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Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Akter K, Kuddus A, Jeny T, Nahar T, Shaha S, Ahmed N, King C, Pires M, Haghparast-Bidgoli H, Azad K, Fottrell E, Morrison J. Stakeholder perceptions on scaling-up community-led interventions for prevention and control of non-communicable diseases in Bangladesh: a qualitative study. BMC Public Health 2023; 23:719. [PMID: 37081438 PMCID: PMC10116471 DOI: 10.1186/s12889-023-15551-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Engaging communities is an important component of multisectoral action to address the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. We conducted research with non-communicable disease stakeholders in Bangladesh to understand how a community-led intervention which was shown to reduce the incidence of type 2 diabetes in rural Bangladesh could be scaled-up. METHODS We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data. RESULTS Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention. CONCLUSIONS Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
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Affiliation(s)
- Kohenour Akter
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasnova Jeny
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Carina King
- Karolinska Institutet, K9 Global Folkhälsa, K9 GPH Stålsby Lundborg Alfvén, Stockholm, 171 77, Sweden
| | - Malini Pires
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Edward Fottrell
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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King C, Pires M, Ahmed N, Akter K, Kuddus A, Copas A, Haghparast-Bidgoli H, Morrison J, Nahar T, Shaha SK, Khan AKA, Azad K, Fottrell E. Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare): an updated study protocol for a parallel arm cluster randomised controlled trial. Trials 2023; 24:218. [PMID: 36959617 PMCID: PMC10034243 DOI: 10.1186/s13063-023-07243-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
The "Diabetes: Community-led Awareness, Response and Evaluation" (D:Clare) trial aims to scale up and replicate an evidence-based participatory learning and action cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control.The trial was originally designed as a stepped-wedge cluster randomised controlled trial, with the interventions running from March 2020 to September 2022. Twelve clusters were randomly allocated (1:1) to implement the intervention at months 1 or 12 in two steps, and evaluated through three cross-sectional surveys at months 1, 12 and 24. However, due to the COVID-19 pandemic, we suspended project activities on the 20th of March 2020. As a result of the changed risk landscape and the delays introduced by the COVID-19 pandemic, we changed from the stepped-wedge design to a wait-list parallel arm cluster RCT (cRCT) with baseline data. We had four key reasons for eventually agreeing to change designs: equipoise, temporal bias in exposure and outcomes, loss of power and time and funding considerations.Trial registration ISRCTN42219712 . Registered on 31 October 2019.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Malini Pires
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Andrew Copas
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | | | - Joanna Morrison
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - AKAzad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
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Fottrell E, King C, Ahmed N, Shaha SK, Morrison J, Pires M, Kuddus A, Nahar T, Haghparast-Bidgoli H, Khan AA, Azad K. Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial. Lancet Reg Health Southeast Asia 2023; 10:100122. [PMID: 36938333 PMCID: PMC10015271 DOI: 10.1016/j.lansea.2022.100122] [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] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
Background The DMagic trial showed that participatory learning and action (PLA) community mobilisation delivered through facilitated community groups, and mHealth voice messaging interventions improved diabetes knowledge in Bangladesh and the PLA intervention reduced diabetes occurrence. We assess intervention effects three years after intervention activities stopped. Methods Five years post-randomisation, we conducted a cross-sectional survey among a random sample of adults aged ≥30-years living in the 96 DMagic villages, and a cohort of individuals identified with intermediate hyperglycaemia at the start of the DMagic trial in 2016. Primary outcomes were: 1) the combined prevalence of intermediate hyperglycaemia and diabetes; 2) five-year cumulative incidence of diabetes among the 2016 cohort of individuals with intermediate hyperglycaemia. Secondary outcomes were: weight, BMI, waist and hip circumferences, blood pressure, knowledge and behaviours. Primary analysis compared outcomes at the cluster level between intervention arms relative to control. Findings Data were gathered from 1623 (82%) of the randomly selected adults and 1817 (87%) of the intermediate hyperglycaemia cohort. 2018 improvements in diabetes knowledge in mHealth clusters were no longer observable in 2021. Knowledge remains significantly higher in PLA clusters relative to control but no difference in primary outcomes of intermediate hyperglycaemia and diabetes prevalence (OR (95%CI) 1.23 (0.89, 1.70)) or five-year incidence of diabetes were observed (1.04 (0.78, 1.40)). Hypertension (0.73 (0.54, 0.97)) and hypertension control (2.77 (1.34, 5.75)) were improved in PLA clusters relative to control. Interpretation PLA intervention effect on intermediate hyperglycaemia and diabetes was not sustained at 3 years after intervention end, but benefits in terms of blood pressure reduction were observed. Funding Medical Research Council UK: MR/M016501/1 (DMagic trial); MR/T023562/1 (DClare study), under the Global Alliance for Chronic Diseases (GACD) Diabetes and Scale-up Programmes, respectively.
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Key Words
- ADS, Appraisal of Diabetes Scale
- BADAS, Diabetic Association of Bangladesh
- BMI, Body Mass Index
- Bangladesh
- CVD, Cardiovascular disease(s)
- Cardiovascular risk
- Cluster randomised controlled trial
- Community intervention
- Control
- DBP, Diastolic blood pressure
- DDS, Dietary Diversity Score
- Diabetes
- GAD-7, Generalised Anxiety Disorder Assessment
- IQR, Inter-quartile range
- NCD, Non-communicable disease(s)
- PHQ-9, Patient Health Questionnaire 9
- PLA, Participatory Learning and Action
- PP, Pulse pressure
- Prevention
- Rural
- SBP, Systolic blood pressure
- T2DM, Type-2 diabetesmellitus
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Affiliation(s)
- Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
- Corresponding author. UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Naveed Ahmed
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Kumer Shaha
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- UCL Institute for Global Health, University College London, London, UK
| | - Malini Pires
- UCL Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A.K. Azad Khan
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Ward ZJ, Yeh JM, Reddy CL, Gomber A, Ross C, Rittiphairoj T, Manne-Goehler J, Abdalla AT, Abdullah MA, Ahmed A, Ankotche A, Azad K, Bahendeka S, Baldé N, Jain SM, Kalobu JC, Karekezi C, Kol H, Prasannakumar KM, Leik SK, Mbanya JC, Mbaye MN, Niang B, Paturi VR, Raghupathy P, Ramaiya K, Sethi B, Zabeen B, Atun R. Estimating the total incidence of type 1 diabetes in children and adolescents aged 0-19 years from 1990 to 2050: a global simulation-based analysis. Lancet Diabetes Endocrinol 2022; 10:848-858. [PMID: 36372070 DOI: 10.1016/s2213-8587(22)00276-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 05/24/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies of type 1 diabetes in childhood and adolescence have found large variations in reported incidence around the world. However, it is unclear whether these reported incidence levels are impacted by differences in country health systems and possible underdiagnosis and if so, to what degree. The aim of this study was to estimate both the total and diagnosed incidence of type 1 diabetes globally and to project childhood type 1 diabetes incidence indicators from 1990 to 2050 for each country. METHODS We developed the type 1 diabetes global microsimulation model to simulate the natural history and diagnosis of type 1 diabetes for children and adolescents (aged 0-19 years) in 200 countries and territories, accounting for variability in underlying incidence and health system performance. The model follows an open population of children and adolescents in monthly intervals and simulates type 1 diabetes incidence and progression, as well as health system factors which influence diagnosis. We calibrated the model to published data on type 1 diabetes incidence, autoantibody profiles, and proportion of cases diagnosed with diabetic ketoacidosis from 1990 to 2020 and assessed the predictive accuracy using a randomly sampled test set of data withheld from calibration. FINDINGS We estimate that in 2021 there were 355 900 (95% UI 334 200-377 300) total new cases of type 1 diabetes globally among children and adolescents, of which 56% (200 400 cases, 95% UI 180 600-219 500) were diagnosed. Estimated underdiagnosis varies substantially by region, with over 95% of new cases diagnosed in Australia and New Zealand, western and northern Europe, and North America, but less than 35% of new cases diagnosed in west Africa, south and southeastern Asia, and Melanesia. The total number of incident childhood cases of type 1 diabetes is projected to increase to 476 700 (95% UI 449 500-504 300) in 2050. INTERPRETATION Our research indicates that the total global incidence of childhood and adolescent type 1 diabetes is larger than previously estimated, with nearly one-in-two children currently undiagnosed. Policymakers should plan for adequate diagnostic and medical capacity to improve timely type 1 diabetes detection and treatment, particularly as incidence is projected to increase worldwide, with highest numbers of new cases in Africa. FUNDING Novo Nordisk.
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Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Jennifer M Yeh
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Che L Reddy
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Apoorva Gomber
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Carlo Ross
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Academic Foundation Programme, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thanitsara Rittiphairoj
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of Health Systems Management, Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jennifer Manne-Goehler
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Asmahan T Abdalla
- International University of Africa, College of Medicine, Khartoum, Sudan
| | - Mohamed Ahmed Abdullah
- International University of Africa, College of Medicine, Khartoum, Sudan; Sudanese Childhood Diabetes Association, Khartoum, Sudan
| | - Abdurezak Ahmed
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amos Ankotche
- Department of Internal Medicine, Endocrinology and Geriatrics, Unit of Training and Research, Medical Science of Abidjan, University of Côte D'Ivoire, Abidjan, Ivory Coast
| | - Kishwar Azad
- BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Silver Bahendeka
- Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda
| | - Naby Baldé
- Department of Endocrinology, University Hospital, Conakry, Guinea
| | - Sunil M Jain
- TOTALL Diabetes Hormone Institute, Indore, Madhya Pradesh, India
| | | | | | - Hero Kol
- Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia
| | | | - Sai Kham Leik
- Department of Social, Economic, and Adminstrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Maïmouna Ndour Mbaye
- Centre du Diabète Marc Sankalé, Dakar, Senegal; Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal
| | - Babacar Niang
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | | | - Palany Raghupathy
- Paediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bangalore, India
| | | | | | - Bedowra Zabeen
- Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders, Dhaka, Bangladesh; Changing Diabetes in Children Programme, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Rifat Atun
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
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Mohsin F, Mahbuba S, Jasim S, Islam N, Nahar J, Akhter S, Mollah AH, Azad K. Clinical Presentation of Congenital Adrenal Hyperplasia in Children: Experience in a Tertiary Care Hospital of Bangladesh. Mymensingh Med J 2022; 31:725-732. [PMID: 35780357] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This cross sectional study was conducted in Paediatric Endocrine Outpatient Department of BIRDEM General Hospital, a tertiary care centre in Dhaka, Bangladesh among patients diagnosed with congenital adrenal hyperplasia (CAH) from January 2005 to December 2018. The study was aimed to find out the clinical and laboratory profile of all patients at presentation diagnosed with CAH during the study period. Data were obtained by reviewing the medical records of the patients. Total 102 children with CAH were diagnosed during the study period. Among them 68 were female and 34 were male (female to male ratio of 2:1). Median age was 3.5 month (range 0.2-158 month) and 5.5 month (range 1-108 month) in female and male respectively (p=0.42). Family history was available in 93 patients. Consanguinity was present in 16(17.2%), history of sib death in 12(12.9%), other family members were affected in 8(8.6%). Sixty patient (58.8%) had salt-wasting (SW), 39(38.2%) had simple virilizing (SV) and 3(2.9%) had non- classic form of CAH. Median age of presentation was 2 month (range 0.2-70 month) and 42 month (range 0.8-158 month) in SW and SV group respectively (p=0.001) and 119 month (range 108-152 month) in non- classic group. Common presentations were: genital ambiguity (64.7%), vomiting (46.5%), failure to thrive (41.6%), features of early puberty (precocious pseudopuberty) (24.5%), diarrhea (12.0%). Hyperpigmentation was noted in 49.0% of patients. Among the salt-wasting type in male failure to thrive (FTT) was the most common presentation (83.3%), followed by vomiting (75.0%). In female genital ambiguity was the commonest presentation (97.2%), followed by vomiting (77.1%). Among the simple virilizing type in male early puberty was the commonest presentation (100%) and genital ambiguity was the presenting feature in all the female (100.0%).
