Rural Population Of Bangladesh Research Articles

Prevalence of Microalbuminuria and Overt Proteinuria in Hypertension and Their Relations with Renal Function in a Rural Population of Bangladesh

Hypertension is the third leading cause of chronic kidney disease (CKD) in Bangladesh. Microalbuminuria and overt proteinuria are the markers of the CKD. So detection of microalbuminuria and overt proteinuria in hypertensive subjects will help to identify the patient at risk of developing progressive renal impairment. This cross sectional study was carried out in a rural area of Bangladesh.1134 adult population (age between 18 and 65 years) were screened. A total of 217 (19.1%) were detected hypertensive; spot urine dipstick test was done among them. Those who where dipstick negative further studied for presence of microalbumin [ mg/L ]. Blood glucose level, serum creatinine, and estimated glomerular filtration rate (eGFR) were evaluated. A group of normotensive people (n=245) taken as comparison group. Microalbuminuria and overt proteinuria were present in 26.4% and 9.7% of the hypertensive subjects, respectively. Correlation between microalbuminuria and eGFR showed that two variables exhibited a tendency for negative relationship, although correlation was not statistically significant (P=0.186, r=-0.064). Overt proteinuric subjects showed no statistically significant deterioration of eGFR (81.6±21.1). Microalbuminuria and overt proteinuria are prevalent among the hypertensive rural Bangladeshi people. So early detection of microalbuminuria and overt proteinuria will help to prevent or delay the development of end stage renal disease. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.18700 Bangladesh J Medicine 2013; 24 : 59-64

Medicinal plant usage by traditional medical practitioners of rural villages in Chuadanga district, Bangladesh

Traditional medical practitioners (Kavirajes) administer primary health care to most of the rural population in Bangladesh. They use medicinal plants for various formulations to treat ailments. The medicinal plants used by the traditional medical practitioners vary considerably from region to region. The objectives of this study were to identify native medicinal plants and their ethno-medicinal use among the traditional medical practitioners of Chuadanga district, Bangladesh. After obtaining informed consent, interviews were conducted with the Kavirajes with the help of a semi-structured questionnaire. Plant specimens, as pointed out by respondents, were collected and identified at the Bangladesh National Herbarium. The results show 119 plant species belonging to 64 families were used by the traditional medical practitioners for treatment of various ailments. The most frequently used families were Asteracea with six species followed by Moraceae, Solanaceae and Apocynaceae with five species. Among the selected species the maximum contribution was recorded for herbs with 38% species followed by trees (32%), shrubs (21%), climbers (7%) and palm (2%). Assessments of reported ethno-medicinal activity indicate that these plant species can potentially be of pharmacological interest as well as for conservation of biodiversity.

A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort

ObjectiveLimited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes. However, most of these were in populations with pre-existing cardiovascular diseases (CVD) and studies in general population are lacking. MethodsThe study included 11,153 participants in a population-based, prospective cohort study in Araihazar, Bangladesh. Resting blood pressure was measured at baseline and every two years thereafter. Participants were followed up for an average of 6.5years (2002–2009). ResultsMale gender, older age, baseline systolic blood pressure (SBP), and absence of betel leaf use were independently positively associated with greater SBP variability over time. There was a significant association between SBP variability and the risk of death from overall CVD, especially from major CVD events. The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models. In addition, the hazard ratio (HR) of stroke mortality was greater for individuals with both high baseline and high SBP variability. Similar patterns of HRs were observed for all-cause and CVD mortalities. ConclusionIn this rural Bangladeshi population, variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP.

Prevalence and Associated Risk Indicators of Retinopathy in a Rural Bangladeshi Population with and without Diabetes

