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Arsenic Poisoning In Bangladesh Question: Discuss about the Systematic Review Of The Arsenic Poisoning In Bangladesh.     Answer: Introduction: Evidence on topic In Bangladesh arsenic poisoning through groundwater is the major public health issue In this country approximately half of the 7-11 million hand pumped tube-wells,  supply ground water with arsenic concentration greater than the 50 microgram/L,. It is more than the maximum level of the arsenic allowed in drinking water According to world report, it is estimated that around 80% (19.3 million) of the people in Bangladesh are affected by arsenic poisoning. The report highlights that it is the neglected issue even decades after the identification of the issue Every one in ten has the probability of developing cancer in Bangladesh and the risk is also found in people of West Bengal, India Elevated concentrations of Arsenic in vegetables, garden soil, and daily intake of Arsenic from other vegetables was observed. It indicated potential health risks when compared with the  FAO/WHO values of metals What Motivated This Review? The issue was found to be neglected even after it was identified decades ago. Further, there are no systematic reviews on this topic although there are many researchers who have explored this topic. Personal interest to learn the changes in arsenic poisoning levels, health issues, and public responses motivated this review. Methods: Search Strategy The data sources that are chosen for this systematic review are Google scholar, CINAHL, PubMed, Medline and web of sciences. In all the five electronic databases, articles that are published within 2010-2017, were considered. The time period was chosen to get latest updates in last seven years. Additional searches include websites for collecting recent information.  The main search terms used for this purpose are – “arsenic” or “poisoning” or “Bangladesh”. Subsequent search includes arsenic* or poisoning and health problems, cancer risk, effected people etc.   Inclusion/Exclusion Criteria Articles containing the terms arsenic poisoning or contamination in Bangladesh were considered. Arsenic poisoning in any other countries were excluded. Articles dealing with arsenic and other trace elements such as phosphate were excluded Studies published in languages other than English were excluded Factors effecting the variability of arsenic in groundwater was excluded Different sources of arsenic pinioning was considered such as rice, vegetables and other dietary components were considered The figure given below shows the PRISMA diagram on how the articles were selected for review.  Results As per longitudinal cohort study, massive mitigation efforts have reduced the water arsenic in rural Bangladesh. However, children still have elevated arsenic exposure from other sources such as rice. Urinary arsenic remains elevated in children. There is a consumption of vegetables and drinking water from other areas contaminated with arsenic Bangladesh is at high risk of an epidemic of arsenic poisoning The country is at greatest risk of arsenic related diseases Arsenic effected people are suffering from social stigma. Mental and physical health issue (skin, liver, lung, and bladder and impaired cognitive development in children) )was profound in Bangladesh associated with arsenic As per the metaanalysis arsenic poisoning is associated with the adverse pregnancy outcomes and infant mortality A recent metaanalysis report showed diabetes associated with arsenic exposure. Evidence was obtained from 32 studies, R = 1.57; 95% CI 1.27–1.93 There is a significant improvement in the awareness of the arsenic poisoning Many international organisations such as UNICEF, WHO, and national NGOs are working on this issue There is greater human health risk due to Arsenic accumulation in rice. From the floodplains, soils have higher soil arsenic concentrations. Arsenic concentrations was high in paddy soil when compared to non-paddy soils Excess mortality in rural areas among adults was associated with the arsenic exposure through drinking water In next 20 years, there could be loss of US$ 12.5 billion if the arsenic poisoning remains same. Economic burden due to health care cost and diseases may woren in near future 4% of the cohort’s future deaths will be attributable to arsenic, if exposure above permissible limit is eliminated by 2030 Conclusion: The issue of arsenic poisoning issue in Bangladesh is prominent public health issues despite several mitigating efforts. There is need of continuous efforts and awareness programs to avoid the terrorism of arsenic. The objectives from the evidence are- Need of increase in awareness particularly in rural areas Collaborate with government and non-governmental bodies to formulate policies on decreasing installation of tube wells Training of health care professionals on how to educate people about health issues and when to seek intervention Further Research Intervention is suggested to increase the assistance to arsenicosis patients by providing more safe alternatives, as well as improving diagnosis and care for patients. Appropriate and robust intervention needs to be devised.   References Chowdhury, M. T. A., Deacon, C. M., Jones, G. D., Huq, S. I., Williams, P. N., Hoque, A. M., … & Meharg, A. A. (2017). Arsenic in Bangladeshi soils related to physiographic region, paddy management, and mirco-and macro-elemental status. Science of The Total Environment, 590, 406-415. Farzan, S. F., Karagas, M. R., Jiang, J., Wu, F., Liu, M., Newman, J. D., … & Argos, M. (2015). Gene–arsenic interaction in longitudinal changes of blood pressure: Findings from the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh. Toxicology and applied pharmacology, 288(1), 95-105. Jochem, W. C., Razzaque, A., & Root, E. D. (2016). Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh. International journal of health geographics, 15(1), 32. Khan, S., Chowdhury, P., Hasnat Milton, A., Hussain, S., & Rahman, M. (2016). A Review of groundwater arsenic contamination in Bangladesh: the millennium development goal era and beyond. Kippler, M., Skröder, H., Rahman, S. M., Tofail, F., & Vahter, M. (2016). Elevated childhood exposure to arsenic despite reduced drinking water concentrations—a longitudinal cohort study in rural Bangladesh. Environment international, 86, 119-125. Loewenberg, S. (2016). In Bangladesh, arsenic poisoning is a neglected issue. The Lancet, 388(10058), 2336. Rahman, M. M., Asaduzzaman, M., & Naidu, R. (2013). Consumption of arsenic and other elements from vegetables and drinking water from an arsenic-contaminated area of Bangladesh. Journal of hazardous materials, 262, 1056-1063. Rahman, M. M., Dong, Z., & Naidu, R. (2015). Concentrations of arsenic and other elements in groundwater of Bangladesh and West Bengal, India: potential cancer risk. Chemosphere, 139, 54-64. Sung, T. C., Huang, J. W., & Guo, H. R. (2015). Association between arsenic exposure and diabetes: a meta-analysis. BioMed research international, 2015. (2017). WHO | Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation. [online] Available at: [Accessed 13 Sep. 2017]. Yunus, F. M., Khan, S., Chowdhury, P., Milton, A. H., Hussain, S., & Rahman, M. (2016). A review of groundwater arsenic contamination in Bangladesh: the millennium development goal era and beyond. International journal of environmental research and public health, 13(2), 215.

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