Guide Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time (Directions in Development)

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In , hypertension occurred to The four main types of NCDs are cardiovascular diseases such as heart attacks and stroke , cancer, chronic respiratory diseases such as chronic obstructed pulmonary disease and asthma , and diabetes. These NCDs share smoking, excessive alcohol, lack of physical activity, and poor eating habits as common modifiable risk factors.

This makes screening where possible an important intervention in their control, especially in LMICs where access to curative services is limited. The primary health care PHC systems of most countries in SSA evolved in response to the impact of communicable diseases. The exact form of a health system in SSA that adequately responds to the epidemic of NCDs remains a subject of continuing research.

One of the most decentralized structures within the health system of many countries in SSA is the operation of community pharmacies CPs. Community pharmacies are found to operate in settings where other health services such as clinics and hospitals are not available. A systematic review of the evidence on the feasibility and acceptability of using CPs to screen for major diseases concluded that screening for some diseases in CPs was generally feasible. In Ghana, NCDs are now recognized as major causes of significant illness and deaths.

The regulated nature of community pharmacy practice in Ghana implies that the integration of NCD screening in CPs can be formalized and supervised. As part of an intended program to introduce screening for NCDs in CPs in three districts in southeastern Ghana, we conducted a survey among clients of CPs in these districts to assess acceptability and to identify other possible threats to effective implementation. Most inhabitants live in rural settlements. The main occupations are subsistence farming and fishing.


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The respective district capitals, Akosombo, Odumase, and Somanya, are all suburban. Each district has at least either a district hospital Asuogyaman, Lower Manya Krobo or a polyclinic Yilo Krobo that are staffed by a medical officer and where comprehensive services, including special clinics and surgeries, are performed.

The public health services in the three districts are managed by the District and Municipal Health Management Teams. The approach to the delivery of public health services is based on the PHC concept, with emphasis on the control of communicable diseases and provision of maternal and child health services.

Tackling Noncommunicable Diseases in Bangladesh: Now Is the Time

The delivery of adult health services including NCD screening remain largely at the level of health centers and hospitals at subdistrict and district levels, respectively. There is a total of nine CPs in the three districts. The most highly patronized CPs in the three districts were selected, and the owners were approached for permission to interview clients. All adult clients reporting to the CPs during the day were targeted to be interviewed.


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  6. The interviews were conducted by trained research assistants and in dialects that clients were comfortable to speak in. Most of the questions on the questionnaire were close ended. The data were entered into a computer using a platform created in Microsoft Access Double data entry was used to ensure accuracy. Data were then exported into Stata version 12, College Station, Texas for analysis.

    Proportions and percentages were computed based on the number of respondents who agreed to respond that specific question.

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    We included in the multivariate logistic regression model variables that were significant in bivariate analysis at a P value of less than 0. The final model was obtained using backward elimination procedures. In such instances, Fisher's exact estimates are reported. We planned to enroll respondents on the basis that it will afford an estimation of the proportion of clients willing to be screened for NCD within a margin of error of 3. The target sample size was not achieved due to logistical constraints see below. Individual informed consent was obtained from each participant prior to the start of interview.

    The request to participate in the survey was made only after clients had been served at the CPs and were about to exit. No information that identified individual clients was obtained. Out of this number, The main reason given by clients who refused to participate was time constraint. Interviewed clients consisted of The majority were Christians, Just about half, Most of the clients , About half of the clients , Most respondents , About a quarter, 62 Obesity, smoking, and excess dietary salt were known to The fact that family history was a risk factor for these diseases was much less known 88, ie, Please ask Thomas Breineder to update the entry or send us the correct email address.

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    If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation. Creativity was required, they said. There was discussion of the pharmaceutical industry and its long history of partnering to fight disease, as well as consideration of the need for partnerships in combating the effects of drug addiction, which, itself, should be considered a non-communicable disease, one speaker said.

    The General Assembly also heard the conclusion of its debate, begun yesterday. In closing, Mohamed Khaled Khiari Tunisia , summing up on behalf of the General Assembly President, commended delegates for having fulfilled the mission set out for the meeting by adopting a robust outcome document. There was broad agreement about the constraints non-communicable diseases posed to global development, and he believed there would be ample opportunity for States to begin changing the landscape of non-communicable diseases before the next review.

    The Chairs of the respective round tables also delivered summaries of those meetings. Globalization, trade liberalization, increased affluence, personal freedom, urbanization and congested living conditions were all contributing to unhealthy lifestyles and posing risk factors. He highlighted the need for regional and international collaboration in efforts to reach non-communicable disease and capacity-building targets.

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    He also stressed the need for cohesive implementation plans that incorporated international agreements and instruments as well as the imperative to recognize and agree that tobacco control remained the most challenging but cost-effective strategy to control non-communicable diseases.

