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Al-Zubayer MA, Alam K, Shanto HH, Maniruzzaman M, Majumder UK, Ahammed B. Machine learning models for prediction of double and triple burdens of non-communicable diseases in Bangladesh. J Biosoc Sci 2024; 56:426-444. [PMID: 38505939 DOI: 10.1017/s0021932024000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Increasing prevalence of non-communicable diseases (NCDs) has become the leading cause of death and disability in Bangladesh. Therefore, this study aimed to measure the prevalence of and risk factors for double and triple burden of NCDs (DBNCDs and TBNCDs), considering diabetes, hypertension, and overweight and obesity as well as establish a machine learning approach for predicting DBNCDs and TBNCDs. A total of 12,151 respondents from the 2017 to 2018 Bangladesh Demographic and Health Survey were included in this analysis, where 10%, 27.4%, and 24.3% of respondents had diabetes, hypertension, and overweight and obesity, respectively. Chi-square test and multilevel logistic regression (LR) analysis were applied to select factors associated with DBNCDs and TBNCDs. Furthermore, six classifiers including decision tree (DT), LR, naïve Bayes (NB), k-nearest neighbour (KNN), random forest (RF), and extreme gradient boosting (XGBoost) with three cross-validation protocols (K2, K5, and K10) were adopted to predict the status of DBNCDs and TBNCDs. The classification accuracy (ACC) and area under the curve (AUC) were computed for each protocol and repeated 10 times to make them more robust, and then the average ACC and AUC were computed. The prevalence of DBNCDs and TBNCDs was 14.3% and 2.3%, respectively. The findings of this study revealed that DBNCDs and TBNCDs were significantly influenced by age, sex, marital status, wealth index, education and geographic region. Compared to other classifiers, the RF-based classifier provides the highest ACC and AUC for both DBNCDs (ACC = 81.06% and AUC = 0.93) and TBNCDs (ACC = 88.61% and AUC = 0.97) for the K10 protocol. A combination of considered two-step factor selections and RF-based classifier can better predict the burden of NCDs. The findings of this study suggested that decision-makers might adopt suitable decisions to control and prevent the burden of NCDs using RF classifiers.
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Affiliation(s)
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | | | - Md Maniruzzaman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
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Kamara IF, Tengbe SM, Bah AJ, Nuwagira I, Ali DB, Koroma FF, Kamara RZ, Lakoh S, Sesay S, Russell JBW, Theobald S, Lyons M. Prevalence of hypertension, diabetes mellitus, and their risk factors in an informal settlement in Freetown, Sierra Leone: a cross-sectional study. BMC Public Health 2024; 24:783. [PMID: 38481202 PMCID: PMC10935859 DOI: 10.1186/s12889-024-18158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes mellitus are on the increase in sub-Saharan Africa (SSA). Informal settlement dwellers exhibit a high prevalence of behavioural risk factors and are highly vulnerable to hypertension and diabetes. However, no study has assessed the prevalence of hypertension, diabetes, and NCDrisk factors among informal settlement dwellers in Sierra Leone. We conducted a study in June 2019 to determine the prevalence of hypertension, diabetes, and NCD risk factors among adults living in the largest Sierra Leonean informal settlement (KrooBay). METHODS AND MATERIALS We conducted a community-based cross-sectional survey among adults aged ≥ 35 years in the KrooBay community. Trained healthcare workers collected data on socio-demographic characteristics and self-reported health behaviours using the World Health Organization STEPwise surveillance questionnaire for chronic disease risk factors. Anthropometric, blood glucose, and blood pressure measurements were performed following standard procedures. Logistics regression was used for analysis and adjusted odd ratios with 95% confidence intervals were calculated to identify risk factors associated with hypertension. RESULTS Of the 418 participants, 242 (57%) were females and those below the age of 45 years accounted for over half (55.3%) of the participants. The prevalence of smoking was 18.2%, alcohol consumption was 18.8%, overweight was 28.2%, obesity was 17.9%, physical inactivity was 81.5%, and inadequate consumption of fruits and vegetables was 99%. The overall prevalence of hypertension was 45.7% (95% CI 41.0-50.5%), systolic hypertension was 34.2% (95% CI 29.6-38.8%), diastolic blood pressure was 39.9% (95% CI 35.2-44.6), and participants with diabetes were 2.2% (95% CI 0.7-3.6%). Being aged ≥ 55 years (AOR = 7.35, 95% CI 1.49-36.39) and > 60 years (AOR 8.05; 95% CI 2.22-29.12), separated (AOR = 1.34; 95% 1.02-7.00), cohabitating (AOR = 6.68; 95% CL1.03-14.35), vocational (AOR = 3.65; 95% CI 1.81-7.39 ) and having a university education (AOR = 4.62; 95% CI 3.09-6.91) were found to be independently associated with hypertension. CONCLUSION The prevalence of hypertension,and NCD risk factors was high among the residents of the Kroobay informal settlement. We also noted a low prevalence of diabetes. There is an urgent need for the implementation of health education, promotion, and screening initiatives to reduce health risks so that these conditions will not overwhelm health services.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | | | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | - Desta Betula Ali
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Fanny F Koroma
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- United States CDC Country Office, EOC, Wilkinson Road, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Santigie Sesay
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - James B W Russell
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mary Lyons
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Kabir A, Karim MN, Billah B. The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases. BMC Prim Care 2023; 24:60. [PMID: 36864391 PMCID: PMC9979470 DOI: 10.1186/s12875-023-02016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). METHODS A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. RESULTS The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. CONCLUSION All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Siddiquea BN, Afroz A, Chowdhury MRK, Savira F, Alif SM, Bhattacharya O, Hossain MN, Ali L, Chowdhury HA, Shetty A, Islam MS, Billah B. Knowledge, attitudes and practices of COVID-19 in rural Bangladesh: a cross-sectional study. BMJ Open 2023; 13:e064754. [PMID: 36792336 PMCID: PMC9933131 DOI: 10.1136/bmjopen-2022-064754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES Understanding the knowledge, attitudes and practices (KAP) of COVID-19 within distinct populations may aid further public health messaging. This study's aims were to explore KAP towards COVID-19 in rural Bangladesh and identify any potential links to sociodemographics, existing clinical conditions and sources of information. DESIGN Cross-sectional community-based study. SETTING Participants were recruited from 18 villages using multistage cluster random sampling. METHODS Data were collected through face-to-face interviews, from June to November 2021, using a structured questionnaire. Data included sociodemographics, clinical conditions, sources of information and KAP of COVID-19 questions. Χ2 test, multiple logistic regression and correlation analyses were performed. RESULTS A total of 1603 participants were included with mean ages of 42.3±14.2 years, ranging from 18 to 60 years. Of these, 51% were male, 42.2% had secondary education and 45% had comorbidities. Television was the main source of COVID-19 information (55.8%). The overall correct response rate of KAP questions was 90%, 78% and 59%, respectively. In stepwise multiple logistic regression, good knowledge was associated with higher education (adjusted OR (AOR): 4.61, 95% CI: 2.40 to 8.85, p<0.001), employment, high body mass index (overweight and obese) and trust in the sources of information. Being female (AOR: 1.48, 95% CI: 1.19 to 1.85, p<0.001), having depression (AOR: 1.80, 95% CI: 1.34 to 2.43, p<0.001), being a past smoker and sources of information (family members/friends/relatives/neighbours) were associated with positive attitudes. Good practices were associated with older age (AOR: 1.52, 95% CI: 1.10 to 2.11, p=0.01), higher education (AOR: 2.78, 95% CI: 1.58 to 4.89, p<0.001) and having anxiety, while current smokers and fully vaccinated people were less likely to be engaged in good practices. Positive significant correlations between domains of KAP were observed as well as between past vaccination KAP and COVID-19 KAP. CONCLUSION This study uncovered gaps in understanding and practices, and identified targeted intervention especially for young and less educated people using mass media to promote updated knowledge regarding COVID-19 and the efficacy of preventive practices.
