Tubewells and arsenic in Bangladesh: Challenging a public health success story

Bangladesh has seen one of the developing world's great public health successes, the conversion of the drinking water source for 94% of the rural population to 'safe water', in the form of tubewells, with the aim of reducing morbidity and mortality from water-borne disease. Now, that success is being endangered by the discovery that 20 million people may be in great danger and another 20 million in lesser danger of being poisoned by arsenic contamination from tubewell water. This article reports findings from the first national probability sample survey of the rural population and a census of tubewells investigating the social, demographic and epidemiological context of the crisis. The survey covered 3780 households containing 20260 people. The tubewell census covered 9174 tubewells. The article presents data on the respondents' history of drinking tubewell water, knowledge of the arsenic problem, identification of arsenicosis, as well as the impact upon them of the national campaign, the testing of tubewells, and their subsequent sources of water. Eighty-seven per cent of households drank water from ordinary tubewells (at most risk from arsenic poisoning) and 7% from deep tubewells. Among males, 47.5% had heard that something may be wrong with tubewell water, compared with 39.6% of females. A much lower proportion (20.6% males, 11.3% females) had heard that the water contained a poison called arsenic. Only about 1.5% of the entire population had stopped using tubewell water. Of survey respondents, 0.5% of males and 0.4% of females reported symptoms consistent with chronic arsenicosis. Suggestions are made for a more effective programme.