Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Jul;115(7):1107-12.
doi: 10.1289/ehp.10051.

Association Between Manganese Exposure Through Drinking Water and Infant Mortality in Bangladesh

Free PMC article

Association Between Manganese Exposure Through Drinking Water and Infant Mortality in Bangladesh

Danella Hafeman et al. Environ Health Perspect. .
Free PMC article


Background: Manganese is a common natural contaminant of groundwater in Bangladesh. In this cross-sectional study we assessed the association between water manganese and all-cause infant mortality in the offspring of female participants in the Health Effects of Arsenic Longitudinal Study Cohort.

Methods: In 2001, drinking water samples were collected, a history of well use was obtained, and a history of birth outcomes was ascertained. To avoid misclassification of exposure, women were included only if they had been drinking from the same well for most of their childbearing years (marriage years - well years </= 2). Of a total of 26,002 births (among 6,537 mothers), 3,837 children were born to women with this profile. The current analysis was based on the portion of these infants (n = 3,824) with recorded exposure and outcome status, 335 of whom died before reaching 1 year of age.

Results: Infants exposed to water manganese greater than or equal to the 2003 World Health Organization standard of 0.4 mg/L had an elevated mortality risk during the first year of life compared with unexposed infants [odds ratio (OR) = 1.8; 95% confidence interval (CI), 1.2-2.6]. Adjustment for water arsenic, indicators of social class, and other variables did not appreciably alter these results. When the population was restricted to infants born to recently married parents (marriage year 1991 or after), this elevation was more pronounced (OR = 3.4; 95% CI, 1.5-7.9).

Conclusions: These preliminary findings indicate a possible association between manganese exposure and infant mortality. However, given the methodologic limitations of this study, the association needs to be confirmed through future work.


Figure 1
Figure 1
Map of wells with known manganese concentration in the 26-km2 study site, according to manganese levels (< 0.4 mg/L vs. ≥ 0.4 mg/L) (n = 1,299 wells).

Similar articles

See all similar articles

Cited by 33 articles

See all "Cited by" articles


    1. Ahsan H, Chen Y, Parvez F, Argos M, Hussain AI, Momotaj H, et al. Health Effects of Arsenic Longitudinal Study (HEALS): description of a multidisciplinary epidemiologic investigation. J Expo Sci Environ Epidemiol. 2006a;16(2):191–205. - PubMed
    1. Ahsan H, Chen Y, Parvez F, Zablotska L, Argos M, Hussain I, et al. Arsenic exposure from drinking water and risk of premalignant skin lesions in Bangladesh: baseline results from the Health Effects of Arsenic Longitudinal Study. Am J Epidemiol. 2006b;163(12):1138–1148. - PubMed
    1. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108(4):e67. - PubMed
    1. Aschengrau A, Zierler S, Cohen A. Quality of community drinking water and the occurrence of spontaneous abortion. Arch Environ Health. 1989;44(5):283–290. - PubMed
    1. Baqui AH, Black RE, Arifeen SE, Hill K, Mitra SN, al Sabir A. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull WHO. 1998;76(2):161–171. - PMC - PubMed

Publication types

LinkOut - more resources