Developed by Shawkat Jahangir NCD icddr,b © 2019                                                                         Information provided by Dr. Noshin Farzana NCD icddr,b

Theme 9:

Evidence of NCD in Bangladesh:  
Prevention & Control

PATTERNS OF NCDs, AMONG  URBAN AREAS (GARO AND MANIPURI) OF BANGLADESH

Nahin Ahmed, Prof Rasheda Akhter

Project Research Physician, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

Introduction: Non communicable disease (NCD) are now a day a global health issues and possess greater imminence to human health. Four main types of Non communicable Diseases (NCDs) are Cardio vascular diseases, chronic respiratory disease which include Asthma and Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Cancer. Objective: A qualitative type of explorative study was conducted to fulfill the research objectives because the research question was aimed to explore the perception and pattern of NCDs among indigenous population. The study will help us to understand the perception of NCDs among Garo and Manipuri people. Study site: The study was conducted in Sylhet amongst Manipuri and in Dhaka amongst the Garo indigenous communities. Eighteen in-depth interview, three key informant interview, two focus group discussion were conducted to explore the perception of NCDs of Garo and Manipuri. Finding: Among both indigenous males displayed a greater understanding about the perception of NCDs whereas Garo female displayed less understanding about NCDs. Both of the communities to some extent were unable to describe about the risk factor for NCDs. Pattern of NCDs were unite common, Diabetic cases were being among Garo but Hypertension and cancers were present among both of these communities. Manipuri displayed a greater dependency on qualified medical practitioner. Garo displayed greater adherence to non-qualified local pharmacists and they were not aware of their health issues. One interesting findings from Garo if they got to know they have high blood pressure they drink tamarind water and take rest for some time then again goes to work. Recommendation: This qualitative study has given me the opportunity to explore the perception of NCD. Screening of Diabetes, Hypertension and Cancer should be done on both of the communities and especially on Garo communities as they are more exposed to tobacco and alcohol consumption.




Prevalence and Determinants of Hypertension (HTN) Among the Elderly (>60 Years) in Rural Bangladesh

Khandaker Afsana Mim, Farhana Khanam Keya, Rahvia Alam Sthity, Kazi Munisul Islam

 icddr,b, Mohakhali Dhaka, Bangladesh

Hypertension is a growing concern globally affecting 1.13billion people worldwide. Bangladesh is no exception with prevalence of HTN 25.7% and 48% among >35years according to JNC VII and AHC/ACC classifications respectively. While there are a number of publications, knowledge about determinants of HTN among elderly people >60 years is limited.This was a cross-sectional study, conducted from October-November 2013 in Char-Bhadrasan Upazilla of Faridpur district about 100 km north-east of Dhaka city. Medical students from Faridpur Medical College collected the data using convenience sampling method, visiting all households of selected areas of that Upazilla. Inclusion criteria included >60 years and permanent residents of the study area. Data were collected by a pre-approved structured questionnaire which included personal and demographic information,blood pressure (BP) and morbidity data,any duplication of data was excluded if found.Thirty-six percent of the elderly people were hypertensive, 4.3% had isolated systolic, 12.3% had isolated diastolic and 19.4% had both systolic and diastolic hypertensive. Thirty-eight percent of the males and 34% of the females were hypertensive, and the trend was also similar in different age groups.The odds of having any type of hypertension among previous and current smokers was 1.9 compared to non-smokers after adjusting for gender and education. Multiple linear regression analysis demonstrated that any type of current and previous smoking, family income > TK 20,000, any physical morbidity and education raised systolic BP from 1.8 to 5.9 mm of Hg and diastolic BP from 1.8 to 3.3 mm of Hg after adjusting for sex, education and age. HTN affected more than one third of the elderly rural population sampled and was grossly ignored as a major morbidity of non-communicable diseases among same population. Proper government policy should include early diagnosis and treatment of unrecognized HTN especially among the rural elderly people.







Retinopathy of Prematurity [ROP]: our Recent Experience in Bangladesh

Dipak Nag1, Pankaj Roy1, Rinku Paul2, Afsana Habib3

1National Institute of Ophthalmology and Hospital, Bangladesh

2 Lions Eye Institute and Hospital, Bangladesh

3 Helen Keller International, Bangladesh


Introduction: To see the changes of demographic features, Retinopathy of prematurity (ROP) characteristics, risk factors and treatment pattern of ROP over time in Bangladesh. Method: Babies born ≤34 weeks and birth weight ≤1750grams were included in the study. Babies born >34 weeks and birth weight >1750grams and have turmoil perinatal history were also included in the study. The demographic features, ROP characteristics, risk factors and treatment modalities were recorded. These variables were then compare with the major landmark studies and also studies of the subcontinents. Result: Among 760 screened babies, the mean gestational age was29.18 ±2.18 wks (minimum 24 weeks to maximum 38 weeks) and the mean birth weight was 1172.5±271.08gms (minimum600 grams to maximum 2500 grams) who developed ROP. Aggressive posterior retinopathy of prematurity (AP-ROP) was found significantly high (17.6%) with a few came with RD(6.2%) due to delay first presentation for screening. After adjusting possible confounder’s apnea and blood transfusion were found as independent risk factors for developing ROP. Treatable ROP was found in 27.54%.Apart from laser photocoagulation (LP) in (38.13%), intravitreal bivacizumab (IVB) injection (8.63%), both LP and IVB (14.75%) and surgery (8.63%) were found as the treatment modalities. The results were more or less similar to other Asian but different from western countries. Conclusion: Higher gestational age, heavier babies were found to have ROP. Considerable number were developed more aggressive form of disease (AP-ROP). The risk factors were little different from the initial studies but still remained with the perinatal causes. The treatment options of ROP were also changed.




















