The rising threat of NCDs in Bangladesh

The World Health Organisation (WHO) says that non-communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide. Almost three quarters of all NCD deaths, and 82% of the 16 million people who died prematurely, or before reaching 70 years of age, occur in low- and middle-income countries like Bangladesh.

In Bangladesh, the numbers of people suffering from NCDs are rising very rapidly. According to Institute for Health Metrics and Evaluation (IHM), some NCDs like stroke, ischaemic heart disease (e.g. hypertension, heart attack), Chronic Obstructive Pulmonary Disease (COPD), diabetes and lung cancer were the main reasons for causing deaths in Bangladesh in 2017. These diseases also caused a significant number of disabilities. Dietary risks, high blood pressure, tobacco, blood sugar, high BMI etc. were among the top contributing factors.

The Government of Bangladesh has paid special attention to tackle NCDs at the primary care level and rolling out WHO-PEN protocol for early detection and management of cardiovascular diseases, diabetes, chronic respiratory diseases and cancer to prevent life threatening complications (e.g. heart attacks, stroke, kidney failure etc.).

As part of the protocol, the patients diagnosed with hypertension and diabetes will be counselled about living a healthy lifestyle and provided with required expensive anti-hypertensive and anti-diabetic drugs at free of cost at the primary healthcare level.

20% of adults aged ≥25 years are hypertensive in Bangladesh. Only 12% of adults were previously diagnosed with hypertension, indicating a gap in case detection. Almost half of the patients with diagnosed hypertension were not adhering to treatment. Overall, 10% of our people are diabetic. The rise of NCDs has been driven by primarily four major risk factors: physical inactivity, unhealthy diets, tobacco use, and the harmful use of alcohol.

NCDs are predisposed by various risk factors including behavioural, environmental and metabolic (diabetes). There is increasing and strong evidence of a causal link between dietary behaviours and patterns, nutrients, physical activity and NCDs. Numerous observational studies have associated obesity with increased total mortality and increased risks of disease or death from diabetes, ischaemic heart disease and ischaemic stroke, cancers, chronic kidney disease, and osteoarthritis.

The risks of diabetes and ischaemic heart disease increase monotonically with an increase in the body-mass index (BMI=Kg/m2), starting at a BMI in the low 20s. According to ICDDR,B, NCDs account for an estimated 59% of total deaths in Bangladesh (886,000 deaths a year). In Bangladesh, 48% of men smoke; 20% of men and 32% of women have raised blood pressure. There were 7.1 million cases of diabetes in Bangladesh in 2015; a further 3.7 million cases may go undiagnosed. An estimated 129,000 deaths were attributed to diabetes in 2015.

The epidemic of NCDs poses devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems. The socioeconomic costs associated with NCDs make the prevention and control of these diseases a major development imperative for the 21st century.

E-mail: tareq.salahuddin@thedailystar.net