Md. Mizanur Rahman

Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey

OBJECTIVE To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors. METHODS Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities. FINDINGS The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence. CONCLUSION Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.

Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

Background Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health systems dependency on OOP payments and providing more financial risk protection.

Awareness, treatment, and control of diabetes in Bangladesh: a nationwide population-based study.

Objectives To examine awareness, treatment, and control of diabetes mellitus among the adult population in Bangladesh. Methods The study used data from the 2011 nationally representative Bangladesh Demographic and Health Survey (BDHS). The BDHS sample is comprised of 7,786 adults aged 35 years or older. The primary outcome variables were fasting blood glucose, diagnosis, treatment, and control of diabetes. Multilevel logistic regression models were used to identify the risk factors for diabetes awareness. Results Overall, age-standardized prevalence of diabetes was 9.2%. Among subjects with diabetes, 41.2% were aware of their condition, 36.9% were treated, and 14.2% controlled their condition. A significant inequality in diabetes management was found from poor to wealthy households: 18.2% to 63.2% (awareness), 15.8% to 56.6% (treatment), and 8.2% to 18.4% (control). Multilevel models suggested that participants who had a lower education and lower economic condition were less likely to be aware of their diabetes. Poor management was observed among non-educated, low-income groups, and those who lived in the northwestern region. Conclusions Diabetes has become a national health concern in Bangladesh; however, treatment and control are quite low. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes.

Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey.

Objectives: We investigated the prevalence, awareness, treatment, and control of hypertension and associated risk factors in the Bangladeshi adult population. Methods: The data for this study were extracted from the nationally-representative 2011 Bangladesh Demographic and Health Survey. Socio-demographic profiles, height, weight, blood pressure measurements, and management were recorded from 7876 adults aged 35 years or older. Multilevel logistic regression models were used to identify the risk factors for hypertension awareness, treatment, and control. Results: Overall, age-standardized prevalence of prehypertension and hypertension were 27.1 and 24.4%, respectively. Among patients with hypertension, 50.1% were aware of their condition, 41.2% were in treatment, but only 31.4% had controlled hypertension. There was a wide disparity in hypertension management between the poor and the wealthy households. Rich households were more likely to be aware of their hypertension [odds ratio (OR) 1.92, 95% confidence interval (CI) 0.97–3.79, P = 0.06], receiving treatment (OR 3.34, 95% CI 1.55–7.18, P < 0.001) and controlling their condition (OR 2.88, 95% CI 1.28–6.46, P = 0.01), as compared to the poor residents. Participants who had lower education were less likely to be aware of, in treatment for, and in control of their condition. Conclusion: One in four adults had hypertension in Bangladesh, and awareness and treatment of hypertension are quite low. Improvements in detection and treatment strategies are needed to prevent the growing disease burden associated with hypertension.

Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

Summary Background Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level. Methods We used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations. Findings Life expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015. Interpretation Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment. Funding Bill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.

Higher Gravidity and Parity Are Associated with Increased Prevalence of Metabolic Syndrome among Rural Bangladeshi Women

Background Parity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown. Objective This study investigates the association between parity or gravidity and metabolic syndrome in rural Bangladeshi women. Methods A cross-sectional study was conducted in 1,219 women aged 15–75 years from rural Bangladesh. Metabolic syndrome was defined according to the standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between parity and gravidity and metabolic syndrome, with adjustment of potential confounding variables. Results Subjects with the highest gravidity (> = 4) had 1.66 times higher odds of having metabolic syndrome compared to those in the lowest gravidity (0-1) (P trend = 0.02). A similar association was found between parity and metabolic syndrome (P trend = 0.04), i.e., subjects in the highest parity (> = 4) had 1.65 times higher odds of having metabolic syndrome compared to those in the lowest parity (0-1). This positive association of parity and gravidity with metabolic syndrome was confined to pre-menopausal women (P trend <0.01). Among the components of metabolic syndrome only high blood pressure showed positive association with parity and gravidity (P trend = 0.01 and <0.001). Neither Parity nor gravidity was appreciably associated with other components of metabolic syndrome. Conclusions Multi parity or gravidity may be a risk factor for metabolic syndrome.

Nationwide Survey of Prevalence and Risk Factors for Diabetes and Prediabetes in Bangladeshi Adults

Diabetes is a major noncommunicable disease, ranking as a leading cause of death and disability worldwide (1). Globally, the prevalence of diabetes is ∼8%, and nearly 80% of patients with diabetes live in low- and middle-income countries (2). Like many developing countries, prevalence of diabetes in Bangladesh increased substantially from 4% in 1990 to 10% in 2011 and is projected to reach 13% by 2030 (3,4). Despite this heavy burden, currently there are no epidemiologic studies in Bangladesh that investigate prevalence of diabetes and risk factors using nationally representative data. Therefore, we estimated the prevalence of diabetes and prediabetes and identified associated risk factors using Bangladesh nationwide survey data by multilevel logistic regression models. Our analysis was based on the 2011 Bangladesh Demographic and Health Survey. Data were available as of February 2013, including 8,835 residents (4,524 men and 4,311 women) aged …

Maternal Pregnancy Intention and Professional Antenatal Care Utilization in Bangladesh: A Nationwide Population-Based Survey

