NON-COMMUNICABLE DISEASES A big hurdle in the path of achieving SDG

Background

As the disease burden has shifted worldwide, Non-communicable diseases (NCDs) became a new

epidemic. Bangladesh, unlike the rest of the world, is also affected with NCD. These NCDs appears

to be more virulent in the developing countries, like Bangladesh, as it seriously affects the

development, productivity and healthcare cost. Of 56.9 million global deaths in 2016, 40.5 million,

or 71%, were due to non-communicable diseases (NCDs). In Bangladesh, the number is also as high

as 67% of all deaths (estimated total is over 500,000). Among them about 22% are premature deaths

which means death between 30-69 years, and this is the most serious because this age group is

considered most productive and driving force of the country’s overall development. While NCDs

affect all economic groups, the poor are disproportionately affected leading to a vicious cycle of

disease, poverty and non-productivity. Changing lifestyle and dietary habits, rapid urbanization,

growth of commuting, tobacco and alcohol use, uncontrolled growth in consumption of processed

foods and beverages, indoor air pollution, road-traffic injuries, lack of awareness about healthful

behavioral patterns and psychological stresses are among the important factors responsible for non-

communicable diseases. For enhanced life-expectancy, the proportion of population affected with

NCDs is on the rise.

Approximately 6.4% adults were found to have diabetes in STEPS 2018 survey. Survey on mental

health in Bangladesh reveals that 16.1% of adult and 18.4% of child and adolescent population

suffer from any form of mental disorders. Common mental illnesses in adults are anxiety disorders,

depression, schizophrenia and substance abuse. In children and adolescents, mental retardation was

found to be 3.4% and autism was 0.8%.

a. The first group Major NCDs includes

Cardiovascular diseases (CVDs), cerebrovascular disease (stroke), cancer,

diabetes, chronic obstructive pulmonary disease (COPD), renal disease etc.

b. The Mental Health component includes

mental health; autism; neuro developmental disorders (NDDs), substance–abuse

and harmful use of alcohol

c. Other components include

Injury prevention including poisoning and snakebite; violence against women and

children, climate change; occupational health; environmental health hazards

(water, arsenicosis, air, and soil); strengthening the prevention and treatment for

disability through physical therapy/physiotherapy, especially among elderly

people/senior citizens; palliative care; ear care; oral health; prevention of

thalassemia emergency preparedness and response (EPR) and post-disaster health

management.

Goal

To reduce mortality and morbidity of NCDs in Bangladesh through control of risk factors and

improving health service delivery.

Objectives:

To promote development and implementation of effective, integrated, sustainable, and evidence-

based public policies for non communicable diseases, their risk factors, and determinants.To foster,

support, and promote social and economic conditions that address the determinants of chronic non

communicable diseases and empower people,to increase control over their health and to adopt

healthy behaviors.To strengthen the capacity and competencies of the health system for the

integrated early detection, management and control of the risk factors of non communicable

diseases.

Non Communicable disease control targets

In alignment with the UN High Level Political Declaration of 2011, Bangladesh is committed

towards achieving the 2025 NCD targets and 2030 SDG targets. Potential indicators for the 2025

targets are listed in Annexure 3. Through the implementation of the Multisectoral NCD Control and

Prevention of NCDs (2018–2025), Bangladesh aims to achieve the proposed 2025 targets:

Baseline 2018 2025 targets

Overall mortality from

cardiovascular diseases, cancers,

diabetes or chronic respiratory

diseases

59% 67% 25% relative

reduction

Reduction in the harmful use of

alcohol

0.9% (STEPS

2010) 1.3 (STEPS 2018)

10% relative

reduction

Reduction in prevalence of current

tobacco use in persons aged over

15 years

43.3% (2009) 35.3% (2017) 30% relative

reduction

Reduction in prevalence of

insufficient physical activity

27% (STEPS

2010) 15.1%(STEPS 2018)

10% relative

reduction

Reduction in mean population

intake of salt/sodium

10.6 gm/day

(95% CI 9.6-11.6)

9 gm/day

(95% CI 8.7-9.3)

30%relative

reduction

Relative reduction in prevalence

of raised blood pressure

17.9% (STEPS

2010)

25.4% (STEPS

2018)

25% relative

reduction

Halt rise in obesity and diabetes

Overweight:

14.3% =>BMI 25-

29.9 kg/M2,

obese:

3.6%=>BMI30kg/

M2 (STEPS 2010)

Diabetes: 6.3 % of

the adults (IDF)

5.5% (STEPS

2006)

Overweight: 22.6%

=>BMI25-29.9

kg/M2

obese:6.7%=>BMI3

0kg/M2 (STEPS

2018)

Diabetes: 6.4 % of

the adults

(STEPS 2018)

