TY - JOUR
T1 - A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh
AU - George, Christine Marie
AU - Van Geen, Alexander
AU - Slavkovich, Vesna
AU - Singha, Ashit
AU - Levy, Diane
AU - Islam, Tariqul
AU - Ahmed, Kazi Matin
AU - Moon-Howard, Joyce
AU - Tarozzi, Alessandro
AU - Liu, Xinhua
AU - Factor-Litvak, Pam
AU - Graziano, Joseph
N1 - Funding Information:
This study was supported by funds from the National Institute of Health grant number NIEHS ES P42 10349 and the Earth Institute at Columbia University. In addition, Christine Marie George was the recipient of an EPA Star Fellowship and a Fulbright Fellowship. We would like to thank the Christian Commission for Development Bangladesh (CCDB) and our arsenic testers for their support of our project: Dr. Afroz Mahal and Almas Hossain. We would also like to thank the staff at the Columbia University Arsenic & Health Research in Bangladesh office and our interviewers from Dhaka University, Department of Geology for their tireless support: Khaled Hasan, Zakir Hossain, Sawkat Haiat Sarwar, Dr. Rakibuz Zaman, Dr. Mahfuzar Rahman, Dr Abu Bakar Siddique, Golam Sarwar, Nur-E-Azam Sarwar, Shariful Islam Khan, Lisma Akhter, Shawkat Jahangir, Shahid Ahmed Sorwar, Nahid Farjana, Tahmina Akter, Jesmin Neher, Murad Hossain, Ershad Bin Ahmed, Iftakharul Alam, Jahid Alam, Masud Al Noor, Majibul Hosain, Anisur Rahaman Khan, Jismin Neher, Jakir Hossain Mir, Kalpana Rani Das, and Abul Kalam Azad.
PY - 2012
Y1 - 2012
N2 - Objective. To reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks. Methods. We conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks. Results: Overall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50g/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source. Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased. Conclusion: The overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.
AB - Objective. To reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks. Methods. We conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks. Results: Overall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50g/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source. Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased. Conclusion: The overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.
KW - Arsenic
KW - Bangladesh
KW - Health educational intervention
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UR - http://www.scopus.com/inward/citedby.url?scp=84870212838&partnerID=8YFLogxK
U2 - 10.1186/1476-069X-11-41
DO - 10.1186/1476-069X-11-41
M3 - Article
C2 - 22713347
AN - SCOPUS:84870212838
SN - 1476-069X
VL - 11
JO - Environmental Health: A Global Access Science Source
JF - Environmental Health: A Global Access Science Source
IS - 1
M1 - 41
ER -