A Study by Gonoshasthaya Kendra*.

SAVAR GONOSHASTHAYA KENDRA 2005

* The study is conducted by a team of experts headed by Dr. Rafiqul Huda Chaudhury.
   The other members  of the  team  are: Dr. M. A. Kashem, Dr. Zafrullah Chowdhury, Dr. Manzur  Kader Ahmed,Reahna Sultana, Syeda Mumtaz,
   Dr. Mohibullah Kondhker and Dr. Rezaul Huq.

The present paper aims to map the disease burden of the older population in rural Bangladesh using data collected by Savar Gonoshasthaya Kendra (GK) in the month of June/July 2005. This data was collected as a part of a routine monitoring of heath status among the older population living in 603 villages where GK is involved in providing health care services. This has yielded information on health and socio-economic status of nearly 35,000 people of 60 years and above. The present study is based on 5,076 cases as a preliminary analysis. 10,29950 (over one million) people reside in these 603 villages.

Over one-tenth of the older population reported to be fully or partially disabled. Hearing impairment is the single largest disability. Nearly two-fifth of the disabled population reported to be affected by acute hearing impairment including deafness. This is followed by paralysis and mental disorder.

The disability rate increases with age and is higher for older females than older males. The majority of both older males and females reported arthritis and anaemia as the most common chronic ailments they suffer from followed by vision and hearing impairment, malnutrition, asthma, obstructive uropathy, skin disease and diabetes.

Among acute diseases, this group of people most frequently complained of fever, followed by gallbladder pain. Dental problem also constitutes a matter of concern for over one-quarter of older males and females. The disease burden pattern observed for older males and females also holds for all socio-economic groups. However, the well off in general tend to report more frequently their ailments compared to their poor and ultra poor counterparts in most cases, excepting anaemia, malnutrition, skin disease and diarrhoea. These are diseases of poor and ultra-poor older men and women. The majority (56-59%) of older men and women report suffering from multiple diseases.

On average, older men and women suffer from 3 diseases. It increases with age, particularly among males. Mean number of diseases is slightly higher for females than males. It is reported to be higher among well-off older men and women than among ultra-poor and poor older men and women.

Two thirds of ailing older men and women reported to have not received treatment for their ailment(s). This overall finding also holds for the majority of the diseases, particularly the most frequently mentioned diseases. Proportionately older males than females sought treatment for their ailment. Those few who sought treatment, also obtained their treatment from non-professional sources, such as village pharmacies and village doctors.

The primary health care facilities are ill prepared to cater to the specific health needs of the older population in rural Bangladesh. This calls for mainstreaming health services for older population into primary health care system to address the common diseases of the growing older population by arranging gerontology services and training of health care providers on gerontology.

For details, please contact: gkresearch@dhaka.net

Authors: Corbett McDonald, Rezaul Hoque, Nazmul Huda, Nicola Cherry

Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK, Gonoshasthaya Kendra, Nayarhat, Savar, Dhaka, Bangladesh, Institute of Child and Mother Health, Matuail, Dhaka, and Department of Public Health Sciences, University of Alberta, Edmonton,Canada

ABSTRACT

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 ≤50 μg/L and increased more than 20 times at >50 μg/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 μg/L, especially in villages where skin lesions have been identified.

Key words:  Skin lesions; Arsenic; Arsenic exposure; Prevalence; Bangladesh

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