Targeting non-communicable diseases, icddr,b in Bangladesh is paving the way for a healthier future

Non-communicable Diseases (NCDs) were a facet of developed countries, but there has been a considerable shift (in lifestyles, diets etc) in the past 15-20 years in many low and middle income countries which now account for 80% of NCD-related deaths worldwide.

Farasha Bashir

Health was given limited attention in the Millennium Development Goals focusing primarily on maternal health and communicable diseases. When the 17 Sustainable Development Goals (SDGs) were revealed, public health researchers and practitioners across the world rejoiced. Enshrined in the SDGs is an almost comprehensive guide – under Goal 3 – relating to improving health conditions and access and reducing persistent health inequities globally.

The focus has shifted to include non-communicable diseases (NCDs), which now account for two-thirds of deaths globally. Low and middle income countries (LMICs) bear the greatest burden of NCDs and can be traced to nearly 80 per cent of NCD-related deaths in these settings.

NCDs are categorised as chronic health conditions that develop and progress steadily with age, and negatively impact on quality of life. With an increasing life expectancy throughout the global South, cardiovascular diseases, diabetes, cancer and chronic obstructive pulmonary diseases are gaining traction as common and persistent burdens. These NCDs are generally attributable to an unhealthy diet including diets high in sugar and transfat, consumption of inadequate fruits and vegetables, physical inactivity, consumption of alcohol and tobacco use of any form.

Currently, 59 per cent of total deaths in Bangladesh are related to NCDs, leading to a threat of an endemic.

While the detrimental effects of NCDs are prevalent throughout all economic strata, those who are financially disadvantaged are more likely to be negatively affected. NCDs often require long-term management, and given the high costs of treating chronic illnesses and the lack of resources and health coverage for all, most are forced to seek care through out-of-pocket expenditure. This leads to dire financial consequences for the individual and their family, as well as wage loss and missed schooling for children.

The government of Bangladesh has made a strong commitment to tackle the rising number of NCD cases. In 2016, the Ministry of Health and Family Welfare (MoHFW) introduced the Health Nutrition and Population Sector Intervention Program which outlines four key action plans, which have already been implemented, aimed at promoting healthy lifestyles and environments. Additionally, a Non-Communicable Diseases Centre was established under MoHFW to bring NCD services to the doorstep of the population, especially through Upazila Health Complexes which provide NCD services. In addition, the government enforced a ban on tobacco product advertisements and the National Integrated Multimodal Transport Policy encouraged walking and cycling as the primary form of commute. Currently, there are plans to form a multi-sector NCD Coordination Committee to effectively manage coordination at all levels across the government.

Complementing the government’s efforts, icddrb’s Initiative for Non-Communicable Diseases is conducting research to assess incidence, prevalence, risk factors pertaining to various NCDs and  trials to reduce the burden of NCDs. They are also simultaneously identifying the barrier to care in the current health system. The initiative has also branched out to examine emerging issues relating to NCDs, including mental health and neurodevelopmental disorders.

The research institute conducted the first ever study to assess the NCD risk factors among the adult population (aged 25-64) in an urban slum, reporting a high prevalence (30.4 per cent – almost a third) of NCD risk factors among the adults living in poor settlements. Insufficient consumption of fruits and vegetables was one of the primary factors with an overwhelming majority (94.9 per cent) of the slum dwellers. This was followed by smoking (35.7 per cent), physical inactivity (15.2 per cent), being overweight (18.7 per cent) and obesity (3.7 per cent).

Hypertension, once known as a ‘rich man’s disease’ is alarmingly on the rise in Bangladesh. The multi-country study Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) study has found that 26 per cent[1] of the adults at 40 years of age or older residing in rural Bangladesh have hypertension and three out of four hypertensive individuals are partaking in at least one anti-hypertensive medication.

The burden in Bangladesh is higher compared to a similar study group in Pakistan that reports 19 per cent hypertensive patients, but only 40.4 per cent are on a hypertensive medication. However, despite a higher proportion of individuals on an anti-hypertensive medication only 53 per cent have their blood pressure under control in Bangladesh, which is the lowest in comparison to Pakistan and Sri Lanka. This highlights a greater need to raise awareness about hypertension among the adult population while also strengthening primary care for hypertension by improving access to hypertension management and access to anti-hypertensive medicines in rural Bangladesh.

Worryingly, stroke is one of the top two killers among adults in Bangladesh and one out of five individuals with hypertension are reported to have suffered from a stroke (20.6 per cent). This is much higher than its neighbouring countries Pakistan (7.5 per cent) and Sri Lanka (8.9 per cent).

Stroke is followed by diabetes with a 22.4 per cent mortality rate and heart disease with 18.3 per cent.  Similarly, chronic kidney disease (CKD) is critically much higher among hypertensive individuals in Bangladesh (36.4 per cent) than any other co-morbidities. This has yet to be further examined and a  comprehensive evaluation of the country’s population is essential to observe the trend of CKD in the growing numbers of population afflicted by NCDs.

While the Bangladesh government has demonstrated a positive initial approach to addressing the threat of NCDs, greater attention and resources need to be allocated to implementation and evaluation of how these policies or acts can be effectively utilised in the health system. Given the country’s success in reducing maternal and child mortality in the past two decades, Bangladesh has the potential to curb this rising threat from non-communicable diseases by promoting healthier lifestyle behaviours. This includes reducing tobacco consumption, promoting physical activity, healthy eating practices, and supporting adequate medical services by establishing primary care for NCDs in order to expand health coverage for those afflicted with these diseases.

Moreover, the private sector needs to be engaged and mobilised in community-based health promotion programmes. This can ensure that preventive NCD services are available to all throughout the country. As with the MDGs, collective endeavours from the government, NGOs and private sector is necessary to achieve lasting health gains and allow citizens to live healthier lives.

Farasha Bashir is a  Communications Specialist, Communications and Change Management Central Management Services 

[1] Nationally, roughly 1/3 of the over-35 population have hypertension