Community Paramedics: Bridging the Gap in Access to Services  for Prevention of Noncommunicable Diseases

Fazle Razik, Jafar Ahmad Hakim, Tasmia Nahreen Jahangir

Swisscontact Bangladesh

Introduction: This case study presents evidences supporting the significant contribution of Community Paramedics (CPs) towards the prevention, early detection and referral of Noncommunicable Diseases (NCDs) in rural, inaccessible areas of Bangladesh. CPs are skilled primary healthcare providers who receive two years of full-time training including six months hospital- based internship period, certified by the Bangladesh Nursing and Midwifery Council (BNMC). Method: Data for this study has been collected for the year 2018 from project database and End-Line Assessment of ASTHA Phase I that used a mix of quantitative and qualitative methods. Information from 158 self- employed CPs in the project districts Nilphamari, Sunamganj and Patuakhali has been used. Key Informant Interviews (KIIs) were conducted with 30 of these CPs. For triangulation purposes, Focused Group Discussions (FGDs) were conducted with 180 community individuals. Result: 82,938 patients were consulted by the CPs supported by ASTHA, out of which approximately 33,175 were either cases of NCDs or have early signs of such diseases. CPs are trained and equipped to carry out screening of blood pressure, glucose levels in blood, respiratory diseases and other NCDs included in the CP curriculum. As a result, they have effectively detected symptoms in patients and made timely referrals to appropriate doctors or health centers. CPs level of qualification also enabled them to advise patients on appropriate diets and lifestyles and specific tests to be done for early diagnosis of these diseases.  Results also show that CPs have been able to raise awareness on NCD prevention in the community by encouraging people to take screening tests and other preventive measures. Conclusion: While an estimated 886,000 deaths per year are caused due to NCDs in Bangladesh, CPs in ASTHA’s project areas have consulted 33,175 people in a year who might have been exposed to the associated risk factors.






Overweight and Obesity and Its Predictors Among The Rural Community of Bangladesh

Shagoofa Rakhshanda*, Riffat Ara Shawon*, AKM Fazlur Rahman*, Mithila Faruque**, Palash Chandra Banik**, Lingkan Barua**, Md. Rizwanul Karim***, Farhana Islam*, Saidur Rahman Mashreky*

*Center for Injury Prevention and Research, Bangladesh

**Bangladesh University of Health Sciences

***Directorate General of Health Services, Bangladesh

Introduction: The increasing prevalence of obesity and overweight are major public health concerns. In 2016, among adults globally about 39% were overweight and 13% were obese, while about 29.2% and 3.6% adults in Bangladesh were overweight and obese, respectively. There are many influencing factors and predictors of overweight and obesity, which when identified may help to develop interventions accordingly. As such, this study was conducted to find the prevalence of overweight and obesity, and to determine its predictors within a rural population of Bangladesh. Method: This study was a cross-sectional quantitative study that took place in the Raiganj sub-district of Sirajganj district of Bangladesh. The WHO STEPS-wise questionnaire was adopted to measure height, weight, waist and hip circumference of adults of age 18 years and above within the study area. Result: The mean BMI of the study population was 21.9 kg/cm2. Based on their BMI, about 16.2% were overweight (females: 18.7%; males: 11.4%; p=0.0007) and 3.5% were obese (females: 4.6%; males: 1.3%; p=0.6689). According to the measurements of waist circumference and waist-hip ratio, about 18.9% (females: 20.0%; males: 16.8%; p=0.0005) and 57.3% (females: 53.6%; males: 64.7%; p=0.0055) respectively had central obesity. Considering physical activity, obesity was found in 2.0% males who led sedentary lifestyle, and 1.2% in those who performed vigorous physical activities; while obesity was 3.4% among females with sedentary lifestyle, and 5.2% in those who performed vigorous physical activities. Based on dietary intake, the highest (1.9%) of the males who consumed red meat were obese compared to those who consumed other foods; while the highest (6.3%) females who consumed packaged food were obese compared to those who consumed other food. Conclusion: The results from this study indicate that factors such as age, sex, level of physical activity and consumption of food, all has effects on obesity and overweight.

















Prevalence and Determinants of Hypertension and Self-Reported Diabetes Among The Elderly Population of Bangladesh

Abu Abdullah Mohammad Hanif1, Md. Mokbul Hossain1, Md Showkat Ali Khan1,  Md. Moyazzam Hosseain1, Mohammad Aman Ullah2, S M Mustafizur Rahman2, Samir Kanti Sarker2, Abu Ahmed Shamim1, Mehedi Hasan1, Dipak Kumar Mitra3, Malay Kanti Mridha1

1BRAC James P Grant School of Public Health

 2Institute of Public Health Nutrition

3Department of Public Health, North South University, Dhaka, Bangladesh 


Background: There is a lack of data on the prevalence and determinants for hypertension and diabetes among the elderly population of Bangladesh. We assessed the prevalence and factors associated with hypertension and self-reported diabetes using data from the food security and nutrition surveillance. Method: We analyzed data from a nationally representative unweighted sample of 4238 older adults (≥ 60 years). Respondents were asked if any health worker ever advised them about having major NCDs, including hypertension and diabetes. Blood pressure was measured with a digital sphygmomanometer.  We performed descriptive analysis to report prevalence,  Pearson chi-square tests to detect the association of hypertension and diabetes with the selected independent variables. Finally, multi-variable logistics regression models have been run to estimate the odds ratio. Result: 51% of the elderly population were hypertensive, and 12% of them had diabetes. The Odds Ratios (OR) and 95% Confidence Intervals (CI) of the factors associated with hypertension were 1.80(1.50-2.16) for female sex; 1.44 (1.24-1.69) and 1.35 (1.08-1.69) for the age groups 70-79 and 80+ respectively; 2.88 (2.03-4.10) for education above secondary level; 1.88 (1.52-2.32) for diabetes; and 0.67 (0.55-0.80) for heavy physical activity. The ORs and 95% CIs of the factors associated with diabetes are 1.59 (1.18-2.14) for female sex; 2.11 (1.64-2.730 for urbanites; 3.58 (2.37-5.41) for education level beyond secondary; 1.90 (1.53-2.35) for hypertension; and 0.59 (0.43-0.81) for non-muslims. Conclusion: Among the elderly population in Bangladesh, hypertension was associated with female sex, advanced age, higher education, diabetes, and heavy physical activity. Self-reported diabetes was associated with female sex, urban residence, religion, and hypertension. The ministry of health of Bangladesh should take necessary initiatives to prevent and control diabetes and hypertension among the elderly population.



