Parallel Session D : Noncommunicable Disease
Chair
Prof. Dr. Tahmina Shirin BIO
Director, IEDCR
Co-Chair
Prof. Dr. Sarder Mahmud Hossain BIO
Head, Dept. of Public Health,
Northern University Bangladesh
Moderator
Dr. Mohammad Masumul Haq BIO
Founder and Secretary General,
Cancer Awareness Foundation of Bangladesh
03:07 PM to 03:14 PM
Dr. Deepa Barua
Research Fellow, ARK Foundation,
Bangladesh
Integrating depression care within NCD provision in Bangladesh
Integrating depression care within NCD provision in Bangladesh: a qualitative study
Jerome Wright1, Papiya Mazumdar1, Deepa Barua2, Silwa Lina2, Papreen Nahar3, Hannah Jennings1, Rumana Huque2, Cath Jackson1,
1University of York, UK,
2ARK Foundation, Bangladesh,
3University of Sussex, UK
Background: Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in health care facilities in Bangladesh and Pakistan. Methods: Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers at tending or working in NCD centres in four health care facilities in Bangladesh, and with three policy makers. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention in to usual NCD care. The data were analysed using frame work analysis, organized by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results: Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording system sortraining. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions: Given current resource constraints and priorities, integrating a brief psychological intervention a tthese NCD centres appears premature. An opportune first step calls for responding to patient’s expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will inturn be required before the introduction of a specific psychological intervention such as BA.
Key words: Non-communicable disease, Depression, Behavioural activation, South Asia, NCD facilities, Mental health policy, Mental-physical co-morbidity, Depression care integration.
03:15 PM to 03:22 PM
Shagoofa Rakhshanda
Centre for Injury Prevention and Research (CIPRB),
Bangladesh
Assessing service availability and readiness to manage cervical cancer in Bangladesh
Assessing service availability and readiness to manage cervical cancer in Bangladesh
Shagoofa Rakhshanda1, Koustuv Dalal2, Hasina Akhter Chowdhury1, Cinderella Akbar Mayaboti1, Progga Paromita3, A. K. M. Fazlur Rahman1, A. H. M. Eanayet Hussain4, Saidur Rahman Mashreky1
1Centre for Injury Prevention and Research, Bangladesh (CIPRB), 2 School of Health Sciences, Mid Sweden University, Sundsvall, Sweden, 3 Kirtipasha Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Bangladesh, 4 Directorate General of Medical Education, Dhaka, Bangladesh.
Background: The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. Objective: To assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. Methods: An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. Results: There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. Conclusion: The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals. Key words: Bangladesh, Cervical cancer, Service availability and readiness assessment, WHO SARA
03:23 AM to 03:30 PM
Md. Noor Nabi Sayem
National Heart Foundation Hospital & Research Institute,
Mirpu, Dhaka
Estimating a model for 24-hour urinary sodium excretion from spot urine sodium and creatinine of Bangladeshi population
Estimating a model for 24-hour urinary sodium excretion from spot urine sodium and creatinine of Bangladeshi population
Md. Noor Nabi Sayem, Jubaida Akhtar, Mohammad Abdullah Al-Mamun, Sohel Reza Choudhury
National Heart Foundation Hospital & Research Institute, Mirpur, Dhaka
Background: The best estimate of population distribution and average level of dietary salt intake is provided by measuring 24-hour urinary sodium (Na) excretion in a representative sample. Collection of 24‐hour urine is difficult for community living people, and therefore, use of the spot‐urine Na concentration for estimationof daily salt intake was proposed as an alternative to 24-hour urine collection. Purpose: To develop an equation to estimate population mean levels of 24-hour urinary Na excretion from spot urine estimate of Na for a Bangladeshi population. Methods: We utilized a dataset in which estimates of urinary Na levels were available from urine samples from 24-hour urine collection and from spot urine of 227 participants, aged 40-59 years. We developed formulas to estimate 24-hour urinary Na (24HUNa) and Creatinine (24HUCr) using spot urine Na (SUNa) andcreatinine (SUCr) by multiple linear regression method. The obtained formulas were as follows: (i) PRCr (mg/day) = −6.33 × age (year) + 15.06 × weight (kg) + 23.91 × height (cm) – 3238.45; (ii) estimated 24HUNa(mmol/day) = 1.75 × XNa0.885; where PRCr = predicted value of 24HUCr, XNa = SUNa (mmol/L)/SUCr (mg/L) × PRCr (mg/day). Results: There was little difference between the estimated and measured values in sodium (3.9 mmol/day) excretion which was not statistically significant (p = 0.168). The measured values of 24HUNa were parallellyincreased to every quartile divided by the estimated values 24HUNa. There was a highly statistically significant correlations (r = 0.860, p < 0.001) observed between the estimated and measured vales of Na. Conclusions: These formulas are useful for estimating population mean levels of 24-hour urinary Na excretion, though this method is not suitable for estimating individual Na excretion. For further examine the accuracy and reliability of the formulas, we will apply these equations in another data set.