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Affiliation(s)
- F Mohsin
- Professor Dr Fauzia Mohsin, Professor of Paediatrics, BIRDEM General Hospital & Ibrahim Medical College, Dhaka, Bangladesh; E mail:
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Fottrell E, King C, Azad K. Data processing in the DMagic cluster randomised controlled trial. Lancet Diabetes Endocrinol 2022; 10:241-242. [PMID: 35325596 DOI: 10.1016/s2213-8587(22)00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Edward Fottrell
- UCL Institute for Global Health, University College London, London, WC1N 1EH, UK.
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Zabeen B, Ahmed B, Nahar J, Tayyeb S, Islam N, Mohsin F, Azad K. Higher HbA1c was observed in young people with diabetes who fasted during COVID-19 pandemic lockdown of 2020 Ramadan in Bangladesh - A Post Ramadan survey. Diabetes Res Clin Pract 2022; 186:109812. [PMID: 35301071 PMCID: PMC8920591 DOI: 10.1016/j.diabres.2022.109812] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/30/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Muslim people with T1DM should be actively discouraged from fasting during the COVID-19 pandemic, as diabetes has emerged as a significant risk factor for adverse outcomes of COVID-19 infection. We report the experience of young patients with type 1, type 2 and other types diabetes who fasted during Ramadan 2020 at the time of the COVID-19 pandemic time lockdown. RESEARCH DESIGN AND METHODS A Post- Ramadan survey was designed for young patients who fasted during Ramadan in 2020 during COVID pandemic time. The study was conducted to compared the basal characteristics and other parameters in children and adolescents (<18 years), with young adults (≥18 years) with diabetes at Paediatric Diabetes Center in BIRDEM in Bangladesh. RESULTS Among the study participants, a significantly higher number of participants were in older age group who fasted for more than 15 days (p = 0.045). A considerable proportion (30.7%) of patients developed mild hypoglycaemia, and only eight patients (2.6%) developed moderate to severe hypoglycemia. There was significant reduction of post Ramadan basal insulin dose in both groups (p = 0.001). Although increased bolus insulin dose requirements were observed in older age group, but decreased requirement was observed in younger age group during Ramadan (p = 0.001). Post Ramadan median HbA1C in both groups was increased with marked increase in older age group compared to younger age group though it did not reach the statistical significance. (p = 0.239) CONCLUSIONS: COVID-19 pandemic had minor impact on fasting during Ramadan in our cohort, they could fast safely with less complications during Ramadan. Our data supports Ramadan focused diabetes education with ample self-care, young people with diabetes can fast safely during Ramadan.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh; Changing Diabetes in Children Programme, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh.
| | - Bulbul Ahmed
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
| | - Jebun Nahar
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
| | - Samin Tayyeb
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh; Changing Diabetes in Children Programme, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
| | - Nasreen Islam
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
| | - Fauzia Mohsin
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
| | - Kishwar Azad
- Department of Paediatrics Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh; Changing Diabetes in Children Programme, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM), Bangladesh
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Pires M, Shaha S, King C, Morrison J, Nahar T, Ahmed N, Jennings HM, Akter K, Haghparast-Bidgoli H, Khan AKA, Costello A, Kuddus A, Azad K, Fottrell E. Equity impact of participatory learning and action community mobilisation and mHealth interventions to prevent and control type 2 diabetes and intermediate hyperglycaemia in rural Bangladesh: analysis of a cluster randomised controlled trial. J Epidemiol Community Health 2022; 76:586-594. [PMID: 35277436 PMCID: PMC9118071 DOI: 10.1136/jech-2021-217293] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Background A cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact. Methods Intervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression. Results PLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention. PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00). Conclusion Large impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations. Trial registration number ISRCTN41083256.
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Affiliation(s)
- Malini Pires
- Institute for Global Health, University College London, London, UK
| | - Sanjit Shaha
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Tasmin Nahar
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Kohenour Akter
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Zabeen B, Nahar J, Ahmed B, Tayyeb S, Islam N, Azad K. Vitamin D status in children and adolescents with type 1 diabetes in a specialized diabetes care centre in Bangladesh. Endocrinol Diabetes Metab 2022; 5:e00312. [PMID: 34766458 PMCID: PMC8754235 DOI: 10.1002/edm2.312] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES High prevalence of vitamin D deficiency (VDD) in children and adolescents with type 1 diabetes (T1D) was found in several epidemiological studies. The current study aimed to assess the Vitamin D status in children and adolescents with T1D and to examine the influence of the disease characteristics on vitamin D status in a specialized care centre in a tertiary hospital in Bangladesh. METHODS Participants were enrolled in the cross-sectional study at the time of a regularly scheduled visit to the CDiC Paediatric Diabetes Center in BIRDEM 2(Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital in Bangladesh. The demographic and clinical data were collected through medical records with a structured questionnaire. RESULTS Among sixty study participants, most had inadequate levels of vitamin D: deficiency 31 (51.7%), insufficiency 14 (23.3%) and sufficiency 15 (25.0%). Participants with vitamin D deficiency (VDD) were significantly older compared to the sufficient and insufficient group (p = .029), and were residing in urban areas (p = .036) and from higher socioeconomic status (p = .014). BMI was significantly higher in VDD compared to the sufficient group (p = .040). Although we observed higher median values of daily insulin requirements and HbA1c values in patients with VDD compared to patients with vitamin D insufficiency or vitamin D sufficiency, these differences did not reach statistical significance. CONCLUSIONS The present study revealed that the prevalence of vitamin D deficiency and insufficiency among T1 diabetes children was very high. Future studies in large sample are required to assess hypovitaminosis D in youth with T1D and also the possible relating factors of vitamin D deficiency.
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Affiliation(s)
- Bedowra Zabeen
- Department of PaediatricsLife for a child (LFAC) & Changing Diabetes in Children (CDiC) ProgrammeBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
| | - Jebun Nahar
- Department of PaediatricsBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)DhakaBangladesh
| | - Bulbul Ahmed
- Department of PaediatricsBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)DhakaBangladesh
| | - Samin Tayyeb
- Department of PaediatricsLife for a child (LFAC) & Changing Diabetes in Children (CDiC) ProgrammeBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
| | - Nasreen Islam
- Department of PaediatricsBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)DhakaBangladesh
| | - Kishwar Azad
- Department of PaediatricsLife for a child (LFAC) & Changing Diabetes in Children (CDiC) ProgrammeBangladesh Institute of Research & Rehabilitation in DiabetesEndocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
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12
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Zabeen B, Ahmed B, Islam N, Tayyeb S, Nahar J, Azad K. Comparison of efficacy of detemir and degludec insulin in the management of children and adolescents with type 1 diabetes. J Diabetol 2022. [DOI: 10.4103/jod.jod_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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King C, Shaha SK, Morrison J, Ahmed N, Kuddus A, Pires M, Nahar T, Hossin R, Haghparast-Bidgoli H, Khan AKA, Davies J, Azad K, Fottrell E. Changes in non-communicable diseases, diet and exercise in a rural Bangladesh setting before and after the first wave of COVID-19. PLOS Glob Public Health 2022; 2:e0001110. [PMID: 36962614 PMCID: PMC10021158 DOI: 10.1371/journal.pgph.0001110] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Prevalence of non-communicable diseases (NCDs) is high in rural Bangladesh. Given the complex multi-directional relationships between NCDs, COVID-19 infections and control measures, exploring pandemic impacts in this context is important. We conducted two cross-sectional surveys of adults ≥30-years in rural Faridpur district, Bangladesh, in February to March 2020 (survey 1, pre-COVID-19), and January to March 2021 (survey 2, post-lockdown). A new random sample of participants was taken at each survey. Anthropometric measures included: blood pressure, weight, height, hip and waist circumference and fasting and 2-hour post-glucose load blood glucose. An interviewer-administered questionnaire included: socio-demographics; lifestyle and behavioural risk factors; care seeking; self-rated health, depression and anxiety assessments. Differences in NCDs, diet and exercise were compared between surveys using chi2 tests, logistic and linear regression; sub-group analyses by gender, age and socio-economic tertiles were conducted. We recruited 950 (72.0%) participants in survey 1 and 1392 (87.9%) in survey 2. The percentage of the population with hypertension increased significantly from 34.5% (95% CI: 30.7, 38.5) to 41.5% (95% CI: 38.2, 45.0; p-value = 0.011); the increase was more pronounced in men. Across all measures of self-reported health and mental health, there was a significant improvement between survey 1 and 2. For self-rated health, we observed a 10-point increase (71.3 vs 81.2, p-value = 0.005). Depression reduced from 15.3% (95% CI: 8.4, 26.1) to 6.0% (95% CI: 2.7, 12.6; p-value = 0.044) and generalised anxiety from 17.9% (95% CI: 11.3, 27.3) to 4.0% (95% CI: 2.0, 7.6; p-value<0.001). No changes in fasting blood glucose, diabetes status, BMI or abdominal obesity were observed. Our findings suggest both positive and negative health outcomes following COVID-19 lockdown in a rural Bangladeshi setting, with a concerning increase in hypertension. These findings need to be further contextualised, with prospective assessments of indirect effects on physical and mental health and care-seeking.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Joanna Morrison
- Institute for Global Health, University College London, London, United Kingdom
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Malini Pires
- Institute for Global Health, University College London, London, United Kingdom
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Raduan Hossin
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, United Kingdom
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14
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Pulkki-Brännström AM, Haghparast-Bidgoli H, Batura N, Colbourn T, Azad K, Banda F, Banda L, Borghi J, Fottrell E, Kim S, Makwenda C, Ojha AK, Prost A, Rosato M, Shaha SK, Sinha R, Costello A, Skordis J. Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability. Health Policy Plan 2021; 35:1280-1289. [PMID: 33085753 PMCID: PMC7886438 DOI: 10.1093/heapol/czaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.