Knowledge and Belief About Antibiotic Use Among the Patients Attending A Primary Health Care Center of Bangladesh

Muhammad Sanowar Khan

Sir Salimullah Medical College Hospital

American International University Bangladesh

Narayanpur Tower Hospital and Diabetes and Trauma Center

Navana Digital Diagnostic Center

Background: Misconceptions about antibiotic among community members potentially lead to inappropriate use of antibiotics which leads to antibiotic resistance. This study aimed to assess public knowledge and belief about antibiotic use in a rural area of Bangladesh. Method: A cross-sectional study was done using a pretested questionnaire involving 184 randomly selected respondents, attending for health services in Upazila health complex of Matlab, Chandpur. Knowledge score was calculated by summing participant’s correct responses to 8 statements, followed by categorization into three levels: poor (0-2), moderate (3-5) and high (6-8). Belief grade was calculated using Likert-scale of total five belief items (ranged from 5-25) and beliefs were stated as appropriate if scores were below median line, as moderate if they were at the line and as inappropriate if they were above line. Data were analyzed using STATA (version13) and Chi-square was done between antibiotic knowledge and belief categories and selective respondents characteristics. Result: Mean age of the respondents was 37.45 years (SD ±13.3) and 61% of them were female. About 72% respondents had access to mass media (television, radio, newspaper). 63% respondents were familiar with antibiotics and  55 % of them had moderate to poor level of antibiotic knowledge with a median knowledge score 5. Only 33% had appropriate belief regarding antibiotics with a median belief score 13. Better knowledge level was found among male (p-value: 0.006), high educated respondents (p-value < 0.001) and users of internet (p-value: 0.009).  More inappropriate belief found among older age group (p-value: 0.022), among female (p-value: <0.001) and illiterate educational groups (p-value: <0.001). Conclusion: Interventions are necessary to educate rural people to reduce insufficient antibiotic knowledge and inappropriate belief and to promote appropriate use of antibiotics.



















Willingness-To-Pay for Community-Based Prepayment Scheme Among Chronic Respiratory Patients in Rural Bangladesh

Muhammad Ashique Haider Chowdhury12, Marufa Sultana2, Rashidul Alam Mahumud2, Syeda Novera Anwar3, Ali Tanweer Siddiquee2, Shahed Hossain2, Aliya Naheed2, Ziaul Islam2

1University of Chicago

icddr,b, Mohakhali Dhaka, Bangladesh 3Swisscontact Bangladesh

People of Bangladesh heavily encounter out-of-pocket healthcare cost from chronic diseases including chronic respiratory diseases. It is essential to find ways to reduce out of-pocket health care cost for ensuring universal health coverage, health improvement and reduce poverty. In this study, we explored the extent and determinants of willingness-to-pay for a community-based prepayment scheme among chronic respiratory patients in three sub-districts of Bangladesh.We conducted a cross section survey (n=105) among male and female patients (≥40 years) attending Upazilla Health Complexs and diagnosed with Chronic respiratory illness (COPD and Asthma) by the qualified providers. Patients were selected first come first basis (without any sex stratification) until required sample size is achieved. Trained interviewers interviewed patients in Bangla using a structured questionnaire. We have proposed a hypothetical community-based prepayment healthcare scheme, which was adapted from a scheme being piloted in Chakaria by icddr,b titled as ‘Amader Shasthya’. We applied Contingent Valuation Method (CVM) for assessing willingness-to-pay for health insurance.The average age of the patients was 62.43 (±13.99) years and 63% were male. Average health expenditure in last six month was BDT 4,628 (US$ 58.96).  Patients cope with their healthcare expenditure through regular income (67.24%), family saving (10.34%) and borrowing (9.48%).  The majority of the patients (94.29%) had no knowledge about health insurance. About 61% of the patients agreed to join for a CBHI, 19% did not agree and 20% was not able to decide it. The average estimated WTP for CBHI was BDT 727 (US$ 9.26) as yearly premium. Patient’s household size, health expenditure, and areas of residence significantly influenced WTP for CBHI among COPD and asthma patients.






Non-Adherence to Antihypertensive Treatment in Crucial Hypertensive Patients in Rangpur Hypertension Centre, Bangladesh: A cross-sectional study

Farhana Ul Hoque, Ahmed Hossain

North South University, Dhaka, Bangladesh

Abstract

Introduction: In Bangladesh, morbidity and mortality because of non-communicable diseases (NCDs) has multiplied over the previous couple of decades. Hypertension is a vital risk issue for NCDs and one in every of the foremost essential causes of uncontrolled hypertension is nonadherence to drugs. We tried to seek out the factors that influence non-adherence to antihypertensive therapy so that effective measures may be taken to unravel this downside. Method: In this cross-sectional study, 500 hypertensive patients were recruited from Rangpur, hypertension centre. Result: 70% of this study population were non-adherent to treatment. Lower level of educations, low family income, length of diagnosing, knowledge and belief of the disease, lack of attendant person to go to the physician/hospital, and deficiencies in information from the service supplier are the additional factors determining non-adherence. The study site, monthly family income, length of diagnosing and knowledge level played a significant role in the study outcome. Conclusion: Since hypertension is a chronic disease, patients ought to be inspired to require their medication frequently and follow the lifestyle advised. The term non-adherence to treatment was defined as the discontinuation of medication at the time of interview/treatment. Community based mostly studies ought to be conducted to find the extent of non-adherence to antihypertensive treatment.




