Prevalence and determinants of behavioral risk factors of non-communicable diseases among a selected slum population in Bangladesh

BACKGROUND: Low and middle income countries and also the underprivileged population both are susceptible for the increased burden of non-communicable diseases (NCDs), and the practice of their behavioral risk factors (BRFs) is the main cause. However, these BRFs and their determinants among the slum population of Bangladesh weren’t adequately evaluated. The present study was carried out with the aim to find out the prevalence and determinants of BRFs of NCDs among a selected slum population in Bangladesh.METHODS: This cross-sectional study was conducted in purposively selected Rayerbazar slum of Dhaka city, Bangladesh, in 2017. A total of 192 adult (aged 18 to 65 years) residents were enrolled in this study using the convenient sampling method. A semi-structured questionnaire, adopted version of World Health Organization (WHO) STEPS instrument was used for data collection. Ascertainments of the risk factors were conducted as per the WHO STEPS guideline. Both descriptive and multivariate statistics were performed using the SPSS software.RESULTS: The majority of the respondents (72.4%) were men, and the mean ± standard deviation (SD) of the ages was 37.0 ± 13.6 years. Half (50%) of the respondents were tobacco users. Almost all (98.4%) reported insufficient fruit and vegetables (FAVs) intake. Almost 7 out of 10 (67.7%) of the respondents reported to perform inadequate level of physical activity (PA). However, very negligible (2.6%) proportion of the respondents reported alcohol consumption. The group of the respondents with the age above the mean age (≥ 35 years) reported higher use of tobacco whereas, the group of the respondents with the age below the mean age (< 35 years) reported a higher level of inadequacy of PA.CONCLUSION: BRFs of NCDs were substantial among the selected slum population of Bangladesh, where age was the major determinant. Health promotion and health education measures are recommended for slum population of Bangladesh to aware them of the BRFs of NCDs

High prevalence of musculoskeletal disorders among Bangladeshi women deserves attention

The high prevalence of MSDs among Bangladeshi adults especially women are a significant public health issue that needs urgent attention. By taking action to address this issue, we can improve the quality of life for millions of women in Bangladesh. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 01

High prevalence of musculoskeletal disorders among Bangladeshi women deserves attention

The high prevalence of MSDs among Bangladeshi adults especially women are a significant public health issue that needs urgent attention. By taking action to address this issue, we can improve the quality of life for millions of women in Bangladesh. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 01

Knowledge attitude and practices towards chronic kidney disease among type-2 diabetic patients in Bangladesh

INTRODUCTION: Having proper knowledge, attitude, and practices (KAP) towards chronic kidney disease (CKD) among type-2 diabetes mellitus (T2DM) patients is very important to reduce the disease burden. However, the information about KAP towards CKD among Bangladeshi T2DM patients is unknown, based on the available literatures till the date. OBJECTIVES: We aimed to assess the KAP towards CKD among T2DM patients attended a selected hospital in Dhaka city. METHODS AND MATERIALS: In this cross-sectional study, we conveniently selected Aalok hospital and also its 224 T2DM patients who attended the outdoor. We excluded the already developed CKD patients and aged over 70 years. We adopted a questionnaire from a validated instrument consisted of a 10 itemed knowledge, 8 itemed attitude, and 7 itemed practice domains towards CKD (total 25 items). Data were collected by face-to-face interviews. Both descriptive and comparative (Independent Sample t-tests and One-way ANOVA tests) statistics were used for data analysis where appropriates. RESULTS: Women respondents were higher (69.6%). The mean age of the respondents was 49.8±11.3 years. Most of them had average level of knowledge (69.6%) and attitude (60.7%). Majority also reported a good hypothetical practices in general if they would find out to have CKD. Knowledge was significantly associated (p<0.05) with sex, level of education, occupation, and income, whereas attitude was with sex, occupation, and income. CONCLUSION: T2DM patients of our study reported mostly average level of knowledge and attitude, and a good hypothetical practices in general towards CKD. Proper health awareness programs are needed to increase the KAP towards CKD among T2DM patients in Bangladesh

Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh

Background: Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh. Methods: This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization. Results: The mean (&plusmn;SD) age of participants was 52 (&plusmn;10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P &lt; 0.002), education (P &lt; 0.001) and income (P &lt; 0.001). The median travel and waiting time at the facility was 30 and 45 min respectively. More than one-third (37%) of the participants checked their blood glucose monthly. Most patients were satisfied regarding the family (55%) and hospital (67%) support. Conclusion: T2DM patients had average knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income

Systematic review of food insecurity and violence against women and girls: Mixed methods findings from low- and middle-income settings

