The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.

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Bangladesh has seen one of the developing world's great public health successes, the conversion of the drinking water source for 94% of the rural population to`safe water', in the form of tubewells, with the aim of reducing morbidity and mortality from water-borne disease. Now, that success is being endangered by the discovery that 20 million people may be in great danger and another 20 million in lesser danger of being poisoned by arsenic contamination from tubewell water. This article reports ®ndings from the ®rst national probability sample survey of the rural population and a census of tubewells investigating the social, demographic and epidemiological context of the crisis. The survey covered 3780 households containing 20 260 people. The tubewell census covered 9174 tubewells. The article presents data on the respondents' history of drinking tubewell water, knowledge of the arsenic problem, identi®cation of arsenicosis, as well as the impact upon them of the national campaign, the testing of tubewells, and their subsequent sources of water. Eighty-seven per cent of households drank water from ordinary tubewells (at most risk from arsenic poisoning) and 7% from deep tubewells. Among males, 47.5% had heard that something may be wrong with tubewell water, compared with 39.6% of females. A much lower proportion (20.6% males, 11.3% females) had heard that the water contained a poison called arsenic. Only about 1.5% of the entire population had stopped using tubewell water. Of survey respondents, 0.5% of males and 0.4% of females reported symptoms consistent with chronic arsenicosis. Suggestions are made for a more effective programme.

Objective: Immediate Kangaroo Mother Care (KMC), an intervention following childbirth whereby the newborn is placed skin-to-skin (STS) on mother's chest to promote thermal regulation, breastfeeding and maternalnewborn bonding, is being taught in very low-income countries to improve newborn health and survival. Existing data are reviewed to document the association between community-based KMC (CKMC) implementation and its potential benefits.Study Design: New analyses of the sole randomized controlled study of CKMC in Bangladesh and others' experiences with immediate KMC are presented.Result: Newborns held STS less than 7 h per day in the first 2 days of life do not experience substantially better health or survival than babies without being held STS. Conclusion:Most women who were taught CKMC hold their newborns STS, but do so in a token manner unlikely to improve health or survival. Serious challenges exist to provide effective training and postpartum support to achieve adequate STS practices. These challenges must be overcome before scaling up.

risks involved, and about how to respond to the problem. The health authorities lack good information as to the real dangers involved, and the most appropriate interventions, both in technical terms and in terms of economic and social acceptability. In the absence of such information, the most effective strategy may be to promote more rapid testing of wells and to encourage people to switch wells. ABSTRACTThe presence of arsenic in tubewell water has been identified as a major health problem in Bangladesh. The Bangladesh Government, with international assistance, is attempting to mitigate the effects of arsenic by a major programme of tubewell water testing and education about arsenic and how its ingestion can be avoided. In early 2000 the first nationally representative cluster sample survey of water use in Bangladesh found that knowledge of arsenicosis remained low, tubewell water remained the dominant source of rural water, and few people knew if their tubewell was safe from arsenic contamination or alternatively treated it for arsenic. This paper reports on a follow-up survey of the earlier study population to determine change over two years, and thus for the first time allows a measure of change at the national level. Awareness that there might be something wrong with tubewell water had risen markedly, especially among women respondents. However, there had been only a minor increase in the proportion reporting that they had changed water sources. This indicates a lack of a clear message about the