Burden of skin lesions of arsenicosis at higher exposure through groundwater of taluka Gambat district Khairpur, Pakistan: a cross-sectional survey.

Prior surveys conducted have found higher proportion of arsenic-contaminated wells in villages along river Indus in Pakistan. This study aims to determine the prevalence of arsenicosis skin lesions among population exposed to higher exposure in taluka Gambat district Khairpur in Sindh. The cross-sectional survey was conducted from August 2008 to January 2009 among 610 households. A total of 707 water sources (hand pumps/wells) were tested from the villages of union councils of Agra and Jado Wahan for arsenic levels with Quick rapid arsenic field test kits. A total of 110 households exposed to arsenic levels >50 ppb were identified. Case screening for arsenic skin lesions was performed for 610 individuals residing in these 110 high-risk households. Information regarding household and socio-demographic characteristics, height and weight measurements and arsenic exposure assessment were collected. Physical examinations by trained physicians were carried out to diagnose the arsenic skin lesions. After data cleaning, 534 individuals from all age groups were included in the final analysis which had complete exposure and outcome information. Overall prevalence of arsenicosis skin lesions was 13.5 % (72 cases). Of the 534 individuals, 490 (91.8 %) were exposed to arsenic levels of ≥100 ppb in drinking water (8.2 % to >50-99 ppb, 58.6 % to 100-299 ppb, 14.6 % to 300-399 ppb and 18 % to ≥400 ppb). Prevalence rate (per 100 population) of arsenicosis was highest at arsenic levels of 100-199 ppb (15.2 cases) followed by ≥400 ppb (13.5 cases) and 300-399 (12.8 cases). Prevalence rate was higher among females (15.2) compared to males (11.3). Our study reports arsenicosis burden due to exposure to higher arsenic levels in drinking water in Pakistan. Exposure to very high levels of arsenic in drinking water calls for urgent action along river Indus. Prevalence of skin lesions increases with increasing arsenic levels in drinking groundwater. Provision of arsenic-free drinking water is essential to avoid current and future burden of arsenicosis in Pakistan.