Health education improves both arthritis-related illness and self-rated health: an intervention study among older people in rural Bangladesh

OBJECTIVES

To examine changes in self-reported arthritis-related illness and self-rated health as a result of a health education intervention, and the association between self-reported arthritis-related illness and self-rated health.

STUDY DESIGN

A quasi-experimental study was conducted in eight randomly selected villages in rural Bangladesh (intervention = 4; control = 4).

METHODS

The intervention consisted of home-based physical activities, health advice and aspects of healthcare management over 15 months followed by a 3-month latent period. Data were collected before the intervention and after the latent period. Analyses included 839 participants (≥60 years of age) who participated in both surveys. Participants in the intervention area were further categorized into two groups who self-reported compliance or non-compliance with recommended health advice. Self-rated health was assessed using a single global question. Self-reported arthritis-related illness was indicated by the presence of arthritis, back and joint pain, biting sensation, swelling and inflammation in the joints.

RESULTS

Hierarchical logistic regression analyses revealed that positive effects on episodes of arthritis-related illness [odds ratio (OR) 1.9, 95% confidence interval (CI) 1.3-2.8] and self-rated health (OR 1.4, 95% CI 1.0-1.9) were more likely among the compliant group compared with the control group. Furthermore, positive self-rated health was more likely among participants reporting a positive change in their arthritis-related illness (OR 2.2, 95% CI 1.5-3.2). The results also showed that literate and non-poor participants were more likely to report positive health, and participants with advancing age were less likely to report positive health.

CONCLUSION

Community-based health education is effective in reducing the burden of arthritis-related illness and in enhancing general health in old age.

The impact of health education in managing self-reported arthritis-related illness among elderly persons in rural Bangladesh

This study examines the impact of health education on prevalence of and expenditure on treatment of self-reported arthritis-related illness among elderly persons in rural Bangladesh. An intervention study was conducted, including 1135 elderly persons (>or=60 years) from eight randomly selected villages, four each of an intervention and a control area. The analyses include 839 elderly persons who participated in both pre- and post-intervention surveys (intervention area: n = 425, control area: n = 414). Participants of the intervention area were further categorized as compliant (n = 315) and non-compliant (n = 110) based on adherence to the intervention instructions. The intervention that lasted for 15 months comprised home-based physical exercise, dietary instructions and other aspects of management. Results show that although there was no significant difference in self-reported arthritis-related illness between the compliant and non-compliant groups at baseline, it was significantly lower in the compliant group (71%) at post-intervention compared with the non-compliant (81%). Related monthly expenditure on treatment was significantly reduced in the compliant group (from Taka 104 to Taka 52) but not in the other two groups. Logistic regressions further showed that the control group had a higher probability of increased treatment-related expenditure compared with the compliant group (OR 2.0, 95% CI 1.4-2.8).

Influence of sociocultural and structural factors on functional ability: the case of elderly people in Bangladesh

OBJECTIVE

To describe and contextualize functional status of elderly people (greater or lesser than 60 years) in Bangladesh by relating it to gender, region, and socioeconomic status.

METHODS

In this community-based study (N = 696), functional status was described through assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL). Information was obtained on type of help used for ADLs and IADLs and reason for nonperformance of IADLs.

RESULTS

Findings indicate differential performance in ADLs and IADLs by gender and region. Socioeconomic status is found to influence IADLs only. Empirical evidence regarding type of help used and reason for not performing a task enables understanding of sociocultural and structural influence on functional ability.

DISCUSSION

The underlying assumption of ADL and IADL instruments that an individual will perform an activity given physical or cognitive ability is questioned. It is suggested that sociocultural and structural factors are strong determinants of task performance.

The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals

The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test-retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable differences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r=0.57) and the test-retest reliability was satisfactory (r=0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly.

Folk terminology for diarrhea in rural Bangladesh

Diarrhea, a descriptive term used in medical science for a variety of clinical diseases, denotes an illness that is categorized differently and known by numerous terms in various cultures. These diversified classifications and terminologies are based on the symptoms of diarrheal disorders, their perceived etiology, and their treatment. In Bangladesh, four types of illnesses with names derived from folk terminology have been identified for which the clinical symptoms resemble those of diarrhea. These include dud haga, which is due to ingestion of breast milk by infants; ajirno, which is due to overeating; amasha, a mucoid diarrhea; and daeria, which is severe watery diarrhea or cholera. Use of the word diarrhea in epidemiologic evaluations was discovered to be problematic; people confused this term with daeria, which accounted for only 5% of all episodes of diarrhea. The implications of such epidemiologic information for a large-scale program of oral rehydration therapy are also discussed.