0%

Reduction in the proportion of

households using solid fuels

(wood, crop residue, dried dung,

coal and charcoal) as the primary

source of cooking

41.4% straw &

leave

4.8% brans

42 % wood,

bamboo

10.3 Natural Gas

30.2% straw & leave

3.5% brans

41.3% wood,

bamboo

23.1% Natural Gas

(BBS 2017)

50%

(BBS 2005)

COPD 4.3%

(2007,

Bangladesh Lung

Foundation)

2.97 % (WHO

survey)

COPD 1.9% (2018,

DGHS, NCDC)

Increase the number of eligible

people receiving drug therapy and

counseling (including glycaemic

control) to prevent heart attacks

and strokes

20 Upazila Health

Complexes /200

community clinics

50%

Improve the availability of

affordable basic technologies and

essential medicines, including

generics, required to treat major

NCDs in both public and private

facilities

NCD corner

piloting in every

Upazila Health

Complex

All primary health

care settings are

equipped with basic

technologies and

supplied with

medicines, required

to manage HTN and

diabetes

80%

Tobacco control:

Bangladesh, one of the first countries to sign the WHO FCTC, has

accomplished the Global Adult Tobacco Survey (GATS). This is a key step of

Tobacco Control Framework (FCTC)

The number of smoker is decreased in a encouraging rate. In 2009 average

smoker were 43.3% whereas in 2017 it decreased to 35.3%, a reduction by

18,5% which is a remarkable achievement.

Passive smoking also reduced remarkably. Smoking in restaurants reduced

from 79.7% to 49.7%, indoor smoking from 62.2% to 42.7%, in public transport

from 53.6% to 44%.

Advise to ‘Quit Smoking’ by health staffs increased upto65.8% from 52.9%.

Tobacco advertising, promotion and sponsorship drastically has fallen to 5.5%

from 43.6%

928

20494

43

187 165

38 0

13238 0 11

0100200300400500600700800900

1000

INJ DEAD INJ DEAD INJ DEAD INJ DEAD INJ DEAD INJ DEAD

RTA Cylinder blast Hill collapse Food poisoning

Lightining Drowning

Injuries and death that occured in 2017 1

13

6

45

0

7 8 0 18

31

6

0

90 1

26

0

89

8 8

I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D

R T A C Y L I N D E R B L A S T

H I L L C O L L A P S E

F O O D P O I S O N I N G

L I G H T I N I N G D R O W N I N G F I R E

INJURY REPORT 2018

928

204

9443

187 165

38 0

13238 0 11

0100200300400500600700800900

1000

INJ DEAD INJ DEAD INJ DEAD INJ DEAD INJ DEAD INJ DEAD

RTA Cylinder blast Hill collapse Foodpoisoning

Lightining Drowning

Injuries and death that occured in 2017

11

36

45

0

7 8 0 18

31

6

0

90 1

26

0

89

8 8

I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D I N J D E A D

R T A C Y L I N D E R B L A S T

H I L L C O L L A P S E

F O O D P O I S O N I N G

L I G H T I N I N G D R O W N I N G F I R E

INJURY REPORT 2018

Type of injury Death

Jessore 193

Mymensingh 94

Dhaka 71

Chittagong 57

Faridpur 57

Gaibandha 56

Manikgonj 49

Sirajgonj 49

Jhinaidoho 42

Munshigonj 42

Comilla 39

Pabna 36

Norsingdi 35

204

43

165

0

132

11 0

450

8 18 0

12689

80

100

200

300

400

500

RTA CYLINDERBLAST

HILLCOLLAPSE

FOODPOISONING

LIGHTINING DROWNING FIRE

Mortality number as per injury in 2017 and 20182017 2018

Tangail 32

Rajshahi 31

Chuadanga 24

Kustia 23

Cox-Bazar 22

Magura 22

Narayangaonj 16

Sylhet 15

Gazipur 7

Potuakhali 3

Barisal 1

193

94

7157 57 56

49 4942 42 39 36 35 32 31

24 23 22 2216 15

7 3 1

Typ

e o

f in

jury

Jess

ore

Mym

ensi

ngh

Dh

aka

Ch

itta

gon

g

Fari

dp

ur

Gai

ban

dh

a

Man

ikgo

nj

Sira

jgo

nj

Jhin

aid

oh

o

Mu

nsh

igo

nj

Co

mill

a

Pab

na

No

rsin

gdi

Tan

gail

Raj

shah

i

Ch

uad

anga

Ku

stia

Co

x-B

azar

Mag

ura

Nar

ayan

gao

nj

Sylh

et

Gaz

ipu

r

Po

tuak

hal

i

Bar

isal

District-wise injury in 2018

3106

825613

13731557

747

159 154

461699

0

500

1000

1500

2000

2500

3000

3500

2014 2015 2016 2017 2018

Number of injuries and death reported for 2014-2018 injury

injury death

0

119

1030

159 6

18 15

41

39

31

68

8

0

20

40

60

80

100

120

140

March April May June

NUMBER OF INJURIES AND DEATH IN LIGHTENING

(2017-2018)