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Affiliation(s)
- Anni-Maria Pulkki-Brännström
- Department of Epidemiology and Global Health, Umeå University, Umeå S-901 87, Sweden.,UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Neha Batura
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Tim Colbourn
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh
| | | | - Lumbani Banda
- Parent and Child Health Initiative (PACHI), Area 14 Plot 171, Lilongwe, Malawi
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Edward Fottrell
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Sungwook Kim
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Charles Makwenda
- Parent and Child Health Initiative (PACHI), Area 14 Plot 171, Lilongwe, Malawi
| | - Amit Kumar Ojha
- Ekjut, Plot no. - 556B, Potka Chakradharpur, West Singhbhum, Pin - 833102, Jharkhand, India
| | - Audrey Prost
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Mikey Rosato
- Women and Children First (UK), United House, North Road, London, N7 9DP, UK
| | - Sanjit Kumer Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh
| | - Rajesh Sinha
- Ekjut, Plot no. - 556B, Potka Chakradharpur, West Singhbhum, Pin - 833102, Jharkhand, India
| | - Anthony Costello
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Jolene Skordis
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
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15
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Jennings HM, Morrison J, Akter K, Haghparast-Bidgoli H, King C, Ahmed N, Kuddus A, Shaha SK, Nahar T, Azad K, Fottrell E. Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study. BMC Public Health 2021; 21:1445. [PMID: 34294059 PMCID: PMC8299577 DOI: 10.1186/s12889-021-11395-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.
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Affiliation(s)
- Hannah Maria Jennings
- Department of Health Sciences, University of York and Hull York Medical School, York, UK. .,Institute for Global Health, University College London, London, UK.
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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16
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Morrison J, Akter K, Jennings H, Ahmed N, Kumer Shaha S, Kuddus A, Nahar T, King C, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K, Fottrell E. Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next? Glob Public Health 2021; 17:1299-1313. [PMID: 33966607 PMCID: PMC9487863 DOI: 10.1080/17441692.2021.1923776] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is an urgent need for population-based interventions to slow the growth of the diabetes epidemic in low-and middle-income countries. We tested the effectiveness of a population-based mHealth voice messaging intervention for T2DM prevention and control in rural Bangladesh through a cluster randomised controlled trial. mHealth improved knowledge and awareness about T2DM but there was no detectable effect on T2DM occurrence. We conducted mixed-methods research to understand this result. Exposure to messages was limited by technological faults, high frequency of mobile phone number changes, message fatigue and (mis)perceptions that messages were only for those who had T2DM. Persistent social norms, habits and desires made behaviour change challenging, and participants felt they would be more motivated by group discussions than mHealth messaging alone. Engagement with mHealth messages for T2DM prevention and control can be increased by (1) sending identifiable messages from a trusted source (2) using participatory design of mHealth messages to inform modelling of behaviours and increase relevance to the general population (3) enabling interactive messaging. mHealth messaging is likely to be most successful if implemented as part of a multi-sectoral, multi-component approach to address T2DM and non-communicable disease risk factors.
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Affiliation(s)
- Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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17
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Zabeen B, Maniam J, Balsa AMM, Tayyeb S, Huda K, Azad K, Ogle GD. Incidence of diabetes in children and adolescents in Dhaka, Bangladesh. J Pediatr Endocrinol Metab 2021; 34:509-515. [PMID: 33662193 DOI: 10.1515/jpem-2020-0671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Bangladesh has limited information regarding incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in young people. The objective of this study was to measure minimum incidence of T1D and T2D, and record other types of new-onset diabetes in children and adolescents <20 years (y), in Dhaka District, Bangladesh, from 2011-2018. METHODS Retrospective study using clinical records from Diabetic Association of Bangladesh clinics. Cases were classified by clinical evaluation. RESULTS 725 cases were diagnosed. 482 (66.5%) had T1D, 205 (28.3%) T2D, 14 (1.9%) fibrocalculous pancreatic diabetes, and 24 (3.3%) other types. Male:female ratios for T1D/T2D were 1:1.6 (p<0.0001) (T1D) and 1:1.4 (p<0.01) respectively. T1D cases by age-group were 7.3% (0-4 y), 19.9% (5-9 y), 43.6% (10-14 y) and 29.3% (15-19 y). Mean ± SD ages of onset were 12.3 ± 4.2 y (T1D) and 13.1 ± 2.4 y (T2D). Annual T1D mean incidences/100,000 were 1.22 [95%CI: 0.85-1.58] (<15 y) and 1.25 [0.94-1.57] (<20 y), and for T2D 0.52 [0.33-0.73] (<20 y). T1D incidence <15 y was 1.04 [0.69-1.39] in 2011 and 1.42 [1.04-1.80] in 2018 (p=0.08). T2D incidence rose from 0.22 [0.80-0.36] (2011) to 0.57 [0.36-0.77] (2018), an annualized increase of 12% [8-22%] (p=0.001). Ascertainment was estimated as 95%. CONCLUSIONS T1D was most common, but T2D, FCPD and other forms also occur. T2D incidence increased during the study period.
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Affiliation(s)
- Bedowra Zabeen
- Department of Changing Diabetes in Children and Life for a Child Programme, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka, Bangladesh
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW, Australia
| | - Ana Margarida Morrão Balsa
- Serviço de Endocrinologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Unidade Hospitalar de Vila Real, Vila Real, Portugal
| | - Samin Tayyeb
- Department of Changing Diabetes in Children and Life for a Child Programme, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka, Bangladesh
| | - Kamrul Huda
- Department of Changing Diabetes in Children and Life for a Child Programme, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka, Bangladesh
| | - Kishwar Azad
- Department of Changing Diabetes in Children and Life for a Child Programme, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka, Bangladesh.,Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
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18
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Zabeen B, Khaled MZ, Husain L, Aktar A, Huda K, Kamal YA, Choudhury N, Azad K. Risk factors associated with retinopathy in young people with type 1 diabetes in Bangladesh. Endocrinol Diabetes Metab 2021; 4:e00197. [PMID: 33855204 PMCID: PMC8029569 DOI: 10.1002/edm2.197] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Diabetic retinopathy (DR) is the most common microvascular complications seen in children and adolescents with type 1 diabetes. The aim of this study was to evaluate the prevalence of retinopathy and its association with other risk factors in young people with type 1 diabetes. Methods This study was a cross-sectional study, which was done as part of the ongoing complication assessment in the paediatric diabetes clinic in BIRDEM (Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital. Children, adolescents and young adults with type 1 diabetes who were having diabetes duration >2 years were included in this study. Retinopathy was detected using fundal photography, and grading was done by National Screening Committee of UK by trained ophthalmologists. Results Diabetic retinopathy was observed in 44 (6.6%) patients. Majority (95.4%) of them had early diabetic retinopathy in the form of mild NPDR (nonproliferative diabetic retinopathy) (R1). Patients with retinopathy had higher HbA1c 9.6[8.4-12.3] vs 9.1 [7.9-10.8] (P = .013), longer duration of diabetes 7.6 [5.5-10.7] vs 6.0 [4.5-8.2] years (P = .001) and were older 21.5 [18.0-23.0] vs 18 [16.0-21.0] years (P = .0001) compared with those without retinopathy. On multivariate regression analysis, higher age and median HbA1c were significantly associated with DR. Conclusions Higher HbA1c was the only modifiable risk factor for development of DR in our study population. Early detection of DR with improvement of glycaemic control may reduce the risk of progression of severe stages of the disease.
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Affiliation(s)
- Bedowra Zabeen
- Department of PaediatricsLife for a Child & Changing Diabetes in Children ProgrammeBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
| | - Mohammad Zafar Khaled
- Department of OphthalmologyBangobandhu Sheikh Mujib Medical University (BSMMU)DhakaBangladesh
| | - Lutful Husain
- Orbis InternationalBangladesh Country OfficeDhakaBangladesh
| | - Asma Aktar
- National Institute of Ophthalmology (NIO)DhakaBangladesh
| | - Kamrul Huda
- Life for a child (LFAC) and Changing Diabetes in Children (CDiC) ProgrammeBIRDEM 2Diabetic Association of BangladeshDhakaBangladesh
| | - Yeasmin Afroz Kamal
- Department of OphthalmologyBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)DhakaBangladesh
| | - Nujhat Choudhury
- Department of OphthalmologyBangobandhu Sheikh Mujib Medical University (BSMMU)DhakaBangladesh
| | - Kishwar Azad
- Department of PaediatricsPerinatal Care ProjectBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
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King C, Pires M, Ahmed N, Akter K, Kuddus A, Copas A, Haghparast-Bidgoli H, Morrison J, Nahar T, Shaha SK, Khan AKA, Azad K, Fottrell E. Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare trial): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2021; 22:235. [PMID: 33781315 PMCID: PMC8006505 DOI: 10.1186/s13063-021-05167-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/02/2021] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND An estimated 463 million people globally have diabetes, with the prevalence growing in low-and middle-income settings, such as Bangladesh. Given the need for context-appropriate interventions to prevent type 2 diabetes mellitus (T2DM), the 'Diabetes: Community-led Awareness, Response and Evaluation' (D:Clare) trial will rigorously evaluate the replication and scale-up of a participatory learning and action (PLA) cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control. METHODS This is a stepped-wedge cluster randomised controlled trial, with integrated process and economic evaluations, conducted from March 2020 to September 2022. The trial will evaluate a community-based four-phase PLA cycle intervention focused on prevention and control of T2DM implemented over 18 months, against a control of usual care. Twelve clusters will be randomly allocated (1:1) to implement the intervention at project month 1 or 12. The intervention will be evaluated through three cross-sectional surveys at months 1, 12 and 24. The trial will be conducted in Alfadanga Upazila, Faridpur district, with an estimated population of 120,000. Clusters are defined as administrative geographical areas, with approximately equal populations. Each of the six unions in Alfadanga will be divided into two clusters, forming 12 clusters in total. Given the risk of inter-cluster contamination, evaluation surveys will exclude villages in border areas. Participants will be randomly sampled, independently for each survey, from a population census conducted in January 2020. The primary outcome is the combined prevalence of intermediate hyperglycaemia and T2DM, measured through fasting and 2-h post-glucose load blood tests. A total of 4680 participants provide 84% power to detect a 30% reduction in the primary outcome, assuming a baseline of 30% and an ICC of 0.07. The analysis will be by intention-to-treat, comparing intervention and control periods across all clusters, adjusting for geographical clustering. DISCUSSION This study will provide further evidence of effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect. TRIAL REGISTRATION ISRCTN: ISRCTN42219712 . Registered on 31 October 2019.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Malini Pires
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Andrew Copas
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | | | - Joanna Morrison
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
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Zabeen B, Nahar J, Ahmed B, Islam N, Azad K, Donaghue K. High HbA1c is not a reason not to fast during Ramadan in Children, adolescents and young adults with Type 1 diabetes - An observational study in Bangladesh. Diabetes Res Clin Pract 2021; 173:108673. [PMID: 33539866 DOI: 10.1016/j.diabres.2021.108673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 10/22/2020] [Revised: 12/12/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
AIMS Our aim was to investigate the ability, frequency of acute complications and impact on glycemic control in uncontrolled T1DM who fasted during Ramadan. METHODS 74 Patients with T1D who insisted on fasting were enrolled 1 month prior to Ramadan and given intensive education by Diabetes team on insulin dose, glucose monitoring and dietary adjustments. Patients were divided into two groups ; group A- HbA1c < 9%(<75 mmol/mol) and group B- HbA1c ≥ 9% (≥75 mmol/mol) and different variables were compared. RESULTS Most of the patients fasted 58 (78.4%) for more than 15 days. There was no significant difference (p = 0.790), while comparing the breaking the fast in the two groups. Hypoglycaemia was common acute complications among them. There was no significant difference in the frequency of hypoglycaemia between two groups (P = 0.448). There was increased insulin requirement in both groups during Ramadan (p = 0.00001), with an increase in basal insulin in well controlled (from 24 to 34 units). There was significant reduction of Post Ramadan mean HbA1C in both groups [P = 0.0001)]. CONCLUSION Children, adolescents and young adults with T1D with poor glycaemic control can fast safely during Ramadan with proper education and intensive monitoring.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics, BIRDEM2, Diabetic Association of Bangladesh.
