Background: Patients' perspective of diabetes and adherence to its prescribed medications is a si... more Background: Patients' perspective of diabetes and adherence to its prescribed medications is a significant predic-tor of glycemic control and overall management of the disease. However, there is a paucity of such information in Bangladesh. This study aimed to explore patients' perspective of diabetes, their experience of taking oral hypogly-cemic medications and explore factors that contribute to medication adherence in patients with type 2 diabetes in Bangladesh. Methods: We conducted in-depth face-to-face interviews with 12 type 2 diabetes patients attending a tertiary hospital in Dhaka city between February and March, 2014. Participants were purposively sampled representing different age groups, education levels, years since diagnosis with diabetes, and glycemic status, to achieve maximum variation sampling. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked for errors, coded and analyzed by means of a qualitative content analysis framework. Results: The data analysis generated rich information on the participants' knowledge and perception on diabetes, its causes, self-management, medication use, adverse effects of medication use, medication adherence, and impact of diabetes, Although most of the participants demonstrated substantive knowledge on diabetes and its consequences, they also reported numerous misconceptions about the disease. Knowledge on diabetes medication, their appropriate use and side effects was rather poor. Respondents also reported non-compliance to dietary and physical activity advice by their physicians and concerns on diabetes diabetes-induced psychological stress. High cost of medications, concerns over medication side effects and forgetfulness was noted as factors for non-adherence to medication. Conclusion: Participants' knowledge and perception on diabetes are key factors determining their adherence to medications and, thereby, diabetes management. Healthcare providers should explore to better understand patients' perspective on diabetes, medication beliefs, identify psychological stress and provide more effective health education interventions to enhance medication adherence.
Background: South Asians have a higher overall incidence rate and younger age of onset for acute ... more Background: South Asians have a higher overall incidence rate and younger age of onset for acute myocardial infarction (AMI) compared to Western populations. However, limited information is available on the association of preventable risk factors and outcomes of AMI among young individuals in Bangladesh. The aim of this study was to determine the risk factors and in-hospital outcome of AMI among young (age ≤40 years) adults in Bangladesh.
Aims: To explore the association between knowledge on diabetes and glycemic control among patient... more Aims: To explore the association between knowledge on diabetes and glycemic control among patients with type 2 diabetes in Bangladesh. Methods: A cross-sectional study was conducted among 515 patients with type 2 diabetes attending a tertiary hospital in Dhaka, Bangladesh. Trained interviewers were used to collect data on socioeconomic status, time since the onset of diabetes, co-morbidities, anthropometric measurements, blood tests, knowledge and perceptions about the causes, management, and complications of diabetes through face to face interviewers based on a structured questionnaire. Diabetes knowledge was reported using a composite score. Chi square tests and correlation analysis were performed to measure the association between knowledge on diabetes and glycemic control. Results: Overall, 45.6% participants had good, 37.7% moderate and 16.7% poor knowledge on diabetes. The mean composite score was 0.75 ± 0.28 and the proportion of participants with a score of ≤50% was 16.7%. Only 24.3% participants identified physical inactivity as a risk factor for diabetes. Knowledge on diabetes was significantly associated with education, gender, monthly income, duration of diabetes, body mass index, family history of diabetes, and marital status but not with glycated hemoglobin (HbA1c). Correlation matrix showed weak negative association between diabetes knowledge score and glycemic control (p < 0.001). Conclusion: Patients with type 2 diabetes in Bangladesh have limited knowledge on the causes, management and risk factors for diabetes, despite receiving professional health education and care in a tertiary diabetic hospital. Strategies to improve the quality of diabetes education and identifying other potential factors for glycemic control are important for ensuring optimum management of diabetes in Bangladesh.