Violence against women and girls (VAWG) is a global human rights and public health concern. Food insecurity is a sign of severe poverty, and likely to heighten women’s vulnerability to VAWG and men’s perpetration of it. However, the extent of the association and the multiple pathways between food insecurity and VAWG are not well understood. We systematically assessed peer reviewed quantitative and qualitative literature to explore this in low- and middle-income countries. Fixed effects meta-analysis was used to synthesize quantitative evidence. Qualitative data was analyzed using thematic analysis. From a search of 732 titles, we identified 23 quantitative and 19 qualitative or mixed-methods peer-reviewed manuscripts. In a meta-analysis of 21 cross-sectional studies with 20,378 participants, food insecurity was associated with doubled odds of reported VAWG (odds ratio [OR] = 2.38, 95% confidence interval [CI] = 1.82–3.10). This finding was consistent for both women’s experience or male perpetration of VAWG. Qualitative and mixed-methods papers offered insight that underlying conditions of inequitable gender norms, economic deprivation, and social isolation frame both food insecurity and VAWG. Food insecurity may trigger survival behaviors due to household stress and lack of meeting expected gender roles, which leads to VAWG. VAWG exposure may lead to food insecurity if women are more impoverished after leaving a violent household. Potential protective factors include financial stability, the involvement of men in VAWG programming, transformation of gender norms, and supporting women to develop new networks and social ties. Strong evidence exists for a relationship between food security and VAWG. Future funding should target causal directions and preventive options through longitudinal and interventional research. Strategies to ensure households have access to sufficient food and safe relationships are urgently needed to prevent VAWG

Declining trend of tobacco use in a rural community of Bangladesh: Results of eight years of community interventions

Tobacco use in Bangladesh has been high, but there is no report on community-level intervention to reduce tobacco use. The aim of this article is to report the experience of eight years of community intervention to reduce tobacco use in a rural area of Bangladesh. We have done four householdbased surveys (2006, 2008, 2012, and 2014) in Ekhlaspur village of Chandpur district. One man and one woman aged ≥18 years from each of 600 households were selected for each survey randomly to monitor tobacco use in this village concomitant with community interventions. The intervention package included yard meetings, health facility-based counselling, observance of the world no-tobacco days, and periodic lectures in schools. Chi-square for linear trend analysis was done to examine declining trends of prevalence of tobacco use. There were 953 to 1015 participants, approximately half being men in each survey. Their mean age was 44 to 45 years in all surveys. A decline in tobacco use has been observed from 58.8 in 2006 to 43.4% in 2014 (Ptrend=0.000). There has not been any perceivable change in smoking in women because it was either zero or close to zero across surveys. A similar trend was observed in age groups, educational achievements, and hypertension (Ptrend=0.000). Smoking in men declined from 58.3 to 35.2% (Ptrend= 0.000). Community interventions in a sustainable manner can reduce tobacco use in rural communities of Bangladesh. BSMMU J 2022; 15(3): 157-16

Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Background Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with disability and premature death. Up-to-date estimates of the burden of rheumatoid arthritis are required for health-care planning, resource allocation, and prevention. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we provide updated estimates of the prevalence of rheumatoid arthritis and its associated deaths and disability-adjusted life-years (DALYs) by age, sex, year, and location, with forecasted prevalence to 2050. Methods Rheumatoid arthritis prevalence was estimated in 204 countries and territories from 1990 to 2020 using Bayesian meta-regression models and data from population-based studies and medical claims data (98 prevalence and 25 incidence studies). Mortality was estimated from vital registration data with the Cause of Death Ensemble model (CODEm). Years of life lost (YLL) were calculated with use of standard GBD lifetables, and years lived with disability (YLDs) were estimated from prevalence, a meta-analysed distribution of rheumatoid arthritis severity, and disability weights. DALYs were calculated by summing YLLs and YLDs. Smoking was the only risk factor analysed. Rheumatoid arthritis prevalence was forecast to 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates. Findings In 2020, an estimated 17·6 million (95% uncertainty interval 15·8–20·3) people had rheumatoid arthritis worldwide. The age-standardised global prevalence rate was 208·8 cases (186·8–241·1) per 100 000 population, representing a 14·1% (12·7–15·4) increase since 1990. Prevalence was higher in females (age-standardised female-to-male prevalence ratio 2·45 [2·40–2·47]). The age-standardised death rate was 0·47 (0·41–0·54) per 100 000 population (38 300 global deaths [33 500–44 000]), a 23·8% (17·5–29·3) decrease from 1990 to 2020. The 2020 DALY count was 3 060 000 (2 320 000–3 860 000), with an age-standardised DALY rate of 36·4 (27·6–45·9) per 100 000 population. YLDs accounted for 76·4% (68·3–81·0) of DALYs. Smoking risk attribution for rheumatoid arthritis DALYs was 7·1% (3·6–10·3). We forecast that 31·7 million (25·8–39·0) individuals will be living with rheumatoid arthritis worldwide by 2050. Interpretation Rheumatoid arthritis mortality has decreased globally over the past three decades. Global age-standardised prevalence rate and YLDs have increased over the same period, and the number of cases is projected to continue to increase to the year 2050. Improved access to early diagnosis and treatment of rheumatoid arthritis globally is required to reduce the future burden of the disease.publishedVersio

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Global injury morbidity and mortality from 1990 to 2017: Results from the global burden of disease study 2017

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care