Academic journal article Journal of Health Population and Nutrition

Electrocardiographic Abnormalities among Arsenic-Exposed Persons through Groundwater in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Electrocardiographic Abnormalities among Arsenic-Exposed Persons through Groundwater in Bangladesh

Article excerpt

INTRODUCTION

Tubewells have been used in Bangladesh since the 1940s. During the early days, the vast majority of rural people collected their drinking-water from surface-water sources, such as ponds and rivers. As the water from these sources was not bacteriologically safe, a large number of children and adults died each year from waterborne diseases. Consequently, with the aim of providing safe water to the vast population of Bangladesh, tubewells were installed. About 10 million tubewells (hand-pumps) had been sunk until recently in Bangladesh, which provided 97% of its population with access to safe water. Unfortunately, the identification of arsenic in tubewell water in 1993 gave rise to a new dilemma. Since the initial detection of arsenic contamination in groundwater in Bangladesh, it has rapidly emerged as a major public-health problem. Arsenic contamination in tubewell water has become evident in 61 of the 64 districts of the country. The Bangladesh Arsenic Mitigation and Water Supply Project (BAMWSP) has so far screened tubewells in 271 of 490 upazillas (sub-districts). Of 4,946,933 tubewells, located in 57,482 villages of these upazillas, 29.2% were arsenic-contaminated (>0.05 mg/L). And in 8,540 villages, more than 80% of the tubewells were arsenic-contaminated. Moreover, 38,118 patients with arsenicosis were detected in 255 upazillas. The situation so far uncovered is considered as the tip of the iceberg, and with the passage of time, the size of the population exposed, the number of patients detected, and the complications of arsenic exposure continue to evolve (1-4).

Long-term arsenic exposure above the safe level of 50 [micro]g/L (for Bangladesh) leads to the development of arsenicosis, which is characterized by the appearance of characteristic skin manifestations (melanosis and or keratosis). Other manifestations often present include weakness, conjunctival congestion, chronic cough, chronic bronchitis, peripheral neuropathy (tingling, numbness, burning sensation, and pain), etc. In addition to complications, such as non-pitting oedema (pedal oedema), chronic ulcer of keratosis, peripheral vascular disease (gangrene), hepatopathy, nephropathy, Bowen's disease, cancer, particularly squamous cell and basal cell carcinoma, adverse pregnancy outcomes, diabetes mellitus, and hypertension, may occur. Many of these effects and complications among arsenicosis patients in Bangladesh have already been reported (5-9).

Cardiovascular effects of chronic arsenic exposure have been documented in some studies. A considerable increase in the prevalence of peripheral vascular disease and cardiovascular diseases among patients with chronic arsenic poisoning has been reported in Taiwan, Chile, Japan, Germany, and Sweden (10,11). An association between drinking arsenic-contaminated water by mothers and congenital heart disease was also found in a study (12). In Bangladesh, an association between arsenic in drinking-water and occurrence of hypertension was reported rather recently (8). Various ECG abnormalities, such as QRS complex broadening, prolonged QT intervals, ST segment depressions, T-wave flattening, and even ventricular tachycardia, had been observed among cases of acute arsenic poisoning and in acute promyelocytic leukaemia patients treated with arsenic trioxide (13-17). This makes it likely that individuals exposed to excess arsenic through drinking-water could show some of these ECG abnormalities. However, in Bangladesh so far, no published reports referring to electrocardiographic (ECG) abnormalities in persons exposed to arsenic through drinking-water are available. This study was, thus, undertaken at the community level to explore if people who were chronically exposed to arsenic (>0.05 mg/L) through drinking tubewell water had ECG abnormalities in excess of those having little (<0.05 mg/L) or no arsenic exposure, and to assess whether such abnormalities were more common among those having clinical manifestations of arsenicosis than those having exposure but no arsenicosis. …

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