| | - Jebun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Bulbul Ahmed
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Nasreen Islam
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Kishwar Azad
- Department of Paediatrics, BIRDEM2, Diabetic Association of Bangladesh
| | - Kim Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead Sydney, Australia
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Zabeen B, Bhowmik B, Huda K, Naz F, Tayyeb S, Azad K. Use of telemedicine for the management of type 1 diabetes in children and adolescents in Bangladesh during the COVID-19 pandemic. J Diabetol 2021. [DOI: 10.4103/jod.jod_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Pulkki-Brännström AM, Haghparast-Bidgoli H, Batura N, Colbourn T, Azad K, Banda F, Banda L, Borghi J, Fottrell E, Kim S, Makwenda C, Ojha AK, Prost A, Rosato M, Shaha SK, Sinha R, Costello A, Skordis J. Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability. Health Policy Plan 2020; 36:226. [PMID: 33355346 PMCID: PMC7996644 DOI: 10.1093/heapol/czaa164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zabeen B, Nahar J, Islam N, Azad K, Donaghue K. Effects of Continuous Subcutaneous Insulin Infusion on Glycaemic Control and Acute Complications in Young People with Type 1 Diabetes in Bangladesh. Dubai Diabetes Endocrinol J 2020. [DOI: 10.1159/000511241] [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] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). <b><i>Methods:</i></b> The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. <b><i>Results:</i></b> Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (<i>p</i> = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (<i>p</i> = 0.001), total insulin requirement (<i>p</i> = 0.043), frequency of hypoglycaemic episodes (<i>p</i> = 0.006), and diabetic ketoacidosis (<i>p</i> = 0.002) events during CSII therapy. <b><i>Conclusion:</i></b> In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.
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Mohebbi D, Haghparast-Bidgoli H, Fottrell E, Kuddus A, Azad K. PDB13 The Cost-Effectiveness of Diabetes Prevention Programmes in Bangladesh. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zabeen B, Govender D, Hassan Z, Noble JA, Lane JA, Mack SJ, Atkinson MA, Azad K, Wasserfall CH, Ogle GD. Clinical features, biochemistry and HLA-DRB1 status in children and adolescents with diabetes in Dhaka, Bangladesh. Diabetes Res Clin Pract 2019; 158:107894. [PMID: 31669629 PMCID: PMC6988504 DOI: 10.1016/j.diabres.2019.107894] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
AIMS Little information is published on diabetes in young people in Bangladesh. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting Bangladeshi children and adolescents <22 years of age. METHODS The study was conducted at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM) in Dhaka. One hundred subjects aged <22 years at diagnosis were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C-peptide, and autoantibodies against glutamic acid decarboxylase 65 (GADA) and islet antigen-2 (IA-2A) were measured. High-resolution DNA genotyping was performed for HLA-DRB1. RESULTS Eighty-four subjects were clinically diagnosed as type 1 diabetes (T1D), seven as type 2 diabetes (T2D), and nine as fibrocalculous pancreatic disease (FCPD). Of the 84 with T1D, 37 (44%) were males and 47 (56%) females, with median age at diagnosis 13 years (y) (range 1.6-21.7) and peak age at onset 12-15 years. 85% of subjects were assessed within one month of diagnosis and all within eleven months. For subjects diagnosed with T1D, mean C-peptide was 0.46 ± 0.22 nmol/L (1.40 ± 0.59 ng/mL), with 9 (10.7%) IA-2A positive, 22 (26%) GADA positive, and 5 (6%) positive for both autoantibodies. Analysis of HLA-DRB1 genotypes revealed locus-level T1D association (p = 6.0E-05); DRB1*04:01 appeared predisposing (p < 3.0E-06), and DRB1*14:01 appeared protective (p = 1.7E-02). CONCLUSIONS Atypical forms of T1D appear to be more common in young people in Bangladesh than in European populations. This will be helpful in guiding more specific assessment at onset and potentially, expanding treatment options.
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Affiliation(s)
- Bedowra Zabeen
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Denira Govender
- Life for a Child Program, Diabetes NSW, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, NSW 2006, Australia.
| | - Zahid Hassan
- Dept of Physiology and Molecular Biology, Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, Bangladesh & Dept of Physiology, Tairunnessa Memorial Medical College, Gazipur, Bangladesh.
| | | | - Julie A Lane
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Steven John Mack
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
| | - Mark Alvin Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Kishwar Azad
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh.
| | - Clive Henry Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA.
| | - Graham David Ogle
- Sydney Medical School, University of Sydney, NSW 2006, Australia; Diabetes NSW, Sydney, Australia.
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Morrison J, Akter K, Jennings HM, Nahar T, Kuddus A, Shaha SK, Ahmed N, King C, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation. BMC Endocr Disord 2019; 19:118. [PMID: 31684932 PMCID: PMC6830002 DOI: 10.1186/s12902-019-0447-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 05/27/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes is 7th largest cause of death worldwide, and prevalence is increasing rapidly in low-and middle-income countries. There is an urgent need to develop and test interventions to prevent and control diabetes and develop the theory about how such interventions can be effective. We conducted a participatory learning and action (PLA) intervention with community groups in rural Bangladesh which was evaluated through a cluster randomised controlled trial. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group. We present findings from qualitative process evaluation research to explore how this intervention was effective. METHODS We conducted group interviews and focus group discussions using photovoice with purposively sampled group attenders and non-attenders, and intervention implementers. Data were collected before the trial analysis. We used inductive content analysis to generate theory from the data. RESULTS The intervention increased the health literacy of individuals and communities - developing their knowledge, capacity and self-confidence to enact healthy behaviours. Community, household and individual capacity increased through social support and social networks, which then created an enabling community context, further strengthening agency and enabling community action. This increased opportunities for healthy behaviour. Community actions addressed lack of awareness about diabetes, gendered barriers to physical activity and lack of access to blood glucose testing. The interaction between the individual, household, and community contexts amplified change, and yet there was limited engagement with macro level, or 'state', barriers to healthy behaviour. CONCLUSIONS The participatory approach enabled groups to analyse how context affected their ability to have healthy behaviours and participants engaged with issues as a community in the ways that they felt comfortable. We suggest measuring health literacy and social networks in future interventions and recommend specific capacity strengthening to develop public accountability mechanisms and health systems strengthening to complement community-based interventions. TRIAL REGISTRATION Registered at ISRCTN on 30th March 2016 (Retrospectively Registered) Registration number: ISRCTN41083256 .
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Affiliation(s)
- Joanna Morrison
- University College London Institute for Global Health, London, UK
| | | | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- University College London Institute for Global Health, London, UK
| | | | - Anthony Costello
- University College London Institute for Global Health, London, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- University College London Institute for Global Health, London, UK
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Jennings HM, Morrison J, Akter K, Kuddus A, Ahmed N, Kumer Shaha S, Nahar T, Haghparast-Bidgoli H, Khan AA, Azad K, Fottrell E. Developing a theory-driven contextually relevant mHealth intervention. Glob Health Action 2019; 12:1550736. [PMID: 31154988 PMCID: PMC6338268 DOI: 10.1080/16549716.2018.1550736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 12/02/2022] Open
Abstract
Background: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention. Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh. Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention. Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages. Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.
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Affiliation(s)
| | - Joanna Morrison
- a Institute for Global Health , University College London , London , UK
| | - Kohenour Akter
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Abdul Kuddus
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Naveed Ahmed
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Sanjit Kumer Shaha
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Tasmin Nahar
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | | | - Ak Azad Khan
- c The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Kishwar Azad
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Edward Fottrell
- a Institute for Global Health , University College London , London , UK
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Morrison J, Jennings H, Akter K, Kuddus A, Mannell J, Nahar T, Shaha SK, Ahmed N, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions. WHO South East Asia J Public Health 2019; 8:104-111. [PMID: 31441446 DOI: 10.4103/2224-3151.264855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Diabetes prevalence is increasing rapidly in Bangladesh, and there is an urgent need to promote preventive behaviours for type 2 diabetes, such as maintaining a healthy body weight, eating healthily, avoiding tobacco and being active for 150 minutes per week. Methods We used a qualitative methodology informed by the capability, opportunity, motivation theory of behaviour change to explore the factors affecting physical activity among men and women in rural Bangladesh. We conducted semi-structured interviews and focus group discussions with 64 purposively sampled participants with and without diabetes, and five health workers. From the results of descriptive content analysis, we identified key capabilities, opportunities and motivations to engage with in our mHealth and community mobilization interventions. Results Men and women without diabetes lacked awareness about the need to remain physically active to prevent diabetes, and most felt that their activity levels were sufficient. Housework was not commonly perceived as physical activity among all respondents. These knowledge and capability gaps could be addressed through mHealth messaging and community mobilization providing information on sufficiency and types of physical activity to prevent and control diabetes. Men were physically active while working outside the home, whereas women felt unsafe and conspicuous, and were constrained by family commitments and social expectations of appropriate behaviour. Women engaged in strategies to protect their own and their family’s reputations. These opportunity factors affecting physical activity indicated the need for strategies developed through participatory processes to challenge unhealthy gender norms and increase women’s safety. Conclusion Formative research data can enable the development of contextually relevant interventions. Data show that mHealth interventions should consider gendered barriers to physical activity, tailoring information to meet men’s and women’s needs, and that community mobilization interventions should enable unhealthy, gendered community norms to be challenged. Participatory interventions can enable communities to push the boundaries of socially acceptable behaviours to increase physical activity, helping to prevent and control diabetes.
