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BackgroundThe 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.MethodsA 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.ResultsSurvey 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.ConclusionsDisabled 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.

Objective Arsenic concentrations in 25% of tube wells in Bangladesh exceed 50μg/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 5μg/L, 0.63% at 6-50μg/L, and 6.84% at 81μg/L. In the case-control analysis, relative risk of skin lesions increased threefold at concentrations above 50μg/L (P < 0.05). Conclusion Little serious skin disease is likely to occur if the arsenic concentration in drinking water is kept below 50μg/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.

3 Working group on the confidential enquiry into stillbirths and deaths in infancy. Report of the working group set up by the chief medical officer. London:

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.