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Affiliation(s)
- Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Feby Savira
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Sheikh M Alif
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oashe Bhattacharya
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nassif Hossain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liaquat Ali
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aishwarya Shetty
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Savira F, Alif SM, Afroz A, Siddiquea BN, Shetty A, Chowdhury HA, Bhattacharya O, Chowdhury MRK, Islam MS, Ali L, Billah B. Evaluation of COVID-19 vaccine acceptance and uptake in rural Bangladesh: a cross-sectional study. BMJ Open 2022; 12:e064468. [PMID: 36523245 PMCID: PMC9748515 DOI: 10.1136/bmjopen-2022-064468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the acceptance and uptake of COVID-19 vaccines in rural Bangladesh. DESIGN This was a cross-sectional study conducted between June and November 2021. SETTING This study was conducted in rural Bangladesh. PARTICIPANTS People older than 18 years of age, not pregnant and no history of surgery for the last 3 months were eligible to participate. PRIMARY AND SECONDARY OUTCOMES The primary outcomes were proportions of COVID-19 vaccine acceptance and roll-out participation among the rural population. The secondary outcome was identification of correlates which contributed to COVID-19 vaccine acceptance and roll-out participation. Χ2 tests and multivariable logistic regression analyses were performed to identify relevant correlates such as sociodemographic factors, clinical conditions and COVID-19-related factors. RESULTS A total of 1603 participants were enrolled. The overall COVID-19 vaccine acceptance was very high (1521/1601, 95%), and half of the participants received at least one dose of the COVID-19 vaccine. Majority of participants wanted to keep others safe (89%) and agreed to the benefits of COVID-19 vaccines (88%). To fulfil the requirement of online registration for the vaccine at the time, 62% of participants had to visit an internet café and only 31% downloaded the app. Over half (54%) of participants were unaware of countries they knew and trust to produce the COVID-19 vaccine. Increased age, being housewives, underweight and undergraduate education level were associated with vaccine acceptance, while being female, increased age and being overweight/obese were associated with vaccine uptake. Trust in the health department and practical knowledge regarding COVID-19 vaccines were positively associated with both vaccine acceptance and uptake. CONCLUSION This study found a very high COVID-19 vaccine acceptance in rural Bangladesh. Policymakers should support interventions aimed at increasing vaccine and general health literacy and ensure ongoing vaccine supply and improvement of infrastructure in rural areas.
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Affiliation(s)
- Feby Savira
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sheikh M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Afsana Afroz
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bodrun Naher Siddiquea
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aishwarya Shetty
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hasina Akhter Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Oashe Bhattacharya
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Liaquat Ali
- Pothikrit Institute of Health Studies, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kabir A, Karim N, Billah B. Preference and willingness to receive non-communicable disease services from primary healthcare facilities in Bangladesh: A qualitative study. BMC Health Serv Res 2022; 22:1473. [PMID: 36463166 PMCID: PMC9719224 DOI: 10.1186/s12913-022-08886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden. NCD services have been significantly mobilized to primary healthcare (PHC) facilities to better manage the rising burden of NCDs. However, little is known about community members' preference and willingness to receive NCD services from PHC facilities; therefore, this particular subject is the focus of this study. METHODS A qualitative study was conducted from May 2021 to October 2021. Data were collected via 16 focus group discussions involving community members and 14 key informant interviews with healthcare professionals, facility managers, and public health practitioners. Based on a social-ecological model (SEM), data were analyzed thematically. The triangulation of methods and participants was conducted to validate the information provided. RESULTS Preference and willingness to receive NCD services from PHC facilities were influenced by a range of individual, interpersonal, societal, and organizational factors that were interconnected and influenced each other. Knowledge and the perceived need for NCD care, misperception, self-management, interpersonal, and family-level factors played important roles in using PHC facilities. Community and societal factors (i.e., the availability of alternative and complementary services, traditional practices, social norms) and organizational and health system factors (i.e., a shortage of medicines, diagnostic capacity, untrained human resources, and poor quality of care) also emerged as key aspects that influenced preference and willingness to receive NCD services from PHC facilities. CONCLUSION Despite their substantial potential, PHC facilities may not take full advantage of managing NCDs. All four factors need to be considered when developing NCD service interventions in the primary healthcare system to better address the rising burden of NCDs.
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Affiliation(s)
- Ashraful Kabir
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nazmul Karim
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Mistry SK, Hossain MB, Parvez M, Gupta RD, Arora A. Prevalence and determinants of hypertension among urban slum dwellers in Bangladesh. BMC Public Health 2022; 22:2063. [DOI: 10.1186/s12889-022-14456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In low- and middle- income countries such as Bangladesh, urban slum dwellers are particualry vulnerable to hypertension due to inadequate facilities for screening and management, as well as inadequate health literacy among them. However, there is scarcity of evidence on hypertension among the urban slum dwellers in Bangladesh. The present study aimed to determine the prevalence and factors associated with hypertension among urban slum dwellers in Bangladesh.