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Affiliation(s)
- Joanna Morrison
- .University College London Institute for Global Health, London, United Kingdom
| | - Hannah Jennings
- .University College London Institute for Global Health, London, United Kingdom
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Jenevieve Mannell
- .University College London Institute for Global Health, London, United Kingdom
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Anthony Costello
- .University College London Institute for Global Health, London, United Kingdom
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- .University College London Institute for Global Health, London, United Kingdom
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Morrison J, Akter K, Jennings HM, Kuddus A, Nahar T, King C, Shaha SK, Ahmed N, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Implementation and fidelity of a participatory learning and action cycle intervention to prevent and control type 2 diabetes in rural Bangladesh. Glob Health Res Policy 2019; 4:19. [PMID: 31312722 PMCID: PMC6610980 DOI: 10.1186/s41256-019-0110-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/14/2019] [Accepted: 06/18/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction There is an urgent need to address the growing type 2 diabetes disease burden. 20–30% of adults in rural areas of Bangladesh have intermediate hyperglycaemia and about 10% have diabetes. We report on the implementation and fidelity of a Participatory Learning and Action (PLA) intervention, evaluated through a three-arm cluster randomised controlled trial which reduced the incidence of diabetes and intermediate hyperglycaemia in rural Bangladesh. PLA interventions have been effective in addressing population level health problems in low income country contexts, and therefore we sought to use this approach to engage communities to identify and address community barriers to prevention and control of type 2 diabetes. Methods We used a mixed methods approach collecting quantitative data through field reports and qualitative data through observations and focus group discussions. Through descriptive analysis, we considered fidelity to the participatory approach and implementation plans. Results One hundred twenty-two groups per month were convened by 16 facilitators and supervised by two coordinators. Groups worked through a four phase PLA cycle of problem identification, planning together, implementation and evaluation to address the risk factors for diabetes – diet, physical activity, smoking and stress. Groups reported a lack of awareness about diabetes prevention and control, the prohibitive cost of care and healthy eating, and gender barriers to exercise for women. Groups set targets to encourage physical activity, kitchen-gardening, cooking with less oil, and reduced tobacco consumption. Anti-tobacco committees operated in 90 groups. One hundred twenty-two groups arranged blood glucose testing and 74 groups organized testing twice. Forty-one women’s groups established funds, and 61 communities committed not to ridicule women exercising. Experienced and committed supervisors enabled fidelity to a participatory methodology. A longer intervention period and capacity building could enable engagement with systems barriers to behaviour change. Conclusion Our complex intervention was implemented as planned and is likely to be valid in similar contexts given the flexibility of the participatory approach to contextually specific barriers to prevention and control of type 2 diabetes. Fidelity to the participatory approach is key to implementing the intervention and effectively addressing type 2 diabetes in a low-income country.
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Affiliation(s)
- Joanna Morrison
- 1University College London Institute for Global Health, London, UK
| | | | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- 1University College London Institute for Global Health, London, UK.,3Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Anthony Costello
- 1University College London Institute for Global Health, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- 1University College London Institute for Global Health, London, UK
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Morrison J, Osrin D, Alcock G, Azad K, Bamjan J, Budhathoki B, Kuddus A, Mala MA, Manandhar D, Nkhata A, Pathak S, Phiri T, Rath S, Tripathy P, Costello A, Houweling TAJ. Exploring the equity impact of a maternal and newborn health intervention: a qualitative study of participatory women's groups in rural South Asia and Africa. Int J Equity Health 2019; 18:55. [PMID: 30971254 PMCID: PMC6458781 DOI: 10.1186/s12939-019-0957-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/12/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi. METHODS We conducted 42 focus group discussions (FGDs) with women who had attended groups and women who had not attended, in poor and better-off communities. We also interviewed six better-off women and nine poor women who had delivered babies during the trials and had demonstrated recommended behaviours. We conducted 12 key informant interviews and five FGDs with women's group facilitators and fieldworkers. RESULTS Women's groups addressed a knowledge deficit in poor and better-off women. Women were engaged through visual learning and participatory tools, and learned from the facilitator and each other. Facilitators enabled inclusion of all socioeconomic strata, ensuring that strategies were low-cost and that discussions and advice were relevant. Groups provided a social support network that addressed some financial barriers to care and gave women the confidence to promote behaviour change. Information was disseminated through home visits and other strategies. The social process of learning and action, which led to increased knowledge, confidence to act, and acceptability of recommended practices, was key to ensuring behaviour change across social strata. These equitable effects were enabled by the accessibility, relevance, and engaging format of the intervention. CONCLUSIONS Participatory learning and action led to increased knowledge, confidence to act, and acceptability of recommended practices. The equitable behavioural effects were facilitated by the accessibility, relevance, and engaging format of the intervention across socioeconomic groups, and by reaching-out to parts of the population usually not accessed. A PLA approach improved health behaviours across socioeconomic strata in rural communities, around issues for which there was a knowledge deficit and where simple changes could be made at home.
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Affiliation(s)
- Joanna Morrison
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - David Osrin
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Glyn Alcock
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kishwar Azad
- BADAS, Room No-390, BIRDEM Building 122,Kazi Nazrul Islam Avenue,Shahbagh, Dhaka, 1000, Bangladesh
| | | | | | - Abdul Kuddus
- BADAS, Room No-390, BIRDEM Building 122,Kazi Nazrul Islam Avenue,Shahbagh, Dhaka, 1000, Bangladesh
| | | | | | | | | | | | | | | | - Anthony Costello
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Fottrell E, Ahmed N, Morrison J, Kuddus A, Shaha SK, King C, Jennings H, Akter K, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial. Lancet Diabetes Endocrinol 2019; 7:200-212. [PMID: 30733182 PMCID: PMC6381080 DOI: 10.1016/s2213-8587(19)30001-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Strategies are needed to prevent and control type 2 diabetes and intermediate hyperglycaemia, which together affect roughly a third of adults in Bangladesh. We aimed to assess the effects of mHealth and community mobilisation on the prevalence of intermediate hyperglycaemia and diabetes among the general adult population in rural Bangladesh, and to assess the effect of these interventions on the incidence of type 2 diabetes among people with intermediate hyperglycaemia within the study population. METHODS DMagic was a three-arm, cluster-randomised trial of participatory community mobilisation, mHealth mobile phone messaging, and usual care (control) in 96 villages (population roughly 125 000) in Bangladesh. Community mobilisation involved 18 monthly group meetings, led by lay facilitators, applying a participatory learning and action (PLA) cycle focused on diabetes prevention and control. mHealth involved twice-weekly voice messages over 14 months promoting behaviour change to reduce diabetes risk. The primary outcomes were the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the overall population at the end of the intervention implementation period, and 2-year cumulative incidence of type 2 diabetes in a cohort with intermediate hyperglycaemia at baseline. Primary outcomes were assessed through fasting blood glucose concentrations and 2-h oral glucose tolerance tests among a cross-section of adults aged 30 years and older and a cohort of individuals identified with intermediate hyperglycaemia. Prevalence findings are based on a cross-sectional survey at the end of the study; incidence findings are based on 2-year follow-up survey of a cohort of individuals identified with intermediate hyperglycaemia through a cross-sectional survey at baseline. We also assessed the cost-effectiveness of the interventions. This trial is registered with the ISRCTN registry, number ISRCTN41083256, and is completed. FINDINGS The study took place between June 27, 2015, and June 28, 2018, with the PLA intervention running in 32 villages from June, 2016, to December, 2017, and the mHealth intervention running in 32 villages from Oct 21, 2016, to Dec 24, 2017. End-of study prevalence was assessed in 11 454 individuals and incidence in 2100 individuals. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group at the end of the study (adjusted [for stratification, clustering, and wealth] odds ratio [aOR] 0·36 [0·27-0·48]), with an absolute reduction of 20·7% (95% CI 14·6-26·7). Among 2470 adults with intermediate hyperglycaemia at baseline, 2100 (85%) were followed-up at 2 years. The 2-year cumulative incidence of diabetes in this cohort was significantly lower in the PLA group compared with control (aOR 0·39, 0·24-0·65), representing an absolute incidence reduction of 8·7% (3·5-14·0). There was no evidence of effect of mHealth on combined prevalence of intermediate hyperglycaemia and diabetes (aOR 0·93, 0·74-1·16) or the incidence of diabetes (1·02, 0·73-1·43). The incremental cost-effectiveness ratios for PLA were INT$316 per case of intermediate hyperglycaemia or type 2 diabetes prevented and $6518 per case of type 2 diabetes prevented among individuals with intermediate hyperglycaemia. INTERPRETATION Our data provide strong evidence to support the use of community mobilisation based on PLA to prevent type 2 diabetes in this rural Bangladeshi population. Despite raising knowledge and awareness of diabetes, the mHealth intervention did not change disease outcomes in our population. Replication studies in other populations should be a priority. FUNDING UK Medical Research Council.
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Affiliation(s)
- Edward Fottrell
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK.
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Carina King
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Hannah Jennings
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Houweling TAJ, Looman CWN, Azad K, Das S, King C, Kuddus A, Lewycka S, Manandhar DS, Sah More N, Morrison J, Phiri T, Rath S, Rosato M, Sen A, Tripathy P, Prost A, Osrin D, Costello A. The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials. Int J Epidemiol 2019; 48:168-182. [PMID: 29024995 PMCID: PMC6380297 DOI: 10.1093/ije/dyx160] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Subscribe] [Scholar Register] [Revised: 07/19/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in neonatal mortality are substantial in many developing countries. Little is known about how to address this problem. Trials in Asia and Africa have shown strong impacts on neonatal mortality of a participatory learning and action intervention with women's groups. Whether this intervention also reduces mortality inequalities remains unknown. We describe the equity impact of this women's groups intervention on the neonatal mortality rate (NMR) across socioeconomic strata. METHODS We conducted a meta-analysis of all four participatory women's group interventions that were shown to be highly effective in cluster randomized trials in India, Nepal, Bangladesh and Malawi. We estimated intervention effects on NMR and health behaviours for lower and higher socioeconomic strata using random effects logistic regression analysis. Differences in effect between strata were tested. RESULTS Analysis of 69120 live births and 2505 neonatal deaths shows that the intervention strongly reduced the NMR in lower (50-63% reduction depending on the measure of socioeconomic position used) and higher (35-44%) socioeconomic strata. The intervention did not show evidence of 'elite-capture': among the most marginalized populations, the NMR in intervention areas was 63% lower [95% confidence interval (CI) 48-74%] than in control areas, compared with 35% (95% CI: 15-50%) lower among the less marginalized in the last trial year (P-value for difference between most/less marginalized: 0.009). The intervention strongly improved home care practices, with no systematic socioeconomic differences in effect. CONCLUSIONS Participatory women's groups with high population coverage benefit the survival chances of newborns from all socioeconomic strata, and perhaps especially those born into the most deprived households.