Background: Hypertension is a major risk factor for several cardiovascular diseases (CVD). The pr... more Background: Hypertension is a major risk factor for several cardiovascular diseases (CVD). The prevalence of hypertension is increasing in Bangladesh, especially in urban areas. The objective of this study was to estimate the prevalence of hypertension and its risk factors in an urban area of Bangladesh. Methods: We conducted a cross-sectional survey involving participants aged $ 25 years in an urban area in Dhaka between June-December 2012, using multi-stage random sampling. Data on socioeconomic status, tobacco use, physical activity, diet, extra-salt use, family history of hypertension, CVD, anthropometric measurements and blood pressure were collected using modified WHO-STEPS protocol. Hypertension and pre-hypertension were defined according to JNC-7. Multiple logistic regressions models were used to identify risk factors associated with hypertension. Results: The overall age-adjusted prevalence hypertension and pre-hypertension among 730 participants was 23.7% and 19%, respectively, which was higher among males compared to females (23.6% vs 21.71% and 21.7% vs 17.0%, respectively). Bivariate analysis showed significant relationship of hypertension with age, BMI, no physical activity, tobacco use, extra salt intake and family history of stroke/cardiovascular disease. In the multivariate model, factors significantly associated with hypertension were older age (OR 19.18, 95% CI 13.58–28.11), smoking (OR 3.47, 95% CI 2.85 –5.19), extra salt intake (OR 1.13, 95% CI 1.04–2.21), and high waist circumference (OR 3.41, 95% CI 2.81 –5.29). Conclusions: The prevalence of hypertension and pre-hypertension was high among our study participants. Population-based intervention programs and policies for increased awareness about the risk factors, and lifestyle modification are essential for prevention of hypertension.
Journal of public health (Oxford, England), Jan 16, 2015
Mobile phone SMS is increasingly used as a means of communication between patients and their heal... more Mobile phone SMS is increasingly used as a means of communication between patients and their healthcare providers in many countries of the world. We investigated mobile phone use and factors associated with willingness-to-pay (WTP) for diabetes SMS among patients with type 2 diabetes in Bangladesh. As part of a randomized controlled study, in 515 patients with type 2 diabetes, socioeconomic status, mobile phone use, WTP for diabetes SMS, anthropometry and HbA1c were measured. Multivariate regression was used to identify factors associated with WTP. The median (interquartile range [IQR]) of WTP for diabetes SMS was 20 (45) Bangladesh Taka (BDT) (1 BDT = 0.013 US$). WTP was significantly higher for males [OR 2.4, 95% CI (1.0-5.7)], patients with household income >50 000 BDT [4.6 (1.1-20.4)] and those with primary education [5.6 (1.2-26.6)] and secondary and higher education [5.2 (1.4-19.6)]. The high proportion of mobile phone use and WTP for diabetes SMS are encouraging as possibl...
Introduction Patients undergoing haemodialysis (HD) are frequently troubled by psychiatric disord... more Introduction Patients undergoing haemodialysis (HD) are frequently troubled by psychiatric disorders and coping problems, which can pose a serious threat to their physical and mental well-being. Using religious and spiritual interventions as a means of coping with physical and mental challenges is widely recognized. Although this topic has been well studied, in the Middle East regions, where Islam is the dominant religion, studies are limited. Thus, this study was performed to explore the influence of religiosity and spiritual coping (SC) on the health-related quality of life (HRQoL) of Saudi patients receiving HD. Methods A total of 168 HD patients from three hospitals in Saudi Arabia formed a convenient sample for this descriptive, cross-sectional hospital-based study. Data collection was done via questionnaire-guided interviews using the Muslim Religious Index as well as the Arabic Versions of the Spiritual Coping Strategies scale and Quality of Life Index Dialysis. Regression analysis enabled identification of the factors influencing HRQoL. Findings Older patients were found to reveal higher levels of religiosity, whereas the younger ones expressed a lesser degree of religious and nonreligious coping. Unemployed patients reported greater involvement in religious practices (RP) and more frequently used religious coping than those employed. The latter showed lower intrinsic religiosity and nonreligious coping usage than the unemployed. The respondents reported the greatest satisfaction scores on their psychological/ spiritual dimension and the least scores on the social and economic dimension. Therefore, the factors that could influence the HRQoL of the respondents were identified as involvement in RP, intrinsic religious beliefs, religious coping usage and age. Discussion This study revealed significant findings regarding the importance of religiosity and SC on the HRQoL of the Saudi HD patients. Therefore, it has been highly recommended to integrate religiosity into the health-care process for such patients to facilitate the achievement of overall optimum health levels.