2017 Injury 2017 Death 2018 Injury 2018 Death

0 0 0

6 5

0 0 0 0 0

47 7

53

31

15

7 8

2

0

5

10

15

20

25

30

35

Number of death in drowning 2017-2018

2017 2018

37%

8%

29%

0%

24%

2% 0%

Percentage of injuries in accordings of total in 2017

RTA CYLINDER BLAST HILL COLLAPSE

FOOD POISONING LIGHTINING DROWNING

FIRE

According to Global Burden of Disease Study 2016 report, age-standerised death rate due to NCDs among all population in bangladesh is 369.78(335.79-406.84) per 100000 population.

Death rate due to major NCDs ( CVDs, cancer, diabetes, and chronic respiratory diseases among population aged 30 to 70 years in ( 398.1-503.7) per 100000 population.

Age-standardized mortality rates from major NCDs are following:

Prevalence of major NCDs as percentage

Ishchemic heart disease 3.4

171.68

53.5

41.87

54.98

19.43

Death rate due to major NCDs per 100000 population (30-70 years age)

CVD CRD COPD CANCER DIABETES

Stroke 0.9

CVD 0.4

Diabetes 6.4

COPD 2.97

Prevalence of major NCDs as percentage

Five most frequent cancers in male and female

Cancer type Incidence

Breast 12.10%

Esophagus 11.30%

Cervix uteri 9.70%

Lung 8.80%

Lip and Oral cavity 8.70%

3.4

0.9

0.46.4

2.97

Ishchemic heartdiseaseStroke

CVD

Diabetes

Common mental illness in adult

Anxiety disorder Depression

Schizophrenia Substance abuse

In children and adolescents

Mental retardation

Autism

Mental disorder in percentage

Adult 16.1

Child and adolescent 18.4

12.10%

11.30%

9.70%

8.80%

8.70%

Five most frequent cancer in male and female(in percentage)

Breast Esophagus Cervix uteri Lung Lip and Oral cavity

The STEPS survey for Non-communicable disease

(NCD) risk factors in Bangladesh was carried out

from January to June 2018.

Bangladesh followed all three steps (step—1, Step—2

and Step—3) in this survey. A total of 8185 adults

participated in the survey. The overall response rate

was 82.67%.

Step—1 (Socio demographic and behavioral information)

1. Population characteristics

Among the 8185 respondents, 53% were female and 47% were male. The average age of

the respondents was around 40 year.

2. Unhealthy diet

a. Fruits and vegetables consumption

82% of population don’t eat recommended amount of fruit or

vegetables. (men 83%, women 80%).

b. Extra salt intake

About half (47%) of the population take extra salt while eating

(women 49%, men 44%).

Women

53% Men

47%

2010 vs 2018: Consumption of required amount of fruit and vegetables has increased

from 2.3% (2010) to 18.2% in (2018)

3.Physical inactivity

2010 vs 2018: Insufficient physical activity has dropped down to 15.1%

(2018) from 27% (2010). That means the people are becoming more

physically active than the previous time.

4.Harmful use of alcohol

2010 vs 2018: Lifetime abstainer has decreased from 94% (2010) to 92%

(2018). The percentage of current drinker has increased to 1.3% (2018)

from 0.9% (2010).

5. Tobacco use

Tobacco data are almost same as GATS 2017 data.

6. Cervical cancer

Majority of the respondents never had screening for cervical cancer. Only

7.5% women age between 30—49 years had cervical cancer screening test

in their lifetime.

7. Oral health

About 39.5% of the respondents have pain or discomfort caused by their

teeth or mouth. During the past 12 months but only 5.8% had seen a dentist

within the past 6-12 months. On the other hand, 69.0% never received any

dental care.

Step—2 (Physical measurement)

8. Body mass index (BMI)

Study found 13% were under weight (BMI <18.5 kg/m2) and 22.6%

were overweight (BMI ≥25—29.9 kg/m2), 6.7% were obese (BMI ≥ 30

kg/m2).

9. Blood pressure (BP)

2010 vs 2018: The trend of getting raised blood pressure shows in

increment from 2010 (17.9%) to 2018 (25.4%) and it is consistent in

both men and women.

Step—3 (Biochemical measurement)

10. Diabetes

Prevalence of diabetes was 6.4% among the sample population. Again,

6.4% of the respondents were pre-diabetic. 45.2 % of those having

raised blood glucose, were taking medication.

11. Cholesterol

About 31% of the study population had raised total cholesterol.

Among them 4.7% were taking medication. The survey revealed about

28.6% had raised cholesterol level: they never checked their blood

cholesterol previously; this survey noticed their raised blood cholesterol

for the first time.