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Affiliation(s)
- Tanja A J Houweling
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Institute for Global Health, University College London, London, UK
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kishwar Azad
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sushmita Das
- Society for Nutrition, Education and Health Action (SNEHA), Shahunagar, Mumbai, India
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sonia Lewycka
- Institute for Global Health, University College London, London, UK
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Dharma S Manandhar
- Mother and Infant Research Activities (MIRA), YB Bhawan, Kathmandu, Nepal
| | - Neena Sah More
- Society for Nutrition, Education and Health Action (SNEHA), Shahunagar, Mumbai, India
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Mikey Rosato
- Institute for Global Health, University College London, London, UK
| | - Aman Sen
- Mother and Infant Research Activities (MIRA), YB Bhawan, Kathmandu, Nepal
| | | | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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Houweling TAJ, van Klaveren D, Das S, Azad K, Tripathy P, Manandhar D, Neuman M, de Jonge E, Been JV, Steyerberg E, Costello A. A prediction model for neonatal mortality in low- and middle-income countries: an analysis of data from population surveillance sites in India, Nepal and Bangladesh. Int J Epidemiol 2019; 48:186-198. [PMID: 30325465 PMCID: PMC6380321 DOI: 10.1093/ije/dyy194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In poor settings, where many births and neonatal deaths occur at home, prediction models of neonatal mortality in the general population can aid public-health policy-making. No such models are available in the international literature. We developed and validated a prediction model for neonatal mortality in the general population in India, Nepal and Bangladesh. METHODS Using data (49 632 live births, 1742 neonatal deaths) from rural and urban surveillance sites in South Asia, we developed regression models to predict the risk of neonatal death with characteristics known at (i) the start of pregnancy, (ii) start of delivery and (iii) 5 minutes post partum. We assessed the models' discriminative ability by the area under the receiver operating characteristic curve (AUC), using cross-validation between sites. RESULTS At the start of pregnancy, predictive ability was moderate {AUC 0.59 [95% confidence interval (CI) 0.58-0.61]} and predictors of neonatal death were low maternal education and economic status, short birth interval, primigravida, and young and advanced maternal age. At the start of delivery, predictive ability was considerably better [AUC 0.73 (95% CI 0.70-0.76)] and prematurity and multiple pregnancy were strong predictors of death. At 5 minutes post partum, predictive ability was good [AUC: 0.85 (95% CI 0.80-0.89)]; very strong predictors were multiple birth, prematurity and a poor condition of the infant at 5 minutes. CONCLUSIONS We developed good performing prediction models for neonatal mortality. Neonatal deaths are highly concentrated in a small group of high-risk infants, even in poor settings in South Asia. Risk assessment, as supported by our models, can be used as a basis for improving community- and facility-based newborn care and prevention strategies in poor settings.
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Affiliation(s)
- Tanja A J Houweling
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Institute for Global Health, University College London, London, UK
| | - David van Klaveren
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - Sushmita Das
- Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - Kishwar Azad
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | | | | | - Melissa Neuman
- Institute for Global Health, University College London, London, UK
| | - Erik de Jonge
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Erasmus MC University Medical Center Rotterdam—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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Crehan C, Kesler E, Nambiar B, Dube Q, Lufesi N, Giaccone M, Normand C, Azad K, Heys M. The NeoTree application: developing an integrated mHealth solution to improve quality of newborn care and survival in a district hospital in Malawi. BMJ Glob Health 2019; 4:e000860. [PMID: 30713745 PMCID: PMC6340059 DOI: 10.1136/bmjgh-2018-000860] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 03/30/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/03/2022] Open
Abstract
More than two-thirds of newborn lives could be saved worldwide if evidence-based interventions were successfully implemented. We developed the NeoTree application to improve quality of newborn care in resource-poor countries. The NeoTree is a fully integrated digital health intervention that combines immediate data capture, entered by healthcare workers (HCW) on admission, while simultaneously providing them with evidence-based clinical decision support and newborn care education. We conducted a mixed-methods intervention development study, codeveloping and testing the NeoTree prototype with HCWs in a district hospital in Malawi. Focus groups explored the acceptability and feasibility of digital health solutions before and after implementation of the NeoTree in the clinical setting. One-to-one theoretical usability workshops and a 1-month clinical usability study informed iterative changes, gathered process and clinical data, System Usability Scale (SUS) and perceived improvements in quality of care. HCWs perceived the NeoTree to be acceptable and feasible. Mean SUS before and after the clinical usability study were high at 80.4 and 86.1, respectively (above average is >68). HCWs reported high-perceived improvements in quality of newborn care after using the NeoTree on the ward. They described improved confidence in clinical decision-making, clinical skills, critical thinking and standardisation of care. Identified factors for successful implementation included a technical support worker. Coproduction, mixed-methods approaches and user-focused iterative development were key to the development of the NeoTree prototype, which was shown to be an agile, acceptable, feasible and highly usable tool with the potential to improve the quality of newborn care in resource-poor settings.
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Affiliation(s)
- Caroline Crehan
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
| | - Erin Kesler
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
| | - Bejoy Nambiar
- Institute for Global Child Health, University College London, London, UK
| | - Queen Dube
- Paediatric Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Norman Lufesi
- Ministry of Health Acute Respiratory Illness Unit, Government of Malawi, Lilongwe, Malawi.,Paediatrics and Child Health Association (PACHA), Blantyre, Malawi
| | | | | | - Kishwar Azad
- Ibrahim Medical College, Dhaka, Bangladesh.,Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders at Shahbag, Dhaka, Bangladesh
| | - Michelle Heys
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
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Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, Morrison J, Akter K, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Distribution of diabetes, hypertension and non-communicable disease risk factors among adults in rural Bangladesh: a cross-sectional survey. BMJ Glob Health 2018; 3:e000787. [PMID: 30498584 PMCID: PMC6242007 DOI: 10.1136/bmjgh-2018-000787] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 02/20/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing in low-income settings. We conducted a survey of risk factors, blood pressure and blood glucose in rural Bangladesh and assessed variations by age, sex and wealth. Methods We surveyed a random sample of 12 280 adults aged >30 years in 96 villages in rural Bangladesh. Fieldworkers measured blood glucose and conducted an glucose tolerance test with a repeat blood test 120 min post glucose ingestion. Blood pressure, anthropometric, socioeconomic, lifestyle and behavioural risk factors data were also collected. Data were analysed to describe the prevalence of diabetes, intermediate hyperglycaemia, hypertension and NCD risk factors by age, sex and wealth. Results Women had higher levels of overweight or obesity and lower levels of physical activity and fruit and vegetable consumption than men; 63% of men used tobacco compared with 41.3% of women. Overweight or obesity and abdominal obesity (waist to hip ratio) increased with socioeconomic status (least poor vs most poor: OR (95% CI) 3.21 (2.51 to 4.11) for men and 2.83 (2.28 to 3.52) for women). Tobacco use, passive smoke exposure and salt consumption fell with increasing socioeconomic status in both sexes. Clustering of risk factors showed more than 70% of men and women reported at least three risk factors. Women in the least poor group were 33% more likely to have three or more risk factors compared with women in the most poor group (1.33 (95% CI 1.17 to 1.58)). The combined prevalence of impaired fasting glucose, impaired glucose tolerance and diabetes was 26.1% among men and 34.9% among women, and increased with age. The prevalence of prehypertension and hypertension was 30.7% and 15.9% among men and 27.2% and 22.5% among women, with similar rising prevalence with age. Conclusion NCD risk factors, hyperglycaemia and raised blood pressure are an immediate health threat in rural Bangladesh. Initiatives to improve detection, treatment and prevention strategies are needed.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Fottrell E, Ahmed N, Nahar B, Shaha SK, Kuddus A, Grijalva-Eternod CS, Nahar T, Fall C, Osmond C, Govoni V, Finer S, Yajnik C, Khan AKA, Costello A, Azad K, Hitman GA. Growth and body composition of children aged 2-4 years after exposure to community mobilisation women's groups in Bangladesh. J Epidemiol Community Health 2018; 72:888-895. [PMID: 29907704 DOI: 10.1136/jech-2017-210134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Women's groups interventions in Bangladesh reduced neonatal deaths by 38% and improved hygienic delivery, newborn care practices and breast feeding. We explore the longer-term impact of exposure to women's groups during pregnancy on child growth at 2-4 years. METHODS We performed a cross-sectional survey of child anthropometric measures (analysed as z-scores) among children born to women who had participated in the women's groups interventions while pregnant, compared with an age-matched and sex-matched sample of children born to control mothers. Results were stratified by maternal body mass index (BMI) and adjusted for possible confounding effects of maternal education, household asset ownership and, in a separate model, mother-child height difference, a proxy for improved survival of small babies in intervention groups. RESULTS Data were obtained from 2587 mother-child pairs (91% response). After adjustment for asset ownership, maternal education and potential survival effects, children whose mothers were exposed to the women's group intervention had higher head (0.16 (0.04 to 0.28)), mid-upper arm (0.11 (0.04 to 0.19)), abdominal (0.13 (0.00 to 0.26)) and chest (0.18 (0.08 to 0.29)) circumferences than their control counterparts. No significant differences in subcutaneous fat (subscapular and triceps skinfold thickness) were observed. When stratified by maternal BMI, intervention children had higher weight, BMI and circumferences, and these effects decreased with increasing maternal BMI category. CONCLUSIONS Women's groups appear to have had a lasting, positive impact on child anthropometric outcomes, with most significant results clustering in children of underweight mothers. Observed differences are likely to be of public health significance in terms of the nutritional and metabolic development of children.
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Affiliation(s)
- Edward Fottrell
- Institute For Global Health, University College London, London, UK
| | - Naveed Ahmed
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Badrun Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Kumer Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Tasmin Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Virginia Govoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - A K Azad Khan
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute For Global Health, University College London, London, UK
- WHO Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Graham A Hitman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Haghparast-Bidgoli H, Shaha SK, Kuddus A, Chowdhury MAR, Jennings H, Ahmed N, Morrison J, Akter K, Nahar B, Nahar T, King C, Skordis-Worrall J, Batura N, Khan JA, Mansaray A, Hunter R, Khan AKA, Costello A, Azad K, Fottrell E. Protocol of economic evaluation and equity impact analysis of mHealth and community groups for prevention and control of diabetes in rural Bangladesh in a three-arm cluster randomised controlled trial. BMJ Open 2018; 8:e022035. [PMID: 30127051 PMCID: PMC6104763 DOI: 10.1136/bmjopen-2018-022035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability worldwide, generating substantial economic burden for people with diabetes and their families, and to health systems and national economies. Bangladesh has one of the largest numbers of adults with diabetes in the South Asian region. This paper describes the planned economic evaluation of a three-arm cluster randomised control trial of mHealth and community mobilisation interventions to prevent and control T2DM and non-communicable diseases' risk factors in rural Bangladesh (D-Magic trial). METHODS AND ANALYSIS The economic evaluation will be conducted as a within-trial analysis to evaluate the incremental costs and health outcomes of mHealth and community mobilisation interventions compared with the status quo. The analyses will be conducted from a societal perspective, assessing the economic impact for all parties affected by the interventions, including implementing agencies (programme costs), healthcare providers, and participants and their households. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of intermediate hyperglycaemia and T2DM prevented and cost per case of diabetes prevented among individuals with intermediate hyperglycaemia at baseline and cost per mm Hg reduction in systolic blood pressure. In addition to ICERs, the economic evaluation will be presented as a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Robustness of the results will be assessed through sensitivity analyses. In addition, an analysis of equity impact of the interventions will be conducted. ETHICS AND DISSEMINATION The approval to conduct the study was obtained by the University College London Research Ethics Committee (4766/002) and by the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS-ERC/EC/t5100246). The findings of this study will be disseminated through different means within academia and the wider policy sphere. TRIAL REGISTRATION NUMBER ISRCTN41083256; Pre-results.
