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Naser AM, Doza S, Rahman M, Unicomb L, Ahmed KM, Anand S, Selim S, Shamsudduha M, Narayan KV, Chang H, Clasen TF, Gribble MO, Luby SP. Consequences of access to water from managed aquifer recharge systems for blood pressure and proteinuria in south-west coastal Bangladesh: a stepped-wedge cluster-randomized trial. Int J Epidemiol 2021; 50:916-928. [PMID: 32653912 PMCID: PMC8271187 DOI: 10.1093/ije/dyaa098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Drinking-water salinity has been associated with high blood pressure (BP) among communities in south-west coastal Bangladesh. We evaluated whether access to water from managed aquifer recharge (MAR)—a hydrogeological intervention to lower groundwater salinity by infiltrating rainwater into the aquifers—can reduce community BP. Methods We conducted a stepped-wedge cluster-randomized trial with five monthly visits between December 2016 and April 2017 in 16 communities. At each visit following baseline, four communities were randomized to access MAR water. Systolic BP was the primary outcome, measured during each visit using Omron® HEM–907 devices. We also measured participants’ 24-hour urinary sodium and households’ drinking- and cooking-water salinity each visit. We used multilevel regression models to estimate the effects of MAR-water access on participants’ BP. The primary analysis was intention-to-treat. Results In total, 2911 person-visits were conducted in communities randomized to have MAR-water access and 2834 in communities without MAR-water access. Households without MAR-water access predominantly used low-salinity pond water and 42% (range: 26–50% across visits) of households exclusively consumed MAR water when access was provided. Communities randomized to MAR-water access had 10.34 [95% confidence interval (CI): 1.11, 19.58] mmol/day higher mean urinary sodium, 1.96 (95% CI: 0.66, 3.26; p = 0.004) mmHg higher mean systolic BP and 1.44 (95% CI: 0.40, 2.48; p = 0.007) mmHg higher mean diastolic BP than communities without MAR-water access. Conclusions Our findings do not support the scale-up of MAR systems as a routine drinking-water source, since communities that shifted to MAR water from the lower-salinity pond-water source had higher urinary sodium and BP.
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Affiliation(s)
- Abu Mohd Naser
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Solaiman Doza
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Kazi M Ahmed
- Department of Geology, University of Dhaka, Dhaka, Bangladesh
| | - Shuchi Anand
- Division of Nephrology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Mohammad Shamsudduha
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Department of Geography, University of Sussex, Brighton, UK
| | - Km Venkat Narayan
- Hubert Department of Global Health, Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew O Gribble
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
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