Methods
Data were collected as part of a large-scale cross-sectional survey conducted by Building Resources Across Communities (BRAC) between October 2015 and January 2016. The present analysis was performed among 1155 urban slum dwellers aged 35 years or above. A structured questionnaire was adminstered to collect data electronically and blood pressure measurements were taken using standardised procedures. Binary logistic regression with generalized estimating equation modelling was performed to estimate the factors associated with hypertension.
Results
The prevalence of hypertension was 28.3% among urban slum dwellers aged 35 years and above. In adjusted analysis, urban slum dwellers aged 45–54 years (AOR: 1.64, 95% CI: 1.17–2.28), 55–64 years (AOR: 2.47, 95% CI: 1.73–3.53) and ≥ 65 years (AOR: 2.34, 95% CI: 1.47–3.72), from wealthier households (AOR: 1.94, 95% CI: 1.18–3.20), sleeping < 7 h per day (AOR: 1.87, 95% CI: 1.39–2.51), who were overweight (AOR: 1.53, 95% CI: 1.09–2.14) or obese (AOR: 2.34, 95% CI: 1.71–3.20), and having self-reported diabetes (AOR: 3.08, 95% CI: 1.88–5.04) had an increased risk of hypertension. Moreover, 51.0% of the participants were taking anti-hypertensive medications and 26.4% of them had their hypertension in control.
Conclusions
The findings highlight a high burden of hypertension and poor management of it among the slum dwellers in Bangladesh requiring a novel approach to improve care. It is integral to effectively implement the available national non-communicable disease (NCD) control guidelines and redesign the current urban primary health care system to have better coordination.
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Kabir A, Karim MN, Billah B. Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: A qualitative study. Front Public Health 2022; 10:1015245. [PMID: 36438215 PMCID: PMC9682236 DOI: 10.3389/fpubh.2022.1015245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The weak health system is viewed as a major systematic obstacle to address the rising burden of non-communicable diseases (NCDs) in resource-poor settings. There is little information about the health system challenges and opportunities in organizing NCD services. This study examined the health system challenges and opportunities in organizing NCD services for four major NCDs (cervical cancer, diabetes mellitus, cardiovascular diseases, and chronic respiratory illnesses) at the primary healthcare (PHC) level in Bangladesh. Methods Using a qualitative method, data were collected from May to October 2021 by conducting 15 in-depth interviews with local healthcare providers, 14 key informant interviews with facility-based providers and managers, and 16 focus group discussions with community members. Based on a health system dynamics framework, data were analyzed thematically. Information gathered through the methods and sources was triangulated to validate the data. Results Organization of NCD services at the PHC level was influenced by a wide range of health system factors, including the lack of using standard treatment guidelines and protocols, under-regulated informal and profit-based private healthcare sectors, poor health information system and record-keeping, and poor coordination across healthcare providers and platforms. Furthermore, the lack of functional referral services; inadequate medicine, diagnostic facilities, and logistics supply; and a large number of untrained human resources emerged as key weaknesses that affected the organization of NCD services. The availability of NCD-related policy documents, the vast network of healthcare infrastructure and frontline staff, and increased demand for NCD services were identified as the major opportunities. Conclusion Despite the substantial potential, the health system challenge impeded the organization of NCD services delivery at the PHC level. This weakness needs be to addressed to organize quality NCD services to better respond to the rising burden of NCDs at the PHC level.
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Rahman MA. Socioeconomic inequalities in the risk factors of noncommunicable diseases (hypertension and diabetes) among Bangladeshi population: Evidence based on population level data analysis. PLoS One 2022; 17:e0274978. [PMID: 36126087 PMCID: PMC9488802 DOI: 10.1371/journal.pone.0274978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) such as hypertension and diabetes are among the most fatal disease and prevalent among the adult population worldwide, including Bangladesh, and pose a public health threat. Understanding the socioeconomic inequalities linked to NCD risk factors can aid in the development of effective strategies to reduce the disease's recurrence. However, the literature on socioeconomic inequalities in hypertension and diabetes prevalence in Bangladesh is scant. Therefore, this study seeks to assess the inequality in hypertension and diabetes prevalence and to identify factors that may contribute to socioeconomic inequalities in Bangladesh. METHODS The current study incorporated data from a recent round of Bangladesh Demographic and Health Survey (BDHS 2017-18). The age-standardized prevalence rates of hypertension and diabetes were reported, and the log-binomial regression technique was used to identify the relevant confounders. Additionally, socioeconomic inequalities were quantified using a regression-based decomposition technique in which the concentration index (CIX) and Concentration curve were produced to determine the socioeconomic factors contributing to inequality. RESULTS Hypertension and diabetes were shown to have an age-standardized prevalence of (11.29% 95% CI: 11.13-11.69) and (36.98% 95% CI: 36.79-37.16), respectively. Both hypertension and diabetes were shown to be pointedly linked to the respondents' age, wealth status, being overweight or obese, and a variety of respondents' administrative divisions (p <0.001). In Bangladesh, household wealth status accounted for approximately 25.71% and 43.41% of total inequality in hypertension and diabetes, respectively. While BMI played a significant role in the emergence of inequality, the corresponding percentages for diabetes and hypertension are 4.95 and 83.38, respectively. In addition, urban areas contributed 4.56% inequality to increase diabetes among Bangladeshi inhabitants while administrative region contributed 4.76% of the inequality of hypertension. CONCLUSION A large proportion of Bangladesh's adult population suffers from hypertension and diabetes. It is critical to recognize the value of equity-based initiatives in order to optimize the benefit-risk ratio and cost effectiveness of preventive health programmes. Integrating equity considerations into interventions is critical for policies and programmes to achieve their objectives. As a result, these findings can be taken into account when making existing and prospective policy decisions, as well as following its progression with economic development of Bangladesh.
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Affiliation(s)
- Md. Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
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Choudhury SR, Al-Mamun MA, Akhtar J, Nabi Sayem MN, Zahed Z, Rahman MA, Ahmed J, Zaman MM. Comparison of three spot urine formulae and their validation using 24-hour urine sodium for estimation of daily salt intake: a cross-sectional study among Bangladeshi adults. BMJ Open 2022; 12:e061348. [PMID: 36581969 PMCID: PMC9438190 DOI: 10.1136/bmjopen-2022-061348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh. DESIGN A population-based cross-sectional survey. SETTING A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012-2013. PARTICIPANTS 418 community living residents aged 40-59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study. OUTCOME MEASURES The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion. RESULTS The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67). CONCLUSION Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.