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Affiliation(s)
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Kohenour Akter
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | | | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | | | | | - Rachael Hunter
- Institute of Epidemiology & Health, University College London, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
- World Health Organization, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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de Jonge E, Azad K, Hossen M, Kuddus A, Manandhar DS, van de Poel E, Roy SS, Saville N, Sen A, Sikorski C, Tripathy P, Costello A, Houweling TAJ. Socioeconomic inequalities in newborn care during facility and home deliveries: a cross sectional analysis of data from demographic surveillance sites in rural Bangladesh, India and Nepal. Int J Equity Health 2018; 17:119. [PMID: 30111319 PMCID: PMC6094873 DOI: 10.1186/s12939-018-0834-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/01/2018] [Indexed: 11/19/2022] Open
Abstract
Background In Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants. Understanding how these inequalities vary by country and place of delivery (home or facility) will allow targeting of interventions to those who need them most. We describe socio-economic inequalities in newborn care in rural areas of Bangladesh, Nepal and India for all deliveries and by place of delivery. Methods We used data from surveillance sites in Bangladesh, India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used literacy (ability to read a short text) as indicator of socioeconomic status. We developed a composite score of nine newborn care practices (score range 0–9 indicating infants received no newborn care to all nine newborn care practices). We modeled the effect of literacy and place of delivery on the newborn care score and on individual practices. Results In all study sites (60,078 deliveries in total), use of facility delivery was higher among literate mothers. In all sites, inequalities in newborn care were observed: the difference in new born care between literate and illiterate ranged 0.35–0.80. The effect of literacy on the newborn care score reduced after adjusting for place of delivery (range score difference literate-illiterate: 0.21–0.43). Conclusion Socioeconomic inequalities in facility care greatly contribute to inequalities in newborn care. Improving newborn care during home deliveries and improving access to facility care are a priority for addressing inequalities in newborn care and newborn mortality. Electronic supplementary material The online version of this article (10.1186/s12939-018-0834-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik de Jonge
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Munir Hossen
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 KaziNazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Dharma S Manandhar
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, Kathmandu, 921, Nepal
| | - Ellen van de Poel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Swati Sarbani Roy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Aman Sen
- Mother Infant Research Activities (MIRA), YB Bhavan, Thapathali, Kathmandu, 921, Nepal
| | | | - Prasanta Tripathy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Tanja A J Houweling
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.,Institute for Global Health, University College London, London, UK
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Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, Morrison J, Akter K, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Diabetes knowledge and care practices among adults in rural Bangladesh: a cross-sectional survey. BMJ Glob Health 2018; 3:e000891. [PMID: 30057800 PMCID: PMC6058170 DOI: 10.1136/bmjgh-2018-000891] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/25/2018] [Accepted: 06/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Population knowledge of how to prevent, detect and control diabetes is critical to public health initiatives to tackle the disease. We undertook a cross-sectional survey of adults in rural Bangladesh to estimate knowledge and practices related to diabetes. Methods In 96 villages in Faridpur district, trained fieldworkers surveyed 12 140 randomly selected men and women aged ≥30. They collected data on sociodemographic status, knowledge of diabetes and history of blood and urine glucose testing. Fasting and 2-hour post-glucose load capillary blood tests ascertained the diabetic status of respondents. Levels of knowledge and practices were analysed by sociodemographic characteristics and diabetic status. Results The population showed low levels of diabetes knowledge overall, with only one in three adults able to report any valid causes of the disease. Knowledge of diabetes causes, symptoms, complications, prevention and control was significantly associated with age, education, wealth and employment. Only 14% of respondents reported ever having had a blood glucose test and strong associations with wealth were observed (least poor relative to most poor 2.91 (2.32–3.66)). 78.4% of known diabetics (ie, with a prior diagnosis) reported that they did not monitor their blood glucose levels on at least a monthly basis. However, they had better knowledge of the causes (odds relative to normoglycaemic individuals 1.62 (1.23–2.09)), symptoms (5.17 (3.41–7.82)), complications (5.18 (3.75–7.14)), prevention (4.18 (3.04–5.74)) and control (8.43 (4.83–14.71)). Conclusion Knowledge of diabetes among rural adults in Faridpur is extremely poor. Levels of diabetes testing are low and monitoring of blood glucose among known diabetics infrequent. Diabetes prevention and control efforts in this population must include large-scale awareness initiatives which focus not only on high-risk individuals but the whole population. Trial registration number ISRCTN41083256; Pre-results.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Zabeen B, Balsa AM, Islam N, Parveen M, Nahar J, Azad K. Lipid Profile in Relation to Glycemic Control in Type 1 Diabetes Children and Adolescents in Bangladesh. Indian J Endocrinol Metab 2018; 22:89-92. [PMID: 29535944 PMCID: PMC5838919 DOI: 10.4103/ijem.ijem_217_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. METHODS This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10-18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study. RESULTS The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2-21.4] vs. 19.5 [17.3-21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9-15.2] vs. 10.6 [7.9-12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4-11.8] vs. 7.9 [9.3-10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). CONCLUSION More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics and CDiC BIRDEM, Dhaka, Bangladesh
| | - Ana Margarida Balsa
- Department of Paediatrics and CDiC BIRDEM, Dhaka, Bangladesh
- Diabetes E Nutrição Do Centro Hospitalar Do Baixo Vouga, Aveiro, Portugal
| | - Nasreen Islam
- Department of Paediatrics and CDiC BIRDEM, Dhaka, Bangladesh
| | - Mukta Parveen
- Department of Biochemistry, Gazi Medical College, Khulna, Bangladesh
| | - Jebun Nahar
- Department of Paediatrics and CDiC BIRDEM, Dhaka, Bangladesh
| | - Kishwar Azad
- Department of Paediatrics and CDiC BIRDEM, Dhaka, Bangladesh
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Abstract
INTRODUCTION Diabetic nephropathy is leading cause of morbidity and mortality of type 1 diabetes mellitus (DM). Microalbuminuria is the first clinical sign of nephropathy. METHODS This was a cross-section study with longitudinal evaluation of urinary albumin xcretion in 199 children with type 1 diabetes attending CDiC Clinic in BIRDEM over a period of two years. The aim of the study was to assess the frequency of microalbuminuria and to determine other risk factors. We collected blood and early morning spot urinary sample and analyzed for HbA1c by Clover A1c and urinary microalbumin by a DCA analyzer. Children had urinary microalbumin 30-300 mg/L on at least two occasions were categorized as having persistent microalbuminuria. Demographic and clinical data were recorded including age at onset of diabetes, age during registration, gender and duration of diabetes which were compared between patients without microalbuminuria and with microalbuminuria. RESULT Microalbuminuria developed in forty nine children and adolescents (25%). Among them 24% were Type 1, 27% were with Fibrocalculous pancreatic diabetes (FCPD) and 68% were Type 2 diabetes. Median HbA1c was higher 10.8 [9.4-12.4] vs 9.5 [8.0-11.2] (P.006) in adolescents with microalbuminuria. On logistic regression univariate analysis independent predictors of microalbuminuria were older age, systolic blood pressure, BMI SDS and mean HbA1c which remained significant in multivariate analysis as predictors of microalbuminuria. CONCLUSION We found high prevalence of microalbuminuria which was associated with higher age, systolic blood pressure, BMI SDS and HbA1c.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Jebun Nahar
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Nasreen Islam
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
| | - Kishwar Azad
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Department of Paediatrics and Changing Diabetes in Children Program, BIRDEM, Bangladesh
- Perinatal Care Project, BIRDEM, Dhaka 1000, Bangladesh
| | - Kim Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead Sydney, Westmead, NSW, Australia
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Seward N, Neuman M, Colbourn T, Osrin D, Lewycka S, Azad K, Costello A, Das S, Fottrell E, Kuddus A, Manandhar D, Nair N, Nambiar B, Shah More N, Phiri T, Tripathy P, Prost A. Effects of women's groups practising participatory learning and action on preventive and care-seeking behaviours to reduce neonatal mortality: A meta-analysis of cluster-randomised trials. PLoS Med 2017; 14:e1002467. [PMID: 29206833 PMCID: PMC5716527 DOI: 10.1371/journal.pmed.1002467] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends participatory learning and action (PLA) in women's groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. We examined the effect of women's groups on key antenatal, delivery, and postnatal behaviours in order to understand pathways to mortality reduction. METHODS AND FINDINGS We conducted a meta-analysis using data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial), and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births. Behavioural outcomes included appropriate antenatal care, facility delivery, use of a safe delivery kit, hand washing by the birth attendant prior to delivery, use of a sterilised instrument to cut the umbilical cord, immediate wrapping of the newborn after delivery, delayed bathing of the newborn, early initiation of breastfeeding, and exclusive breastfeeding. We used 2-stage meta-analysis techniques to estimate the effect of the women's group intervention on behavioural outcomes. In the first stage, we used random effects models with individual patient data to assess the effect of groups on outcomes separately for the different trials. In the second stage of the meta-analysis, random effects models were applied using summary-level estimates calculated in the first stage of the analysis. To determine whether behaviour change was related to group attendance, we used random effects models to assess associations between outcomes and the following categories of group attendance and allocation: women attending a group and allocated to the intervention arm; women not attending a group but allocated to the intervention arm; and women allocated to the control arm. Overall, women's groups practising PLA improved behaviours during and after home deliveries, including the use of safe delivery kits (odds ratio [OR] 2.92, 95% CI 2.02-4.22; I2 = 63.7%, 95% CI 4.4%-86.2%), use of a sterile blade to cut the umbilical cord (1.88, 1.25-2.82; 67.6%, 16.1%-87.5%), birth attendant washing hands prior to delivery (1.87, 1.19-2.95; 79%, 53.8%-90.4%), delayed bathing of the newborn for at least 24 hours (1.47, 1.09-1.99; 68.0%, 29.2%-85.6%), and wrapping the newborn within 10 minutes of delivery (1.27, 1.02-1.60; 0.0%, 0%-79.2%). Effects were partly dependent on the proportion of pregnant women attending groups. We did not find evidence of effects on uptake of antenatal care (OR 1.03, 95% CI 0.77-1.38; I2 = 86.3%, 95% CI 73.8%-92.8%), facility delivery (1.02, 0.93-1.12; 21.4%, 0%-65.8%), initiating breastfeeding within 1 hour (1.08, 0.85-1.39; 76.6%, 50.9%-88.8%), or exclusive breastfeeding for 6 weeks after delivery (1.18, 0.93-1.48; 72.9%, 37.8%-88.2%). The main limitation of our analysis is the high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women's groups and context-specific effects. CONCLUSIONS This meta-analysis suggests that women's groups practising PLA improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities, and the responsiveness of health services. Future research could address the mechanisms behind how PLA improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children, and adolescents.
