Background: Chronic exposure to well water arsenic (As) remains a major rural health challenge in Bangladesh and some other developing countries. Many mitigation programs have been implemented to reduce As exposure, although evaluation studies for these efforts are rare in the literature.

Objectives: In this study we estimated associations between a school-based intervention and various outcome measures of As mitigation.

Methods: We recruited 840 children from 14 elementary schools in Araihazar, Bangladesh. Teachers from 7 schools were trained on an As education curriculum, whereas the remaining 7 schools without any training formed the control group. Surveys, knowledge tests, and well-water testing were conducted on 773 children both at baseline and postintervention follow-up. Urine samples were collected from 210 children from 4 intervention schools and the same number of children from 4 control schools. One low-As (< 10 μg/L) community well in each study village was ensured during an 18-month intervention period.

Results: After adjustment for the availability of low-As wells and other sociodemographic confounders, children receiving the intervention were five times more likely to switch from high- to low-As wells ( p < 0.001). We also observed a significant decline of urinary arsenic (UAs) ( p = < 0.001) (estimated β = –214.9; 95% CI: –301.1, –128.7 μg/g creatinine) among the children who were initially drinking from high-As wells (> Bangladesh standard of 50 μg/L) and significantly improved As knowledge attributable to the intervention after controlling for potential confounders.

Conclusions: These findings offer strong evidence that school-based intervention can effectively reduce As exposure in Bangladesh by motivating teachers, children, and parents.

Citation: Khan K, Ahmed E, Factor-Litvak P, Liu X, Siddique AB, Wasserman GA, Slavkovich V, Levy D, Mey JL, van Geen A, Graziano JH. 2015. Evaluation of an elementary school–based educational intervention for reducing arsenic exposure in Bangladesh. Environ Health Perspect 123:1331–1336;  http://dx.doi.org/10.1289/ehp.1409462

Address correspondence to J.H. Graziano, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St., 11th Floor, New York, NY 10032 USA. Telephone (212) 305-1678. E-mail: jg24@columbia.edu

*Current address for K.K.: Department of Environmental Health, School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, USA. E-mail: kmkhan@indiana.edu

We thank the Bangladesh NGO Forum for sharing teaching materials that they had prepared for use in elementary schools as these comprised a portion of our classroom intervention materials. We also thank WaterAid Bangladesh (WAB)—particularly K. Islam—for their collaboration regarding the installation of deep low-As wells, for their success in training village members to maintain these wells, and for successfully transferring the ownership of the wells to the villages, with local government approval. We also thank Z. Rahman and H. Ferdous for their dedicated contributions to the field work.

This work was supported by National Institutes of Health (NIH)/National Institute of Environmental Health Sciences grants P42 ES 10349 and P30 ES 09089, and by a training grant (5D43TW005724) from the NIH Fogarty International Center.

The authors declare they have no actual or potential competing financial interests.

Received: 11 November 2014 Accepted: 6 May 2015 Advance Publication: 8 May 2015 Final Publication: 1 December 2015

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