Objective To investigate the association between maternal pregnancy intention and professional antenatal and delivery care utilization. Methods Our data were derived from the 2011 nationally representative Bangladesh Demographic Health Survey. We included antenatal and delivery care utilization data of the most recent live births for women for the previous three years (n = 4672). We used multilevel logistic regression models to assess the relationship between pregnancy intention and use of professional antenatal and delivery care, with adjustment for potential confounding variables. Results Approximately 13% and 16% of children were reported by their mothers as unwanted and mistimed at the time of conception, respectively. Among the women, 55% received at least one professional antenatal care service; 21% received four or more professional antenatal services, while 32% were attended by professionals during deliveries. Mothers of children whose pregnancies had been unwanted had a greater risk for not seeking professional antenatal and professional delivery care than those whose pregnancies had been wanted [1≥ ANC from professionals: AOR: 0.66; 95% CI:0.51–0.93; 4≥ ANC from professionals: AOR:0.56; 95% CI:0.37–0.84; and delivery care from professionals: AOR: 0.70; 95% CI:0.50–0.97]. Women who were married after age 18, had secondary or higher level of education, and were from the wealthiest households were more likely to utilize antenatal and delivery care. Conclusion Unwanted pregnancy is significantly associated with lower utilization of professional antenatal and delivery care services in Bangladesh. Reducing unwanted births and promoting access to professional antenatal and delivery care are crucial for achieving the Sustainable Development Goals (SDGs) 3 in Bangladesh.

Progress Toward Universal Health Coverage: A Comparative Analysis in 5 South Asian Countries

Importance Achieving universal health coverage is one of the key targets in the newly adopted Sustainable Development Goals of the United Nations. Objective To investigate progress toward universal health coverage in 5 South Asian countries and assess inequalities in health services and financial risk protection indicators. Design and Settings In a population-based study, nationally representative household (335 373 households) survey data from Afghanistan (2014 and 2015), Bangladesh (2010 and 2014), India (2012 and 2014), Nepal (2014 and 2015), and Pakistan (2014) were used to calculate relative indices of health coverage, financial risk protection, and inequality in coverage among wealth quintiles. The study was conducted from June 2012 to February 2016. Main Outcomes and Measures Three dimensions of universal health coverage were assessed: access to basic services, financial risk protection, and equity. Composite and indicator-specific coverage rates, stratified by wealth quintiles, were then estimated. Slope and relative index of inequality were used to assess inequalities in service and financial indicators. Results Access to basic care varied substantially across all South Asian countries, with mean rates of overall prevention coverage and treatment coverage of 53.0% (95% CI, 42.2%-63.6%) and 51.2% (95% CI, 45.2%-57.1%) in Afghanistan, 76.5% (95% CI, 61.0%-89.0%) and 44.8% (95% CI, 37.1%-52.5%) in Bangladesh, 74.2% (95% CI, 57.0%-88.1%) and 83.5% (95% CI, 54.4%-99.1%) in India, 76.8% (95% CI, 66.5%-85.7%) and 57.8% (95% CI, 50.1%-65.4%) in Nepal, and 69.8% (95% CI, 58.3%-80.2%) and 50.4% (95% CI, 37.1%-63.6%) in Pakistan. Financial risk protection was generally low, with 15.3% (95% CI, 14.7%-16.0%) of respondents in Afghanistan, 15.8% (95% CI, 14.9%-16.8%) in Bangladesh, 17.9% (95% CI, 17.7%-18.2%) in India, 11.8% (95% CI, 11.8%-11.9%) in Nepal, and 4.4% (95% CI, 4.0%-4.9%) in Pakistan reporting incurred catastrophic payments due to health care costs. Access to at least 4 antenatal care visits, institutional delivery, and presence of skilled attendant during delivery were at least 3 times higher among the wealthiest mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with the rates among poor mothers. Access to institutional delivery was 60 to 65 percentage points higher among wealthy than poor mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with 21 percentage points higher in India. Coverage was least equitable among the countries for adequate sanitation, institutional delivery, and the presence of skilled birth attendants. Conclusions and Relevance Health coverage and financial risk protection was low, and inequality in access to health care remains a serious issue for these South Asian countries. Greater progress is needed to improve treatment and preventive services and financial security.

Distance associated with marriage migration in a northern and a southern region of Bangladesh: an empirical study.

This paper investigates the distribution of distance associated with marriage migration in the northern region of Rajshahi and the southern region of Khulna in Bangladesh. The study was conducted in 2007 on 2250 respondents who had migrated due to marriage. Of the wide variety of curves that fitted the distance-marriage/contact data, three are discussed: Pareto, exponential, and Pareto-exponential. Logistic regression models were used to identify the covariates of marriage distance migration. In general, the three functions work better for marriages, whereas Pareto-exponential functions are a superior fit for migrations and marriage distance. The models disclose that the distribution of distance is significantly associated with marriage migration (p<0.001). The Pareto-exponential model was 100% stable and its shrinkage was 0.000000125. The main covariates associated with short-distance marriage migration were respondents education, fathers education and religion, whereas age at the time of marriage did not play a significant role in marriage migration. The risk of short-distance migration was greater in higher- than lower-educated Muslim families.