Date of Award

Spring 1-1-2012

Document Type


Degree Name

Master of Arts (MA)



First Advisor

Elisabeth D. Root

Second Advisor

Fernando Riosmena

Third Advisor

Randall Kuhn


Children in Bangladesh continue to experience high mortality rates from acute lower respiratory infections (ALRI) despite ongoing treatment programs. Exposure to inorganic arsenic from contaminated drinking water is also a serious health threat in Bangladesh. While lung diseases are commonly associated with inhalation exposures, studies have suggested that exposure to arsenic from drinking water may also negatively affect the lungs. Employing a disease ecology framework, this thesis examines the patterns of mortality from ALRI and the risk factor of arsenic exposure in children under 2 years old between 1989 and 1996 in Matlab, Bangladesh. During this period a community-based treatment program for ALRI was initiated, while arsenic exposure remained high due to widespread well use and the unknown contamination problem. Using a zero-inflated negative binomial regression model, I first examine the association between arsenic exposure from contaminated drinking water and increased mortality rates. Second, I use a spatial scan statistic to test for local clusters of respiratory infection mortality while using the results of the zero-inflated model to adjust the cluster tests. The results suggest that the ALRI treatment program was successful in reducing mortality and that its placement in the region strongly influences the mortality patterns. Arsenic exposure was not significantly associated with ALRI mortality after controlling for the treatment program, socioeconomic status, and access to care. This study focuses on ALRI mortality and cannot rule out a possible association between arsenic and morbidity from respiratory infections. Future work will address this concern as well as the challenges of estimating retrospective exposure to arsenic from drinking water. The continued burden of ALRI makes it important to continue to evaluate intervention programs alongside potential environmental risk factors, such as arsenic exposure, in order to improve child survival.