groundwater iron an important source for women in Bangladesh

Iron deficiency is the most common micronutrient deficiency in the world.  Although many believe that anemia and iron deficiency are synonymous (as I did until a few weeks ago), iron deficiency is but one  cause of anemia.   Iron deficiency and anemia are both associated with increased risk of morbidity and mortality and pose a real threat to women in the developing world.

Scientists have shown that iron-fortified water and cooking with cookware can both lead to improved iron status but few believed that natural sources of iron in groundwater could offer iron in the correct state, and in high enough concentrations, to have nutritional benefits.  That is, until researchers from a large nutrition study in Bangladesh, JiVita, noted that women in their target area had much lower prevalence of anemia, iron deficiency, and iron deficiency anemia than much of the country.  They started to ask themselves what makes this population different. They failed to attribute these discrepancies to demographics, differences in dietary intake of iron, and differences in the prevalence of other infections/diseases.  Next they turned to the women’s water source.

This population almost exclusively drinks from groundwater through tubewells. Despite the high variability of groundwater iron concentration in Bangladesh, they found a median total iron concentration of 16.7 mg/L -  greater than other parts of the country with higher iron deficiency prevalence. The team estimates that women in the study ingest ~42 mg/day of total iron and expects a 6% increase in ferritin concentration for every additional 10mg/day.

So in short, it seems that groundwater iron can offer nutritional benefits to women.  These nutritional benefits may in turn reduce mortality and morbidity associated with iron deficiency and anemia.

So why do I think this is interesting?

1. This may be important to consider when treating water in areas with high concentrations of iron in their groundwater.  In Bangladesh, what is the impact on nutrition of all the technologies that remove iron at the same time as arsenic?

2. Will iron concentration in groundwater now play an important role in nutrition studies?

If you want to learn more about this, here is a great presentation by Rebecca Merrill who did a large part of this research for her doctoral dissertation.

myopia

The terms myopia and myopic (or the common terms short sightedness or short sighted) have also been used metaphorically to refer to cognitive thinking and decision making that is narrow sighted or lacking in concern for wider interests or longer-term consequences.” -Wikipedia (8/9/09)

I started to think about this term after reading a paper from Environmental Health Perspectives called Public Health Strategies for Western Bangladesh That Address Arsenic, Manganese, Uranium, and Other Toxic Elements in Drinking Water. The authors of this paper sampled a number of tube wells in Western Bangladesh to investigate the water quality, not only with respect to Arsenic but an array of other potential toxicants.   They found levels exceeding WHO health-based drinking water guidelines for Uranium, Manganese, Arsenic, Chromium, and Lead along with significant levels of other important elements like Antimony.  Why is this interesting one may ask?

After drilling millions of tube wells to save people from the morbidity and mortality related to gastrointestinal illnesses, UN agencies and the Bangladesh Government realized that they had exposed millions of people to arsenic.  This arsenic shifted the causes of illness and death related to water to other ailments like cancer (lung/bladder/skin).  Most of you know how this happened but in case you don’t…They simply didn’t test the water for Arsenic!!!

With so much focus on dealing with the arsenic problem, are we forgetting about other potential toxicants in the water?  This study seems to suggest we may be – at least in some parts of Bangladesh.  The government of Bangledesh is focused on testing each and every well for As but does not look at many of these other elements mentioned in the article (it should be noted that Arsenic probably poses the biggest threat to the population but the possible effects of the others are by no means negligible).   The authors note that in wells exceeding limits for As Uranium was not often found in quantities above the limit. However, the household treatment technology that many use to remove arsenic could actually increase the dissolved Uranium concentration (by making otherwise insoluble form soluble)….

This type of myopia happens all the time the water and sanitation sector.  We want to focus only on provision of clean water but don’t want to think about the multiple other pathways for enteric pathogen transmission.   We focus on toilets but forget that there is no readily accessible water to wash hands….Hopefully it won’t take another mass poisoning for us to wake up and look at the big picture.

Check out the article it is pretty interesting (oh and try to estimate the carbon footprint of the samples that made their way from India to Dubai to France to Vermont,USA)