Background: Relapse to drug use after successful treatment and rehabilitation is a common problem... more Background: Relapse to drug use after successful treatment and rehabilitation is a common problem globally. This study aimed to identify the psychological and social factors associated with relapse of drug addiction in Bangladesh. Methods: We conducted a cross-sectional study among 60 individuals (30 relapsed and 30 non-relapsed cases) with a history of drug addiction in four drug treatment and detoxification center in Bangladesh from May to December 2010. Data were collected from all the participants using a pre-tested, semi-structured questionnaire. A 4-point Likert format was used for scoring the questionnaire. Logistic regression models were performed to identify factors associated with relapse to drug addiction. Results: All participants were male, aged between 18 and 41 years with mean (SD) age of 27.63 (4.23) years. The " negative emotion " factor had strong contribution on relapse, while " peer pressure, " " self-efficacy, " and " lack of assertiveness " contributed to relapse moderately. The " parental discord " and " relation with parents " factors showed no relationship with relapse. The thought/belief, feeling/emotion, and behavior/action patterns related to relapse were identified , and the covert or very internal affairs of relapse components were revealed. Conclusion: Psychological factors were associated with an increased likelihood of relapse than social factors. These findings may help clinicians identify substance abuse patients likely to relapse and develop treatment and policy guidelines for prevention of relapse to drug addiction in Bangladesh.
Introduction: Retention of human resources for health (HRH), particularly physicians and nurses i... more Introduction: Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote
areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to
develop appropriate rural retention strategies in Bangladesh.
Methods: We conducted a document review, thorough search and review of relevant literature published from
1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers,
etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health
Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains,
i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.
Results: Over the past four decades, Bangladesh has developed and implemented a number of health-related
policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to
improve geographical representation of the students. Students of special background including children of freedom
fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats
are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further,
in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage
serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government
provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive
enough, and such provision is absent for those working in other rural areas. Although the government has career
development and promotion plans for doctors and nurses, these plans are often not clearly specified and not
implemented effectively.
Conclusion: The government is committed to address the rural retention problem as shown through the
formulation and implementation of related policies and strategies. However, Bangladesh needs more effective
policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and
the execution of these policies and provisions must be monitored and evaluated effectively.
In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health... more In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in
populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality
worldwide and a serious public health threat to developing countries. Recognizing the importance and
urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for
International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was
to understand the current situation of different NCDs public health programs and the current trends in NCDs research and
policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities
among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy
participants representing scientists, physicians, academics and students from several institutes in Germany and abroad.
Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and
Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs
in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the
participants to learn about evidence-based practices and policies for prevention and management of major NCDs and
to debate the way forward.
Background: Hypertension is a major public health problem in both the developed and developing
co... more Background: Hypertension is a major public health problem in both the developed and developing countries and the leading cause of morbidity and mortality globally. The risk factors for hypertension, which can largely be prevented through simple health promotion and preventive measures, are mostly known. However, evidence on strategies for prevention of hypertension in Bangladesh is not available. The aim of this review study was to identify and discuss different approaches to prevent hypertension in Bangladesh. Methods: We performed a systematic search using electronic as well as manual methods for published and unpublished reports of prevention of hypertension. We then identified and discussed prevention strategies for hypertension suitable for Bangladesh context. Results: Several methods have shown to prevent hypertension. However, the challenge remains in implementing these methods in resource poor settings. Integrated action based on comprehensive policy and stepwise implementation should be adopted taking into consideration of local needs. Hypertension prevention should focus on awareness generation, health promotion and reduction of common risk factors using a combination of population based approach and targeted individual interventions. Conclusion: Consorted actions should be taken as a priority to prevent hypertension through intersectoral, multidisciplinary and multilevel approach by the Government and stakeholders for creating greater awareness and healthy life-style.
