Disease Burden In Bangladesh Research Articles

Evaluation of the Weightage on Dermatological Pharmacotherapy in Undergraduate Pharmacology Education of Bangladesh

Background: The aim of pharmacology education is to make graduate competent enough to prescribe safely and effectively. So it is expected that pharmacology education would incorporate all the important aspects of prescribing. Skin diseases are associated with a considerable disease burden in Bangladesh and mostly treated in primary care settings by junior doctors. Materials and methods: This descriptive cross-sectional study was conducted to analyze the undergraduate pharmacology curriculum and written question papers (SAQ) of MBBS curriculum of 07 different universities (Bangladesh University of Professionals, University of Dhaka, University of Chittagong, University of Rajshahi, Shahjalal University of Science and Technology, University of Science and Technology, Chittagong and Gono Bishwabidyalay) of Bangladesh in last 10 years (January 2010 to November 2019). The evaluation was conducted through searching certain key phrases. Results: In Pharmacology & Therapeutics portion of the MBBS curricula, there was not a single hour to teach dermatological pharmacotherapy. Highest presence of dermatological pharmacotherapy related question was observed in Bangladesh University of Professionals (BUP) followed by University of Rajshahi (RU).And statistically significant difference (p<0.00001) was observed among seven universities. Conclusion: Current study revealed negligible presence of dermatological pharmacotherapy in undergraduate pharmacology education of Bangladesh over 10 years period. IAHS Medical Journal Vol 5(2), Dec 2022; 34-37

Tackling “half” of the non-communicable disease burden in Bangladesh: a diagonal service delivery model with a life-course approach

In the context of increasing morbidity and mortality due to non-communicable diseases (NCDs) globally and particularly in low-resource countries, it has become important to explore newer health systems delivery models. In low-and middle-income countries (LMICs) women traditionally challenged with multiple barriers in accessing health services, are at even greater disadvantage compared to men. In Bangladesh, women constitute almost half of the country’s population and are disproportionately affected by NCDs like other LMICs. The country’s reproductive, maternal, newborn, child and adolescent health (RMNCAH) services are well established and designed to reach women in their households through community health workers (CHWs). This paper discusses how NCDs screening and control measures could be integrated into the existing RMNCAH pathway and proposes a conceptual model for such diagonal service delivery integration. The paper also describes multiple RMNCAH service delivery touchpoints that could be utilized for screening and treating women for NCD risk factors, across their life-course.

Frequency of consanguineous marriage among the thalassaemia major patients in Bangabandhu Sheikh Mujib Medical University

Thalassaemia is a commonly occurring hereditary disorder. There is a high prevalence of thalassaemia disease in South-East Asia as well as Bangladesh. It is an autosomal recessive disorder, so consanguineous marriage is a very important factor for this disease. Mutated beta globin gene of haemoglobin from both parents is responsible for this disease to occur. But when the number of thalassaemia carriers is miserably high, then only avoidance of consanguineous marriage can’t prevent the birth of children with thalassaemia major. So, this cross sectional study was conducted among 120 diagnosed (by haemoglobin electrophoresis or high performance liquid chromatography) thalassaemia major patients in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2019 to May 2020. History from each patient was taken and blood samples were collected from their parents to confirm carrier state by haemoglobin electrophoresis. Blood samples were also collected from patients and their parents toperform complete blood count and peripheral Blood Film. This study showed the mean age of the participants was 15±9.34 and 73 (60.8%) patients were male and 47 (39.2%) were female. About, 71% of the study population lived in urban area, 81 (67%) patients were transfusion dependent thalassaemia patients. 15% thalas- saemia major patients had the history of consanguinity of their parents. Among the parents of the thalassaemia major patients, 62.5% were Beta thalassaemia trait (heterozygous state), 25.83% parents were Hb E trait ( heterozygous state), 7.08% parents were suffering from Beta Thalassaemia Major(homozygous state) and 11 (4.58%) parents were suffering from Hb E/Beta Thalassaemia which is a compound heterozygous state. Though consanguinity is a very influential factor, but the most important causative factor is the presence of high number of thalassaemia carrier in the population. So, it’s a burning issue for the nation to perform a routine carrier screening for all rather than focusing on consanguinity only, to lessen the burden of thalassaemia disease in Bangladesh. BSMMU J 2022; 15(1): 25-28

