The global prevalence of chronic kidney disease (CKD) of uncertain etiology may be underreported. Community-level epidemiological studies are few due to the lack of national registries and poor focus on the reporting of non-communicable diseases. Here we describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Thus, proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces.

The exposure of millions to arsenic contaminated water from hand tube wells is a major concern in many Asiatic countries. Field kits are currently used to classify tube wells as delivering arsenic below 50 microg/L (the recommended limit in developing countries) as safe, painted green or above 50 microg/L, unsafe and painted red. More than 1.3 million tube wells in Bangladesh alone have been tested by field kits. A few million U.S. dollars have already been spent and millions are waiting for the ongoing projects. However, the reliability of the data generated through field kits is now being questioned. Samples from 290 wells were tested by field kits and by a reliable laboratory technique to ascertain the reliability of field kits. False negatives were as high as 68% and false positives up to 35%. A statistical analysis of data from 240 and 394 other wells yielded similar rates. We then analyzed 2866 samples from previously labeled wells and found 44.9% mislabeling in the lower range (<50 microg/L) although mislabeling was considerably reduced in the higher range. Variation of analytical results due to analysts and replicates were pointed out adopting analysis of variance (ANOVA) technique. Millions of dollars are being spent without scientific validation of the field kit method. Facts and figures demand improved, environmentally friendly laboratory techniques to produce reliable data.

These study findings suggest that chronic arsenic exposure may increase the risk of fetal and infant death.

ObjectiveThe aim of this study was to identify factors associated with mortality in children under 5 years of age using a nationally representative sample of singleton births for the period of 2004–2011.Design, setting and participantsPooled 2004, 2007 and 2011 cross-sectional data sets of the Bangladesh Demographic and Health Surveys were analysed. The surveys used a stratified two-stage cluster sample of 16 722 singleton live-born infants of the most recent birth of a mother within a 3-year period.Main outcome measuresOutcome measures were neonatal mortality (0–30 days), postneonatal mortality (1–11 months), infant mortality (0–11 months), child mortality (1–4 years) and under-5 mortality (0–4 years).ResultsSurvival information for 16 722 singleton live-born infants and 522 deaths of children <5 years of age included: 310 neonatal deaths, 154 postneonatal deaths, 464 infant deaths, 58 child deaths and 522 under-5 deaths. Multiple variable analysis showed that, over a 7-year period, mortality reduced significantly by 48% for postneonatal deaths, 33% for infant deaths and 29% for under-5 deaths, but there was no significant reduction in neonatal deaths (adjusted OR (AOR)=0.79, 95% CI 0.59 to 1.06) or child deaths (AOR=1.00, 95% CI 0.51 to 1.94). The odds of neonatal, postneonatal, infant, child and under-5 deaths decreased significantly among mothers who used contraceptive and mothers who had other children aged 3 years or older. The risk of neonatal, postneonatal, infant, child and under-5 deaths was significantly higher in mothers who reported a previous death of a sibling.ConclusionsOur study suggests that family planning is needed to further reduce the overall rate of under-5 deaths in Bangladesh. To reduce childhood mortality, public health interventions that focus on child spacing and contraceptive use by mothers may be most effective.