RESEARCH PROGRAM

DCH Trust is doing various research activities on Health, Arsenic and Occupational Health Safety in collaboration with local and international organizations or institutions like Harvard School of Public Health, HarvardUniversity, Oregon State University-USA, Boston Children Hospital -USA, South Australia University, Jadovpur University-India, Universiti Sains Malaysia.

Research Program with Harvard University

1. Title: Molecular Epidemiology of Arsenic exposure and Skin Lesions in Bangladesh

A Collaborative Study between Harvard School of Public Health (HSPH), Boston, USA and Dhaka Community Hospital (DCH) .

DCH and Harvard School of Public Health (HSPH), were conducting this project in Bangladesh. DCH was operating all the field activities including household survey, patient identification, staging and sample collection and testing. The project was also provided alternative safe water and treatment to the patients with free of cost.

Under the project DCH conducted different studies in Bangladesh. a) Case-Control Study b) Repeated Measures Study c) Case-Control Follow up Study d) Biomarker of Arsenic Related Reproductive study e) Bangladesh Follow-Up: Metals and Child Development Study

a) Case-Control Study:InBangladesh, there is a problem with poison called arsenic in the drinking water. This sometimes causes diseases of skin and other parts of body. The reason for our research was to find out how arsenic is handled in the body and whether it has affected human health, particularly skin.

The program activities included:

Consent Form Fill-up,

Questionnaire fill-up about health and drinking water history,

Some biological sample (Drinking water, Toenail, Urine, Blood) collection for arsenic test.

Total 1800participants both male and female directly benefited from this program

b) Repeated Measures Study:We conducted a repeated –measure study on 50 families, 25 families from areas where water samples were reportedly low or few skin lesions havereported and another 25 families from areas where water samples were reportedly high and more skin lesions. The dosimetry study describes the quantitative exposure-biomarker-response relationships for water and dietary exposures versus urine and nail biomarkers.

The program activities included:

Consent Form Fill-up,

Questionnaire fill-up abouthealth and drinking water history,

samples of drinking water, toenails and urine collected longitudinally (monthly) over a 12 month period.

c) Case-Control Follow-up study:This study was re-contactingthe original 1800 participants aspossible who took part in the Case-Control study. Continuation of this study was evaluate the chronic effects of arsenic exposure on skin lesions, the effect of chronic arsenic exposure on glucose toleranceand the effectiveness of the arsenic mitigation program on reducing arsenic exposure.

Schedule activities included:

Administer questionnaires ( socio-demographic variables, medical history, water history, food frequency),

collect the biological samples ( Blood,Toenail, Urine and Skin biopsy).

Photograph skin lesions,

Random glucose test

d) Biomarker of Arsenic Related Reproductive study:Arsenic contamination of tube wells in Bangladesh is a major environmental and public health disaster. While arsenic has been associated with numerous health outcomes including skin lesions, skin cancer, internal organ cancers, neurological effects and cardiovascular effects, little is known about the potential reproductive effects of chronic arsenic exposure.

This investigate focused on the arsenic affected area of Bangladesh with overall objectives -To investigate the relationship between maternal arsenic exposure and arsenic concentrations in the infant, estimate the effects of arsenic exposure on adverse birth outcomes such as low birth weight, low weight for gestational age.

The study activities included:

Consent Form Fill-up,

Questionnaire fill-up (about medical history, nutrition, drinking water history)

Medical examination,

Ultrasonogram,

Sample collection (blood, drinking water, toenails, hair, urine and buccal cell).

e) Bangladesh Follow-Up: Metals and Child Development Study: Overview of the study: To find the children who have been born into the Repro Study & their neurodevelopment. This information helped us learn how exposures to arsenic and other metals such as manganese and lead affect brain development in child. We have schedule a clinic visit for children two times at 12 months of age and when they were between 20-40 months of age.

Target enrollment goals: 827 children who were between 12-40 months old.