Residential area greenness and hypertension: a national assessment on urban adults in Bangladesh

ABSTRACT This study investigated the associations between greenness and blood pressure (BP) metrics (systolic BP [SBP], diastolic BP [DBP], hypertension) among urban adults in Bangladesh and the potential mediation effects of body mass index (BMI) using 2011 Bangladesh Demographic and Health Survey data for 2360 urban adults (aged ≥35 years). The Enhanced Vegetation Index was used as a measure of residential area greenness. Associations between greenness and BP metrics were estimated using linear and binary logistic regression models. We also conducted mediation analyses. Greater area-level greenness was inversely associated with SBP (β −1.33, 95%CI: −2.46, −.20), DBP (β −.83, 95%CI: −1.64, −.02), and hypertension (adjusted odds ratio .87, 95%CI: .77, .98). BMI substantially mediated associations between greenness and BP metrics. Adopting urban greening policies could reduce the risk of hypertension, thus can contribute to reduction of non-communicable disease burden in Bangladesh. Longitudinal studies are required to further investigate the causal pathways.

Financing Cancer Care in Bangladesh: An Alternative Route

The enormous financial burden of cancer treatment due to lack of any structured financing mechanism results in catastrophic health expenditures as well as impoverishment to many households in Bangladesh. This study attempts to design an alternative mechanism for providing financial protection to cancer patients for receiving necessary procedures (e.g., screening, chemotherapy, radiotherapy, and surgical procedures) based on imposing some levy on mobile phone subscribers using primary and secondary data. The study finds that a monthly fixed levy of BDT 21.5 (USD 0.26) on each active mobile phone subscriber can provide annual financial protection of BDT500,000 (USD 5,882) to each of 60,000 cancer patients currently seeking treatment from domestic facilities. A fixed levy is always regressive and therefore burdensome for poverty-stricken subscribers. Allocation of the monthly fixed levy on the mobile phone call rate can generate similar worth more equitably. Successful transformation of this idea into action may increase access to cancer care and reduce financial burden as well as disease burden in Bangladesh.

Socioeconomic Variables Responsible for Enhancing NonCommunicable Diseases Among Bangladeshi Adults: A Factor Analysis Approach

Although half of annual mortality and almost half of the burden of disease in Bangladesh are for NCDs, less evidence are available to identify the variables responsible for NCDs...

Reservoirs of faecal indicator bacteria in well-head hand pumps in Bangladesh.

The majority of the population of Bangladesh (90%) rely on untreated groundwater for drinking and domestic use. At the point of collection, 40% of these supplies are contaminated with faecal indicator bacteria (FIB). Recent studies have disproved the theory that latrines discharging to shallow aquifers are the major contributor to this contamination. In this study, we tested the hypothesis that hand pumps are a reservoir of FIB. We sampled the handle, spout, piston and seal from 19 wells in Araihazar Upazila, Bangladesh and identified that the spout and seal were reservoirs of FIB. These findings led to our recommendation that well spouts be regularly cleaned, including the removal of precipitated deposits, and that the seals be regularly changed. It is envisaged that one or both of these interventions will reduce the numbers of FIB in drinking water, thereby reducing the burden of diarrhoeal disease in Bangladesh.

Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period.

Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty. Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982-96 and 1996-2005. Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = -0.007; 95% CI: -0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = -0.047; 95% CI: -0.061, -0.033). Between 1982-96 and 1996-2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not. Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty.

Use of Multiple Surveillance Modalities to Assess the Epidemiology ofStreptococcus pneumoniaeInfection in Bangladesh

Measuring the broad impact of pneumococcal disease requires multiple surveillance modalities. Four major data sources elucidate the burden of pneumococcal disease in Bangladesh. The Bangladesh Demographic and Health Survey has identified pneumonia as the leading cause of childhood death. By extrapolation of mortality rates in the survey to the Bangladesh population, it has been estimated that approximately 90,000 children >1 month and <5 years of age die of pneumonia every year in Bangladesh. Through hospital-based surveillance, a wide range of pneumococcal serotypes leading to hospitalization and pneumonia have been identified as a leading cause of pediatric hospitalization. Urban community-based surveillance has demonstrated that invasive pneumococcal disease (IPD) is common in the community. Rural community-based surveillance has demonstrated that serious IPD is common in rural areas. Together, these data provide a strong scientific case for the importance of pneumococcal disease prevention to child health in Bangladesh and, therefore, the potential benefit of an effective vaccine.

