Association between Manganese Exposure through Drinking Water and Infant Mortality in Bangladesh

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.