The Optimal Level of Serum Vitamin D in Apparently Healthy Adult Volunteer

Anil-Yadav, Selim S, Haq T, Khan MA, Marufa-Mutari, Mostafahasan-Rajib, Shah AK, Shahed-Morshed, Faisal I, Ghani MH, Hasanat MA, Fariduddin M

Department of Endocriniology, Bangabandhu Shiekh Mujib Medical University, Dhaka, Bangladesh

Background: Vitamin D deficiency is highly prevalent in several parts of the world including in our population.  Vitamin D level has profound clinical implications but there is dilemma of normal vitamin D cut- off level among Bangladeshi population as well in many parts of the world. So this study is aimed to determine the normal level of vitamin D in healthy Bangladeshi adults. Objective: To determine the optimal level of vitamin D in relation to intact PTH and serum calcium in apparently healthy adult volunteer. Materials and method: This observational cross-sectional analytical study was carried out in 30 (age: 37.57±2.22 years) apparently healthy adult participants of BSMMU.  Serum 25(OH) D [high performance liquid chromatography (HPLC) method], intact parathyroid hormone, corrected serum calcium and serum phosphate were measured. Result: The mean 25(OH) D level of the study population was 6.78±8.47 ng/ml and significantly different by age distribution and adequacy sun exposure. A significant negative correlation was found between serum intact parathyroid hormone and serum 25(OH) D (r = - 0.22, P = 0.0).  Serum 25(OH) D levels less than 27.5ng/ml were associated with a steep increase in serum intact parathyroid hormone levels. The quadratic fit with plateau model showed that intact parathyroid hormone stabilizes at 25(OH) D level of 54.5 pg/ml. Conclusion: From this study the optimal level of 25(OH)D for apparently healthy adult in Bangladesh is 27.5 ng/ml.



Media Representation of NCDs in Bangladesh

Md. Mohibur Hossain Nirob1, Umme Nayma2, Md. Shahnewaz Parvez3, Md. Mozahidul Islam4, Md. Shajedur Rahman Shawon5

1Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

2Diploma in Preventive Cardiovascular Medicine, University of South Wales, UK

 3Deputy Program Manager, NCDC, DGHS

4Staff Reporter, Somoy TV

 5PhD candidate, Nuffield Department of Population Health, University of Oxford


 Introduction: Mass media plays a crucial role in population health through disseminating health information to mass people and shaping public health policies.The World Health Organization (WHO) 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs emphasised on mass media engagement to help to achieve its targets.In this study, we explored the coverage of prevention and control measures for NCDs in print media platforms in Bangladesh. Method: In collaboration with the health media monitoring cell of the Directorate General of Health Services(DGHS), we did a content analysis of news published between February 2016 and February 2018 on 20 national newspapers.Two researchers reviewed the articles independently. Result: A total of 6973 health-related articles were analysed and 6.7% (n=476) of them were about NCDs. Conditions like cancer, diabetes, cardiovascular disease and chronic kidney disease were discussed more frequently than other conditions. News representations on chronic respiratory disease, mental health issues and stroke were very low in number. Approximately 30% of all news focusing on NCDs discussed risk factors and preventive measures. News on NCDs discussed more about health service issues, for example, inadequate facilities, lack of resources including specialists, and poor service quality, whereas issues like out-of-pocket expenditure and research activities were discussed least. A handful number of articles talked about arsenic and pollution, and their links with various NCDs. Conclusion: This study highlights the fact that discussions around NCD risk factors, and prevention are still very low. Given the powerful roles of media in health advocacy and community mobilisation, more coverage of NCDs in print media is recommended. We also suggest appropriate training of media personnel on NCD topics and better working relationships between journalists and public health community for effective mass media campaigns on NCDs.














Cardiometabolic Risk in Overweight and Obese Children in Bangladesh

Muhammad Abdul Hannan, Tahniyah Haq, Muhammad Abu Hasanat, Muhammad Fariduddin

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Childhood obesity is increasing dramatically and represents an important public health issue due to associated metabolic and cardiovascular co-morbidities. Very limited data are available regarding cardio-metabolic risk factors among this group in Bangladesh. Objective: To observe the cardio-metabolic risk factors in overweight and obese children.Method: This cross-sectional study was carried out in 88 overweight and obese children recruited consecutively by using CDC percentile chart for body mass index (BMI) in children over a period of 15 months. After completing a questionnaire and relevant clinical examination, blood was collected for fasting plasma glucose (FPG), insulin, HbA1c, lipid profile and C- reactive protein (CRP). Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to determine insulin resistance. Result: Central obesity (100%), dyslipidaemia (88.6%), raised CRP (81.8%) and metabolic syndrome (69.3%) were the most common cardio-metabolic risk factors. Children with grade 3 obesity had significantly higher systolic blood pressure (115.57±11.60 vs 105.71±8.84 mmHg, p=0.043) and insulin resistance (7.15±4.97 vs 3.53±2.04, p= 0.017) than grade 1 obesity. Blood pressure, insulin resistance and CRP increased while high density lipoprotein (HDL) decreased with increasing severity of obesity. BMI z score was a significant predictor of systolic blood pressure, waist circumference was an independent predictor of diastolic blood pressure and HDL, waist height ratio best predicted insulin resistance, CRP and total cholesterol in overweight/obese children.   Conclusion: We have observed a high frequency of cardio-metabolic risk factors in overweight and obese children and they increased worsened with increasing grade of obesity.





















Assessment of Non-Alcoholic Fatty Liver Disease in Obese and Overweight Children at Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh

Romana Akther, Suraiya Begum, Farjana Alam

Introduction and objective: Obesity in children and adolescent is rising alarmingly and approaching an epidemic proportion in many countries. Obesity in childhood appears to increase the risk of subsequent morbidities, such as increased incidence of dyslipidemia, hypertension, type 2 diabetes, non alcoholic fatty liver disease (NAFLD), obstructive sleep apnea. NAFLD has evolved as a key co-morbidity associated with obesity and recently emerged as the leading cause of chronic liver disease in children. So the present study was conducted to assess the Non-Alcoholic Fatty Liver Disease in overweight and obese children.Material and method: It was a cross sectional study done in children aged 5 to 18 years attending in Pediatric Endocrinology clinic, Department of Pediatrics, BSMMU, Dhaka over a period of 14 months. All obese and overweight children were selected after considering inclusion and exclusion criteria. The weight and height of study children were measured to calculate BMI and classified as overweight and obese for particular age and sex. Patients were advised to do serum Alanine aminotransferase (ALT) and ultrasonography of hepatobilliary system. Result: A total of 90 children were enrolled in the study. It was observed that majority were obese. ALT was high in 36% of children. 40% had NAFLD and majority had mild NAFLD.  ALT was raised in 58.3%  of NAFLD children. Conclusion: It was observed that 40% of overweight and obese children had NAFLD. ALT is strongly associated with NAFLD. So by doing ultrasonography and liver function test early detection of NAFLD should be emphasized to prevent further progression of NAFLD.








