Mortality in a cohort of Staffordshire pottery workers: follow-up to December 2008.

OBJECTIVES: To examine mortality from lung cancer, chronic obstructive pulmonary disease (COPD) and chronic non-malignant renal disease (cNMRD) in pottery workers exposed to silica. METHODS: A cohort of Stoke-on-Trent pottery workers (N=5115), previously followed to 1992, was traced for vital status and cause of death to December 2008. Standardised mortality ratio (SMR) analyses, comparing deaths to England and Wales and Stoke-on-Trent, examined underlying cause in 1985-1992 and 1993-2008 and mentioned cause for 1993-2008. Survival analysis considered exposure duration and concentration of respirable silica for lung cancer, COPD and cNMRD, using Cox regression. RESULTS: Excess risks of lung cancer, COPD and cNMRD were seen against both England and Wales and Stoke-on-Trent for 1985-2008. SMRs for lung cancer and COPD were lower in 1993-2008 and non-significant for lung cancer against Stoke-on-Trent in that period (SMR 1.07 95% CI 0.92 to 1.25). Exposure concentration, estimated for 1943 subjects, was related to lung cancer in smokers for early but not later deaths with mean silica concentration >200 µg/m(3) among deaths to June 1992 (HR 2.80 95% CI 1.21 to 6.50). For COPD an increasing trend with duration and (non-significantly) with mean concentration was seen for early but not later deaths in smokers. No relation was observed between estimated exposures and cNMRD. CONCLUSIONS: Excess rates of death from COPD and lung cancer were more marked in the period of the first follow-up (1985-1992) than in the second, with any relation to estimated exposure being limited to the earlier period. Conclusions about COPD and exposure were limited by an early selective destruction of files.

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.

Stillbirth in rural Bangladesh: arsenic exposure and other etiological factors: a report from Gonoshasthaya Kendra.

OBJECTIVE: To use data collected by Gonoshasthaya Kendra, a large nongovernmental organization providing health care to some 600 villages, to describe the epidemiological pattern of stillbirth and any additional contribution made by arsenic contamination of hand-pump wells in Bangladesh. METHODS: Completed pregnancies and outcomes (n = 30 984) for two calendar years, together with existing data on 26 socioeconomic and health factors were selected for study. The health care in these villages was administered from 16 geographical centres; information on the average arsenic concentration in each centre was obtained from the National Hydrochemical Survey. After univariate analysis, a multivariate, multilevel, logistic model for stillbirth was developed. The additional effect of arsenic was calculated having adjusted for all potential confounders thus identified. FINDINGS: The overall stillbirth rate was 3.4% (1056/30 984) and increased with estimated arsenic concentration (2.96% at < 10 microg/l; 3.79% at 10 microg/l to < 50 microg/l; 4.43% at > 50 microg/l). Having adjusted for 17 socioeconomic and health factors, the odds ratios estimated for arsenic (with < 10 microg/l as reference) remained raised: 1.23 (95% confidence interval, CI: 0.87A1.74) at 10 microg/l to < 50 microg/l and 1.80 (95% CI: 1.14A2.86) at 50 microg/l or greater. CONCLUSION: A increased risk of stillbirth is associated with arsenic contamination. This risk, substantial enough to be detected by an ecological approach and not readily attributable to unmeasured confounding, is essentially preventable and all efforts must be made to protect women at high risk.

Prevalence of arsenic-related skin lesions in 53 widely-scattered villages of Bangladesh: an ecological survey.

A survey was carried out to provide a representative assessment of prevalence and risk of arsenic-related skin lesions in relation to geographical distribution of arsenic in wells of rural Bangladesh as a necessary background for research into effects in pregnancy and cancer risks. A systematic random sample of 53 villages in four divisions of Bangladesh served by Gonoshasthaya Kendra was selected, and all women aged 18 years or more (n=16,740) were listed. Trained paramedics recorded the presence of skin thickening and nodules on the palms and soles, together with information on tubewell use. The prevalence was related to the mean concentration of arsenic for the district as indicated by data from the British Geological Survey and to the date the first well in the village was installed. Overall, the observed prevalence was 176 cases (1.3%) in 13,705 women examined, varying from 0% in 26 villages to 23% in one; lesions were observed more frequently on hands than on feet. The estimate doubled with concentrations of arsenic from 11 to < or =50 microg/L and increased more than 20 times at >50 microg/L. In the absence of further information, priority for control measures should be directed at areas where the average concentrations of arsenic are above 50 microg/L, especially in villages where skin lesions have been identified.