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Affiliation(s)
- Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Mohammad Abdullah Al-Mamun
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Jubaida Akhtar
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Noor Nabi Sayem
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Zerin Zahed
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Mohammad Ataur Rahman
- Department of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Jasimuddin Ahmed
- Department of Pathology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
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11
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Sarker AR, Ali SMZ, Ahmed M, Chowdhury SMZI, Ali N. Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS One 2022; 17:e0262900. [PMID: 35073368 PMCID: PMC8786169 DOI: 10.1371/journal.pone.0262900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. Results We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. Conclusions Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.
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Affiliation(s)
| | - S. M. Zulfiqar Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | - Maruf Ahmed
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | | | - Nausad Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
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12
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Al-Shoaibi AAA, Chiang C, Khalequzzaman M, Choudhury SR, Hirakawa Y, Islam SS, Aoyama A, Yatsuya H. Age and sex differences in factors associated with hypertension among an urban poor population in Bangladesh. Nagoya J Med Sci 2022; 84:69-79. [PMID: 35392002 PMCID: PMC8971041 DOI: 10.18999/nagjms.84.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
This study explores the differences in factors associated with hypertension between younger and older subjects in an urban slum community in Bangladesh. We analyzed the data of 1,008 men and 1,001 women obtained from a cross-sectional survey conducted between October 2015 and April 2016. Multivariable logistic regression models were stratified by age (18 to 44 and 45 to 64 years) in men and women separately. The multivariable model included age (continuous) and the following categorical variables simultaneously: education duration, marital status, tobacco smoking, smokeless tobacco use, total physical activity, body mass index (BMI), waist circumference, and the blood levels of glycated hemoglobin (HbA1c), triglycerides, high- and low-density lipoprotein (HDL and LDL) cholesterol. Hypertension was defined as the presence of either blood pressure ≥140/90 mmHg or the use of antihypertensive medication. The prevalence of hypertension was 13.0% (younger men), 14.6% (younger women), 35.6% (older men), and 38.7% (older women). In younger men, higher waist circumference and increased LDL cholesterol levels were significantly associated with hypertension. In older men, physical activity was the only significant factor that was inversely associated with hypertension. In younger women, higher BMI, increased HbA1c, triglycerides, and LDL cholesterol levels were associated with hypertension. In older women, a higher HbA1c was the only factor significantly associated with hypertension. These findings suggest that public health interventions to prevent hypertension may require different approaches according to sex and age groups within the poor urban population in Bangladesh.
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Affiliation(s)
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Md. Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Ghimire K, Mishra SR, Satheesh G, Neupane D, Sharma A, Panda R, Kallestrup P, Mclachlan CS. Salt intake and salt-reduction strategies in South Asia: From evidence to action. J Clin Hypertens (Greenwich) 2021; 23:1815-1829. [PMID: 34498797 PMCID: PMC8678780 DOI: 10.1111/jch.14365] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 08/28/2021] [Indexed: 01/08/2023]
Abstract
The World Health Organization recommends salt reduction as a cost-effective intervention to prevent noncommunicable diseases. Salt-reduction interventions are best tailored to the local context, taking into consideration the varying baseline salt-intake levels, population's knowledge, attitude, and behaviors. Fundamental to reduction programs is the source of dietary salt-intake. In South Asian countries, there is a paucity of such baseline evidence around factors that contribute to community salt intake. Upon reviewing the electronic literature databases and government websites through March 31, 2021, we summarized dietary salt intake levels and aimed to identify major sources of sodium in the diet. Information on the current salt reduction strategies in eight South Asian countries were summarized, namely Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. One hundred twelve publications (out of identified 640) met our inclusion-exclusion criteria for full text review. Twenty-one studies were included in the review. Quality of the included studies was assessed using the US National Heart, Lung, and Blood Institute assessment tool. The primary result revealed that mean salt intake of South Asian countries was approximately twice (10 g/day) compared to WHO recommended intake (< 5 g/day). The significant proportion of salt intake is derived from salt additions during cooking and/or discretionary use at table. In most South Asian countries, there is limited data on population sodium intake based on 24-h urinary methods and sources of dietary salt in diet. While salt reduction initiatives have been proposed in these countries, they are yet to be fully implemented and evaluated. Proven salt reduction strategies in high-income countries could possibly be replicated in South Asian countries; however, further community-health promotion studies are necessary to test the effectiveness and scalability of those strategies in the local context.
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Affiliation(s)
- Kamal Ghimire
- Nepal Development SocietyBhratpur‐10ChitwanNepal
- School of HealthTorrens UniversitySydneyNew South WalesAustralia
| | - Shiva Raj Mishra
- Nepal Development SocietyBhratpur‐10ChitwanNepal
- World Heart FederationSalim Yusuf Emerging Leaders ProgrammeGenevaSwitzerland
| | - Gautam Satheesh
- The George Institute for Global HealthHyderabadTelanganaIndia
| | - Dinesh Neupane
- Welch Center for PreventionEpidemiology and Clinical ResearchDepartment of EpidemiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Abhishek Sharma
- World Heart FederationSalim Yusuf Emerging Leaders ProgrammeGenevaSwitzerland
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
- PRECISIONheorPrecision Value & HealthBostonMassachusettsUSA
| | - Rajmohan Panda
- Department of ResearchPublic Health Foundation of IndiaNew DelhiIndia
| | - Per Kallestrup
- Department of Public HealthCenter for Global HealthAarhus UniversityAarhusDenmark
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14
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Al-Zubayer MA, Ahammed B, Sarder MA, Kundu S, Majumder UK, Islam SMS. Double and triple burden of non-communicable diseases and its determinants among adults in Bangladesh: Evidence from a recent demographic and health survey. Int J Clin Pract 2021; 75:e14613. [PMID: 34235819 DOI: 10.1111/ijcp.14613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are a significant public health problem. NCDs are the leading cause of death in Bangladesh. This study aimed to estimate the prevalence of double burden of NCDs (DBNCDs) and triple burden of NCDs (TBNCDs) such as hypertension, diabetes and overweight or obesity and to explore the risk factors of DBNCDs and TBNCDs in Bangladesh. MATERAILS AND METHODS This study included 12 685 participants (5465 male and 7220 female) from 2017 - 2018 nationally representative Bangladesh Demographic and Health Survey. Descriptive statistics were calculated for the distribution and prevalence of DBNCDs and TBNCDs. Bivariate and multilevel logistic regression analyses were used to assess the individual- and community-level determinants of DBNCDs and TBNCDs. RESULTS The prevalence of DBNCDs and TBNCDs was 21.4% and 6.1%, respectively. At individual-level, higher age, female, currently and formerly/ever married, richest, higher education were more likely to suffer from the DBNCDs and TBNCDs. Furthermore, at the community level, the division had a significant association with DBNCDs and TBNCDs. In addition, family size had a significant effect on DBNCDs, and caffeinate drinks and poverty significantly affected TBNCDs. CONCLUSION Overall, there is a low prevalence of TBNCDs compared with DBNCDs in Bangladesh. Age, gender, marital status, wealth index, education level and division are significantly associated with DBNCDs and TBNCDs. The government and non-government health organisations should pay proper attention to handle the burden of NCDs in Bangladesh.