Comparison of Tobacco Use in Youth Between Two South Asian Countries for Last Decade: Analysis From Nationally Representative GYTS Survey

Md Shehab Uddin Al Abid1, Sohel Reza Choudhury, Md Mostafa Monower

National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh

Introduction: Tobacco is one of the leading preventable cause of premature death due to different NCDs. It is known as “gateway drug”, so tobacco initiation and consumption in youth poses a significant public health problem. Utilizing Global youth tobacco survey (GYTS) data, we tried to analyze and compare prevalence of youth tobacco use, behavior and factors associated in Bangladesh and Sri Lanka between 2007-2015. Method: GYTS is a nationally representative survey on youth tobacco use. In between 2007-2015, there were 2 GYTS survey conducted both in Bangladesh (2007 and 2013) and Sri Lanka (2007 and 2015). Prevalence percentages of different forms of tobacco use and factors influencing were examined using SPSS 23. Result: In 2007, prevalence of youth tobacco users in Bangladesh and Sri Lanka was 6.8% and 9.6% respectively. Later on, in Bangladesh-2013 prevalence percentage was 6.9% and in Srilanka-2015 was 3.7%. Cross-tabulations showed that there was significant reduction of smokeless tobacco user in Sri Lanka than Bangladesh; second-hand smoke exposure both at home and public place significantly reduced in Sri Lanka, anti-tobacco campaign and tobacco education were higher in Sri Lanka, pro-tobacco advertisements were less in Sri Lanka than Bangladesh. It was found that age, gender, second-hand smoke exposure and availability of free tobacco were significantly (P<0.001) associated with tobacco use. Conclusion:  In 2007 Sri Lanka was at worse stage regarding youth tobacco use. But over period of time they moved ahead of Bangladesh. Presence of FCTC compliant law and appropriate policies with strong implementation have influence on youth tobacco behavior as evident from difference of tobacco related indicators in two countries.  This study will give a helpful insight regarding influencing factors of youth tobacco use and re-evaluation of tobacco control policies in respective countries which will ultimately help both countries to fight against non-communicable disease.



















Spectrum of Thalassemia and Other Hemoglobinopathies in Bangladesh: A Decade-Long Single Centered Study at Icddr,B

Anamul Hasan, Bikash Chandra Chanda, Maisha Aniqua, Jigishu Ahmed, Kazi Afrin Binta Hasan, Md. Zahidul Islam, Raisa Akther, Md. Mazed Ali, Palash Kanti Dhar, Sharmine Zaman Urmee, Hafizur Rahman

icddr,b, Mohakhali, Dhaka, Bangladesh

Background: Hemoglobinopathies are the most common hereditary disorders around the world. Thalassemia, a major hemoglobinopathy disorder, is emerging as a global public health concern with higher prevalence in areas extended from Africa over the Mediterranean basin, the Near and Middle East to Southeast Asia along with Indian subcontinent. Bangladesh, situated in the hotspot of world’s thalassemia belt, is experiencing the heterogeneous prevalence of thalassemia.  Method: In a decade-long retrospective study (January, 2007-September, 2019), 7,803 specimens were tested for hemoglobinopathy screening. Data obtained from capillary zone electrophoresis (CZE) and corresponding complete blood count (CBC) were used in our primary investigation. PCR and hybridization-based thalassemia genotype study on 21 highly prevalent mutations in South-East Asia were also conducted whenever required.  Result: 1,947 samples (24.95% of total studied) were found having hemoglobinopathy. The most common scenario encountered was hemoglobin E (HbE) trait (904 from 1,947 samples, 46.43%), followed by β-thalassemia trait (37.60%), HbE disease (6.68%) and HbE β-thalassemia (4.88%). The average HbE in HbE trait, disease and HbE β-thalassemia were 23.62%, 90.70% and 52.99% respectively. The average HbA2 in β-thalassemia trait was 5.15%. Other variants were HbS, HbD-Punjab, Hb Lepore, HbC, Hb Hope, HbH, hereditary persistence of fetal hemoglobin (HPFH) with different minimal percentages. Some rare variants were suspected to be HbJ and HbN requiring further investigation. Thalassemia genotype study of 233 samples showed the presence of α and β-thalassemia mutations with 7.73% and 60.52% respectively. IVS1-5(G-->C) was the most abundant mutation found in total 173 mutated samples with 49.13%. Conclusion: Our data show that hemoglobinopathy pattern in Bangladesh is diverse and heterogeneous. Therefore, techniques like DNA sequencing are required to identify the pattern of mutations.





Assessment of Thyroid Function and Antithyroid Antibodies in Children With Down Syndrome

Baraka Badrudduja Tithi

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Thyroid disorders are very common association with Down syndrome (DS). The prevalence of congenital and acquired hypothyroidism specially subclinical hypothyroidism is high in children with Down syndrome. Hyperthyroidism though rare, is also more prevalent compared to general population. Autoimmune thyroid disorders are also more prevalent in Down syndrome children as they are more prone to develop autoimmune disease. Objective: To assess thyroid function and anti thyroid antibodies in children with Down syndrome. Material and methods: In this observational study, all Down syndrome children (n=81) fulfilling the inclusion criteria were included. Five ml of blood drawn from each patient and tested for serum FT3, FT4, TSH level and anti-Thyroid peroxidase (anti TPO) and anti-Thyroglobulin (anti TG) level. Result: Thyroid dysfunction was present in 46.9% children with Down syndrome, Hypothyroidism was 40.6 %. Most common thyroid dysfunction was subclinical hypothyroidism (34.5%). Both overt hypothyroidism(6.2%) and hyperthyroidism (6.2%) was found . Congenital hypothyroidism was found in 15.1% children and acquired  hypothyroidism was 84.9%. Prevalence of thyroid antibody was 34.56%. Anti TPO positivity was more than anti TG positivity. Anti TPO positivity was statistically significant   among the overt, subclinical hypothyroid, hyperthyroid group. Conclusion: Subclinical hypothyroidism was the commonest thyroid abnormality. We also found hyperthyroidism, and overt hypothyroidism . Thyroid autoimmunity evidenced by anti thyroid anti bodies, was present in 34.56% children.






