A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh

Joseph Graziano; Pam Factor-Litvak; Xinhua Liu; Alessandro Tarozzi; Diane K. Levy; Tariqul Islam; Kazi Matin Ahmed; Joyce Moon-Howard; Christine Marie George; Alexander van Geen; Vesna Slavkovich; Ashit Signha

A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh
Graziano, Joseph
Factor-Litvak, Pam
Liu, Xinhua
Tarozzi, Alessandro
Levy, Diane K.
Islam, Tariqul
Ahmed, Kazi Matin
Moon-Howard, Joyce
George, Christine Marie
van Geen, Alexander
Slavkovich, Vesna
Signha, Ashit
Lamont-Doherty Earth Observatory
Environmental Health Sciences
Sociomedical Sciences
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Book/Journal Title:
Environmental Health
Geographic Area:
Arsenic, Health educational intervention, Bangladesh
BioMed Central
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 50 μg/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.
Environmental health
Public health
Drinking water--Arsenic content
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Joseph Graziano, Pam Factor-Litvak, Xinhua Liu, Alessandro Tarozzi, Diane K. Levy, Tariqul Islam, Kazi Matin Ahmed, Joyce Moon-Howard, Christine Marie George, Alexander van Geen, Vesna Slavkovich, Ashit Signha, , A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh, Columbia University Academic Commons, .

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