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Affiliation(s)
| | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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15
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Khan FA, Khalequzzaman M, Hasan M, Choudhury SR, Chiang C, Aoyama A, Islam SS. Dietary salt intake and its correlates among adults in a slum area in Dhaka, Bangladesh: a cross-sectional study. Nagoya J Med Sci 2021; 83:589-599. [PMID: 34552291 PMCID: PMC8438000 DOI: 10.18999/nagjms.83.3.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
High dietary salt intake increases the risk of noncommunicable diseases (NCDs). NCDs are increasing among the urban poor in Bangladesh, but the data of their dietary salt intake are yet scarce. This study aimed to explore the amount of dietary salt intake among adults in an urban slum area in Dhaka, Bangladesh. A cross-sectional community-based study was conducted. We randomly selected 100 residents (39 men and 61 women) aged 20–59 years without history of NCDs. A modified World Health Organization standard instrument was used for behavioral risk factor assessment and physical measurements. Dietary salt intake was estimated from the measurement of sodium (Na) excretion in spot urine samples.The estimated mean dietary salt intake was 7.8 ± 2.5 g/day, and the mean Na/potassium (K) ratio in urine was 4.9 ± 3.4. More than half (54%) of them always took additional salt in their meals, but only 6% of them consumed 5 or more servings of fruits and vegetables per day. A quarter of them perceived salt reduction not at all important. Increased mean salt intakes were marginally associated with lower waist circumference and lower waist-hip ratio. Dietary salt intake among urban slum residents was higher than the recommended level of 5 g/day; however, its association with NCD risk factors was not significant. Further studies are required to identify the urban poor specific factors.
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Affiliation(s)
- Fahmida Afroz Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Hasan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan.,Nagoya University of Arts and Sciences, Nissin, Japan
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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16
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Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level. METHODS AND ANALYSIS The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ2 test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data. ETHICS AND DISSEMINATION The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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17
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Golestani M, Sadeghi-Bazargani H, Saadati M, Farahbakhsh M, Dalal K. Lifestyle Risk Factor Assessment Through WHO STEP Approach in Tabriz, Iran. Clinicoecon Outcomes Res 2021; 13:487-492. [PMID: 34140788 PMCID: PMC8203186 DOI: 10.2147/ceor.s304189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to assess the lifestyle behaviour and risk factors for lifestyle-related diseases in East Azerbaijan province, Iran. Methods A household study using a two-stage cluster sampling method was performed. Tabriz city was randomly selected for data collection among five geographic regions in the East-Azerbaijan province. Short WHO-STEP and Ultra-short version of Socio-Economic Status assessment questionnaire were used. Six hundred households were asked to respond to the STEP questionnaire. Results A total of 1196 people have participated in the study. People with higher socioeconomic status consumed more fruits, vegetables and fish than the people with lower socioeconomic status. People with academic education less likely to be hypertensive compared to people with non-academic education. People with a medium socioeconomic status are less likely to be hypertensive than people with high socioeconomic status. The majority of participants had poor dietary habits. In this study, 17.22%, 7.53% and 4.35% of respondents had hypertension, diabetes and depression, respectively. Conclusion Considering that lifestyle-related risk factors are common among people. Due to the direct link between lifestyle and the occurrence of many chronic diseases, campaigns for and training programs to implement healthy lifestyle habits are recommended.
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Affiliation(s)
- Mina Golestani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Statistics and Epidemiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Saadati
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Koustuv Dalal
- Department of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,School of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
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18
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Akther J, Das A, Rahman MA, Saha SK, Hosen MI, Ebihara A, Nakagawa T, Suzuki F, Nabi AHMN. Non-coding Single Nucleotide Variants of Renin and the (Pro)renin Receptor are Associated with Polygenic Diseases in a Bangladeshi Population. Biochem Genet 2021; 59:1116-1145. [PMID: 33677630 DOI: 10.1007/s10528-021-10049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
Abstract
Non-coding variants or single-nucleotide polymorphisms (SNPs) play pivotal roles in orchestrating pathogeneses of polygenic diseases, including hypertension (HTN) and diabetes. Renin-angiotensin system (RAS) components-renin and (pro)renin receptor [(P)RR]-maintain homeostasis of body fluids. Genetic variants of RAS components are associated with risk of HTN and type 2 diabetes (T2D) in different ethnic groups. We identified associations of SNPs within the renin and (P)RR genes with HTN, T2D, and T2D-associated hypertension in 911 unrelated Bangladeshi individuals. Five non-coding SNPs were involved in modulating regulatory elements in diverse cell types when tagged with other SNPs. rs61827960 was not associated with any disease; rs3730102 was associated with increased risk of HTN and T2D while under dominant model, it showed protective role against T2D-associated HTN. SNP rs11571079 was associated with increased risk of HTN and T2D-associated HTN and decreased risk of T2D, exerting a protective effect. Renin haplotypes GCA and GTG were related to increased risk of T2D and T2D-associated HTN, respectively. Heterogeneous linkage of genotypic and allelic frequencies of rs2968915 and rs3112298 of (P)RR was observed. The (P)RR haplotype GA was associated with increased risk of HTN and significantly decreased risk of T2D. These findings highlight important roles of non-coding variants of renin and (P)RR genes in the etiology of several polygenic diseases.