Changing Trends in Maternal Mortality in a Tertiary Hospital in Bangladesh

Tahmina Begum, Ferdousi Begum, Ferdousi Islam, Nazneen Begum

Ibrahim Medical College and BIRDEM Hospital, Dhaka, Bangladesh

Introduction: Maternal mortality ratio of a country is an indicator of the overall status of women. Developing countries bear a disproportionate share of maternal deaths. Bangladesh is one of those developing countries where the maternal death rate and ratio are unexpectedly high. Changing trends of causes of maternal death are observed with changing socio-economic condition of the country.Method: The objective of the study is to compare the changing trends in maternal mortality over a year in Dhaka Medical College Hospital (DMCH). A cross-sectional study was conducted on all the patients admitted in the department of Obstetrics and Gynecology in DMCH from July 2010 to June 2011. Only maternal death cases were enrolled through inclusion and exclusion criteria. Data were collected, analyzed and finally data were compared with previous study conducted on July 2003 to June 2004 by Khatun K in DMCH and measuring the changing trends of maternal death in DMCH.  Result: During the study period trends shows that maternal mortality is reduced by 9.91% and the maternal death due to direct causes are reduced by 8.30 %. The maternal death due to eclampsia and unsafe abortion are reduced by 11.73 %, and 4.12% but maternal death from obstetric hemorrhage and obstructed labor is raised 7.59 % and 3.38 % respectively. Death from indirect causes increased more than twice (14.42%).  Death from indirect causes increased more than twice (14.42%): Jaundice 2.88%; anaemic heart failure 2.85%; and renal failure 1.92%.Conclusion: Significant increase in maternal death due to indirect causes is observed in this study, with simultaneous reduction of death due to direct cause.








Risk Factors and Outcome of Early and Late Onset Preeclampsia

Ferdousi Begum, Tamima Sultana Elin

Ibrahim Medical College and BIRDEM Hospital, Dhaka, Bangladesh

Background: Early- and late-onset preeclampsia, defined as preeclampsia developed before and after 34 weeks of gestation, respectively. The early-onset disease is associated with poorer outcomes. Moreover, the risk factors between early -and late- onset preeclampsia could be differed owing to the varied pathophysiology. Method: To identify the differences in risk factors and outcome of early and late onset preeclampsia. A case control study was carried out involving pregnancy with preeclampsia [50 early onset preeclampsia (EOP) and 50 late onset preeclampsia (LOP) and 50 controls (pregnancy without preeclampsia) at BIRDEM general hospital, Dhaka, Bangladesh from March to August 2019 using proper inclusion and exclusion criteria. Data were collected by using a pre tested semi structured questionnaire. Data were collected by interviewing study subjects and from case records; and were analyzed using SPSS. Result: As risk factors: Chronic HTN (OR= 2.0, 95% CI 1.65-2.46), nulliparity and family history of HTN were significantly associated with EOP, while GDM (OR=13.8, 95% CI 1.7-111.7) and chronic HTN (OR= 2.06, 95% CI 1.68-2.53) were significantly associated with LOP. Maternal complications like HELLP, AKI and fetal complication like preterm delivery, IUD, IUGR and NICU admission and low birth weight were significantly more in EOP. Conclusion: EOP is a distinct and a more severe clinical entity, associated with intrauterine growth restriction, high rates of adverse birth outcomes, a much earlier gestational age at onset and delivery. EOP and LOP should be addressed differently and national policy should develop on screening and management.





 

Electronic Health Record System for Ncds Diagnosis, Care and Management

Syed Emdadul Haque1, Md. Tariqul Islam1, Md. Alauddin Ahmed1, H E M Mahbubul Eunus1, A.K.M. Rabiul Hasan1, Md. Tariqul Islam1, Golam Sarwar1, Rabab Al Shams1, Habibul Ahsan12

1UChicago Research Bangladesh

2University of Chicago

Background: Globally, technology can help to collect health record to store, produce scientific evidences and support the policy makers. We can easily get the information using an electronic-based system and quickly supply the information. Therefore, UChicago Research Bangladesh (URB) IT team developed an electronic data collection and management system named Electronic Data Management System (EDMS). Therefore, URB researchers plan to know clearly to determine prevalence and pattern of major diseases in rural Bangladesh by age, gender, socio-economic status, diagnosis of diseases, types of medicine and the cost using the recorded systems.   Method: This EDMS system is running in the study area in Araihazar Upazilla in Narayanganj district, Bangladesh. In Araihazar, URB recruited 37,000 participants for their ongoing research studies. The trained staffs are managing EDMS for the community people who come to the clinic for their treatment purposes. EDMS allows capturing each event of the patients. Result: Last five years, 28,205 participants were visited in the primary health care center where 9,340 were male and 18,865 were female. Out of total participants visited in the health care center 19,813 were visited in the lab for their diseases diagnosis. During, 2017-2019, there were 386 CVD patients and 362 endocrine metabolic patients visited in the clinic for their care and management.    Conclusion: The system will give us opportunities to develop a clinical data depository which will help us to address the future research questions related to NCDs. It is not difficult to manage patients with NCDs in a primary health care setting using EDMS. The system may act as an extendable and sustainable infrastructure for comprehensive health care and services for a broad spectrum of diseases and health events. Govt. can introduce such system for the whole country including potential institutes and researchers can get the new evidences related to maintain the quality of services, rational use of drug, and cost of diseases management.