Zinc in well water and infant mortality in bangladesh: a report from gonoshasthaya kendra.

Zinc supplementation reduces the duration, severity and recurrence of diarrhoea in young children. This study examines whether zinc, found naturally in drinking water, reduced infant deaths from diarrhoea in rural Bangladesh. Information was compiled for births over two calendar years with follow-up for deaths within one year of birth. The study included 29,744 live births and 934 deaths in some 600 villages under the care of Gonoshasthaya Kendra (GK), grouped into 15 health centre regions within 12 upazillas. Individual matching of death to birth data was not possible, but information on exposures through well water and on potential confounders was available for each upazilla. Average concentration of zinc in well water, reported by the British Geological Survey, was grouped into high (>0.07 mg/L), moderate (0.020-0.070 mg/L) and low (<0.020 mg/L) concentrations. Odds ratios (OR) were calculated for zinc by age and cause of death. Zinc concentration was unrelated to all-cause mortality but a decrease in deaths from diarrhoea (N = 50) was seen in areas with high zinc (OR = 0.30; 95% CI 0.13-0.69). No relation to diarrhoeal deaths was found with other well contaminants (arsenic, manganese) having accounted for zinc. Upazillas with a high proportion of women without education had higher rates of death from diarrhea, but the decrease in risk with high zinc remained (OR adjusted = 0.41; 95% CI 0.20-0.84). It is concluded that exposure to zinc through drinking water may reduce risk of diarrhoeal deaths.

Manganese, arsenic, and infant mortality in Bangladesh: an ecological analysis.

Recent studies in Bangladesh indicate that arsenic and manganese in tube-well water may increase the incidence of infant mortality. The study reported here examined whether these findings could be replicated. Data available from some 600 villages under the care of the nongovernmental organization (NGO) Gonoshasthaya Kendra included details of 29744 live births and 934 infant deaths in a 2-year period, with age and cause. These were analyzed by mean well levels of arsenic and manganese as reported by the British Geological Survey for the 12 upazillas. Odds ratios were calculated by age at death and cause. The effect of arsenic on all-cause infant mortality, although small and not significant, was consistent with earlier reports. The previous finding of an increased risk of infant mortality at concentrations of manganese > or =0.4 mg/L was not evident.

Risk of arsenic-related skin lesions in Bangladeshi villages at relatively low exposure: a report from Gonoshasthaya Kendra.

OBJECTIVE: Arsenic concentrations in 25% of tube wells in Bangladesh exceed 50 microg/L, a level known to be hazardous. Levels in individual wells vary widely. We gathered data on arsenic exposure levels and skin lesion prevalence to address the lack of knowledge about risks where the average arsenic concentrations was lower. METHODS: The nongovernmental organization Gonoshasthaya Kendra did three related studies of keratotic skin lesions since 2004: (1) an ecological prevalence survey among 13 705 women aged > 18 in a random sample of 53 villages; (2) a case-control study of 176 cases and age- and village-matched referents; and (3) a prevalence survey of the entire population of 11,670 in two additional villages. We calculated prevalence as a function of average arsenic concentrations as reported in the National Hydrochemical Survey, and measured arsenic concentrations in wells used by subjects in the case-control study. FINDINGS: The prevalence of skin lesions was 0.37% in people exposed to arsenic concentrations below 5 microg/L, 0.63% at 6-50 microg/L, and 6.84% at 81 microg/L. In the case-control analysis, relative risk of skin lesions increased threefold at concentrations above 50 microg/L (P < 0.05). CONCLUSION: Little serious skin disease is likely to occur if the arsenic concentration in drinking water is kept below 50 microg/L, but ensuring this water quality will require systematic surveillance and reliable testing of all wells, which may be impractical. More research is needed on feasible prevention of toxic effects from arsenic exposure in Bangladesh.