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Affiliation(s)
- Jobaida Akther
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Ashish Das
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Arifur Rahman
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh.,National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Sajoy Kanti Saha
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Ismail Hosen
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Akio Ebihara
- Laboratory of Applied Biochemistry, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan.,United Graduate School of Agricultural Science, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Tsutomu Nakagawa
- Laboratory of Applied Biochemistry, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan.,United Graduate School of Agricultural Science, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Fumiaki Suzuki
- Laboratory of Applied Biochemistry, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - A H M Nurun Nabi
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh.
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Urmy NJ, Hossain MM, Shamim AA, Khan MSA, Hanif AAM, Hasan M, Akter F, Mitra DK, Hossaine M, Ullah MA, Sarker SK, Rahman SM, Bulbul MMI, Mridha MK. Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey. Osong Public Health Res Perspect 2021; 11:351-364. [PMID: 33403198 PMCID: PMC7752145 DOI: 10.24171/j.phrp.2020.11.6.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. Methods Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. Results The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. Conclusion The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.
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Affiliation(s)
- Nushrat Jahan Urmy
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Akter
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Bashundhara, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Sm Mustafizur Rahman
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Rawal L, Jubayer S, Choudhury SR, Islam SMS, Abdullah AS. Community health workers for non-communicable diseases prevention and control in Bangladesh: a qualitative study. Glob Health Res Policy 2020; 6:1. [PMID: 33407942 PMCID: PMC7786185 DOI: 10.1186/s41256-020-00182-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh. METHODS We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders' consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n = 4); key informant interviews with central level health policymakers/ managers (n = 15) and focus group discussions with CHWs (4 FGDs; total n = 29). Participants in a stakeholder consultative meeting included members from the government (n = 4), non-government organisations (n = 2), private sector (n = 1) and universities (n = 2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. RESULTS The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation. CONCLUSION Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.
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Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, Australia.
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia.
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia.
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh.
| | - Sohel R Choudhury
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh
| | | | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, 8 Duke Avenue, Kunshan, 215347, People's Republic of China.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
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Tanimura C, Aoto H, Kobayashi N, Majbauddin A, Morita T, Otani S, Inoue K, Tokushima Y, Fukada M, Hanaki K, Sakai C, Okura T, Kageyama S, Kurozawa Y, Flores R, Raymundo R. Effects of a Self-efficacy Theory-Based Training Program for Peers of Patients with Type 2 Diabetes. Yonago Acta Med 2020; 63:282-293. [PMID: 33253342 DOI: 10.33160/yam.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022]
Abstract
Background Training peer leaders to deliver patient education is expected to be a low-cost approach to providing healthcare in urban-poor areas affected by a shortage of healthcare professionals. The purpose of this study was to examine the effects of a training program on the self-efficacy and knowledge of peer leaders with type 2 diabetes. Methods A single-group longitudinal survey with baseline, intervention, and follow-up periods was conducted at a diabetes clinic in a small municipality in Metro Manila, Philippines. The intervention, a self-efficacy theory-based training program for peer-leaders of diabetic patients conducted in August 2017, comprised hands-on learning, demonstrations, quizzes, role-playing, group sharing, physical exercise, and a buffet lunch. The primary outcome was participants' self-efficacy for management of their diabetes. Secondary outcomes were participants' knowledge of diabetes and levels of emotional distress, motivation, and confidence for guiding their peers, satisfaction with the training program, hemoglobin A1c, and quality of life. Results At 12 and 18 months after the intervention, participants' knowledge of diabetes was significantly increased compared with baseline (both P < 0.05). At earlier time points, an increasing, but not significant, trend was observed. The change in knowledge of diabetes from baseline to 18 months after intervention tended to be positively correlated with the change in self-efficacy (r = 0.594, P = 0.054). No significant differences were observed for any of the other outcomes, although the descriptive statistics showed an increasing trend for all of the outcomes except motivation. Conclusion The training program significantly improved participants' knowledge of diabetes at 12 and 18 months after the training programs compared with baseline. A positive correlation between the changes in the levels of knowledge and self-efficacy suggested that the observed improvement of self-efficacy was facilitated by the improvement of knowledge of diabetes.
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Affiliation(s)
- Chika Tanimura
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Haruka Aoto
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | | | - Abir Majbauddin
- Arid Land Research Center, Tottori University, Tottori 680-0001, Japan
| | - Tetsuji Morita
- Department of Rehabilitation Daisen Rehabilitation Hospital, Hoki-cho 689-4102, Japan
| | - Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan
| | - Kazuoki Inoue
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yasuko Tokushima
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Mika Fukada
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Keiichi Hanaki
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Chieko Sakai
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tsuyoshi Okura
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Seiji Kageyama
- Division of Virology, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Reynaldo Flores
- Mayor Juan R. Sanchez Memorial Health Center, Municipality of Pateros, Metro Manila, Philippines
| | - Ronaldo Raymundo
- Municipal Health Office, Municipality of Pateros, Metro Manila, Philippines
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22
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Sampa MB, Hossain MN, Hoque MR, Islam R, Yokota F, Nishikitani M, Ahmed A. Blood Uric Acid Prediction With Machine Learning: Model Development and Performance Comparison. JMIR Med Inform 2020; 8:e18331. [PMID: 33030442 PMCID: PMC7582147 DOI: 10.2196/18331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Uric acid is associated with noncommunicable diseases such as cardiovascular diseases, chronic kidney disease, coronary artery disease, stroke, diabetes, metabolic syndrome, vascular dementia, and hypertension. Therefore, uric acid is considered to be a risk factor for the development of noncommunicable diseases. Most studies on uric acid have been performed in developed countries, and the application of machine-learning approaches in uric acid prediction in developing countries is rare. Different machine-learning algorithms will work differently on different types of data in various diseases; therefore, a different investigation is needed for different types of data to identify the most accurate algorithms. Specifically, no study has yet focused on the urban corporate population in Bangladesh, despite the high risk of developing noncommunicable diseases for this population. Objective The aim of this study was to develop a model for predicting blood uric acid values based on basic health checkup test results, dietary information, and sociodemographic characteristics using machine-learning algorithms. The prediction of health checkup test measurements can be very helpful to reduce health management costs. Methods Various machine-learning approaches were used in this study because clinical input data are not completely independent and exhibit complex interactions. Conventional statistical models have limitations to consider these complex interactions, whereas machine learning can consider all possible interactions among input data. We used boosted decision tree regression, decision forest regression, Bayesian linear regression, and linear regression to predict personalized blood uric acid based on basic health checkup test results, dietary information, and sociodemographic characteristics. We evaluated the performance of these five widely used machine-learning models using data collected from 271 employees in the Grameen Bank complex of Dhaka, Bangladesh. Results The mean uric acid level was 6.63 mg/dL, indicating a borderline result for the majority of the sample (normal range <7.0 mg/dL). Therefore, these individuals should be monitoring their uric acid regularly. The boosted decision tree regression model showed the best performance among the models tested based on the root mean squared error of 0.03, which is also better than that of any previously reported model. Conclusions A uric acid prediction model was developed based on personal characteristics, dietary information, and some basic health checkup measurements. This model will be useful for improving awareness among high-risk individuals and populations, which can help to save medical costs. A future study could include additional features (eg, work stress, daily physical activity, alcohol intake, eating red meat) in improving prediction.