Sociodemographic Status and Multimorbidity Development Among Adults: A Systematic Review and Meta-Analysis

Ahmed Hossain, Saifur Rahman Chowdhury, Dipak Chandra Das, Topu Chandra Das

Department of Public Health, North South University, Dhaka, Bangladesh 

Introduction: With the growth of ageing populations, multimorbidity has become a major concern in public health. Although multimorbidity is associated with age, its prevalence varies by different measures of sociodemographic status. We performed a systematic review to identify and synthesise the existing literature on the association between sociodemographic status and multimorbidity development. Method: We searched PubMed, EMBASE, Google Scholar and ScienceDirect databases for relevant articles that are published from January 2005 to June 2019. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Result: A total of 45 observational studies involving 88,122 participants were selected, and 24 studies were included in one or more meta-analyses. Most of the articles defined multimorbidity as having two or more diseases. The overall pooled prevalence of multimorbidity was 32.1% (95% CI= 29.0–35.3%). There was a considerable difference in the pooled estimates between low and middle income countries (LMICs) and high income countries (HICs), with prevalence being 38.9% (95% CI= 33.5–44.4%) and 28.7% (95% CI= 25.4–32.0%), respectively. All studies found a significant positive association between the occurrence of multimorbidity and age (odds ratio [OR], 1.26 to 7.46). Multimorbidity was associated with older age than the younger in pooled analysis (OR=2.27; 95% CI= 1.97-2.62). Multimorbidity occurrence is high among female gender was found in pooled analysis (OR=1.20; 95% CI= 1.10-1.30). A positive association was also observed between lower socioeconomic status (OR, 1.22 to 1.95) and multimorbidity development.  Low versus high education level was associated with a 68% increased odds of multimorbidity (OR= 1.68, 95% CI= 1.45 to 1.97). Increasing deprivation was consistently associated with increasing risk of multimorbidity development, where we found a mixed evidence on income. Conclusion: The occurrence of multimorbidity is higher in low and middle income countries (LMICs) compared to high income countries (HICs). Age, lower socioeconomic status and gender are the significant sociodemographic determinants of multimorbidity. A deeper understanding of the socioeconomic and demographic patterning of multimorbidity will help to identify sub-populations at greatest risk of becoming multimorbid.



Association of Smoking and SLT With Blood Lipids in A Urban Slum Population of Dhaka

Ahmad Khairul Abrar1 Sohel Reza Choudhury1 Md Khalequzzaman2 Mohammad Abdullah Al-Mamun1, Chifa Chiang3 Hiroshi Yatsuya3, Atsuko Aoyama3

1Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh, 2Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 3Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan


Introduction: Cardiovascular disease is the leading cause of death in Bangladesh. Tobacco is the most important preventable risk factor for majority of NCDs including cardiovascular diseases. Both cigarette and smokeless tobacco (SLT) contain highly addictive nicotine as well as many toxicants and carcinogens. Effect of smoking on blood lipid is well known, as it decreases HDL, but effect of SLT on blood lipids is not clear yet. This paper is aimed to find association of blood lipid with smoking and SLT consumption. Method: A community based cross sectional study was conducted on urban slum dwellers of Dhaka City. 2010 adults (equal proportion of men and women) were interviewed with a pretested standard questionnaire and their biological samples were analyzed. Respondents were categorized into four groups according to their tobacco use habit: tobacco non-consumers, smokers, SLT users and dual users of cigarette and SLT. Smokers were categorized into two groups, who smoke <10 cigarettes per day (CPD) and who smoke ≥10 CPD. SLT users were categorized in three groups; who consume <5 episodes per day, 5-9 episodes per day and ≥10 episodes per day. Association of smoking and SLT use with blood lipids was determined by ANOVA, taking into consideration the other confounding factors; age, sex and body mass index (BMI). To determine the proper association, overlapping dual users of cigarette and SLT were excluded during analysis. Result: Among the subjects, majority (60%) were non-consumer, 21% were smoker, 15% were SLT user and only 4% were dual user. Mean age of SLT users was highest and it was lowest in non-consumers of tobacco (p<0.001). Highest mean total cholesterol (p<0.001) and triglyceride (TG) was found among the SLT users. Among smokers, High density lipoprotein (HDL) was found to be lowest (p<0.001) and LDL to TC ratio and LDL to HDL ratio was found to be highest (p<0.01). After adjustment of covariates, only HDL remained significant statistically (p<0.05). In SLT users TC (p<0.01), TG and HDL (p<0.01) were found to increase significantly with the increased frequency of SLT use. After adjustment of confounder, pattern of increase persisted without statistical significance. Conclusion: Increased level of TC and LDL might be associated with cardiovascular diseases caused by SLT consumption. Strict control of SLT as well as smoking might be helpful in prevention of cardiovascular diseases.



Burden of Dementia Among Elderly Population in Bangladesh and Multi Morbidity

Md.Saimul Islam1, Josepha Elizabeth1, Bilkis Ara1, Mir Nabila Ashraf1, Md. Badrul Islam1and3, Maliha Hakim2, Quazi Deen Mohammad2, Aliya Naheed1

1Initiative for Noncommunicable Diseases, Health Systems and Population Studies Division, icddr,b, Mohakhli, Dhaka, Bangladesh 2 Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh3icddr,b, Mohakhali, Dhaka, Bangladesh


