Health effects of flooding in rural Bangladesh.

BACKGROUND: There is little information available on nontraumatic health risks as the result of floods, and on the factors that determine vulnerability to them (especially in low-income settings). We estimated the pattern of mortality, diarrhea, and acute respiratory infection following the 2004 floods in rural Bangladesh. METHODS: We conducted controlled interrupted time-series analysis of adverse health outcomes, from 2001 to 2007, in a cohort of 211,000 residents of the Matlab region classified as flooded or nonflooded in 2004. Ratios of mortality, diarrhea, and acute respiratory infection rates in flooded compared with nonflooded areas were calculated by week for mortality and diarrhea, and by month for acute respiratory infection. We controlled for baseline differences as well as normal seasonal patterns in the flooded and nonflooded areas. Variations in flood-related health risks were examined by age, income level, drinking-water source, latrine type, and service area. RESULTS: After fully controlling for pre-flood rate differences and for seasonality, there was no clear evidence of excesses in mortality or diarrhea risk during or after flooding. For acute respiratory infection, we found no evidence of excess risk during the flood itself but a moderate increase in risk during the 6 months after the flood (relative risk = 1.25 [95% confidence interval = 1.06-1.47]) and the subsequent 18 months. CONCLUSIONS: We found little evidence of increased risk of diarrhea or mortality following the floods, but evidence of a moderate elevation in risk of acute respiratory infection during the 2 years after flooding. The discrepancies between our results and the apparent excesses for mortality and diarrhea reported in other situations, using less- controlled estimates, emphasize the importance of stringent confounder control.

Spatio-temporal patterns of under-five mortality in Matlab HDSS in rural Bangladesh.

BACKGROUND: Knowledge of spatial and temporal distributions of mortality and morbidity is important to prioritise areas for adjusting the public health system where people need services most. A Health and Demographic Surveillance System (HDSS) plays an important role where accurate national vital events are not available in identifying areas and periods with excess mortality risks. METHODS: The HDSS in Matlab, a rural area of Bangladesh, provided data on yearly number of deaths and children aged below 5 years for each of 90 villages during 1998-2007, along with village location points, longitudes and latitudes. Kulldorff's space-time scan statistic was used to identify villages and periods that experienced high mortality risks in the HDSS area with a statistical significance of p < 0.001. Logistic regression was conducted to examine if village-level education and economic status explained village-level mortality risks. RESULTS: There were 3,434 deaths among children aged below 5 years in the HDSS area during 1998-2007 with an average yearly rate of 13 deaths per 1,000 under-five child-years. The mortality rate showed a declining trend with high concentration in 1998-2002, but not in 2003-2007. Two clusters of villages had significantly higher mortality risks in 1998-2002, but not later, and the mortality risks in the high-risk clusters reduced little, but remained significant after controlling for adult education and economic status at village level. CONCLUSIONS: Spatial clustering of childhood mortality observed during 1998-2002 had disappeared in subsequent years with a decline in mortality rates. Space-time scanning helps identify high-risk areas and periods to enhance public health actions.

Socio-demographic differentials of adult health indicators in Matlab, Bangladesh: self-rated health, health state, quality of life and disability level.

BACKGROUND: Mortality has been declining in Bangladesh since the mid- twentieth century, while fertility has been declining since the late 1970s, and the country is now passing through the third stage of demographic transition. This type of demographic transition has produced a huge youthful population with a growing number of older people. For assessing health among older people, this study examines self-rated health, health state, quality of life and disability level in persons aged 50 and over. DATA AND METHODS: This is a collaborative study between the World Health Organization Study on global AGEing and adult health and the International Network for the Demographic Evaluation of Populations and Their Health in developing countries which collected data from eight countries. Two sources of data from the Matlab study area were used: health indicator data collected as a part of the study, together with the ongoing Health and Demographic Surveillance System (HDSS) data. For the survey, a total of 4,000 randomly selected people aged 50 and over (HDSS database) were interviewed. The four health indicators derived from these data are self-rated health (five categories), health state (eight domains), quality of life (eight items) and disability level (12 items). Self-rated health was coded as dummy while scores were calculated for the rest of the three health indicators using WHO-tested instruments. RESULTS: After controlling for all the variables in the regression model, all four indicators of health (self-rated health, health state, quality of life and disability level) documented that health was better for males than females, and health deteriorates with increasing age. Those people who were in current partnerships had generally better health than those who were single, and better health was associated with higher levels of education and asset score. CONCLUSIONS: To improve the health of the population it is important to know health conditions in advance rather than just before death. This study finds that all four health indicators vary by socio-demographic characteristics. Hence, health intervention programmes should be targeted to those who suffer and are in the most need, the aged, female, single, uneducated and poor.

Epidemiological transition in rural Bangladesh, 1986-2006.

BACKGROUND: For understanding epidemiological transition, Health and Demographic Surveillance System plays an important role in developing and resource-constraint setup where accurate information on vital events (e.g. births, deaths) and cause of death is not available. METHODS: This study aimed to assess existing level and trend of causes of 18,917 deaths in Matlab, a rural area of Bangladesh, during 1986-2006 and to project future scenarios for selected major causes of death. RESULTS: The results demonstrated that Matlab experienced a massive change in the mortality profile from acute, infectious, and parasitic diseases to non-communicable, degenerative, and chronic diseases during the last 20 years. It also showed that over the period 1986-2006, age-standardized mortality rate (for both sexes) due to diarrhea and dysentery reduced by 86%, respiratory infections by 79%, except for tuberculosis which increased by 173%. On the other hand, during the same period, mortality due to cardiovascular and cerebrovascular diseases increased by a massive 3,527% and malignant neoplasms by 495%, whereas mortality due to chronic obstructive pulmonary disease and injury remained in the similar level (12-13% increase). CONCLUSION: The trend of selected causes of death demonstrates that in next two decades, deaths due to communicable diseases will decline substantially and the mortality due to non-communicable diseases (NCDs) will increase at massive proportions. Despite Matlab's significant advances in socio-demographic indicators, emergence of NCDs and mortality associated with it would be the major cause for concern in the coming years.