Educational Partnerships Build Local Capacity to Tackle Environmental Health Problems in India

Professors Allan Smith and Kirk Smith of the UC Berkeley School of Public Health have long-standing relationships with colleagues and institutions in India where the program’s research focus is two-fold: arsenic exposure and indoor air pollution.

Arsenic in Drinking Water
Principal invesitgator Allan Smith, professor of epidemiology, described arsenic in West Bengal, India and neighboring Bangladesh as “the greatest mass poisoning on earth. Millions of people have been exposed and are still being exposed to arsenic in their drinking water.” Ingestion of arsenic-laden drinking water has caused large numbers of people to develop skin pigmentation changes and keratoses on the palms and soles.

Allan Smith’s previous research showed that in northern Chile, after many years, one in 10 people exposed to ground water naturally contaminated with high concentrations of arsenic die as a result of that exposure. “If prompt action isn’t taken in India and Bangladesh, in the long term they’ll have similar mortality,” he said.

Allan Smith and Program Director Ondine von Ehrenstein, epidemiologist at Berkeley, are collaborating with investigators at three institutes in West Bengal, including the All India Institute of Hygiene and Public Health, India’s sole public health school. Scholars from the institutes have collaborated with Berkeley researchers to enhance understanding of exposure to arsenic-laden drinking water.

Scholar Soma Mitra, from the Institute of Post Graduate Medical Education and Research in Kolkata, worked on field research in West Bengal and spent a month at Berkeley to fine tune her methods in studying the role of nutritional deficiencies—such as lack of dietary fiber, calcium, and animal protein—in susceptibility to arsenic-induced skin conditions, such as lesions and pigment changes (see citation).

Current scholars visiting Berkeley include Arin Basu, assistant director of the program in West Bengal, and Anamika Basu from the Indian Institute of Chemical Biology. Anamika Basu is conducting postdoctoral research on genetic susceptibility to arsenic effects with Berkeley Professor of Toxicology Martyn Smith. Arin Basu is studying arsenic metabolism and toxicity in the West Bengal population.

Other trainees have focused on arsenic’s effects on children’s cognitive development, and still others have been engaged in implementing and evaluating interventions to reduce exposure. One such intervention, now in its third year of testing, replaces deep tube wells with shallow, concrete wells. The tube wells were originally constructed to provide a source of drinking water uncontaminated with biological pathogens, such as those that cause diarrhea and parasitic disease. Unfortunately, the tube wells accessed deep groundwater sources ridden with arsenic. The new dug wells, encased in a thick layer of sand that acts as a fi lter for pollutants, tap surface water not contaminated with arsenic. Meera Hira Smith, researcher at Berkeley, directs this program and monitors these new dug wells with Indian colleagues in West Bengal.

Indoor Air Pollution and Tuberculosis
Other Fogarty scholars from India are collaborating with Berkeley Professor of Environmental Health Sciences Kirk Smith and his team to address a potential link between exposure to indoor air pollution and tuberculosis, which has extracted a devastating toll in India, where it is estimated that about 400,000 women and children die prematurely from the exposures each year.

The Berkeley team has designed a study involving three research centers in India and one in Nepal, where 45 percent of the population is thought to be infected with tuberculosis. Although the relationship between indoor air pollution and acute respiratory infections and chronic respiratory disease is well documented, the association between indoor air and tuberculosis has not been well examined.

The study, launched in 2004, comprises four individual case-control studies (one at each research center), and is focusing on women over the age of 20. Because women are most likely to prepare meals, they are known to have the highest exposures to indoor air pollution from cook stoves. They are also less likely to smoke, a behavior that can complicate study results when examining respiratory health.

Two of the study’s trainees, Sankar Sambandam and Ayyappan Ramalingam, both affiliated with participating research center Sri Ramachandra Medical College in Chennai, India, spent Spring semester 2005 at Berkeley. The two took courses on such topics as global burden of disease, environmental epidemiology and characterization of airborne chemicals. Since they have returned home, in addition to collaborating on the tuberculosis study, the two have been involved in an effort to incorporate environmental measures into an upcoming nationwide household health survey in India.

Currently, Suman Sharma, an environmental toxicologist with Nepal’s Ministry of Environment, is here taking courses and working with Kirk Smith and other faculty to develop a research protocol to study childhood pneumonia and indoor air pollution exposure in Nepal.

Workshops Complement Scholar Training
The Fogarty program also sponsors meetings and workshops. An eight-day workshop in December 2005 trained 30 researchers, doctors and policymakers in environmental and molecular epidemiology methods and risk assessment. The participants—from India, Nepal, Pakistan, Sri Lanka, and Bangladesh—were chosen from over a hundred applicants. A workshop planned for March 2006 will bring together investigators from the four tuberculosis study sites to discuss preliminary results and equip researchers with statistical analysis skills.