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Affiliation(s)
- Nadine Seward
- Institute for Global Health, University College London, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Melissa Neuman
- Institute for Global Health, University College London, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - David Osrin
- Institute for Global Health, University College London, London, United Kingdom
| | - Sonia Lewycka
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, United Kingdom
| | - Sushmita Das
- Society for Nutrition, Education & Health Action, Mumbai, India
| | - Edward Fottrell
- Institute for Global Health, University College London, London, United Kingdom
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Bejoy Nambiar
- Institute for Global Health, University College London, London, United Kingdom
| | - Neena Shah More
- Society for Nutrition, Education & Health Action, Mumbai, India
| | - Tambosi Phiri
- Parent and Child Health Initiative Trust, Lilongwe, Malawi
| | | | - Audrey Prost
- Institute for Global Health, University College London, London, United Kingdom
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Clarke K, Azad K, Kuddus A, Shaha S, Nahar T, Aumon BH, Hossen MM, Beard J, Costello A, Houweling TAJ, Prost A, Fottrell E. Correction: Impact of a Participatory Intervention with Women's Groups on Psychological Distress among Mothers in Rural Bangladesh: Secondary Analysis of a Cluster-Randomised Controlled Trial. PLoS One 2017; 12:e0183203. [PMID: 28796842 PMCID: PMC5552076 DOI: 10.1371/journal.pone.0183203] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0110697.].
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Zabeen B, Nahar J, Tayyeb S, Nahar N, Azad K, Donaghue K. Fibrocalculous pancreatic diabetes in Bangladeshi children and adolescents—a not so rare form of secondary diabetes. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fottrell E, Jennings H, Kuddus A, Ahmed N, Morrison J, Akter K, Shaha SK, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. The effect of community groups and mobile phone messages on the prevention and control of diabetes in rural Bangladesh: study protocol for a three-arm cluster randomised controlled trial. Trials 2016; 17:600. [PMID: 27993166 PMCID: PMC5170893 DOI: 10.1186/s13063-016-1738-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/23/2016] [Accepted: 12/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background Increasing rates of type 2 diabetes mellitus place a substantial burden on health care services, communities, families and individuals living with the disease or at risk of developing it. Estimates of the combined prevalence of intermediate hyperglycaemia and diabetes in Bangladesh vary, and can be as high as 30% of the adult population. Despite such high prevalence, awareness and control of diabetes and its risk factors are limited. Prevention and control of diabetes and its complications demand increased awareness and action of individuals and communities, with positive influences on behaviours and lifestyle choices. In this study, we will test the effect of two different interventions on diabetes occurrence and its risk factors in rural Bangladesh. Methods/design A three-arm cluster randomised controlled trial of mobile health (mHealth) and participatory community group interventions will be conducted in four rural upazillas in Faridpur District, Bangladesh. Ninety-six clusters (villages) will be randomised to receive either the mHealth intervention or the participatory community group intervention, or be assigned to the control arm. In the mHealth arm, enrolled individuals will receive twice-weekly voice messages sent to their mobile phone about prevention and control of diabetes. In the participatory community group arm, facilitators will initiate a series of monthly group meetings for men and women, progressing through a Participatory Learning and Action cycle whereby group members and communities identify, prioritise and tackle problems associated with diabetes and the risk of developing diabetes. Both interventions will run for 18 months. The primary outcomes of the combined prevalence of intermediate hyperglycaemia and diabetes and the cumulative 2-year incidence of diabetes among individuals identified as having intermediate hyperglycaemia at baseline will be evaluated through baseline and endline sample surveys of permanent residents aged 30 years or older in each of the study clusters. Data on blood glucose level, blood pressure, body mass index and hip-to-waist ratio will be gathered through physical measurements by trained fieldworkers. Demographic and socioeconomic data, as well as data on knowledge of diabetes, chronic disease risk factor prevalence and quality of life, will be gathered through interviews with sampled respondents. Discussion This study will increase our understanding of diabetes and other non-communicable disease burdens and risk factors in rural Bangladesh. By documenting and evaluating the delivery, impact and cost-effectiveness of participatory community groups and mobile phone voice messaging, study findings will provide evidence on how population-level strategies of community mobilisation and mHealth can be implemented to prevent and control noncommunicable diseases and risk factors in this population. Trial registration ISRCTN41083256. Registered on 30 Mar 2016 (Retrospectively Registered). Trial acronym D-Magic: Diabetes Mellitus – Action through Groups or mobile Information for better Control.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK.
| | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Azad K, Mathews J. Preventing newborn deaths due to prematurity. Best Pract Res Clin Obstet Gynaecol 2016; 36:131-144. [DOI: 10.1016/j.bpobgyn.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022]
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Das S, Alcock G, Azad K, Kuddus A, Manandhar DS, Shrestha BP, Nair N, Rath S, More NS, Saville N, Houweling TAJ, Osrin D. Institutional delivery in public and private sectors in South Asia: a comparative analysis of prospective data from four demographic surveillance sites. BMC Pregnancy Childbirth 2016; 16:273. [PMID: 27649897 PMCID: PMC5029035 DOI: 10.1186/s12884-016-1069-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/23/2015] [Accepted: 09/13/2016] [Indexed: 11/29/2022] Open
Abstract
Background Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share. Methods We used records of maternity care collected in socio-economically disadvantaged communities between 2005 and 2011. Institutional delivery was summarized by four potential determinants: household asset index, maternal schooling, maternal age, and parity. We developed logistic regression models for private sector institutional delivery with these as independent covariates. Results The data described 52 750 deliveries. Institutional delivery proportion varied and there were differences in public-private split. In Bangladesh and urban India, the proportion of deliveries in the private sector increased with wealth, maternal education, and age. The opposite was observed in rural India and Nepal. Conclusions The proportion of institutional delivery increased with economic status and education. The choice of sector is more complex and provision and perceived quality of public sector services is likely to play a role. Choices for safe maternity are influenced by accessibility, quantity and perceived quality of care. Along with data linkage between private and public sectors, increased regulation should be part of the development of the pluralistic healthcare systems that characterize south Asia. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1069-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sushmita Das
- SNEHA (Society for Nutrition, Education and Health Action), 310, Urban Health Centre, 60 Feet Road, Dharavi, Mumbai, 400 017, Maharashtra, India
| | - Glyn Alcock
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh
| | - Dharma S Manandhar
- Mother and Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Bhim Prasad Shrestha
- Mother and Infant Research Activities (MIRA), YB Bhavan, Thapathali, GPO Box 921, Kathmandu, Nepal
| | - Nirmala Nair
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Shibanand Rath
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, India
| | - Neena Shah More
- SNEHA (Society for Nutrition, Education and Health Action), 310, Urban Health Centre, 60 Feet Road, Dharavi, Mumbai, 400 017, Maharashtra, India
| | - Naomi Saville
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - David Osrin
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Zabeen B, Nahar J, Tayyeb S, Mohsin F, Nahar N, Azad K. Characteristics of children and adolescents at onset of type 2 diabetes in a Tertiary Hospital in Bangladesh. Indian J Endocrinol Metab 2016; 20:638-642. [PMID: 27730073 PMCID: PMC5040043 DOI: 10.4103/2230-8210.190544] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Recent data show that the prevalence of diabetes among children and adolescents is increasing in some ethnic groups. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes (T2D) in youth. METHODS The aim of this study was to describe the baseline characteristics of children and adolescents diagnosed ≤18 years who had features of T2D and presented at Changing Diabetes in Children, Paediatric Diabetes Clinic at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine, and Metabolic Disorders. All patients who were newly diagnosed and came to the clinic from March 2011 to March 2015 were included. RESULTS Among 939 newly registered patients, 77 (8%) had a diagnosis of T2D. The age at diagnosis was 9-10 years in 11 patients (14%), 11-14 years in 46 (60%) and 15-17 years in other 20 patients (26%). Majority of the children had a positive family history of T2D (94%) and 58% were obese. Median fasting insulin (27.9 [17.3-99.3]) was high in 76% patients. Insulin was started initially along with metformin in 40 patients and could be stopped in six patients in 3 months. CONCLUSION Our study reflects that T2D is emerging as a problem in children and adolescents in Bangladesh.
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Affiliation(s)
- Bedowra Zabeen
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Jebun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Samin Tayyeb
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Fauzia Mohsin
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Nazmun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Kishwar Azad
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
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Harris-Fry HA, Azad K, Younes L, Kuddus A, Shaha S, Nahar T, Hossen M, Costello A, Fottrell E. Formative evaluation of a participatory women's group intervention to improve reproductive and women's health outcomes in rural Bangladesh: a controlled before and after study. J Epidemiol Community Health 2016; 70:663-70. [PMID: 26739272 PMCID: PMC4941186 DOI: 10.1136/jech-2015-205855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/01/2015] [Accepted: 12/14/2015] [Indexed: 01/25/2023]
Abstract
Background Women's groups using participatory methods reduced newborn mortality in rural areas of low income countries. Our study assessed a participatory women's group intervention that focused on women's health, nutrition and family planning. Methods The study was conducted in three districts in Bangladesh between October 2011 and March 2013, covering a population of around 230 000. On the basis of allocation for the preceding cluster randomised trials, three unions per district were randomly allocated to receive a women's group intervention and three per district were control clusters. Outcomes included unmet need for family planning, morbidity, dietary diversity, night blindness, healthcare decision-making and knowledge of sexual and reproductive health, nutrition and anaemia. A difference-in-difference analysis was used to adjust for secular trends and baseline differences between women taking part in the intervention and a random sample from control clusters. Results We interviewed 5355 (91% response rate) women before the intervention and 5128 after (96% response rate). There were significant improvements in women's dietary diversity score (increase of 0.2 (95% CI 0.1 to 0.3)) and participation in healthcare decision-making (proportion increase (95% CI) 14.0% (10.6% to 17.4%)). There were also increases in knowledge about: contraception (4.2% (2.0% to 6.3%)), ways to treat (55.4% (52.2% to 58.5%)) and prevent (71.0% (68.0% to 74.1%)) sexually transmitted infections, nutrition (46.6% (43.6% to 49.6%)) and anaemia prevention (62.8% (60.9% to 64.6%)). There were no significant differences in unmet need for family planning, morbidity or night blindness. Conclusions Participatory women's groups have considerable potential to improve women's health knowledge, but evidence of impact on certain outcomes is lacking. Further formative work and intervention development is needed to optimise the impact of this approach for women's health.
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Affiliation(s)
| | - Kishwar Azad
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Leila Younes
- UCL Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Munir Hossen
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, UK
| | - Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
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Houweling TAJ, Morrison J, Alcock G, Azad K, Das S, Hossen M, Kuddus A, Lewycka S, Looman CW, Magar BB, Manandhar DS, Akter M, Dube ALN, Rath S, Saville N, Sen A, Tripathy P, Costello A. Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa. J Epidemiol Community Health 2016; 70:31-41. [PMID: 26246540 PMCID: PMC4717375 DOI: 10.1136/jech-2014-204685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/20/2015] [Accepted: 07/14/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa. METHODS We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70,574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results. RESULTS Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them. CONCLUSIONS Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants' convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos.
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Affiliation(s)
- Tanja A J Houweling
- Institute for Global Health, University College London, London, UK Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Glyn Alcock
- Institute for Global Health, University College London, London, UK
| | - Kishwar Azad
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sushmita Das
- Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Shahunagar, Dharavi, Mumbai, Maharashtra, India
| | - Munir Hossen
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sonia Lewycka
- Institute for Global Health, University College London, London, UK
| | - Caspar W Looman
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Mahfuza Akter
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | | | | | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Aman Sen
- Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
| | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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