Natural, inorganic arsenic contamination of groundwater threatens the health of more than 100 million people worldwide, including residents of the densely populated river deltas of South and Southeast Asia. Contaminated groundwater from tube wells in Cambodia was discovered in 2001 leading to the detection of the first cases of arsenicosis in 2006. The most affected area was the Kandal Province. The main objective of this study was to determine the prevalence of arsenicosis in Cambodia based on acceptable criteria, and to investigate the use of hair arsenic as a biomarker not only for arsenicosis-related signs but also for associated symptoms. A cross-sectional epidemiological study of 616 respondents from 3 purposely selected provinces within the Mekong River basin of Cambodia was conducted. The Kandal Province was chosen as a high arsenic-contaminated area, while the Kratie Province and Kampong Cham Province were chosen as moderate and low arsenic-contaminated areas, respectively. The most prevalent sign of arsenicosis was hypomelanosis with a prevalence of 14.5% among all respondents and 32.4% among respondents with a hair arsenic level of ≥1 μg/g. This was followed by hyperkeratosis, hyperpigmentation and mee's lines. Results also suggest a 1.0 μg/g hair arsenic level to be a practical cut off point for an indication of an arsenic contaminated individual. This hair arsenic level, together with the presence of one or more of the classical signs of arsenicosis, seems to be a practical criteria for a confirmed diagnosis. Based on these criteria, the overall prevalence of arsenicosis for all provinces was found to be 16.1%, with Kandal Province recording the highest prevalence of 35.5%. This prevalence is comparatively high when compared to that of other affected countries. The association between arsenicosis and the use of Chinese traditional medicine also needs further investigation.
To evaluate the current status of arsenic exposure in the Mekong River basin of Cambodia, field interview along with urine sample collection was conducted in the arsenic-affected area of Kandal Province, Cambodia. Urine samples were analyzed for total arsenic concentrations by inductively coupled plasma mass spectrometry. As a result, arsenicosis patients (n = 127) had As in urine (UAs) ranging from 3.76 to 373 µg L(-1) (mean = 78.7 ± 69.8 µg L(-1); median = 60.2 µg L(-1)). Asymptomatic villagers (n = 108) had UAs ranging from 5.93 to 312 µg L(-1) (mean = 73.0 ± 52.2 µg L(-1); median = 60.5 µg L(-1)). About 24.7 % of all participants had UAs greater than 100 µg L(-1) which indicated a recent arsenic exposure. A survey found that females and adults were more likely to be diagnosed with skin sign of arsenicosis than males and children, respectively. Education level, age, gender, groundwater drinking period, residence time in the village and amount of water drunk per day may influence the incidence of skin signs of arsenicosis. This study suggests that residents in Kandal study area are currently at risk of arsenic although some mitigation has been implemented. More commitment should be made to address this public health concern in rural Cambodia.
We investigated relationship of arsenicosis symptoms with total blood arsenic (BAs) and serum albumin (SAlb) of residents in the Mekong River basin of Cambodia. We found that arsenicosis patients had significantly higher BAs and lower SAlb than asymptomatic villagers (Mann-Whitney U test, p<0.01). Arsenicosis symptoms were found to be 76.4% (1.764 times) more likely to develop among individuals having an SAlb≤44.3gL(-1) than among those who had an SAlb>44.3gL(-1) (OR=1.764, 95% CI=0.999-3.114) and 117.6% (2.176 times) as likely to occur among those with BAs>5.73µgL(-1) than for those having BAs≤5.73µgL(-1) (OR=2.176, 95% CI=1.223-3.872). Furthermore, a significant negative correlation was also found between BAs and SAlb (rs (199)=-0.354, p<0.0001). As such, this study suggests that people with low SAlb and/or high BAs are likely to rapidly develop arsenicosis symptoms.