Key words: Spot Urine, Creatinine, Sodium
03:31 PM to 03:38 PM
Taslima Khatun
National Cheng Kung University,
Taiwan
The association of Nutrition and depression among diabetic and non-diabetic people in India
The association of Nutrition and depression among diabetic and non-diabetic people in India
Taslima Khatun1, Debdeep Mukharjee2, A Hoque1, TK Biswas3
1PhD Student, National Cheng Kung University (NCKU), Taiwan and Assistant Professor, Faculty of Public Health, Dept. of Community Nutrition, Bangladesh University of Health Sciences (BUHS), Bangladesh;
2Quality Manager, West Bengal Govt. District Hospital, Purulia, India;
3Lecturer cum visiting physician, Dept. of international medicine, State ayurvedic Medical College and Hospital; India.
Introduction: Depression level and poor nutrition are independently associated with poor glycemic control in subjects with type 2 diabetes (T2D); however, the relationship between them is still ambiguous. The aim of this study was to determine the association between nutrition and symptoms of depression among diabetic and non-diabetic Indians. Methods: In this cross-sectional analytical study total 510 subjects along with 155 diabetes mellitus (DM) subjects and 355 healthy non diabetes mellitus (NDM) subjects were studied purposively. Study subjects were determined by a 24-hr. recall method questionnaire and food intake pattern was measured by a specific food frequency questionnaire (FFQ) for 30 days. Quality of diet was determined using the Healthy Eating Index-2010 (HEI-10) score. The HEI-2010 comprises 12 components that sum to a maximum total score of 100. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Data was analyzed with univariate and multivariate techniques. Results: Diabetic subjects were more depressed compared to their counterparts (41.6 vs. 29.9 respectively, p <0.001). More than half (57.4%) of the diabetic subjects were extreme depressed, where rest of them were either moderate depressed (16.1%) or severe depressed (26.5%). On the other hand, NDM subjects only 18.0% had extreme depressed, where rest of the subjects were either normal ups and downs or mild mood disturbed. Significant difference was found in DM and NDM subjects (<0.001). Healthy Eating Index 10 (HEI- 10) score were less among for depression diabetic subjects (31.87 ± 8.62) than non-diabetic subjects (42.88 ± 7.88) (p<0.001). The level of depression associated with healthy eating index scores among the study subjects. Conclusion: Diabetic depressed people are living in Kolkata with low quality of dietary intake. Symptoms of depression are higher among diabetic cases, where healthy eating index scores were higher among non-diabetic subjects. For both issues hereby needed comprehensive intervention.