Purpose: To determine the prevalence of retinopathy among people with normal and abnormal glucose metabolism in a remote rural community of Bangladesh, and to identify the associated risk indicators for developing retinopathy in this population.Methods: A population-based cross-sectional study was conducted through screening in camp settings, which included a total of 836 participants (468 male and 368 female) aged 30 years or over. Retinopathy was determined by fundus photography. Anthropometric measures (body mass index and waist-to-hip ratio), oral glucose tolerance, glycosylated hemoglobin (HbA1c), blood pressure, lipid profile, serum creatinine and urine albumin creatinine ratio (UACR) were measured. Logistic regression analysis was used with adjustment for potential confounders.Results: The overall prevalence of retinopathy was 5.4% (95% confidence interval, CI, 3.9–6.9). The prevalence rates of retinopathy among diabetic, impaired glucose regulation and non-diabetic subjects were 21.6%, 13% and 3.5%, respectively. Adjusted odds ratios for retinopathy were 2.53 (95% CI 1.52–5.41) for abnormal glucose metabolism and 1.98 (95% CI 1.17–5.63), 1.74 (95% CI 1.09–3.02) and 1.63 (95% CI 1.08–3.12) for hypertension, HbA1c and UACR, respectively. Additionally, age, body mass index, triglyceride and total cholesterol were also found to be significant independent risk indicators for the occurrence of retinopathy in this population.Conclusion: A high prevalence of retinopathy was observed in this rural Bangladeshi population. In addition to blood glucose control for diabetes, screening for hypertension, obesity, hyperlipidemia and proteinuria as well as adequate treatment of these risk indicators may prevent retinopathy in rural Bangladeshi populations.

Anthropometric indices of obesity and type 2 diabetes in Bangladeshi population: Chandra Rural Diabetes Study (CRDS)

Obesity is a risk factor for type 2 diabetes (DM); however, no study has specially assessed the anthropometric indices as predictors of diabetes in rural Bangladeshi population. To identify markers for diabetes through body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist height ratio (WHtR) and identify the optimal cut-off values suitable for Bangladeshi adult population. A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey. Age adjusted data for anthropometric indices and diabetes risk were assessed and their relationships were examined. Age adjusted prevalence of DM in men and women were 9.5% and 7.0%, respectively. Both men and women with DM had a higher rate of general obesity (defined by BMI) and central obesity (defined by WC, WHR and WHtR) than non-diabetic subjects. In both men and women the most sensitive indice was WHR for predicting DM. The appropriate cut-offs values for WHR to predict DM in men and women were 0.93 and 0.87, respectively. WC of 82 cm for both sexes was appropriate to predict DM. Those of BMI and WHtR were 21.2 kg/m2, 21.8 kg/m2 and 0.53, 0.54 in men and women, respectively. Compared with BMI, measures of central obesity, WHR, WC, WHtR showed a better association with the risk of DM for both sexes in rural Bangladeshi population. Follow-up studies are needed for validifying these cut-offs values.

A survey of the dog population in rural Bangladesh

Globally, Bangladesh ranks third in the number of human deaths from rabies. Although dogs are the principal known transmitters of rabies and knowledge of dog populations is essential for effective national control and proper planning, dog control programs are scarce in Bangladesh. Our objective was to count dogs in a rural area to understand the dog population of the country. For this purpose we selected six unions of Raipura upazila in Narsingdi district. Dog counting was done by direct observation following accepted guidelines. We determined the mean density of the dog population in Bangladesh to be 14 dog/km2 (95% CI 3.7, 24) and the human:dog ratio to be 120 (95% CI 55, 184). Our paper contribute to the literature which shows great variation in the human:dog ratio across regions of the developing world. The human:dog ratio depends on the area's human (as well as dog) population, whereas dog density per unit area indicates the true number of dogs. We propose that extrapolating from the human:dog ratios of other regions not be relied upon for estimating dog populations, unless the ratios can be supplemented by actual counts of dogs within the target area.

Anthropometric indicators of obesity for identifying cardiometabolic risk factors in a rural Bangladeshi population.

Aims/IntroductionThe aim of the present study was to evaluate the predictive ability of body mass index (BMI), waist circumference (WC), waist‐to‐hip ratio (WHR), waist‐to‐height ratio (WHtR) and body fat percentages (BF%) for the presence of cardiometabolic risk factors, namely type 2 diabetes (DM), hypertension (HTN), dyslipidemia and metabolic syndrome (MS).Materials and MethodsA total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly selected in a population‐based, cross‐sectional survey. The association of anthropometric indicators with cardiometabolic risk conditions was assessed by using receiver operating characteristic curve analysis and adjusted odds ratios (ORs) for DM, HTN, dyslipidemia and MS.ResultsArea under the curve cut‐off values showed that the association of WHR, BF% and WC was higher than that for other indices for DM, HTN and MS, respectively, for both sexes, and WHtR for men and WHR for women for dyslipidemia. The ORs were highest for WHR for DM and WC for MS for both sexes, and WHtR for men and WC for women for HTN and dyslipidemia, respectively. The optimal cut‐off values for obesity for the present study in men and women showed BMIs of 22 and 22.8 kg/m2, WHRs of 0.93 and 0.87, WHtRs of 0.52 and 0.54, BF% of 21.4 and 32.4%, and WCs of 82 and 81 cm, except for MS, which were 90 for men and 80 for women.ConclusionsCompared with BMI, measures of central obesity, particularly WHR, WC, WHtR and BF%, showed a better association with obesity‐related cardiometabolic risk factors for both sexes.

