NCDs in Bangladesh and High-level Meeting of the UN General Assembly in September, 2011

Among low and middle income countries, 79% of deaths and 85% of the global burden of disease are due to the major non-communicable diseases (NCDs) which include cardiovascular diseases, diabetes mellitus, cancer and chronic respiratory diseases . The burden of (NCDs) is also increasing in South Asia: almost half of all deaths in South Asia are now attributable to non-communicable diseases, accounting for 47% of global burden of disease. Mortality from selected NCDs varies from 7% in Nepal to 40% in Maldives. Bangladesh is no exception─ currently, it is undergoing an epidemiological transition which is characterized by double burden of diseases (communicable and non-communicable, with the latter being predominant). In 2002, the top 10 causes of death in Bangladesh included cardiovascular disease, stroke, asthma/chronic obstructive pulmonary disease (COPD) and diabetes. In terms of the number of years of lives lost due to ill-health, disability and early death (DALYs), NCDs (inclusive of injuries) accounted for 61% of the total disease burden.

There is a paucity of data regarding prevalence of NCD risk factors in Bangladesh. In a WHO sponsored study in 2005 conducted in ten surveillance sites of an NGO spread all over the country, it was found that the prevalence of smoking was quite high among men (60%) while consumption of alcohol very low (2.9%). The prevalence of hypertension was 9.3%. Consumption of vegetables was very common and frequent, regardless of the socio-economic condition, although fruit consumption was very low and essentially seasonal. Nearly 41% were involved in vigorous, and about 61% moderate, intensity physical activities.  Overweight (6.7%) and obesity (0.7%) among adults were higher among women than men. A substantial proportion (70%) of these largely rural populations had three or more risk factors, the NCD risk factors clustering being associated with increasing age, being male, and higher educational achievements. Evidence from both developed and developing countries shows that a comprehensive, PHC─based preventive programme has the potential to reduce risk factors and is the most cost-effective approach to contain the emerging epidemic of NCDs.

Unfortunately, Bangladesh’s health systems is not prepared to face the challenges posed by the NCDs. NCD is yet to find its right place in the list of health priorities for the country. Only recently there has been some progress in making related plans (Strategic Plan for Surveillance and Prevention of Non-communicable Diseases in Bangladesh, 2007–2010, National Strategic Plan of Action for Tobacco Control, 2007–2010, National Cancer Control Strategy and Plan of Action 2009–2015), but the implementation has been very slow due to lack of resources.  There is yet to establish a nationwide, functional NCD surveillance system which is essential for monitoring the outcomes of the various plans and strategies. There is the need of training health workers in NCDs at PHC level; some treatment is available only at tertiary care level.

Recently, there has been a surge in interest in the prevention and control of NCDs at global level (The UN General Assembly Resolution A/RES/64/265). As a continuation of this, there is going to be a High-level Meeting on NCDs convened by the General Assembly of the UN in September 2011. This will be attended by the heads of states and governments and it is hoped that this will usher a new era in the fight against the NCDs worldwide, especially in the LMICs.