Key words: Nutrition, Depression, Diabetes, Diabetic, Non-diabetic, Healthy eating index score, Dietary practice
03:39 PM to 03:46 PM
Shirajum Monira
Department of Statistics,
University of Rajshahi, Bangladesh
Psychological Effect of University Closure among Public University Students in Bangladesh: Understanding the Prevalence and Correlates of Depression, Anxiety and, Stress
Psychological Effect of University Closure among Public University Students in Bangladesh: Understanding the Prevalence and Correlates of Depression, Anxiety and, Stress
Shirajum Monira1, Minhazul Abedin2, Md. Monimul Huq1
1Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
2Department of Public Health Sciences, Centre for Injury Prevention and Research, Bangladesh
Introduction: The spread of the COVID-19 infection has become a public health emergency throughout the world and many countries are currently experiencing multiple waves of the pandemic. Because of its highly contagious nature, the Bangladeshi government shortly closed all educational institutions to ensure the safety of the mass population. This unprecedented situation under lockdown with the uncertainty of academic and professional careers had multifaceted impacts on the mental health of students especially university students. The study aimed to find the prevalence and correlates of depression, anxiety, and stress among the current public university students in Bangladesh. Method: An online cross-sectional study was conducted among 1,034 current public university students of Bangladesh via email and Facebook. A semi-structured questionnaire was adopted with a snowball sampling technique among the survey respondents. The survey comprised of three standardized scales— the Patient Health Questionnaire-9, the General Anxiety Disorder-7, and Perceived Stress Scale (PSS-10) for depression, anxiety, and stress. Result: Among the 1,034 respondents, 90.4% (n=934) showed a mild-to-severe level of depression, 83.6% (n=865) showed a mild-to-severe level of anxiety, and 94.3% (n=975) had a moderate-to-high level of stress. Sex, source of information, fear of infection for family members, extra-curricular activities were found to be significant predictors in the logistic regression model. Income and age were only significant in predicting depression. Fear of infection, perception of online classes, and tuition activity were significantly predicted the stress in the model. Conclusion: This study implies that public university students are extremely vulnerable due to the high prevalence of depression, anxiety, and stress due to the long-lasting pandemic, which had negatively affected their overall wellbeing. Poor students need to be supported financially who were self-supported during normal times. Utilizing university authority, the government should design sophisticated eHealth intervention and prevention strategies to address their mental health issue during this hard time.
Key words: Mental health, COVID-19, COVID-19 lockdown, Public university students, Prevalence
03:47 PM to 03:54 PM
Sheikh Mohammad Mahbubus Sobhan
National Heart Foundation Hospital and Research Institute
Mirpur, Dhaka
Trans Fatty Acid Contents in Partially Hydrogenated Oils Available in Markets of Dhaka City
Trans Fatty Acid Contents in Partially Hydrogenated Oils Available in Markets of Dhaka City
Sheikh Mohammad Mahbubus Sobhan1, Sohel Reza Choudhury1, Nazma Shaheen2, Abu Ahmed Shameem1, Mohammad Abdullah Al Mamun1, Nisarga Bahar1, Muhammad Ruhul Quddus3, Vandana Shah4
1National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka,
2Institute for Nutrition and Food Science, University of Dhaka,
3 Carmen Washington, 4Global Health Advocacy Incubator
Introduction: Non-communicable Diseases (NCD) are major driver of preventable cause of mortality and morbidity. NCDs attributes 71% deaths and cardiovascular diseases (CVD) has the highest chunk. Industrial trans fatty acid (iTFA) is estimated to cause 540,000 deaths every year. High trans-fat ridden food consumption links with coronary heart disease. In Bangladesh, 30% people dies of CVD, of which 5776 deaths are due to TFA. Partially-hydrogenated oil (PHO) are the main source of TFA in foods. Government sought local evidence, but very little is known about TFA content in Bangladeshi foods. Objective: Main objective was to generate local evidence by collecting information about PHO market chain. We also wanted to collect samples from wholesale/retail market and from manufacturer and analyze