Response: Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years (Diabetes Metab J2013;37:46-53)

We sincerely appreciate the interest and comments regarding our study, Increasing prevalence of type 2 diabetes in a rural Bangladeshi population: a population based study for 10 years which was published in Diabetes & Metabolism Journal 2013;37:46-53. Our responses to Nan Hee Kim's comments follow: We agree with reviewer's comment that it may be more convincing if we included all the mentioned factors (like dietary data, smoking habits, and physical activity, etc.). We should keep in mind that this is a rural agricultural society where manual labour is the only means for farming. Therefore, other than the land lords (few indeed) people work manually for 8 to 10 hours. Therefore questions like leisure time physical may not be relevant. In addition, variables like dietary data and smoking habits were not included in previous two studies (1999 and 2004). It should be noted that in 2009 study, we did not find any significant association of body mass index (BMI), socioeconomic condition, education level, family history of diabetes, smoking habits, and physical inactivity as risk indicators for diabetes [1]. This is possibly owing to the fact that almost no women in culture smoke and physical activity is high with a low BMI. Second, we used the same cutoff level for waist-hip ratio (WHR) to maintain the flow of our previous two studies [2]. We have also attempted with 3 cutoff level for WHR but did not get any significant findings possibly due to low statistical power in each stratum. This may also be mentioned that previous cross-sectional and prospective studies in Bangladesh have found WHR a better predictor of type 2 diabetes than waist circumference [1-4]. Third, decreasing prevalence of hypertension is noteworthy. Landmark study like WHO MONICA [5] is in agreement with our findings. It is true that antihypertensive is only used when diagnosed with hypertension and therefore should not affect the prevalence of hypertension in ideal situation. In this context people can buy almost any drugs over the desk in a pharmacy. People often use these antihypertensive drugs with increasing age and obesity without any prescription. Therefore we cannot rule out the possibility for such unexplained observations. However, we cannot ignore the possibility of measurement error but the measurement of blood pressure was conducted by trained physicians in all studies. We again thank the reviewer for providing very thoughtful comments.

Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years

BackgroundTo observe changes in the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG) and its associated risk factors in a rural Bangladeshi population over a 10-year period.MethodsThree cross-sectional studies were undertaken in a rural community (aged ≥20 years) in 1999, 2004, and 2009. Structured questionnaires including sociodemographic parameters, anthropometric measurements, blood pressure, and blood glucose values were recorded. DM and IFG were diagnosed using 1999 World Health Organization criteria.ResultsAge standardized prevalence of DM increased significantly (P<0.001) from 1999 to 2009 (2.3%, 6.8%, and 7.9% in 1999, 2004, and 2009, respectively). The prevalence of IFG increased significantly (P=0.011) from 4.6% to 5.8% between 1999 and 2004 but then decreased from 5.8% to 5.3% during 2004 to 2009. Significant linear trends were shown in both sexes for general and central obesity as indicated by body mass index, waist circumference, and waist hip ratio (WHR). Increasing age and systolic blood pressure were significant risk factors for DM in all three studies. WHR for males was also significantly associated with the risk of DM in all three studies. WHR for females was only significantly associated with DM in 2009.ConclusionA significant rise in the prevalence of DM was observed in this population over 10 years. This increase was seen in both sexes, and in all age groups. A significant increase in the prevalence of the associated risk factors of general and central obesity was observed in both sexes.

Cognitive testing of the WHOQOL-BREF Bangladesh tool in a northern rural Bangladeshi population with lymphatic filariasis

The purpose of this study was to test the cultural suitability of the WHOQOL-BREF Bangladesh for a rural village population in Bangladesh. Participants (n = 35) were purposefully stratified for age, gender, education level and location from the Nilphamari district in northern rural Bangladesh. Cognitive interviews were conducted via an emergent probing method to identify issues with language and constructs within the tool. Data were collected through note taking and recordings of interviews. A coding framework was used to identify key issues with questions, which were analysed using SPSS version 19 and Chi-square analysis using a Fisher's exact test to determine statistically significant variances within the sample. Twenty-two of the 26 questions in the tool were found to be problematic. The majority of problems with questions related to wording and conceptual difficulties. The majority of participants found the tool to be overly formal. Issues with translation appeared to affect the interpretation of a number of questions, and some concepts in the tool were found to be irrelevant in a village setting. There were statistically significant differences between those of different educational backgrounds and between genders. The study found that the WHOQOL-BREF Bangladesh as it currently stands is not culturally or linguistically suitable for use within a rural northern Bangladeshi population.

