Tackling the expanding burden of non-communicable diseases in Bangladesh

In the last three decades, Bangladesh has made remarkable advances in deaths from infectious diseases — more than a twofold reduction. However, non-communicable diseases like stroke, heart disease and diabetes have become increasingly common among adults due to rapid urbanisation, and changes in lifestyles and economic circumstances. 

According to a 2022  World Health Organization (WHO) report, 70% of deaths in Bangladesh occur due to non-communicable diseases, up from 59% as recently as in 2015; 80% of such deaths could have been prevented. 

As we enter another new year, taking stock of the major national challenges involving the prevention of non-communicable diseases should be a priority.

A 2023 British Medical Journal study showed that between 2003 and 2017, adult mortality due to strokes, heart attacks, and cancers increased by 68%, 29%, and 26%, respectively, in Bangladesh, while deaths from infectious diseases saw a 25% decline. Interestingly, however, the mortality from other non-communicable diseases, including diabetes, renal failure, and liver diseases, collectively declined. 

These contrasting trends imply that the risk factors for stroke and heart diseases, such as obesity, are on the rise, while the declining mortality from other non-communicable diseases indicates improvement in the country's healthcare management over the past decades.

Abnormal levels of lipids, including fats and oils, in the blood increase stroke and heart disease risks. While the body needs a certain amount of cholesterol for cell repair and hormone production, abnormally high levels of low-density lipoprotein (LDL), or the "bad" cholesterol, and low levels of high density lipoprotein (HDL), or "good" cholesterol can lead to fatty deposits (plaques) forming in the coronary arteries — the major blood vessels supplying oxygen and nutrients to the heart. 

This condition, known as dyslipidemia, causes chest pain and shortness of breath. Hardened plaques can break and damage blood vessels, resulting in the formation of blood clots. If clots substantially obstruct blood flow to the brain and heart, they can cause strokes and/or heart attacks. 

Scientists at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) recently found that almost eight out of 10 individuals in Bangladesh may suffer from some form of dyslipidemia, with many having low "good" cholesterol levels but high "bad" cholesterol levels. The findings suggest an alarmingly high prevalence. And it may help explain the increasing adult mortality from heart disease and stroke in Bangladesh.

In addition to health and well-being risks, non-communicable diseases impose a massive economic cost. Take the non-alcoholic fatty liver disease, which affects about 45 million people in Bangladesh. It is the most common liver disease in the world and often occurs alongside obesity, type II diabetes, dyslipidemia, and metabolic syndrome. In the long run, this disease can cause liver cirrhosis and cancer and often require liver transplantation. 

A 2023 study estimated the cost imposed on fatty liver patients in Bangladesh, including hospitalisation, physician fees, testing and investigation, expenditures,  medicines, and nonmedical costs such as transport and tips. The average cost was more than Tk17,000 per patient. However, cases that had progressed to cirrhosis drove up the cost to as high as Tk2 lakh. 

Meanwhile, individuals having both fatty liver and diabetes/ hypertension had to endure an average expense of Tk27,000 to Tk30,000 per patient. In a lower-middle-income country like Bangladesh, these costs represent a substantial financial burden for large sections of the population. 

Collectively, the findings scream urgency for implementing changes in order to prevent and reduce the burden of non-communicable diseases at the grassroots level. The WHO has recommended targeted public health interventions such as media campaigns to discourage tobacco use and control fatty-food promotions, especially directed to children. 

The degree of adherence to these policies is captured by a policy implementation score for the prevention of non-communicable diseases. This is based on awarding a full point for complete implementation of a WHO-recommended prevention policy and half a point for partial implementation. 

In 2021, Bangladesh had a total score of nine out of a possible 19 points- essentially remaining stagnant since 2017.  In contrast, Turkey, the best-performing country in 2021, had a score of 17.5. 

This is a key area that must continue to be monitored, and further progress can help bring about rapid change at the national level.

In addition to policy interventions, community-level health education and promotion programs aiming to raise awareness have been suggested as cost-effective solutions. This may involve dietary counselling programs in outpatient clinics and door-to-door home health education in the community clinics.  

Finally, changes in urban planning and infrastructure that encourage exercise and discourage poor diets are key. For instance, safe and walkable urban spaces and investing in cycling lanes increase the likelihood of exercise. Meanwhile, poor dietary habits and obesity may be countered by ensuring easy access to high-quality nutritious foods.  

Preventing non-communicable diseases is a matter of collective approach that needs active public engagement as well as extensive research. It is true that interventions and programs aimed at targeting the risk factors reduce deaths. However, academic research on the effectiveness of the measures is also critical for further designing successful programs and policy changes.

Ornob Alam is a scientific writer at icddr,b and a current PhD student at New York University.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.