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Journal of Water Resource and Protection, 2013, 5, 42-45
http://dx.doi.org/10.4236/jwarp.2013.58A006 Published Online August 2013 (http://www.scirp.org/journal/jwarp)
Studies for Intervention and Effect Assessment on
Yajuan Xia#, Kegong Wu, Zhiwei Guo, Weihong Yang, Yanhong Li, Jun Liu
Inner Mongolia Center for Endemic Disease Control & Research, Huhhot, China
Received May 28, 2013; revised June 30, 2013; accepted July 29, 2013
Copyright © 2013 Yajuan Xia et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Chronic exposed to high arsenic via drinking water is worldwide public health problem. A large number of epidemiol-
ogical studies showed that exposed to arsenic cause the human body skin lesions and also induce cancer, cardiovascular
and other kind of diseases. So arsenism not only affect the person’s work capability and life quality but also result in
economic losses and mental suffering. How to prevent and control the effects of high arsenic? What intervention is
more important and necessary for arsenism? How to scientifically assess the interventions effect of short-term and
long-term? Through a systematic follow-up investigation in different high arsenic regions in Inner Mongolia, the envi-
ronmental arsenic and human body internal arsenic exposure were analyzed, the clinical characteristics and signs of
arsenism patients were examined. We established the evaluation system of intervention and control measures for popu-
lation exposed to high arsenic. This evaluation system and control measures included government and exposed popula-
tion. For government, change water supply and keep it work well and health education is very important. For exposed
population, improving the diet and treating the symptoms or signs related to arsenic is more necessary. Arsenic in hu-
man body such as nail or urine sample arsenic must be reduced to normal value and this index show that the subject if
still or not expose to high arsenic.
Keywords: Exposed to Arsenic; Intervention; Assessment
Chronic exposed to high arsenic via drinking water is
worldwide public health problem. More than 20 coun-
tries in different parts of the world, including China, In-
dia and Bengal, have reported that groundwater con-
tained high-arsenic level caused chronic aresenism. A
large number of epidemiological studies showed that
exposed to arsenic cause the human body skin lesions
and also induce cancer, cardiovascular and other kind of
diseases [1-4]. So arsenism not only affect the person’s
work capability and life quality but also result in eco-
nomic losses and mental suffering. How to prevent and
control the effects of high arsenic? What intervention is
more important and necessary for arsenism? How to sci-
entifically assess the interventions effect of short-term
and long-term? In order to reduce the damage of arsen-
ism, China governments have provided large funds to
conduct research on epidemiological investigation, clinic
diagnosis and control measurements. In addition to
changing water in arsenic area, other general preventive
measurements have been taken. This paper provides
some answers through a systematic follow-up investi-
gation in different high arsenic regions in Inner Mongo-
2. Interventions and Control Measures
According to the epidemiological investigation and re-
sults, we conducted a systematic follow-up investigation
after taken some intervention and control measures in
different high arsenic regions. We analyzed the environ-
mental arsenic and human body internal arsenic, exam-
ined the clinical characteristics and signs of arsenism
patients, did questionnaire of person’s behavior habit
changes. The results are as follows.
2.1. Changing Water Supply, the Arsenic in
Drinking Water Is Must Meet to Standard of
*This work was supported by WHO and Inner Mongolia science and
See Table 1. The results show that compare to control
area, the population arsenic in urine sample before and
opyright © 2013 SciRes. JWARP
Y. J. XIA ET AL. 43
Table 1. Urine arsenic and changes in different population
after stop high-arsenic drinking.
Different population N Mean(mg/L)
Control area (As < 0.03 mg/L) 26 0.021 ± 0.013
High-As village: before changing
water supply (0.101 - 0.8247 mg/L) 105 0.709 ± 0.045＊
After changing water supply
for 1 year (As < 0.05 mg/L) 105 0.069 ± 0.053＊
After changing water supply
for 6 years (As < 0.05 mg/L) 105 0.029 ± 0.045
*Compare to control p < 0.01.
after changing water supply one year, there is significant
difference. But after changing water supply for 6 years
there are no difference in urine sample compare to con-
trol. This mean if the persons stop drinking high-As water
for several years, the urine As will tend to normal. So
changing water supply is the most useful control measures.
2.2. Improving Nutrition and Discharging
Arsenic from Body
Analyzed the epidemiology database, the results show
that nail As levels tended to increase with water arsenic
concentrations increasing, while nail arsenic levels tend
to decrease with nail selenium increasing. See Figures 1
and 2 .
Does selenium can discharge arsenic from body? We
try to give the organic selenium 200 μg/day to population
for 3 months who still drink high-arsenic water, analyzed
the urine arsenic and hair arsenic. The results show that
Selenium can discharge the arsenic from the body al-
though the person was still drinking high arsenic water.
There is significant difference of urine and hair arsenic
between before and after given selenium supplement
(p < 0.01). See Table 2 .
Although the urine and nail arsenic is normal after
population stop drinking high arsenic water for several
years, but if we improve their nutrition and give them
supplements, how about the result, does can discharge
some arsenic from body and combined to cell or organ?
We selected some subjects who stop drinking high arse-
nic water for 6 year and give them Centrum supple-
ments (Wyeth company products, complete from A to
Zinc and contain selenium 25 μg/pill), 1 pill each day for
one month, analyzed the urine and nail arsenic. See Ta-
ble 3, there is no significant difference after given sup-
plements, but the nail or urine arsenic increased, from the
results we can guess if the supplements can accelerate
remove the arsenic that combined to cell or organ. So the
supplement or diet is an important cofactor to reduce the
damage of arsenic.
