Epidemiology of childhood and adolescent cancer in Bangladesh, 2001-2014

Background: Cancer burden among children and adolescents is largely unknown in Bangladesh. This study aims to provide a comprehensive overview on childhood and adolescent cancers and to contribute to the future strategies to deal with these diseases in Bangladesh. Methods: Data on malignant neoplasms in patients aged less than 20years diagnosed between 2001 and 2014 (N=3143) in Bangladesh was collected by the National Institute of Cancer Research and Hospital and ASHIC Foundation. The age pattern and distribution of cancer types were analysed and the incidence rates were calculated. Results: The age-standardised incidence rate was 7.8 per million person-years for children (0-14 years) in the last time period (2011-2014). Retinoblastoma (25%) and leukaemia (18%) were the most common childhood cancers. For adolescents (15-19 years), the age-specific incidence rate was 2.1 per million person-years in the same time period. Most common adolescent cancers were malignant bone tumours (38%), germ cell and gonadal tumours (17%), and epithelial tumours (16%). There were more boys affected (M: F ratio 2.0 in children and 1.4 in adolescents) than girls. Conclusion: Cancer incidences were lower than expected most likely due to a low level of awareness about cancer among clinicians and the population, inadequate access to health care, lack of diagnostic equipment and incomplete recording of cases. Improvements on different levels should be made to get a better epidemiologic insight and to detect cancer earlier resulting in a better outcome for affected chil

Drinking Water Salinity and Raised Blood Pressure: Evidence from a Cohort Study in Coastal Bangladesh.

BACKGROUND: Millions of coastal inhabitants in Southeast Asia have been experiencing increasing sodium concentrations in their drinking-water sources, likely partially due to climate change. High (dietary) sodium intake has convincingly been proven to increase risk of hypertension; it remains unknown, however, whether consumption of sodium in drinking water could have similar effects on health. OBJECTIVES: We present the results of a cohort study in which we assessed the effects of drinking-water sodium (DWS) on blood pressure (BP) in coastal populations in Bangladesh. METHODS: DWS, BP, and information on personal, lifestyle, and environmental factors were collected from 581 participants. We used generalized linear latent and mixed methods to model the effects of DWS on BP and assessed the associations between changes in DWS and BP when participants experienced changing sodium levels in water, switched from "conventional" ponds or tube wells to alternatives [managed aquifer recharge (MAR) and rainwater harvesting] that aimed to reduce sodium levels, or experienced a combination of these changes. RESULTS: DWS concentrations were highly associated with BP after adjustments for confounding factors. Furthermore, for each 100 mg/L reduction in sodium in drinking water, systolic/diastolic BP was lower on average by 0.95/0.57 mmHg, and odds of hypertension were lower by 14%. However, MAR did not consistently lower sodium levels. CONCLUSIONS: DWS is an important source of daily sodium intake in salinity-affected areas and is a risk factor for hypertension. Considering the likely increasing trend in coastal salinity, prompt action is required. Because MAR showed variable effects, alternative technologies for providing reliable, safe, low-sodium fresh water should be developed alongside improvements in MAR and evaluated in "real-life" salinity-affected settings. https://doi.org/10.1289/EHP659

Climate change, environmental stress and loss of livelihoods can push people towards illegal activities: a case study from coastal Bangladesh

This paper aims to understand how environmental stressors influence people’s livelihood options in the coastal belt of Bangladesh. We argue that environmental stressors such as cyclones, riverbank erosion, salinity intrusion, and floods have negative impacts on people’s lives by reducing their livelihood options. Twelve in-depth interviews (Livelihood Histories) and twelve Focus Group Discussions (FGD) based on two Participatory Rural Appraisal (PRA) tools (Village Timeline and Contextual Change) were carried out in three different sites in coastal Bangladesh were conducted under the study. Our study finds that when there are insufficient adaptation strategies to environmental stressors, many people turn to livelihoods banned by the government. These ‘illegal livelihoods’ include using fine mesh nets to collect shrimp fry in the rivers as well as logging in the Sundarbans. These people are often the poorestand vulnerable, and law enforcement only exacerbate their vulnerability. We end by concluding those that have turned to ‘illegal livelihoods’ as a result of detrimental environmental stressors should be viewed as a special category of vulnerable people by policymakers, and steps need to be taken to ensure resilience to different environmental stressors