Patterns of Nonarticular Rheumatism in a Rural Area of Bangladesh

Objectives: Estimate the prevalence of nonarticular (soft tissue) rheumatism in a rural population of Bangladesh. Methods: The survey was carried out in eight villages of Sonargaon upazila of Narayanganj district about 30 kilometers from Dhaka. All subjects of both genders (5217) of ?15 years old of 8 villages were evaluated. Door to door survey was done to cover missing cases. Trained field workers identified subjects with musculoskeletal pain using Bengali version of the COPCORD (Community Oriented Program for the Control of Rheumatic Disease) questionnaire. Positive respondents were examined by trained internist and rheumatologists for definite non articular rheumatic disorders. COPCORD guideline was used for diagnosis. Results: MSK pains (positive respondent) were 1260 (24.2%) in out of 5217 (male 2556, female 2661). Among of them definite soft tissue rheumatic diseases were identified in 439 (male 102 and female 337). Major occupations were house wives (54.7), weavers (18%), and peasants (5.1%). Definite point prevalence of nonarticular rheumatism was 8.41% (male 3.7%, female 11.09%). The most common diseases were fibromyalgia (3.95%), repetitive strain injury (2.3%), nocturnal muscle cramp (0.59%), myofascial neck pain (0.48%), planter fasciitis (0.46%). Conclusion: Prevalence of nonarticular rheumatism is common in this rural community. Fibromyalgia is the leading disease. DOI: http://dx.doi.org/10.3329/jom.v13i2.12752 J Medicine 2012; 13 : 165-169

The Prevalence rate of Hypertension in Rural Population of Bangladesh

Background: The non-communicable diseases like hypertension, diabetes and asthma are emerging as a major health problem in Bangladesh. Recently, these are given high research priority by the Government of Bangladesh. The prevalence of hypertension is increasing rapidly, but there is no current study on prevalence of hypertension in rural population of Bangladesh. There are some studies conducted on prevalence of hypertension from mid 70's to late 90's. Those studies showed the prevalence of hypertension is increasing significantly in both urban and rural population. In rural population the prevalence of hypertension was in 23.6% 1. After that there is no population based study was conducted on prevalence of hypertension in rural population of Bangladesh. Methods: We measured blood pressure, body weight and height of 532 individuals at and above the age of 20 years (age range 20-70 years) of both sexes accept pregnant and those who were under medication of hypertension. We collected information about smoking, family history of hypertension, status of physical activity, diabetes, annual income etc. Result: The overall prevalence rate of hypertension was 30.64% (male 31.53% and female 29.36%). In the study, the blood pressure was measured in all study subjects. The mean blood pressure was higher in hypertensive participants than that of non hypertensive. The prevalence of hypertension (30.64%) observed in this study was higher than the previous study. In this study showed that with the increasing age more the prevalence of hypertension. The similar funding also observed in recent Indian study. Our study showed that the hypertension prevalence was high among people with high BMI and obesity, positive family history, smoking and less physical activity. Conclusion: The prevalence of hypertension in the rural population was found to be on the increased compare to previous reports of Bangladesh and other Asian studies. Advanced age, obesity, higher incomes, family history of hypertension, smoking and reduced physical activity were proved significant risk factors for hypertension, whereas, sex, occupation, showed no association with hypertension. DOI: http://dx.doi.org/10.3329/jdnmch.v18i1.12225 J. Dhaka National Med. Coll. Hos. 2012; 18 (01): 12-17

