Promoting and maintaining urinary continence: Follow-up from a cluster-randomized trial of elderly village women in Bangladesh.

AIMS: Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. METHODS: Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.

Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial.

BACKGROUND: Group exercise-based programmes for urinary incontinence appear to be promising low-cost interventions for women in developing countries, but no evidence exists to support whether they could be implemented or effective in such populations. We aimed to evaluate whether a group intervention that comprised pelvic floor muscle training, mobility exercises, and bladder education would be more effective than education alone, and report changes between villages (ie, clusters) rather than between individual participants. METHODS: In this cluster randomised trial, we recruited women from 16 pairs of villages in Bangladesh, with each pair comprising similar villages from the same sub-district. Women aged 60-75 years were interviewed to establish eligibility. Women were eligible if they had current urinary incontinence, and were excluded if they had a third degree or higher uterine prolapse, if they were unable to walk or stand without help, or if they had insufficient intellectual capacity to understand questions and follow instructions. The villages were randomly assigned within each pair to either exercise plus education or education-only intervention by use of a random number generator from a fixed seed. Women were excluded after consenting if they lived too far from the centre of the village. The exercise intervention was a physiotherapist-led group exercise class that was held twice weekly for 12 weeks, with home exercises between classes and to 24 weeks. Both groups received bladder-health education. Participants were followed up for 24 weeks. A 3-day continence record was collected at recruitment and every 4 weeks up until 24 weeks. This record involved the participant tying a knot in ribbons worn under the clothing each time they had an episode of urinary leakage. The primary outcome was change in number of knots (recorded leakage episodes) from recruitment to 24 weeks. Safety was assessed in all participants in the exercise intervention group. The trial is registered at ClinicalTrials.gov, number NCT02453100. FINDINGS: Between Aug 22, 2015, and July 2, 2018, of 3577 women aged 60-75 years identified, 1003 were eligible, of whom 625 consented to participate (n=335 exercise plus education villages, and n=290 in education-only villages). Of these consenting women, 46 were excluded (n=37 exercise plus education, n=9 education only) because they lived too far from the centre of the village. At week 24, 283 (95%) of 298 in the exercise plus education group and 274 (98%) of 281 in the education-only group completed a 3-day continence record. The estimate of change in number of leakage episodes between baseline and 24 weeks was -7·7 (95% CI -10·6 to -4·8) at the village level in an unadjusted model, and -6·64 (-7·95 to -5·33) in a random-effects model accounting for cluster randomisation. No adverse events were reported. INTERPRETATION: A structured group-exercise intervention has the potential to manage urinary incontinence in older women in communities largely outside the reach of pharmaceutical or surgical interventions. FUNDING: Canadian Institutes for Health Research.

Hydrodynamic performance of a hybrid anaerobic baffled reactor (HABR): effects of number of chambers, hydraulic retention time, and influent temperature.

Hydrodynamic performance of a biological reactor is an important design concern since it directly affects the treatment efficiency. In this research, a hybrid anaerobic baffled reactor (HABR) was proposed with improved design concepts and principles. The HABR consisted of a front sedimentation chamber, four regular baffled chambers followed by two floated filter media chambers. The effects of operating variables 5-20 hr hydraulic retention time (HRT) and 10-40 °C of influent temperature, as well as their interactive effects, on the hydrodynamic behaviour were investigated by residence time distributions study and response surface methodology. The study suggests that the hydrodynamic performance is greatly influenced by the number of chambers in the reactor rather than HRT and influent temperature. The influence of HRT and feed temperature were mainly observed on the front chambers (1-4) rather than rear chambers (5-7). The optimum reactor performance - low dead space (<10%), excellent hydraulic efficiency (>0.75), and intermediate mixing pattern (Peclet number > 10) - were achieved using the proposed HABR with more than five chambers.

Disability among elderly rural villagers: report of a survey from Gonoshasthaya Kendra, Bangladesh.

BACKGROUND: The study was set up to identify the extent and nature of difficulty with activities of daily living (disabilities) among elderly village residents of Bangladesh, to describe help currently given and to identify possible interventions. It was carried out at Gonoshasthaya Kendra (GK), a community development organization responsible for the health care of 600 villages with a population of some 1.5 million. METHODS: A survey card was designed and piloted using 12 questions on disability, elaborated from the Washington Group Disability questions, together with a checklist of health problems. A survey was carried out in 2010 in 535 villages under the care of GK since 2005, with village paramedics interviewing residents believed to be age 60 years or older. Respondents were matched where possible to data from the 2005 GK household census, giving data on education, occupation, socioeconomic group and smoking habit. RESULTS: Survey cards were completed for 43417 residents of which 17346 were matched to residents recorded in the GK census as born ≤ 1945. The proportion reporting 'much difficulty' on one or more functional capacities increased steadily with age, reaching 55% (1796/3620) among those ≥ 85 years. Difficulties most frequently reported were lifting and carrying, vision and going outside the home. At all ages women were more likely to report 'much difficulty' than men (OR = 1.43 (1.35 to 1.48)), with widows and the illiterate at greater risk. Health problems, particularly hemiplegia, resting tremor, urinary incontinence and depression were strongly related to the 12 disabilities assessed. Help came almost entirely from family members; of 11211 villagers with 'much difficult' on at least one functional capacity, only 15 reported getting help outside the family. CONCLUSIONS: Disabled elderly residents were dependent on the family for help but, with family cohesiveness under threat from migration to the city, there is a pressing need for the development and critical evaluation of community-based interventions designed specifically for the elderly in poor rural societies. New approaches to training and practice will be needed to integrate such disability management into primary care.

Heavy metal concentrations in some macrobenthic fauna of the Sundarbans mangrove forest, south west coast of Bangladesh.

Heavy metal concentrations in some macrobenthic fauna have been reported for the first time from the Sundarbans mangrove forest, south west coast of Bangladesh, in the northern part of Bay of Bengal. The concentration of Fe, Cu, Zn, Cd and Pb in macrobenthos ranged from 235 ± 10.11 to 1,051 ± 38.42, 3.66 ± 0.89 to 7.55 ± 1.29, 76.8 ± 8.55 to 98.5 ± 6.49, 0.46 ± 0.11 to 0.859 ± 0.2 and 4.66 ± 1.17 to 6.77 ± 2.1 µg/g, respectively. Significant variations (p ≤ 0.05) in heavy metal concentrations have been observed among the mud crab, mudskipper and gastropod. However, heavy metal burdens did not vary significantly among the hermit and horseshoe crabs. In mud crab, horseshoe crab and gastropod, heavy metal concentrations were recorded in the sequence: Fe > Zn > Pb > Cu > Cd. Hermit crab and mudskipper contained heavy metals in the order of Fe > Zn > Cu > Pb > Cd. Fe and Zn concentrations were found significantly (p ≤ 0.05) higher in macrobenthos. The lead (Pb) concentration found in the edible portion of macrobenthos exceeded the international permissible limits certified by the WHO. Bioconcentration factors >1.00 obtained for Fe (17.05 in mudskipper) and Cd (1.87 in gastropod) indicated that these metals were highly bioaccumulated and biomagnified in benthic fauna of Sundarbans. The findings of this study refer to the potential impact of heavy metals in the mangrove ecosystem of Bangladesh.