International Journal of Health Geographics | 2010
Authors:
DOI: 10.1186/1476-072X-9-53
Journal: International Journal of Health Geographics
Year: 2010
Publisher:
Document Type: Article
Open Access: All Open Access; Gold Open Access; Green Open Access
Cited by: 48
Background: Arsenic exposure in pregnancy is associated with adverse pregnancy outcome and infant mortality. Knowledge of the spatial characteristics of the outcomes and their possible link to arsenic exposure are important for planning effective mitigation activities. The aim of this study was to identify spatial and spatiotemporal clustering of fetal loss and infant death, and spatial relationships between high and low clusters of fetal loss and infant death rates and high and low clusters of arsenic concentrations in tube-well water used for drinking.Methods: Pregnant women from Matlab, Bangladesh, who used tube-well water for drinking while pregnant between 1991 and 2000, were included in this study. In total 29,134 pregnancies were identified. A spatial scan test was used to identify unique non-random spatial and spatiotemporal clusters of fetal loss and infant death using a retrospective spatial and spatiotemporal permutation and Poisson probability models.Results: Two significant clusters of fetal loss and infant death were identified and these clusters remained stable after adjustment for covariates. One cluster of higher rates of fetal loss and infant death was in the vicinity of the Meghna River, and the other cluster of lower rates was in the center of Matlab. The average concentration of arsenic in the water differed between these clusters (319 μg/L for the high cluster and 174 μg/L for the low cluster). The spatial patterns of arsenic concentrations in tube-well water were found to be linked with the adverse pregnancy outcome clusters. In the spatiotemporal analysis, only one high fetal loss and infant death cluster was identified in the same high cluster area obtained from purely spatial analysis. However, the cluster was no longer significant after adjustment for the covariates.Conclusion: The finding of this study suggests that given the geographical variation in tube-well water contamination, higher fetal loss and infant deaths were observed in the areas of higher arsenic concentrations in groundwater. This illustrates a possible link between arsenic contamination in tube-well water and adverse pregnancy outcome. Thus, these areas should be considered a priority in arsenic mitigation programs. © 2010 Sohel et al; licensee BioMed Central Ltd.
Abortion, Spontaneous; Adult; Arsenic; Arsenic Poisoning; Bangladesh; Cluster Analysis; Female; Geographic Information Systems; Humans; Infant; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Poisson Distribution; Pregnancy; Retrospective Studies; Rural Health; Socioeconomic Factors; Water Pollutants, Chemical; Young Adult; Bangladesh; Meghna River; arsenic; arsenic; drinking water; infant mortality; mitigation; pollution exposure; pregnancy; spatial analysis; adult; arsenic poisoning; article; Bangladesh; chemically induced disorder; cluster analysis; female; geographic information system; health; human; infant; infant mortality; low birth weight; newborn; Poisson distribution; pregnancy; retrospective study; socioeconomics; spontaneous abortion; water pollutant