Background: Patients' perspective of diabetes and adherence to its prescribed medications is a si... more Background: Patients' perspective of diabetes and adherence to its prescribed medications is a significant predic-tor of glycemic control and overall management of the disease. However, there is a paucity of such information in Bangladesh. This study aimed to explore patients' perspective of diabetes, their experience of taking oral hypogly-cemic medications and explore factors that contribute to medication adherence in patients with type 2 diabetes in Bangladesh. Methods: We conducted in-depth face-to-face interviews with 12 type 2 diabetes patients attending a tertiary hospital in Dhaka city between February and March, 2014. Participants were purposively sampled representing different age groups, education levels, years since diagnosis with diabetes, and glycemic status, to achieve maximum variation sampling. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked for errors, coded and analyzed by means of a qualitative content analysis framework. Results: The data analysis generated rich information on the participants' knowledge and perception on diabetes, its causes, self-management, medication use, adverse effects of medication use, medication adherence, and impact of diabetes, Although most of the participants demonstrated substantive knowledge on diabetes and its consequences, they also reported numerous misconceptions about the disease. Knowledge on diabetes medication, their appropriate use and side effects was rather poor. Respondents also reported non-compliance to dietary and physical activity advice by their physicians and concerns on diabetes diabetes-induced psychological stress. High cost of medications, concerns over medication side effects and forgetfulness was noted as factors for non-adherence to medication. Conclusion: Participants' knowledge and perception on diabetes are key factors determining their adherence to medications and, thereby, diabetes management. Healthcare providers should explore to better understand patients' perspective on diabetes, medication beliefs, identify psychological stress and provide more effective health education interventions to enhance medication adherence.
Background: South Asians have a higher overall incidence rate and younger age of onset for acute ... more Background: South Asians have a higher overall incidence rate and younger age of onset for acute myocardial infarction (AMI) compared to Western populations. However, limited information is available on the association of preventable risk factors and outcomes of AMI among young individuals in Bangladesh. The aim of this study was to determine the risk factors and in-hospital outcome of AMI among young (age ≤40 years) adults in Bangladesh.
Aims: To explore the association between knowledge on diabetes and glycemic control among patient... more Aims: To explore the association between knowledge on diabetes and glycemic control among patients with type 2 diabetes in Bangladesh. Methods: A cross-sectional study was conducted among 515 patients with type 2 diabetes attending a tertiary hospital in Dhaka, Bangladesh. Trained interviewers were used to collect data on socioeconomic status, time since the onset of diabetes, co-morbidities, anthropometric measurements, blood tests, knowledge and perceptions about the causes, management, and complications of diabetes through face to face interviewers based on a structured questionnaire. Diabetes knowledge was reported using a composite score. Chi square tests and correlation analysis were performed to measure the association between knowledge on diabetes and glycemic control. Results: Overall, 45.6% participants had good, 37.7% moderate and 16.7% poor knowledge on diabetes. The mean composite score was 0.75 ± 0.28 and the proportion of participants with a score of ≤50% was 16.7%. Only 24.3% participants identified physical inactivity as a risk factor for diabetes. Knowledge on diabetes was significantly associated with education, gender, monthly income, duration of diabetes, body mass index, family history of diabetes, and marital status but not with glycated hemoglobin (HbA1c). Correlation matrix showed weak negative association between diabetes knowledge score and glycemic control (p < 0.001). Conclusion: Patients with type 2 diabetes in Bangladesh have limited knowledge on the causes, management and risk factors for diabetes, despite receiving professional health education and care in a tertiary diabetic hospital. Strategies to improve the quality of diabetes education and identifying other potential factors for glycemic control are important for ensuring optimum management of diabetes in Bangladesh.