Figure 1. The scatter of water arsenic and nail arsenic.
Figure 2. The scatter of nail arsenic and nail selenium.
Table 2. The effect of discharge ar se nic from selenium.
Selenium N Urine As Mean
Hair As mean
Before given 48 1.078 ± 0.085 4.75 ± 3.25
After given 48 0.046 ± 0.031 1.75 ± 0.98
p < 0.01.
2.3. Treating the Related Symptoms
There is no specific therapeutic drug for arsenism at the
moment, so it is difficult for fully cure the patients. Our
clinical investigation showed that even in some places
where the water source was changed, the control of ar-
senism is not satisfactory, the clinical symptoms and
signs of only 30% patients were improved and 52% pa-
tients no change while 18% patients got worse after in-
tervention . The improvement of symptoms or signs of
arsenism subject will take more than one year, so the
improvement of symptoms or signs of arsenism is not
good indicator in short time. But it still can improve the
life quality of patients through some intervention meas-
ures and treating the related symptoms or disease caused
by arsenic, and the clinical characteristic and signs of
patients would be improved .
Copyright © 2013 SciRes. JWARP
Y. J. XIA ET AL.
Copyright © 2013 SciRes. JWARP
Table 3. The results of supplement for population who stop drinking high- As water.
N Urine As Mean(mg/L) Nail As mean(μg/g)
Before given supplements 36 0.0195 ± 0.013 0.8024 ± 1.58
After given supplements for 3 days (organic selenium ) 36 0.0219 ± 0.085
After given supplements for 5 days (organic selenium ) 36 0.0271 ± 0.031
After given supplements for 30 days (organic selenium ) 36 0.0238 ± 0.045 0.7111 ± 1.28
Urine arsenic: F = 0.126, P = 0.945, p > 0.05: nail arsenic: t = 1.186, p = 0.244, p > 0.05.
2.4. Health Education
Tell people knowledge about the damage of arsenic and
how to reduce the damage whether change water supply
or not. Through health education, more persons know the
knowledge and they actively try to reduce the damage of
arsenic and change their behavior. Table 4 shows the
health knowledge awareness rate of population and be-
havior changes. Such as if the water supply does not
changed, the family try to drink the relative lower arsenic
water, and they try to improve their nutrition and eat
some supplements. The results show health education is
more effective intervention measure.
3. Assessment for the Effects of Intervention
and Control Measures
From our systematic follow-up investigation, we thought
the assessment system should be including environ-
mental indicator (water arsenic), human body internal
arsenic exposure (urine or nail arsenic), health education
effects (awareness rate of health knowledge and behavior
change levels) and patients actively treat the symptoms
or signs related to arsenic.
3.1. Assessment for Effects of Short-Term
Changing water supply and the arsenic meet to standard
of drinking water is the most important and effective
control measure. Arsenic in human body sample (nail or
urine) is a sensitive and rapid indicator that can reflect if
the subjects still exposed to high arsenic or not. So the
water arsenic and population urine or nail arsenic is the
indicators for short-term assessment of intervention and
3.2. Assessment for Effects of Long-Term
Assessment for intervention effects of long-term should
be included the assessment for government and exposed
1) To ensure the quality of change water, the local go-
vernment must focus on the long-term management. The
most important thing is to arrange the qualification test-
ing laboratory monitor the water quality for two times
Table 4. The effects of health education.
Education Awareness rate
of health knowledge Behavior changes
before 50.9% (55/108) 40.74% (44/108)
After 87.96% (95/108) 74.07% (80/108)
Awareness rate: χ2 = 34.909, p < 0.01; behavior changes χ2 = 24.539, p <
each year (one time for dry season and one time for wet
season). If the result is not meet to standard of drinking
water, the lab technologist needs to collect sample and
test again. If the result is really does not meet to the
standard, the local government should find the reasons
why and take appropriate measures. If the results are
above 0.1 mg/L in any serial two times, the water supply
must stop drinking;
2) Monitoring the arsenic in human body sample (nail
or urine). This index can reflect if the low-arsenic water
supply works well or not;
3) Health education, tell the population knowledge
about the damage of arsenic and how to reduce the dam-
age whether change water supply or not. More persons
know the knowledge, the better effect of control. If the
water supply does not changed at the moment, the gov-
ernments should tell the residents which well or water
supply is relatively safe.
For exposed subjects:
1) Ask the person improve the diet or take some sup-
plement. Sufficient nutrition is good for reduce the dam-
age of arsenic;
2) Although the improvement of symptoms or signs of
arsenism is not good indicator in short time, after take
intervention measures for long time, the symptoms or
signs related to arsenic will be improve;
3) Ask the patients actively treat the symptoms or
signs related to arsenic. It will be relieved the patient’s
suffering and delayed the occurrence of long-term effects
caused by arsenic.
The assessment and evaluation system of intervention
and control measures should be including government
and personal efforts and actions. The effect of interven-
tion and control measures should consider the recent time
Y. J. XIA ET AL. 45
and long term. We thought the effects evaluation for
long-term intervention is more important and necessary
for arsenism control.
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Copyright © 2013 SciRes. JWARP