Critical pathway analysis to determine key uncertainties in net impacts on disease burden in Bangladesh of arsenic mitigation involving the substitution of arsenic bearing for groundwater drinking water supplies

It has been increasingly recognised that calculation of the disease burden due to populations, such as in Bangladesh, extensively using hazardous arsenic bearing well waters, must explicitly account for the trade-off between diarrhoeal disease incidence and that of arsenic-related diseases. This is because it is likely that moves to alternative drinking water sources, be they surface waters or even more distant groundwaters, without further mitigation would result in a concurrent increase in diarrhoeal disease. In this paper, we update the model of Lokuge[ 1 ] of the effects of such arsenic mitigation on disease burden in Bangladesh, using updated population data and background disease estimates. We run a critical pathway analysis on the model using Standardised Mortality Ratios (SMRs) for diabetes mellitus and ischemic heart disease from different epidemiological studies recently reviewed by Navas-Acien.[ 2 , 3 ] Our analysis agrees with that of Lokuge[ 1 ] that mitigation simply involving the substitution of a range of surface waters for well water sources with As > 50 μ g/L would have a net positive impact on disease burden, as determined by deaths and Disability Life Adjusted Years (DALYs). In contrast, however, there is considerable ambiguity in the analogous results for mitigation for all the population exposed to well water with As > 10 μ g/L. Depending upon the data source chosen for diabetes mellitus and ischaemic heart disease SMRs, such mitigation is modelled to have either a positive or a negative net impact on overall disease burden. The modelled negative impacts are entirely commensurate with the rationale for seeking groundwater as an alternative to surface waters as a drinking water supply, and highlight the practical requirement for multiple mitigation strategies, including those directed at ensuring the microbiological safety and continued protection of any alternative water supplies. Our study highlights the need for (i) adequate epidemiological studies involving multiple exposure categories, ideally resulting in an accurate dose-response relationship for arsenic uptake and the non-malignant high incidence conditions diabetes mellitus and ischemic heart disease for individuals with the socioeconomic and nutritional status of the Bangladeshi populations, and (ii) refined estimates of the diarrhoel disease burden arising from usage of surface waters.

Cheap shot at ECT

1 Gessner BD, Sutanto A, Linehan M, et al. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 2005; 365: 43–52. 2 Sgambatti de Andrade ALS, Turchi Martelli CM. Globalisation of Hib vaccination—how far are we? Lancet 2005; 365: 5–7. 3 World Health Organization. Review panel on Haemophilus influenzae type b (Hib) disease burden in Bangladesh, Indonesia and other Asian countries, Bangkok, 28–29 January 2004. WER 2004; 79: 173–75. 4 Financing Task Force of the Global Alliance for Vaccines and Immunization. Guidelines for preparing a national immunization program financial sustainability plan, April 2004. Available at: http://www.vaccinealliance.org/ Task_Forces/Financing_Task_Force/guidelines.p hp (accessed Jan 26, 2005).