Background: Hypertension is a major risk factor for several cardiovascular diseases (CVD). The pr... more Background: Hypertension is a major risk factor for several cardiovascular diseases (CVD). The prevalence of hypertension is increasing in Bangladesh, especially in urban areas. The objective of this study was to estimate the prevalence of hypertension and its risk factors in an urban area of Bangladesh. Methods: We conducted a cross-sectional survey involving participants aged $ 25 years in an urban area in Dhaka between June-December 2012, using multi-stage random sampling. Data on socioeconomic status, tobacco use, physical activity, diet, extra-salt use, family history of hypertension, CVD, anthropometric measurements and blood pressure were collected using modified WHO-STEPS protocol. Hypertension and pre-hypertension were defined according to JNC-7. Multiple logistic regressions models were used to identify risk factors associated with hypertension. Results: The overall age-adjusted prevalence hypertension and pre-hypertension among 730 participants was 23.7% and 19%, respectively, which was higher among males compared to females (23.6% vs 21.71% and 21.7% vs 17.0%, respectively). Bivariate analysis showed significant relationship of hypertension with age, BMI, no physical activity, tobacco use, extra salt intake and family history of stroke/cardiovascular disease. In the multivariate model, factors significantly associated with hypertension were older age (OR 19.18, 95% CI 13.58–28.11), smoking (OR 3.47, 95% CI 2.85 –5.19), extra salt intake (OR 1.13, 95% CI 1.04–2.21), and high waist circumference (OR 3.41, 95% CI 2.81 –5.29). Conclusions: The prevalence of hypertension and pre-hypertension was high among our study participants. Population-based intervention programs and policies for increased awareness about the risk factors, and lifestyle modification are essential for prevention of hypertension.
Journal of public health (Oxford, England), Jan 16, 2015
Mobile phone SMS is increasingly used as a means of communication between patients and their heal... more Mobile phone SMS is increasingly used as a means of communication between patients and their healthcare providers in many countries of the world. We investigated mobile phone use and factors associated with willingness-to-pay (WTP) for diabetes SMS among patients with type 2 diabetes in Bangladesh. As part of a randomized controlled study, in 515 patients with type 2 diabetes, socioeconomic status, mobile phone use, WTP for diabetes SMS, anthropometry and HbA1c were measured. Multivariate regression was used to identify factors associated with WTP. The median (interquartile range [IQR]) of WTP for diabetes SMS was 20 (45) Bangladesh Taka (BDT) (1 BDT = 0.013 US$). WTP was significantly higher for males [OR 2.4, 95% CI (1.0-5.7)], patients with household income >50 000 BDT [4.6 (1.1-20.4)] and those with primary education [5.6 (1.2-26.6)] and secondary and higher education [5.2 (1.4-19.6)]. The high proportion of mobile phone use and WTP for diabetes SMS are encouraging as possibl...
Introduction Patients undergoing haemodialysis (HD) are frequently troubled by psychiatric disord... more Introduction Patients undergoing haemodialysis (HD) are frequently troubled by psychiatric disorders and coping problems, which can pose a serious threat to their physical and mental well-being. Using religious and spiritual interventions as a means of coping with physical and mental challenges is widely recognized. Although this topic has been well studied, in the Middle East regions, where Islam is the dominant religion, studies are limited. Thus, this study was performed to explore the influence of religiosity and spiritual coping (SC) on the health-related quality of life (HRQoL) of Saudi patients receiving HD. Methods A total of 168 HD patients from three hospitals in Saudi Arabia formed a convenient sample for this descriptive, cross-sectional hospital-based study. Data collection was done via questionnaire-guided interviews using the Muslim Religious Index as well as the Arabic Versions of the Spiritual Coping Strategies scale and Quality of Life Index Dialysis. Regression analysis enabled identification of the factors influencing HRQoL. Findings Older patients were found to reveal higher levels of religiosity, whereas the younger ones expressed a lesser degree of religious and nonreligious coping. Unemployed patients reported greater involvement in religious practices (RP) and more frequently used religious coping than those employed. The latter showed lower intrinsic religiosity and nonreligious coping usage than the unemployed. The respondents reported the greatest satisfaction scores on their psychological/ spiritual dimension and the least scores on the social and economic dimension. Therefore, the factors that could influence the HRQoL of the respondents were identified as involvement in RP, intrinsic religious beliefs, religious coping usage and age. Discussion This study revealed significant findings regarding the importance of religiosity and SC on the HRQoL of the Saudi HD patients. Therefore, it has been highly recommended to integrate religiosity into the health-care process for such patients to facilitate the achievement of overall optimum health levels.
