Stillbirth in Rural Bangladesh: Arsenic Exposure and Other Etiological Factors: A Report from Gonoshasthaya Kendra/Mortinaissances Dans le Bangladesh Rural: Exposition a L'arsenic et Autres Facteurs etiologiques/Mortinatalidad En El Bangladesh Rural: Exposicion a Arsenico Y Otros Factores Etiologicos

By Cherry, Nicola; Shaikh, Kashem et al. | Bulletin of the World Health Organization, March 2008 | Go to article overview

Stillbirth in Rural Bangladesh: Arsenic Exposure and Other Etiological Factors: A Report from Gonoshasthaya Kendra/Mortinaissances Dans le Bangladesh Rural: Exposition a L'arsenic et Autres Facteurs etiologiques/Mortinatalidad En El Bangladesh Rural: Exposicion a Arsenico Y Otros Factores Etiologicos


Cherry, Nicola, Shaikh, Kashem, Mcdonald, Corbett, Chowdhury, Zafrullah, Bulletin of the World Health Organization


Background

Stillbirth is a major cause of pregnancy loss, particularly in poor countries. In sub-Saharan Africa and southern Asia, some 5% of pregnancies end in this way, whereas in Europe and North America the proportion is generally less than 1%. In the latter regions, much is known about such causal factors as hypertension, obesity, eclampsia, advancing age and smoking. (1) In poor countries, there has been much less research, and the main concern has been for early pregnancy, inadequate nutrition, endemic malaria, stature and poor physique, all or any of which may have an important role. (2) Our immediate need is to determine whether, in Bangladesh, the widespread arsenic contamination of water in hand-pump tubewells is potentially hazardous for pregnant women. Though this question could be approached ecologically with the considerable information on the geographical distribution of arsenic in wells based on the National Hydrochemical Survey, together with stillbirth rates by district, the possibility of confounding by socioeconomic factors and health status also has to be excluded.

Serious natural contamination of water with arsenic and other minerals in village hand-pump tubewells in Bangladesh and West Bengal is well documented, (3) as are the skin lesions that resuh. (4-10) A wide range of other types of disease, mainly from occupational exposure to inhaled arsenic, have included internal cancers of the lung and other organs and various chronic inflammatory diseases, but effects on the outcome of pregnancy have not been clearly identified. (11) However, the longstanding use of arsenic as an abortifacient, together with results from animal studies, (12) suggests that such effects are not improbable, and there is evidence that arsenic concentrations in the urine of pregnant women reflect their level of chronic exposure. (13) In 2001, a study in Bangladesh of pregnancy outcomes in 192 women, half in a village with high arsenic levels, found 17 stillbirths compared with seven in a similar village with low levels. (14) A more recent study of 533 women drawn randomly from 74 villages, mostly with high arsenic concentrations (mean 277 [micro]g/1; median 116 [micro]g/1) showed evidence of increased risk of fetal and infant death. (15) This study, although based on only 48 stillbirths, allowed analysis of reproductive history and educational status by logistic regression. (15) A study of 202 pregnant women identified from a cross-sectional survey of almost 8000 people in 21 West Bengal villages found evidence of a significant increase in stillbirth at concentrations of [greater than or equal to] 200 [micro]g/l. (16) However, a study of 2006 pregnant women in three selected upazillas (subdistricts) found no association with stillbirth. (17)

There is still a requirement for evidence based on reliable data in well-supervised large populations exposed to arsenic over a range of concentrations. These requirements are largely met by Gonoshasthaya Kendra (GK; the People's Health Centre), a large, well established nongovernmental organization, which currently provides comprehensive health care for the entire population of about one million in some 600 villages, spread across four of Bangladesh's six main divisions. Most of the villages in the GK network are located in districts where the average arsenic concentration in hand-pump tubewells is low (< 50 [micro]g/l), but many are in areas with average concentrations well above that; in addition, there is enormous variation between and within villages. Cross-sectional and case-referent surveys of skin lesions in a large sample of GK villages have shown an average prevalence of 0.37% at concentrations < 5 [micro]g/l, rising to 6.84% at > 50 [micro]g/1. (18,19)

As GK has always maintained a complete census of residents in its villages and has systematically recorded all pregnancies with outcome, together with some 30 health and socioeconomic variables, these data should provide useful information on the epidemiology of stillbirth in this population of over a million residents in rural Bangladesh against which any additional effect of arsenic can be assessed.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Stillbirth in Rural Bangladesh: Arsenic Exposure and Other Etiological Factors: A Report from Gonoshasthaya Kendra/Mortinaissances Dans le Bangladesh Rural: Exposition a L'arsenic et Autres Facteurs etiologiques/Mortinatalidad En El Bangladesh Rural: Exposicion a Arsenico Y Otros Factores Etiologicos
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.