Risky Trade-offs: Bangladeshi Quest for Safe Water

Vol. 112, No. 11 EnvironewsOpen AccessRisky Trade-offs: Bangladeshi Quest for Safe Wateris accompanied byThe Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh M. Nathaniel Mead M. Nathaniel Mead Search for more papers by this author Published:1 August 2004https://doi.org/10.1289/ehp.112-a636bAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit In an attempt to eliminate epidemic levels of diarrhea and other infectious diseases associated with the use of surface waters, millions of shallow tube wells were drilled into the Ganges Delta alluvium in Bangladesh beginning in the early 1970s. This process reduced the rates of water-related infectious diseases but created a new public health dilemma: a surge in diseases such as skin ailments, diabetes mellitus, and various cancers, all resulting from habitual consumption of groundwater naturally high in arsenic.A number of interventions have been proposed to help remedy the widespread arsenic exposure, but these interventions may only be bringing the catastrophic water situation in Bangladesh full circle. A new study by epidemiologists led by Kamalini Lokuge of the Australian National University suggests that, while these interventions will eventually result in less disease overall, they may initially cause a steady and considerable increase in diarrheal disease [EHP 112:1172–1177]. The study indicates that any large-scale transition away from household tube wells as a source of drinking water, without proper evaluation of the risks, may be premature.In attempting to quantify the disease burden resulting both from arsenic exposure and from the potential side effects of widely available arsenic mitigation interventions, Lokuge and her colleagues used previously published information to estimate mortality rates and disability-adjusted life years (DALYs). Simply put, a DALY is a measure of the burden of disease; it reflects how much a person’s expectancy of healthy life is reduced by premature death as well as by disability caused by disease.The Australian team used World Health Organization data to estimate the DALYs lost per year to arsenic-related effects including diabetes, ischemic heart disease, and a number of cancers. They calculated that arsenic exposure causes the loss of 174,174 DALYs per year in Bangladeshis exposed to arsenic concentrations above 50 micrograms per liter (μg/L), the nation’s cut-off point for safe drinking water.Then they calculated the DALYs that would be lost to infectious disease, provided Bangladeshis adopted certain arsenic mitigation options currently advocated by the federal Bangladesh Arsenic Mitigation and Water Supply Project and immediately accessible to the majority of the Bangladeshi population year-round. These include surface water supplies, uncontaminated community tube wells, and low-cost filtration systems. These alternative options carry the potential for increased water-related infections, compared with household tube wells.Assuming that mitigation efforts were undertaken only in those areas where the arsenic concentration of drinking water is highest (100–300 μg/L), the team found that the long-range benefits of arsenic mitigation in terms of DALYs gained and deaths avoided would outweigh any initial decline in public health due to water-related infectious diseases. However, there would initially be a period of some years (the number of which is still unknown) before any benefit would accrue, and some additional years until the total benefit outweighed the cost of the water-related infectious disease increase. The investigators also conclude, moreover, that if the Bangladeshi people gradually stop using the alternative water sources and processes (for example, because of the inconvenience of maintenance or complacency as disease drops off), the initial DALY-based cost of water-related infectious diseases would remain while the long-range benefits would disappear.The study demonstrates that implementation of any arsenic-mitigating intervention must take into account not only the strategy’s effectiveness in reducing arsenic exposure but also its safety in terms of water-related infectious diseases, the likelihood of population-wide compliance, and different exposure levels within the population. The investigators contend that such information is vital to developing appropriate policies toward resolving the drinking water crisis in Bangladesh.FiguresReferencesRelatedDetailsRelated articlesThe Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh17 June 2004Environmental Health Perspectives Vol. 112, No. 11 August 2004Metrics About Article Metrics Publication History Originally published1 August 2004Published in print1 August 2004 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. 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The effect of arsenic mitigation interventions on disease burden in Bangladesh.

Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs; undiscounted) lost per year in those exposed to arsenic concentrations > 50 μg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 μg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections.

Anticipating rotavirus vaccines: hospital-based surveillance for rotavirus diarrhea and estimates of disease burden in Bangladesh

Rotavirus is the most common cause of severe diarrhea in children worldwide, and a vaccine may soon be licensed and available for use in immunization programs. To assess the need for a rotavirus vaccine in Bangladesh, we estimated the disease burden of rotavirus diarrhea from national vital statistics for births and diarrheal deaths, together with hospital surveillance data on the proportion of severe childhood diarrhea attributed to rotavirus. From 1990 through 1993, hospital surveillance was conducted of a systematic, random 4% sample of >80,000 patients with diarrhea who sought care each year at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). Rotavirus was detected in 20% (1561 of 7709) of fecal specimens from children with diarrhea <5 years of age; 92% of all cases (1436) occurred in children <2 years of age, but only 3% (50) of cases occurred in infants <3 months of age. Children infected with rotavirus were more likely to have watery stools (P < 0.001), severe vomiting (P < 0.001) but less severe dehydration (P = 0.007) than children infected with other enteropathogens. We estimate that in this setting, where 18% of children die by age 5 and about 25% of these succumb to diarrhea, between 14,850 and 27,000 of the 3 million Bangladeshi children born in 1994 will die of rotavirus by the age of 5 years, equivalent to 1 rotavirus death per 111 to 203 children. The estimated burden of rotavirus diarrhea in Bangladesh is sufficiently great to warrant field testing of rotavirus vaccines for possible inclusion in the current immunization program.