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Affiliation(s)
- Masuda Begum Sampa
- Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
| | - Md Nazmul Hossain
- Department of Marketing, Faculty of Business Studies, University of Dhaka, Dhaka, Bangladesh
| | - Md Rakibul Hoque
- School of Business, Emporia State University, Kansas, KS, United States
| | - Rafiqul Islam
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Fumihiko Yokota
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | | | - Ashir Ahmed
- Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
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Chiang C, Aoyama A, Khalequzzaman M, Choudhury SR, Paul D, Rayna SE, Khan FA, Hirakawa Y, Iso H, Yatsuya H. Glycated haemoglobin (HbA1c) as a reliable option for detecting diabetes among the urban poor population in Bangladesh. Eur J Public Health 2020; 30:839-841. [PMID: 30649278 DOI: 10.1093/eurpub/cky275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our previous epidemiological survey targeting urban slum dwellers in Bangladesh showed that the prevalence of diabetes defined by glycated haemoglobin (HbA1c) was higher than the national estimation, and higher in women than men. Subsequently, we conducted the oral glucose tolerance test (OGTT) and found that HbA1c values were consistent with the OGTT findings for detecting diabetes. Our findings indicated that HbA1c ≥6.5% was a rational cut-off, but the optimal HbA1c cut-off for this population might be lower than the internationally recommended threshold. Measuring HbA1c would be a reliable and feasible option for detecting diabetes among underprivileged population in developing countries.
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Affiliation(s)
- Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel R Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Debatosh Paul
- Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahrin E Rayna
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Fahmida A Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Hiroyasu Iso
- Public Health Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan.,Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
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Sakamoto M, Begum S, Ahmed T. Vulnerabilities to COVID-19 in Bangladesh and a Reconsideration of Sustainable Development Goals. Sustainability 2020; 12:5296. [DOI: 10.3390/su12135296] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bangladesh is one of the high-risk countries of the COVID-19 pandemic and its consequent losses due to social and economic conditions. There is a significant possibility that economic stagnation would push a large population back into poverty. In the present study, we have reviewed the chronology and epidemiology of COVID-19 in Bangladesh and investigated the country’s vulnerabilities concerning COVID-19 impacts. We focused primarily on four areas of vulnerabilities in Bangladesh: The garment industry, urban slums, social exclusion, and pre-existing health conditions. The result implicated that the country would take time to recover its economy due to the vulnerabilities mentioned above, and many people in Bangladesh would not be able to tolerate the current situation because they do not have enough reserves to do so. We concluded that if at least some Sustainable Development Goals (SDGs) had been at least partly attained, the situation would not be as dire as it is now. Based on this conclusion, we suggested a tolerance capacity to indicate how long people can survive without outside support. It is a holistic assessment rather than the indicators presently defined in each SDG, but it should be attained through a harmonized approach to SDGs.
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Sampa MB, Hoque MR, Hossain MN. Impacts of Anthropometric, Biochemical, Socio-demographic, and Dietary Habits Factors on the Health Status of Urban Corporate People in a Developing Country. Healthcare (Basel) 2020; 8:E188. [PMID: 32605101 PMCID: PMC7551820 DOI: 10.3390/healthcare8030188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/10/2023] Open
Abstract
This study focused on urban corporate people and applied multinomial logistic regression (MLR) to identify the impact of anthropometric, biochemical, socio-demographic and dietary habit factors on health status. Health status is categorized into four levels: healthy, caution, affected, and emergent. A cross-sectional study, based on convenience sampling method, was conducted to select 271 employees from 18 institutions under the Grameen Bank Complex, Dhaka, Bangladesh. Biochemical measurements such as blood uric acid are highly significant variables in the MLR model. When holding other factors as constants, with a one-unit increase in blood uric acid, a person is 11.02 times more likely to be "emergent" compared to "caution". The odds are also higher, at 1.82, for the blood uric acid to be "affected" compared "caution". The results of this study can help to prevent a large proportion of non-communicable diseases (NCDs) by reducing the most significant risk factor: blood uric acid. This study can contribute to the establishment of combined actions to improve disease management.
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Affiliation(s)
- Masuda Begum Sampa
- Advanced Information Technology, Kyushu University, Fukuoka 819-0395, Japan
| | - Md. Rakibul Hoque
- School of Business, Emporia State University, Emporia, KS 66801, USA;
| | - Md. Nazmul Hossain
- Faculty of Business Studies, University of Dhaka, Dhaka-1000, Bangladesh;
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Adams AM, Islam R, Yusuf SS, Panasci A, Crowell N. Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings. PLoS One 2020; 15:e0233635. [PMID: 32542043 PMCID: PMC7295220 DOI: 10.1371/journal.pone.0233635] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/08/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country’s goal of Universal Health Coverage by 2030. Methods This descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed. Results Significant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet. Conclusions Study results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.