Background: Relapse to drug use after successful treatment and rehabilitation is a common problem... more Background: Relapse to drug use after successful treatment and rehabilitation is a common problem globally. This study aimed to identify the psychological and social factors associated with relapse of drug addiction in Bangladesh. Methods: We conducted a cross-sectional study among 60 individuals (30 relapsed and 30 non-relapsed cases) with a history of drug addiction in four drug treatment and detoxification center in Bangladesh from May to December 2010. Data were collected from all the participants using a pre-tested, semi-structured questionnaire. A 4-point Likert format was used for scoring the questionnaire. Logistic regression models were performed to identify factors associated with relapse to drug addiction. Results: All participants were male, aged between 18 and 41 years with mean (SD) age of 27.63 (4.23) years. The " negative emotion " factor had strong contribution on relapse, while " peer pressure, " " self-efficacy, " and " lack of assertiveness " contributed to relapse moderately. The " parental discord " and " relation with parents " factors showed no relationship with relapse. The thought/belief, feeling/emotion, and behavior/action patterns related to relapse were identified , and the covert or very internal affairs of relapse components were revealed. Conclusion: Psychological factors were associated with an increased likelihood of relapse than social factors. These findings may help clinicians identify substance abuse patients likely to relapse and develop treatment and policy guidelines for prevention of relapse to drug addiction in Bangladesh.
Introduction: Retention of human resources for health (HRH), particularly physicians and nurses i... more Introduction: Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote
areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to
develop appropriate rural retention strategies in Bangladesh.
Methods: We conducted a document review, thorough search and review of relevant literature published from
1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers,
etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health
Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains,
i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.
Results: Over the past four decades, Bangladesh has developed and implemented a number of health-related
policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to
improve geographical representation of the students. Students of special background including children of freedom
fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats
are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further,
in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage
serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government
provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive
enough, and such provision is absent for those working in other rural areas. Although the government has career
development and promotion plans for doctors and nurses, these plans are often not clearly specified and not
implemented effectively.
Conclusion: The government is committed to address the rural retention problem as shown through the
formulation and implementation of related policies and strategies. However, Bangladesh needs more effective
policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and
the execution of these policies and provisions must be monitored and evaluated effectively.
In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health... more In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in
populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality
worldwide and a serious public health threat to developing countries. Recognizing the importance and
urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for
International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was
to understand the current situation of different NCDs public health programs and the current trends in NCDs research and
policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities
among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy
participants representing scientists, physicians, academics and students from several institutes in Germany and abroad.
Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and
Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs
in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the
participants to learn about evidence-based practices and policies for prevention and management of major NCDs and
to debate the way forward.
Background: Hypertension is a major public health problem in both the developed and developing
co... more Background: Hypertension is a major public health problem in both the developed and developing countries and the leading cause of morbidity and mortality globally. The risk factors for hypertension, which can largely be prevented through simple health promotion and preventive measures, are mostly known. However, evidence on strategies for prevention of hypertension in Bangladesh is not available. The aim of this review study was to identify and discuss different approaches to prevent hypertension in Bangladesh. Methods: We performed a systematic search using electronic as well as manual methods for published and unpublished reports of prevention of hypertension. We then identified and discussed prevention strategies for hypertension suitable for Bangladesh context. Results: Several methods have shown to prevent hypertension. However, the challenge remains in implementing these methods in resource poor settings. Integrated action based on comprehensive policy and stepwise implementation should be adopted taking into consideration of local needs. Hypertension prevention should focus on awareness generation, health promotion and reduction of common risk factors using a combination of population based approach and targeted individual interventions. Conclusion: Consorted actions should be taken as a priority to prevent hypertension through intersectoral, multidisciplinary and multilevel approach by the Government and stakeholders for creating greater awareness and healthy life-style.
Background The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "... more Background The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of " leaving no one behind ". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.
Uploads
Papers by Dr. S. M. Shariful Islam
areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to
develop appropriate rural retention strategies in Bangladesh.
Methods: We conducted a document review, thorough search and review of relevant literature published from
1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers,
etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health
Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains,
i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.
