NCDs in Bangladesh
Bangladesh is in the midst of an epidemiological transition like many low- and middle-income countries with proles shifting from communicable diseases to NCDs. The major NCDs that contribute to 41% of the total deaths include: cardiovascular diseases (17%), cancers (10%), chronic respiratory diseases (11%) and diabetes (3%). The 2010 NCD STEPwise approach to surveillance (STEPS) survey showed a high prevalence of NCD risk factors among Bangladeshi people.
1. More than 96% of the people consumed less than the recommended minimum of five servings of fruits and/or vegetables per day
2. 27% did not achieve the weekly-recommended physical activity level (>600 metabolic equivalent task (MET)-minutes per week).
3. 53% of men are daily tobacco smokers; 29% of men and 34% of women consume some form of smokeless tobacco.
4. Hypertension, an intermediate risk factor for cardiovascular diseases and heart attacks, was prevalent in 18% of the population.
5. 13% of men and 22% of women were overweight, and 4% reported having diabetes.
Three quarters of the population is exposed to two or more risk factors with a high proportion of clustering of risk factors.
Population data on salt intake is limited. In a recent study among 200 residents in Bangladesh, mean intake of salt was 17 g/day, which is much higher than the WHO recommended maximum daily intake of 5 g/day.
Injuries, including those from road trac crashes, and drowning also contribute to the NCD burden. According to the Bangladesh Health and Injury Survey, the all-ages fatal drowning rate is 11.7 per 100000 and the all-ages road trac mortality rate is 14.4 per 100000.
Though the overall mortality rate in Bangladesh has decreased significantly over the last few decades, deaths due to chronic diseases or NCDs such as diabetes mellitus, cardiovascular disease and cancer are increasing at an alarming rate with around 27% deaths caused by NCDs.
The prevalence rate of diabetes among the rural and urban population of Bangladesh are around 7% and 17% respectively and it causes almost 6.2% of the total death. Around 12.5% of all deaths are caused due to various types of cardiovascular diseases. The prevalence of ischemic heart diseases among the rural population is around 3.4%. On the other hand hypertension prevails among around 9.8% and 15.6% male and female living in rural settings of Bangladesh. Although definite figures about the incidence of cancer is not available in Bangladesh, it is estimated that there are around 800,000 cancer patients in the country of the 130 million people and about 200,000 new cases are being added every year. Around 150,000 cancer patients die annually. These figures, according to Bangladesh Cancer Society, are: a prevalence rate of 7.10 per 1,000 persons, an incidence rate of 1.8 per 1,000 persons and a mortality rate of 1.3 per 1,000 persons as compared to an overall crude death rate of 4.8 per 1,000 persons.
Risk factors of developing these kinds of NCDs have been identified as unhealthy dietary behaviour, lack of physical activity and habit of both smoking and non-smoking tobacco. In Bangladesh among the urban population around 58% and 16% take more carbohydrate and fat respectively than their required dietary allowances. About 43% rural and 90% urban populations lead sedentary lifestyles. Another risk factor for developing NCD is tobacco use and in Bangladesh current tobacco use (smoking or smokeless) among all adults is 43.3% (41.3 million). The proportion is higher in males (58.0%) than females (28.7%). Tobacco use is more prevalent in rural areas (45.1%) than urban areas (38.1%) and among persons with no formal education (62.9%) and in the lowest quintiles of socioeconomic status (SES) (55.6%).