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Affiliation(s)
- Alayne M. Adams
- Department of Family Medicine, McGill University, Montreal, Canada
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Rubana Islam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Anthony Panasci
- Department of Global Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Crowell
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
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Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, Farhana Z, Chowdhury N, Turin TC. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26:10. [PMID: 32514373 PMCID: PMC7262759 DOI: 10.1186/s40885-020-00143-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- Department of Community Health Sciences, University of Calgary, TRW Building (3rd Floor), 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Meshbahur Rahman
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tanjila Akter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tania Akhter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Arifa Ahmed
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Minhajul Arifin Shovon
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Zaki Farhana
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Nashit Chowdhury
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
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Rawal LB, Kanda K, Biswas T, Tanim MI, Poudel P, Renzaho AMN, Abdullah AS, Shariful Islam SM, Ahmed SM. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level. BMJ Open 2019; 9:e029562. [PMID: 31594874 PMCID: PMC6797278 DOI: 10.1136/bmjopen-2019-029562] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level. DESIGN We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners' service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted. SETTING Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions. PARTICIPANTS Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters. RESULTS Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments' initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems. CONCLUSION The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Kie Kanda
- Health Section, Japanese International Cooperation Agency (JICA), Accra, Ghana
| | - Tuhin Biswas
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute for Social Science Research, University of Queensland, Long Pocket Precinct, Indooroopilly Queensland, Brisbane, Queensland, Australia
| | - Md Imtiaz Tanim
- Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- mPower Social Enterprises Ltd, Dhaka, Bangladesh
| | - Prakash Poudel
- Collaboration for Oral Health Outcomes, Research, Translation and Evaluation (COHORTE) Research Group, Western Sydney University, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, Kunsan, China
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Syed Masud Ahmed
- Centre of Excellence for Universal Health Coverage (CoE-UHC), James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Al-Shoaibi AAA, Matsuyama A, Khalequzzaman M, Haseen F, Choudhury SR, Hoque BA, Chiang C, Hirakawa Y, Yatsuya H, Aoyama A. Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study. Nagoya J Med Sci 2018; 80:559-569. [PMID: 30587870 PMCID: PMC6295424 DOI: 10.18999/nagjms.80.4.559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/23/2018] [Indexed: 02/03/2023]
Abstract
The increasing burden of noncommunicable diseases (NCDs) in Bangladesh can be attributable to rapid urbanization and coinciding changes in lifestyle accompanied by nutrition transition. The objective of this study is to explore respondents' lived experiences and perceptions relating to NCDs and nutrition change in an urban slum community in Dhaka. Qualitative methods were employed to explore a general understanding of behavior related to NCDs among residents of the slum community. We conducted key informant interviews of six men and seven women of various backgrounds and five focus group discussions to focus salient topics emerged from the interviews. The transcriptions of the audio-recordings were thematically analyzed, using the constant comparison method. Four major themes emerged: (1) financial hardship influencing health; (2) urbanized lifestyle affecting diet; (3) tobacco and sweetened tea as cornerstones of social life; and (4) health-seeking behavior utilizing local resources. One notable finding was that even with general economic improvement, respondents perceived poverty to be one of the major causes of NCDs. A promising finding for potentially curbing NCDs was the current trend for women to walk for exercise contrary to the commonly held notion that urban dwellers generally lead sedentary lifestyles. This study described how urban slum dwellers in Dhaka, experiencing a transition from a traditional to urbanized lifestyle, perceived their daily practices in relation to NCDs and nutrition. Our research revealed both adverse and encouraging elements of perceptions and behavior related to NCDs, which may contribute to the optimal design of NCD prevention and health promotion programs.
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Affiliation(s)
| | - Akiko Matsuyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
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30
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Gebremariam LW, Hirakawa Y, Rayna SE, Khan FA, Chiang C, He Y, Temengil EJ, Madraisau S, Khalequzzaman M, Choudhury SR, Yatsuya H, Aoyama A. Pilot peer health education for noncommunicable disease prevention in Bangladesh, Ethiopia, and Palau. Journal of Global Health Reports 2018. [DOI: 10.29392/joghr.2.e2018039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Socioeconomic Inequalities in the Risk Factors of Noncommunicable Diseases Among Women of Reproductive Age in Sub-saharan Africa: A Multi-Country Analysis of Survey Data. Front Public Health 2018; 6:307. [PMID: 30406072 PMCID: PMC6207690 DOI: 10.3389/fpubh.2018.00307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/05/2018] [Indexed: 01/25/2023] Open
Abstract
Background: Understanding the socioeconomic discordance associated with the risk factors of non-communicable diseases (NCDs) can help direct effective interventions to end its persistent occurrence. We examined the prevalence of high blood pressure, overweight/obesity, alcohol consumption and tobacco use among women and compared across wealth quintiles in sub-Saharan Africa countries. Methods: This study included 454,080 women of reproductive age (15–49 years) from the current Demographic and Health Survey (DHS) conducted between 2008/09-2017 across 33 sub-Saharan Africa countries. The outcome variables were high blood pressure, overweight/obesity, alcohol consumption and tobacco use. The prevalence of the risk factors of NCDs and sample characteristics across different levels of wealth quintiles were examined. Furthermore, socioeconomic inequalities were measured using concentration index (CI) and Lorenz curve considering urban-rural differentials. Results: The prevalence of high blood pressure and overweight/obesity were 1.2–17.3% and 6.7–44.5% respectively with significant wealth quintile differences. More so, alcohol consumption prevalence was 4.1–47.3% and tobacco use was 0.3–9.9%. The overall prevalence of high blood pressure was 5.5%, overweight/obesity accounted for about 23.1%, alcohol consumption and tobacco users were 23.9 and 2.4%, respectively. The socioeconomic inequalities in high blood pressure (CI = 0.1352, p < 0.001); overweight/obesity (CI = 0.2285, p < 0.001), and alcohol consumption (CI = 0.0278, p < 0.001) were significantly more in the higher socioeconomic group, compared to the lower socioeconomic group. In contrast, the prevalence of tobacco use (CI = −0.2551, p < 0.001) was significantly more in the lower socioeconomic group, compared to the higher socioeconomic group. The test for differences in rural vs. urban concentration indices for high blood pressure, overweight/obesity, alcohol consumption, and tobacco use were statistically significant in all the health indicators (p < 0.05). Conclusion: An effective intervention should incorporate a high-risk approach to terminate risk distribution by directing resources to key population women. To improve the benefit to risk ratio and enhance the cost effectiveness of preventive health programmes, it is paramount to understand the worth of equity-based strategies. Integrating equity elements to interventions is a key measure toward ensuring that policies and programmes meet their milestones. Government should strengthen living standards, literacy and healthcare system to curtail the increasing prevalence of the risk factors of NCDs.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
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Shafique S, Bhattacharyya DS, Anwar I, Adams A. Right to health and social justice in Bangladesh: ethical dilemmas and obligations of state and non-state actors to ensure health for urban poor. BMC Med Ethics 2018; 19:46. [PMID: 29945594 PMCID: PMC6019983 DOI: 10.1186/s12910-018-0285-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country is thus facing many issues that raise moral and ethical concerns. Methods A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor. Results We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens. Conclusions The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh.
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Affiliation(s)
- Sohana Shafique
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
| | | | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Department of International Health, Georgetown University, Washington, DC, USA
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