Results: Over the past four decades, Bangladesh has developed and implemented a number of health-related
policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to
improve geographical representation of the students. Students of special background including children of freedom
fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats
are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further,
in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage
serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government
provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive
enough, and such provision is absent for those working in other rural areas. Although the government has career
development and promotion plans for doctors and nurses, these plans are often not clearly specified and not
implemented effectively.
Conclusion: The government is committed to address the rural retention problem as shown through the
formulation and implementation of related policies and strategies. However, Bangladesh needs more effective
policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and
the execution of these policies and provisions must be monitored and evaluated effectively.
populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality
worldwide and a serious public health threat to developing countries. Recognizing the importance and
urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for
International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was
to understand the current situation of different NCDs public health programs and the current trends in NCDs research and
policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities
among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy
participants representing scientists, physicians, academics and students from several institutes in Germany and abroad.
Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and
Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs
in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the
participants to learn about evidence-based practices and policies for prevention and management of major NCDs and
to debate the way forward.
countries and the leading cause of morbidity and mortality globally. The risk factors for hypertension,
which can largely be prevented through simple health promotion and preventive measures, are
mostly known. However, evidence on strategies for prevention of hypertension in Bangladesh is not
available. The aim of this review study was to identify and discuss different approaches to prevent
hypertension in Bangladesh.
Methods: We performed a systematic search using electronic as well as manual methods for published
and unpublished reports of prevention of hypertension. We then identified and discussed prevention
strategies for hypertension suitable for Bangladesh context.
Results: Several methods have shown to prevent hypertension. However, the challenge remains in
implementing these methods in resource poor settings. Integrated action based on comprehensive
policy and stepwise implementation should be adopted taking into consideration of local needs.
Hypertension prevention should focus on awareness generation, health promotion and reduction of
common risk factors using a combination of population based approach and targeted individual
interventions.
Conclusion: Consorted actions should be taken as a priority to prevent hypertension through
intersectoral, multidisciplinary and multilevel approach by the Government and stakeholders for
creating greater awareness and healthy life-style.
areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to
develop appropriate rural retention strategies in Bangladesh.
Methods: We conducted a document review, thorough search and review of relevant literature published from
1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers,
etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health
Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains,
i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.
Results: Over the past four decades, Bangladesh has developed and implemented a number of health-related
policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to
improve geographical representation of the students. Students of special background including children of freedom
fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats
are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further,
in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage
serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government
provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive
enough, and such provision is absent for those working in other rural areas. Although the government has career
development and promotion plans for doctors and nurses, these plans are often not clearly specified and not
implemented effectively.
Conclusion: The government is committed to address the rural retention problem as shown through the
formulation and implementation of related policies and strategies. However, Bangladesh needs more effective
policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and
the execution of these policies and provisions must be monitored and evaluated effectively.
populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality
worldwide and a serious public health threat to developing countries. Recognizing the importance and
urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for
International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was
to understand the current situation of different NCDs public health programs and the current trends in NCDs research and
policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities
among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy
participants representing scientists, physicians, academics and students from several institutes in Germany and abroad.
Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and
Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs
in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the
participants to learn about evidence-based practices and policies for prevention and management of major NCDs and
to debate the way forward.
countries and the leading cause of morbidity and mortality globally. The risk factors for hypertension,
which can largely be prevented through simple health promotion and preventive measures, are
mostly known. However, evidence on strategies for prevention of hypertension in Bangladesh is not
available. The aim of this review study was to identify and discuss different approaches to prevent
hypertension in Bangladesh.
Methods: We performed a systematic search using electronic as well as manual methods for published
and unpublished reports of prevention of hypertension. We then identified and discussed prevention
strategies for hypertension suitable for Bangladesh context.
Results: Several methods have shown to prevent hypertension. However, the challenge remains in
implementing these methods in resource poor settings. Integrated action based on comprehensive
policy and stepwise implementation should be adopted taking into consideration of local needs.
Hypertension prevention should focus on awareness generation, health promotion and reduction of
common risk factors using a combination of population based approach and targeted individual
interventions.
Conclusion: Consorted actions should be taken as a priority to prevent hypertension through
intersectoral, multidisciplinary and multilevel approach by the Government and stakeholders for
creating greater awareness and healthy life-style.