Study activities included:

Re-consent fill-up,

Questionnaire fill-up ( Medical history, Nutrition, Maternal stress)

medical examination,

Maternal IQ test,

Home score, sample collection (Blood, Hair, Nail, Buccal, water),

Bayley Scales of Infant Development

Data entry in RedCap

Research Program with Boston Children Hospital, USA

2 .a) Case-Control Study of Neural Tube Defects and Arsenic -Pilot Study

This study collaborate between Boston Children Hospital, USA andDhaka Community Hospital.

Neural tube defects are serious birth defects that result from the failure of the neural tube to close in early gestation, resulting in life-long disabilities and varying degreesof paralysis in surviving infants. This study was a case-control study to examine the association between environmental arsenic exposure and neural tube defects in Bangladesh. The cases to recruit from neurological clinics and controls from same communities that gives rise to the cases.

The specific aim of this study :i) to investigate the relationship between maternal arsenic exposure and risk of nural tube defects ii) to investigate the association between neural tube defects and genetic polymorphisms of arsenic biotransformation as well as of folate metabolism iii) to investigate gene-environment interactions among children with neural tube defects.

Study activities included:

Consent form fill-up, Questionnaire fill-up ( Mother and family history,Child history, Nutrition)

Sample collection (Blood, Hair, Nail, Buccal, water),

GIS of drinking water,

Data entry in RedCap

b) A New Model for Chronic Respiratory Disease: Dose Enviromental Arsenic Exposure Induce a Novel Form of Cystic Fibrosis

This research study has assessed the relationship between environmental arsenic exposure, respiratory function and sweat chloride levels in Bangladesh. The goal was to recruit 100 adult participants both men and women. All participants from the Case-Control study who could approachabout the Cystic Fibrosis Study. This study participant wasrecruited fromPabna.Participantswere divided into following 6 groups: Group-1: Men with Low arsenic exposure based on their toenail (Controls)Group-2: Men with High arsenic exposure based on their toenail (Controls)Group-4: Women with Low arsenic exposure based on their toenail (Controls)Group-5: Women with High arsenic exposure based on their toenail (Controls)Group -5: Men with High arsenic exposure based on presence of skin lesions (Cases)Group-6: Women with High arsenic exposure based on presence of skin lesions (Cases)

There was only onevisit for this study. The following data were collected during the study visit:

Informed Consent

Study Questionnaire

Sample collection

Pulmonary Function Test

Sweat test

Chest X-ray

Research Program with Oregon State University, USA

3. Arsenic Exposure and Immune Function Pilot Study

This study collaborate between Oregon State University, USA and Dhaka Community Hospital

This was the pilot study on 50 children who were 3 years of age or older, 25 children whose mothers had high arsenic concentrations in their water during pregnancy and match them on age and gender to 25 children whose mother had very low arsenic concentrations in their water during pregnancy. The reason of this study is to find out if arsenic affects Childs health and their ability to fight infections.Study activities included:

Consent form fill-up,

Questionnaire fill-up ( Physical examination, Medical history, Feeding & Drinking water,

Household Characteristics and Nutrition)

Sample collection (Blood, Hair, Nail, Fecal)

Research Program with Universiti Sains Malaysia

4. Epidemiology and Genetic Anlaysis on Nonsyndomic Cleft Lip and Palate Patients among Bangladesh PopulationsUniversiti Sains Malaysia

This study is a part of voluntarily in a research study of non-syndomic cleft lip and palate.The specific objectives of this study –to determine the clinic epidemiology, environmental factors and inheritance pattern of cleft population in Bangladesh, to treat underprivileged children with cleft lip and palate, to determine the effectiveness of cleft treatment protocol in Bangladesh populations and to determine genetic analysis in Bangladesh populations and novel candidate genes involved in the development of cleft lip and population.

And the research activities included :Data Collection of cleft patient and families,

Treatment to the cleft patient,

Improvement of Treatment protocol,

Collection of Blood and Tissue samples,

Investigation of Genetic Analysis from Blood and Tissue sample,

Data analysis.