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Are interventions to reduce the impact of arsenic contamination of groundwater on human health in developing countries effective? A systematic review

Jones-Hughes, Tracey; Peters, Jaime; Whear, Rebecca; Cooper, Chris; Evans, Hywel; Depledge, Michael; Pearson, Mark

Authors

Tracey Jones-Hughes

Jaime Peters

Rebecca Whear

Chris Cooper

Hywel Evans

Michael Depledge



Abstract

Background
Within developing countries, groundwater provides an alternative drinking source to polluted surface water. However, the presence of arsenic in some groundwater sources has resulted in chronic worldwide poisoning. The aim of this review was to determine the effectiveness of field-based technologies for the removal of arsenic from groundwater in developing countries.

Methods
A structured search strategy was conducted in a range of databases. Titles, abstracts and full texts were screened using pre-defined inclusion criteria. Included studies were quality appraised prior to data extraction. The primary outcome was the percentage of effluent water samples meeting WHO guidelines for arsenic concentrations (≤0.01 mg/L). Secondary outcomes included: (a) arsenic concentrations in effluent water samples meeting the national guideline limit (≤0.05 mg/L), (b) arsenic concentrations in human tissue, and (c) knowledge and attitudes related to the interventions.

Results
Fifty-one reports, evaluating 50 different technologies, were included. Sixty-seven percent (n = 34) of studies were conducted in Bangladesh. Fifty of the included reports were appraised as ‘weak’, with one ‘strong’ report of a randomised-controlled trial.

In summary, the effectiveness of the oxidation and filtration interventions is poor, while the evidence for coagulation, co-precipitation and filtration, subterranean and membrane and electrolytic methods is mixed. Evidence regarding adsorption and zero valent iron interventions is more persuasive with most results suggesting good evidence of effectiveness (i.e. ≥95% of samples with arsenic concentrations ≤0.01 mg/L). In particular, activated alumina and sono/three-kolshi/gagri/pitcher filters have ≥95% of samples meeting national guidelines. Disappointingly, only one study reports excellent evidence of effectiveness: BRAC (2000) for activated alumina (i.e. ≥95% of samples with arsenic concentrations ≤0.01 mg/L).

The success of each technology was highly dependent on context, especially their acceptability to users, a sense of ownership and expectations of women’s roles in society.

Conclusions
Most studies were poorly conducted and reported. Consequently, although some technologies met national guidelines, the evidence-base for decision-making regarding arsenic mitigation technologies at household- and community-level is weak. To improve this situation, primary research needs to be commissioned with adequate sample sizes, testing the impact of key contextual factors, using valid tools for analysis, and meeting standards for completeness of reporting.

Journal Article Type Review
Publication Date May 31, 2013
Journal Environmental Evidence
Print ISSN 2047-2382
Electronic ISSN 2047-2382
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 2
Issue 1
Article Number 11
APA6 Citation Jones-Hughes, T., Peters, J., Whear, R., Cooper, C., Evans, H., Depledge, M., & Pearson, M. (2013). Are interventions to reduce the impact of arsenic contamination of groundwater on human health in developing countries effective? A systematic review. Environmental Evidence, 2(1), doi:10.1186/2047-2382-2-11
DOI https://doi.org/10.1186/2047-2382-2-11
Keywords Arsenic mitigation; Arsenicosis; Drinking water; Groundwater; Developing countries; Systematic review
Publisher URL https://environmentalevidencejournal.biomedcentral.com/articles/10.1186/2047-2382-2-11
Copyright Statement © Jones-Hughes et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Copyright Statement
© Jones-Hughes et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.





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