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

Bangladesh was the scene for one of the developing worlds great public health successes the reduction of morbidity and mortality from water-borne disease by converting the drinking water source for 94 percent of the rural population to tubewells. Now that success is being endangered by the discovery that 20 million people are in great danger and another 20 million in some danger of being poisoned by arsenic contamination from tubewell water. This article reports findings from the first national probability survey of the rural population and a census of tubewells aimed at looking at the social demographic and epidemiological context of the crisis. The survey covered 3780 households reporting on the water source and development of arsenicosis among over 20000 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. The study found that the tubewell revolution has been promoted not only by health considerations but also by the demand for a household water facility and the desire by women to reduce workloads associated with using surface water. Because of this and because the population had absorbed the message about safe tubewell water it is argued that the movement away from the use of tubewell water should be as limited as possible except in the event where no safe tubewells are found in the neighbourhood. The most urgent need is not changing the source of water but comprehensive national water testing. (authors)