Molecular epidemiology of tuberculosis in rural Matlab, Bangladesh

To characterise and classify clinical isolates collected from tuberculosis (TB) patients in rural Bangladesh and to investigate the mode of transmission. An epidemiological study using a combination of conventional and molecular methods was performed in a rural population of Bangladesh. A total of 168 clinical isolates were collected from TB patients. Deletion analysis, used for rapid differentiation of members of the Mycobacterium tuberculosis complex, spoligotyping and variable number tandem repeats of mycobacterial interspersed repetitive units (VNTR-MIRU) typing were used. Deletion analysis identified all isolates as M. tuberculosis and further divided them into 109 strains (65%) carrying the M. tuberculosis deletion region 1 (TbD1-intact or 'ancestral' strains) and 59 strains (35%) lacking this region (TbD1 or 'modern' strains). MIRU analyses showed that 149 strains (89%) had unique patterns, whereas 19 strains (11%) clustered into eight groups. The largest cluster comprised five TbD1 strains of the Beijing type. The rate of recent transmission was estimated to be 6.5%. Our results suggest that TB in rural Bangladesh is caused primarily by reactivation of latent infections involving TbD1 intact strains, overlaid with the recent emergence of Beijing strain clusters that include multidrug-resistant isolates.

Serum Lipid Profile Among Urban and Rural Bangladeshi Population

Background: There is lack of any evidence based comparative information of lipid profile level between urban and rural population in Bangladesh. Methodology: Between April and September 2010; applying age stratified (every 5 years interval; 40 to 93 years) randomization technique, 132 individuals aged 40 years and above from the rural Mirzapur were enrolled. On the other hand, 396 (1:3 ratio) urban individuals of Dhaka, the capital city, within same age interval were randomly selected from a total of 3,179 individuals who attended the Clinical Laboratory of icddr, b in Dhaka to investigate their lipid profile, served as control group. Results: Residents in urban area demonstrated significantly higher level of serum total cholesterol (TC) [rural (4.44 mmol/L) vs. urban (4.84 mmol/L); mean difference (95% CI) p value; -0.40 (-0.61, -0.18) <0.01], LDL cholesterol [2.74 vs. 3.00; -0.24 (-0.45, -0.04) 0.01], triglyceride (TG) [1.56 vs. 2.02; -0.45 (-0.65, -0.23) <0.01], TC:HDL [4.41 vs. 5.10; -0.64 (-0.91, -0.37)], and LDL:HDL [2.78 vs. 3.10; -0.31 (-0.53, -0.09)] compared to the rural population; however, serum HDL level [1.11 vs. 1.00; 0.11 (0.02, 0.21) 0.01], was found higher among rural population. Conclusion: Findings of the study demonstrated significant higher levels of serum lipoprotein in urban than the rural population of Bangladesh.

Prevalence of Type 2 Diabetes and Impaired Glucose Regulation with Associated Cardiometabolic Risk Factors and Depression in an Urbanizing Rural Community in Bangladesh: A Population-Based Cross-Sectional Study

BackgroundTo determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression.MethodsA total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed.ResultsThe prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and β-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male.ConclusionRising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.

Maternal vitamin A and β-carotene supplementation and risk of bacterial vaginosis: a randomized controlled trial in rural Bangladesh

Bacterial vaginosis (BV) in pregnancy is linked to preterm birth, but its risk factors are not well understood. Micronutrient deficiencies may be associated with an increased risk of this condition. We assessed the effect of weekly vitamin A or β-carotene supplementation during pregnancy until 3 mo postpartum on BV risk in rural northeastern Bangladesh. In this cluster-randomized, placebo-controlled trial, 33 clusters (n = 33) were randomly assigned to 3 groups. Women (n = 1812) were examined for BV by using self-administered swabs and the Nugent scoring method in early pregnancy, at 32 wk of gestation, and at 3 mo postpartum. The prevalence of BV in early pregnancy, before supplementation, was 7.6% (95% CI: 6.3%, 9.1%) overall. Neither the prevalence nor the incidence of BV in the third trimester differed by supplement group. However, the prevalence (OR: 0.71; 95% CI: 0.52, 0.98) and incidence (RR: 0.58; 95% CI: 0.41, 0.81) of BV at 3 mo postpartum was lower among women in the vitamin A group (9.1% and 6.7%, respectively) than in the placebo group (12.4% and 11.8%, respectively), but not in the β-carotene group. Both vitamin A and β-carotene reduced the prevalence and incidence of BV at both time points (ie, third trimester and 3 mo postpartum) by 30-40% compared with placebo (all P < 0.05). Weekly vitamin A supplementation reduced the risk of maternal BV in this rural Bangladeshi population. Enhancement of vitamin A status before and during pregnancy may reduce the risk of BV in areas with vitamin A deficiency. This trial is registered at clinicaltrials.gov as NCT00198822.

