Int J Health Geogr - Spatial patterns of fetal loss and infant death in an arsenic-affected area in Bangladesh.

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Resumo

CKGROUND: 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 ?g/L for the high cluster and 174 ?g/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.

Resumo Limpo

ckground arsenic exposur pregnanc associ advers pregnanc outcom infant mortal knowledg spatial characterist outcom possibl link arsenic exposur import plan effect mitig activ aim studi identifi spatial spatiotempor cluster fetal loss infant death spatial relationship high low cluster fetal loss infant death rate high low cluster arsenic concentr tubewel water use drinkingmethod pregnant women matlab bangladesh use tubewel water drink pregnant includ studi total pregnanc identifi spatial scan test use identifi uniqu nonrandom spatial spatiotempor cluster fetal loss infant death use retrospect spatial spatiotempor permut poisson probabl modelsresult two signific cluster fetal loss infant death identifi cluster remain stabl adjust covari one cluster higher rate fetal loss infant death vicin meghna river cluster lower rate center matlab averag concentr arsenic water differ cluster gl high cluster gl low cluster spatial pattern arsenic concentr tubewel water found link advers pregnanc outcom cluster spatiotempor analysi one high fetal loss infant death cluster identifi high cluster area obtain pure spatial analysi howev cluster longer signific adjust covariatesconclus find studi suggest given geograph variat tubewel water contamin higher fetal loss infant death observ area higher arsenic concentr groundwat illustr possibl link arsenic contamin tubewel water advers pregnanc outcom thus area consid prioriti arsenic mitig program

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