those for fatty acid profile. Method: Samples were collected from 4 popular wholesale and 9 randomly selected retail markets across Dhaka City. Shopkeepers were interviewed to identify PHO brands, average weekly sales, price, and main consumers. Total 24 Samples were collected- 20 from wholesale/retail markets and 4 from 4 PHO production factories. Samples were coded as individual aliquots. Then shipped to Institute of Health Laboratory, Lisbon, Portugal and analyzed using gas chromatography, auto sampler, and flame ionization detector. Result: Among 24 samples, TFA ranged from 0.69g to 20.9g/100g. Mean TFA level was 11g/100g. 92% of PHO samples exceeded 2% TFA threshold recommended by WHO. Only 2 samples were within safe limit. Vast variation was found within brands, e.g. TFA levels of 1 brand’s samples ranged 0.69g to 14.5g/100g. Beyond high TFA, saturated fatty acids represent highest value in all samples, with > 50% of the total profile, hence solid consistency at room temperature. Conclusion: Study-findings reveals, alarming TFA levels in PHO products which poses enormous health risk. Government should follow WHO’s recommendations mandating 2% TFA limit or ban PHO. To tackle NCDs and attain SDG target 3.4, Bangladesh should promulgate regulations.
Key words: Non-communicable Diseases, cardiovascular diseases, Saturated fats, iTFA, PHO
03:55 PM to 04:02 PM
Dr. Taslima Zannat
Medical Officer, Ullapara Health Complex,
Sirajganj, Bangladesh
Medication Adherence and Health Related Quality of Life among Hypertensive Senior Citizens
Medication adherence and health related quality of life among hypertensive senior citizens
Dr. Taslima Zannat1, Dr. Shafia Shaheen1, Dr. Ahmad K. Abrar2
1National Institute of Preventive & Social Medicine (NIPSOM),
2National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka (NHFH&RI)
Introduction: Aging, an inevitable process, and hypertension, an important non-communicable disease, are both major public health challenge especially in the LMICs. To maintain quality of life, the elderly hypertensive people are advised to be adherent with medication Objective:To assess health related quality of life and antihypertensive medication adherence among hypertensive senior citizens and to explore the factors associated with these. Method: In this cross-sectional study conveniently selected 156 elderly hypertensive people from Hypertension and Research Centre, Rangpur were interviewed in 2020, using pretested semi-structured questionnaire. Health related quality of life was assessed using EQ-5D-3L scale, where a high EQ-5D index value indicates better quality of life. Medication adherence was assessed by Morisky Medication Adherence-8 scale, where a high score indicates high adherence. Result: Mean age of the respondents was 66.24±6.63 years. More than half (60.9%) of the participant were male, having a mixed educational qualification varied from illiterate (17.9%) to graduation (20.5%). About one-third (32.1) of them was retired, other were currently employed and homemaker. About one-third (37.2%) had a personal income less than 1000 taka/month. Most of them (97.4%) had additional comorbidity other than hypertension. About 60% of the participant had to take two or more antihypertensive meds. More than one-third (41%) respondents reported to have a high medication adherence. Mean quality of life was 63±26%, where 100% indicates the perfect health. The quality of life was significantly better among the male and among those who were comparatively younger, employed, higher educated, married, physically active, had self-income, had two or less comorbidities and had good medication adherence. Medication adherence was low in the females, homemakers, tobacco users, and in those who had to take more antihypertensive meds and had a poor quality of life. Variation in quality of life remained significantly associated with age, gender, self-income, and employment status, duration of disease and medication adherence after controlling the covariates. Conclusion: High medication adherence is associated with a better quality of life keeping other factors aside. So, health professionals should try to improve antihypertensive medication adherence among geriatric population to improve their quality of life.
Key words: Hypertension, Quality of life, Medication adherence, Elderly,
04:03 PM to 04:17 PM
Q/A Session
04:18 PM to 04:30 PM
Sum up by the Chair and Co-Chair
Troubleshooting
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