Folk Medicinal Uses of Verbenaceae Family Plants in Bangladesh

Folk medicinal practitioners form the first tier of primary health-care providers to most of the rural population of Bangladesh. They are known locally as Kavirajes and rely almost solely on oral or topical administration of whole plants or plant parts for treatment of various ailments. Also about 2% of the total population of Bangladesh are scattered among more than twenty tribes residing within the country's borders. The various tribes have their own tribal practitioners, who use medicinal plants for treatment of diseases. The objective of the present survey was to conduct an ethnomedicinal survey among the Kavirajes and tribal practitioners to determine which species of plants belonging to the Verbenaceae family are used by the practitioners. The Verbenaceae family plants are well known for constituents having important bio-active properties. The present survey indicated that 13 species belonging to 8 genera are used by the folk and tribal medicinal practitioners of Bangladesh. A comparison of their folk medicinal uses along with published reports in the scientific literature suggests that the Verbenaceae family plants used in Bangladesh can potentially be important sources of lead compounds or novel drugs for treatment of difficult to cure debilitating diseases like malaria and rheumatoid arthritis.

ECONOMIC CONSEQUENCES OF MATERNAL ILLNESS IN RURAL BANGLADESH

We use panel data on household consumption combined with information taken from the medical records of women who gave birth in health facilities to explore the economic consequences of maternal ill health, in the context of a rural population in Bangladesh. The findings suggest that there is a large reduction in household resources associated with maternal illness, driven almost entirely by spending on health care. In spite of this loss of resources, we find that households are able to fully insure consumption against maternal ill health, although confidence intervals are unable to rule out a small effect. Households in our study area are shown to have good access to informal credit (whether it be from local money lenders or family relatives), and this appears critical in helping to smooth consumption in response to these health shocks, at least in the short term.

Iron Status of Women Is Associated with the Iron Concentration of Potable Groundwater in Rural Bangladesh1–3

Women of reproductive age are at a high risk of iron deficiency, often as a result of diets low in bioavailable iron. In some settings, the iron content of domestic groundwater sources is high, yet its contribution to iron intake and status has not been examined. In a rural Bangladeshi population of women deficient in dietary iron, we evaluated the association between groundwater iron intake and iron status. In 2008, participants (n= 209 with complete data) were visited to collect data on 7-d food frequency, 7-d morbidity history, 24-h drinking water intake, and rice preparation, and to measure the groundwater iron concentration. Blood was collected to assess iron and infection status. Plasma ferritin (μg/L) and body iron (mg/kg) concentrations were [median (IQR)] 67 (46, 99) and 10.4 ± 2.6, respectively, and the prevalence of iron deficiency (ferritin < 12μg/L) was 0%. Daily iron intake from water [42 mg (18, 71)] was positively correlated with plasma ferritin (r= 0.36) and total body iron (r= 0.35) (P< 0.001 for both). In adjusted linear regression analyses, plasma ferritin increased by 6.1% (95% CI: 3.8, 8.4%) and body iron by 0.3 mg/kg (0.2, 0.4) for every 10-mg increase in iron intake from water (P< 0.001). In this rural area of northern Bangladesh, women of reproductive age had no iron deficiency likely attributable to iron consumed from drinking groundwater, which contributed substantially to dietary intake. These findings suggest that iron intake from water should be included in dietary assessments in such settings.

Prevalence of Diabetes Mellitus and its Associated Risk Indicators in a Rural Bangladeshi Population

Background: Substantial racial heterogeneity in diabetes leads to the necessity of conducting epidemiological studies in different communities. Such studies are still inadequate in Bangladeshi population, particularly in truly respective rural areas. The objectives of the study were to estimate the prevalence of diabetes and to identify its associated risk indicators in a rural population of Bangladesh. Methods: This population based cross-sectional study was conducted in remote rural areas of Northern Bangladesh, which included a total of 836 participants aged at or above 25 years through screening in camp settings. Diabetes was diagnosed by WHO criteria after a 2-sample OGTT. BMI, waist-hip ratio, blood pressure, lipid profile and serum creatinine were also estimated. Results: The prevalence of diabetes was found to be 7.2% (95% CI 5.4-9.0) and that of impaired glucose regulation (including both impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)) was 6.5% (95% CI 4.8-8.2). The prevalence of diabetes and impaired glucose regulation differed between males and females, but, both increased with age in males as well as females. A good correlation was observed between fasting blood glucose and 2hr after glucose (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI and WHR were found as significant independent risk indicators for the occurrence of diabetes in this population.