Introduction: Dementia is one of the major causes of disability among elderly people (≥60 years) worldwide; 66% of people with Dementia live in the low and middle-income countries (LMIC). The number of elderly in Bangladesh has increased from 7.2 million in 2000 to 12.1 million in 2015, but the burden of Dementia is unknown. We estimated the burden of Dementia and multi morbidity among elderly population in Bangladesh. Method: Between January and June 2019, we randomly selected one urban and one rural community in each of Dhaka, Sylhet, Chittagong, Barishal, Khulna, Rangpur and Rajshahi divisions and listed all individuals  ≥60 years living in randomly selected 9,000 households. Consent was obtained prior to data collection on age, sex, education, and occupation. Mini Mental State Examination (MMSE) was administered by trained research staff following consent. Dementia was reported if MMSE score was <24. Hypertension was reported if systolic blood pressure was ≥140 mm of Hg or diastolic blood pressure was ≥90 mm of Hg in two readings, or the individual was on an anti-hypertensive medication (NICE hypertension guideline). Diabetes was reported if random blood sugar (RBS) was recorded >11.1 mmol/L using Accu-Chek. Results: Out of 4,191 eligible participants we randomly selected 2,797 elderly (66.7%). The mean age(±SD) was 68(±7.2) years, 58% was male, 32% recruited from urban areas, 25% completed primary education, and 60.2% belonged to poorest to middle income group. MMSE score was <24 in 226 participants (8.1%) and burden has been estimated 808.0 per 10,000 elderly populations. Burden of Dementia was 2.5 times higher in individuals above 70 years than the younger elderly (1,356.7 per 10,000 vs. 541.7 per 10,000; P<0.001); 2.7 times higher in females than males (1,170.3 per 10,000 vs.  430.7 per 10,000; P<001); 3 times higher in individual who did not complete primary education than those completed (966.8 per 10,000 vs.  321.2 per 10,000; P<001); 2 times higher among those who were not currently involved in any occupation than those involved (968.2 per 10,000 vs.  417.7 per 10,000; P<001);  and 2 times higher among the poorest to poor income group than the richer income groups (1,026.7 per 10,000 vs. 549.0 per 10,000; P<001). Burden of Dementia was the highest in Rajshahi division (1491.4 per 10,000) followed by Rangpur (1,192.2 per 10,000), Khulna 782.4 per 10,000), Barishal (733.5 per 10,000), Chattogram (674.5 per 10,000), Sylhet (464.5 per 10,000), and Dhaka (293.4 per 10,000). Overall 37% elderly had hypertension, and 17% had diabetes. Participants with Dementia had 34% higher odds of having hypertension than those did not have Dementia (OR 1.34, 95% CI: 1.02-1.76). The odds of having diabetes were not different among participants with Dementia than those did not have Dementia (OR 1.14, 95% CI: 0.81-1.61).Conclusion: Burden of Dementia is substantial in elderly people in Bangladesh with variability by socio demographic characteristics and region. Multi morbidity is higher among elderly with Dementia suggesting comprehensive health care need among elderly. Further investigations in to the risk factors of Dementia will be essential for developing low cost intervention in Bangladesh.  

















Fasting Lipid Profile in Overweight and Obese Children: A Hospital Based Study

Monira Hossain, Ismot Ara Zannat, Suraiya Begum, Shahana A Rahman

Introduction: Obesity has become one of the most important public health problems in recent years. Childhood obesity increases the risk of dyslipidemia, hypertension, type 2 diabetes (T2DM), metabolic syndrome etc. Aim of this study was to assess fasting lipid profile and pattern of dyslipidemia in overweight and obese childrenin Bangladesh. Materials and method: It was a cross sectional study done in children, aged 5 to 16 years, attending the paediatric endocrine clinic and paediatric outpatient department, Bangabandhu Sheikh Mujib Medical Universityover a period of 18 months. All overweight, obese and normal weight children were selected after considering inclusion and exclusion criteria. They were categorized as group-I (overweight/obese) and group-II (normal weight) according to the CDC criteria. Among a total of 150 children 100 were group-I in 50 were group-II. Result: Dyslipidemia was present in 80.0% and 64.0% among group-I and group-IIrespectively (p<0.05). Total cholesterol, LDL and TG were significantly higher amonggroup-I (p<0.05). HDL was low in both groups (p>0.05). Most of the childrenin group-I had one or two lipid parameters abnormality and group-II children had one parameter abnormality. It was found that first issue was 2.66 times, watching TV >3 hr was 4.47 times, breast feeding<6 month was 4.16 times, daily excess caloric intake was 17.36 times and maternal BMI >24.9 was 2.70 times higher obesity (95% CI). Conclusion: It was observed that 80% patients had dyslipidemia in overweight and obese children. Total cholesterol, low density lipoprotein and triglyceride level were significantly higher in this group.The first issue, excessive sedentary activities like watching television, lack of exclusive breast feeding, excess calorie intake and overweight/obese motherhad higher risk to develop overweight or obesity in children.






Double Burden Malnutrition Among School Age Children in Bangladesh


Aliya Naheed1, Md. Saimul Islam1, Dewan S Alam1,2, Nazaratun Monalisa1, Louis Niessen1and4, Abdullah Al Mamun3


1Inititative for Non-communicable Disease , Health Systema and Population Studies Division, icddr,b , Dhaka, Bangladesh; 2 School of Kinesiology and Health Science, Faculty of Health York University, Canada; 3Institute for Social Science Research,Faculty of Humanities and Social Sciences, University of Quensland, Australia; 1and4Liverpool School of Tropical Medicine,UK

Background: Double burden of malnutrition is a public health concern in developing countries, including Bangladesh. We estimated burden of malnutrition among school age children, in urban areas in Bangladesh and observed variations by age, sex, socio economic status and division.  Method: We randomly selected 30 wards of the city corporations in Dhaka, Sylhet, Chattogram, Khulna, Barishal, Rajshhi and Rangpur divisions. Twenty households were randomly selected from each ward and one child aged 5 to 18 years of age was recruited per household following consent. Trained research staff obtained data on age and sex of children. Principal Component Analysis (PCA) was carried out for assessment of socio economic status (SES) of the households. Height and weight were measured to calculate Body mass index (BMI) following a standardized formula. International Obesity Taskforce cut off values were applied for assessing normal weight (BMI 5th-85th percentile), underweight (BMI <5th percentile), overweight (BMI 85th –94th percentile) and obese (BMI ≥95th percentile). Result: Between January and June 2013, we recruited 4,140 children from 7 divisions. The average age (±SD) of the children was 11±3 years; 50% were female. According to BMI 56% children had normal weight, 30% children had underweight, 10% had overweight and 4% had obesity. Prevalence (38% vs 25%; P<0.001), but did not vary across SES. Prevalence of overweight and obesity did not vary across age, but was highest in the richest quintile (17.3% vs. 14.5; P=0.001) and the lowest in the poorest quintile (9.7%) (P<0.001). Prevalence of underweight was highest in Rajshahi (37.5%) and the lowest in Dhaka (25.5%) (P<0.003). Prevalence of overweight and obesity was the highest in Dhaka (21.5%) and the lowest in Rangpur (6.7%) (P<0.001). Conclusion: One third of school age children in urban areas have under nutrition, and nearly one out of seven children has overweight with variations across age, socioeconomic status and divisions. Overall situation suggests an alarming increase in the double burden of malnutrition in Bangladesh. Obesity control programme should be included in adolescent health while addressing under nutrition.