and kidney, as well as skin changes such as hyperkeratoses (hard
patches) and pigmentation changes. These and other health damaging effects are
summarised in Table 1. It has been estimated that one in ten people who drink
water containing >500 µg of arsenic per litre may ultimately die from cancers of the
lung, bladder and skin. Occupational exposure by arsenic is mainly by inhalation
and increased risks of lung cancer have been reported at cumulative exposure
levels of = 0.75mg/cubic metre. This amounts to around 15 years exposure at a
work-room concentration of 50µ/cubic metre. Tobacco smoking has been found to
interact with arsenic in increasing the lung cancer risk. Because of multiple
exposures and interaction with other toxic exposures, the relationship between
arsenic and disease is not clear cut for all the postulated effects, such as diabetes
and cerebrovascular disease.
• Lung disease
• Gastrointestinal symptoms
• Enlarged liver
• Diabetes
Who is at risk?
The very young are particularly vulnerable to the toxic effects, although all ages can
be affected. Poverty and poor nutrition increase the chance of toxic effects. A
vicious cycle can result, where people made sick by arsenic lose their jobs and
become a burden to their family. Many of the long-term harmful effects are
irreversible. In the early stages, drinking arsenic-free water and eating nutritious,
vitamin-rich food can reverse some effects. Surface waters, such as lakes and
rivers, are less likely to contain toxic levels of arsenic. While safer in terms of
arsenic levels, such waters may carry a much greater risk of infection. Waterborne
infection kills far more people than arsenic, so the use of alternative sources has to
be carefully considered, taking the ability to limit or control infection hazards into
account.
Unlike fluoride, arsenic has no apparent beneficial health effects for man and other
animals. Unfortunately, we cannot completely remove all traces of this element
from water. The acceptable upper limit for arsenic in water has been progressively
lowered: before 1993, the WHO guideline value was 0.05 mg/ litre. Now it is 0.01
mg/litre [mg/l or milligrams per litre].
While chemical or filtration treatment is effective, there can be problems in the use
of chemicals to remove arsenic. For example, alum (aluminium sulphate) requires
prolonged contact with the water to remove sufficient arsenic, which may be
difficult in supplies without a water treatment works. Letting the water settle helps
in iron rich waters, but only a proportion of the arsenic sinks with the iron, so this is
not satisfactory for high levels of contamination. The amount removed varies
according to several factors such as the concentrations of arsenic and iron and the
standing time.
Arsenic is now little used in industrial and agricultural processes. In the past it was
used as a pesticide, especially in orchards and as a component of wood
preservative: small amounts could be leached from treated wood, such as electricity
pylons. In the early stages of the investigation of the problem in Bangladesh, this
was suggested as a possible cause. While arsenic can be found in minute amounts
in air, food and water, the largest exposure is via the natural levels in water.
The Bangladesh arsenic emergency has shown the problem of using shallow wells in
areas with high natural arsenic levels. The long term potential answers for
Bangladesh include the following: