Association of climate variability and childhood diarrhoeal disease in rural Bangladesh, 2000-2006.

This study examined the effects of meteorological factors, particularly, extreme weather events, on the prevalence of childhood diarrhoeal disease in Matlab, Bangladesh. Logistic regression models were used to examine impacts of temperature, rainfall and the extreme weather factors (the number of hot days and days with heavy rainfall) on childhood diarrhoea from 2000 to 2006 at the bari (cluster of dwellings) level. The results showed that the increases in the number of hot days and days with heavy rainfall were associated with an increase in daily diarrhoea cases by 0·8-3·8% and 1-6·2%, respectively. The results from multivariable stepwise models showed that the extreme weather factors were still positively associated with childhood diarrhoea, while the associations for average temperature and rainfall could be negative after other variables were controlled. The findings showed that not only the intensity, but also the frequency of extreme weather events had significant effects on childhood diarrhoea.

Assessment of non-marital sexual behaviours of men in Bangladesh: a methodological experiment using a modified confidential ballot-box method.

This study assessed the effectiveness of a modified ballot-box method (MBBM) in eliciting non-marital sexual behaviours compared with face-to-face interview (FTFI). A cross-sectional survey collected data from men aged 18-49 years in Bangladesh using a multistage cluster sampling method. In total, 3499 and 3623 respondents were interviewed by MBBM and FTFI, respectively. In the MBBM, pre-recorded questions were administered using a portable audio-cassette player with two pairs of headphones used concurrently by the respondent and the interviewer. Overall, 18% of the respondents had non-marital sexual exposure in the past year. The MBBM elicited higher responses of non-marital sex (adjusted odds ratio (aOR) 1.3, 95% confidence interval [CI]: 1.1, 1.5) compared with FTFI. The interview methods did not, however, revealed significant differences in response to condom-use rates and the number of non-marital sexual partners. The MBBM is more effective than the FTFI method in eliciting higher responses rates of non-marital sexual contacts and may be recommended for reliable estimates of sexual behaviours.

A population-based case-control study of 1250 stroke deaths in rural Bangladesh.

BACKGROUND AND PURPOSE: There are limited population-based studies to determine the risk factors for stroke in Bangladesh. METHODS: A health and demographic surveillance system has been maintained in Matlab, Bangladesh (population 223 886, 142 villages in 2008). All adult stroke and injury deaths (2005-2008) were monitored by verbal autopsy. Risk factors for stroke deaths were calculated using a multivariable logistic regression model with adult injury deaths as controls. RESULTS: A total of 1250 stroke deaths (51% women; mean age 72.3 years, range 20-101) occurred out of 4955 total deaths and were compared with 246 adult injury deaths (47% women, mean age 55.8 years, range 20-100). The population-attributable mortality of stroke was 25.2% based on the verbal autopsy instrument and 17.8% when accounting for the reported sensitivity and specificity of a similar verbal autopsy instrument that has been validated for stroke death. Risk of stroke death was significantly increased with hypertension (OR 7.94, 95% CI 4.44-15.54, P < 0.001), diabetes mellitus (OR 2.54, 1.21-6.21, P = 0.02), and betel consumption (OR 2.36, 1.45-3.80, P < 0.001) when adjusted for age and sex. An increased risk was not observed with heart disease (OR 1.37, 0.45-5.95, P = 0.62), cigarette smoking (OR 1.41, 0.82-2.45, P = 0.22), tobacco powder (OR 1.15, 0.30-7.64, P = 0.86), or cigar/hookah pipe smoking 0.94 (0.45-2.18, P = 0.88) when adjusted for age and sex. There were more strokes in winter (December-March) than summer (June-September) (P < 0.001). CONCLUSIONS: There is a high modifiable burden of risk factors for adult stroke deaths in rural Bangladesh, most notably including hypertension. Betel consumption may be an under-recognized risk factor for stroke death.

Effect of deep tube well use on childhood diarrhoea in Bangladesh.

OBJECTIVE: To determine whether the installation of deep tube wells to reduce exposure to groundwater arsenic in rural Bangladesh had an effect on the incidence of childhood diarrhoeal disease. METHODS: Episodes of diarrhoeal disease in children aged under 5 years that occurred on one specified day each month between 2005 and 2006 were reported to community health workers for six rural villages. A geographical information system containing details of household water use and sanitation in the villages was built using data obtained by a global positioning system survey. The information system also included health, spatial and demographic data. A field survey was carried out to determine whether households obtained drinking water from deep tube wells installed in 2005. The effect of deep tube well use on the incidence of childhood diarrhoea was assessed using a random effects negative binomial regression model. FINDINGS: The risk of childhood diarrhoea was 46% lower in the 179 households that used a deep tube well than in the 364 that used a shallow tube well (P=0.032). Neither socioeconomic status, latrine density, population density nor study year had a significant influence on disease risk. The incidence of childhood diarrhoea declined dramatically between 2005 and 2006, irrespective of water source. CONCLUSION: The introduction of deep tube wells to reduce arsenic in drinking water in rural Bangladesh had the additional benefit of lowering the incidence of diarrhoea among young children.

Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh.

Recent mortality data indicate that approximately half a million people drown each year worldwide, with more than 97% of such deaths occurring in low-income and middle-income countries. The purpose of this study was to examine verbal autopsy data on the circumstances of childhood drowning in Matlab, Bangladesh. The study analysed 10 years (1996-2005) of data which reported 489 deaths in children under 5 years and recorded preimmersion, immersion and postimmersion events. The data summarised household characteristics, age, gender and time of drowning event. The study also examined traditional rescue methods performed on children who were removed from the water OR found drowning. Of 489 deaths, 57% were aged 1-2 years and had a drowning mortality rate of 521 per 100 000 children. Most drowning events occurred during the morning (68%), in ponds (69%), and while the mother was busy doing household chores (70%). Traditional rescue methods were attempted in 55% of children and the most frequently reported measure was to spin the child over head (35%). Only 3% of families tried to perform resuscitation. Verbal autopsy data for Matlab is a useful resource for childhood injury research in a low-income country. The study is one of the first to publish data on traditional rescue practices performed on drowning children in rural Bangladesh. The findings suggest that interventions should be designed using locally identified risk factors to reduce childhood drowning incidents. Community-based resuscitation techniques and emergency medical systems are needed to improve postimmersion recovery of the child.

Implementation of a medical geographic information system: concepts and uses.

This paper introduces a medical geographic information system which has been implemented to enhance public-health research by facilitating the modelling of spatial processes of disease, environment, and healthcare systems in a rural area of Bangladesh. In 1966, a surveillance system was implemented to record all vital demographic events in the study area. Selected information on reproductive and child health, socioeconomic conditions, and health and family-planning interventions is being collected for the surveillance database. This paper discusses the conceptual design of integrating the surveillance database with the medical geographic information system and its use in conducting multidisciplinary health research. The paper is intended to help those who wish to implement a health-based geographic information system to understand the links between people and their environments and to better meet the health needs of target communities.