    He advocated an increased investment to tackle non-communicable diseases, adding that combating them would promote economic growth in the long-run and lead to social well-being. Thailand had taken steps to develop national programmes to address the situation, he said, noting that the sixth National Health Assembly of the countries in the South-East Asia region had adopted a resolution in June on regional targets for tackling the scourge, which had already led to strengthening regional health information systems.

    During their first meeting on the matter, held in April, ASEAN leaders discussed a regional action plan and a network to support it. Thailand also supported the inclusion of non-communicable diseases as a stand-alone in the new development agenda. Thailand had implemented health coverage nationwide in and it was poised to cooperate with other countries to ensure that such coverage was global. Nicaragua had developed a strategy to enable its citizens to live a good, clean, health life, which was implemented by the Labour Ministry and Health Ministry. The Government also had instituted policies on good nutrition and environmental well-being.

    Last year, the public health service had increased its network of health clinics to 1,, including for non-communicable diseases. In , the country had hosted a regional public-health meeting aimed at formulating strategies with neighbouring countries. That had led to the creation of the Central American health programme, which focused on, among others, issues related to child nutrition, teen pregnancy, dengue fever and tobacco use. Nicaragua had already implemented the programme in communities, and understood that, in the long-term, an adequate response to non-communicable diseases and their prevention was crucial.

    The priority areas were boosting general awareness of the diseases and promoting healthy lifestyles, with community and media involvement important. Screening for diabetes and cancer were allied with a referral mechanism, and efforts were being made to improve capacities for prevention, treatment and rehabilitation. A monitoring framework had been established to track morbidity and mortality rates, and primary health care was being revitalized to integrate responses to both communicable and non-communicable diseases.

    There was a regional non-communicable disease crisis in the Pacific, he said, adding that he was optimistic about efforts to address it because the diseases were generally preventable. He outlined efforts made by the Government, working with academia and civil society, to reduce smoking and said New Zealand was at the forefront of creating smoke-free environments, educating the population on dangers and beginning to ban advertisements and sponsorship. All sectors of society must be involved in order to ensure that policies intended to reduce and control non-communicable diseases were effective.

    Uruguay had specific policies in the four main risk-factor levels that were coordinated by the Health Ministry and other sectors. It had shown great leadership in tackling the problem and had almost fully implemented the framework convention on tobacco control, as well as instituted a ban on smoking in public areas; it also had imposed new tax policies on tobacco use. In that connection, it prohibited the use of colours and names on cigarette packaging that would confuse consumers about the harmful effects of tobacco products, and it had set up a tobacco-control sector within the Health Ministry, which helped to draft rules on tobacco control.

    The Ministry attached particular importance to South-South cooperation, and had exchanged good practices with the Pan-American Health Organization. He stressed the importance of the global plan of action for control of non-communicable diseases as well as including their impact as a specific goal in the post agenda.

    That situation must be rectified through greater actions to prevent non-communicable diseases and ensure treatment for all in need. It was also necessary to reduce prejudices about those diseases. France had always championed the need to prioritize the fight against those. It supported good nutrition policies, had forbidden tobacco in all public places since and had taken vigorous steps to prevent alcohol use in pregnant women.

    Tackling Noncommunicable Diseases in Europe

    The Ministry of Health had adopted a collaborative approach, setting targets to reduce salt in food and working with private partners to conduct a Cardiac Arrest Surveillance System. The Ministry was also promoting high-quality research, and the Government was applying the World Health Organization Choice methodology, providing information on cost-effectiveness to guide policy decisions. Among national challenges was coordinating local and national efforts.

    Despite constraints, Bangladesh had made remarkable progress in attaining the Millennium Development Goals. Life expectancy had increased sharply but non-communicable diseases were on the rise as urbanization grew. Slum dwellers were especially at risk, he said, noting that non-communicable diseases made up 61 per cent of the total disease burden. In order to establish large-scale efforts, technical skills were necessary, but many developing countries could not afford the investment. A global resource pool could be a major boon, allowing more confidence in target setting for poor countries such as his own.

    Despite recent efforts, more must be done. He called for strengthening national capacities for diagnostic technologies and palliative care. Treatment must be affordable, particularly in developing countries. It was vital to enhance the ability of developing countries to launch awareness campaigns about the dangers of tobacco and alcohol use, he said, urging the tobacco, medical and beverage industries to contribute to the promotion of healthy lifestyles.

    Tackling Noncommunicable Diseases in Bangladesh : Now is the Time

    The international community must work on successful prevention, and support must be given to develop adequate health-care infrastructure. Such concerns should be adequately reflected in the post development agenda and the sustainable development goals. The representative of Zimbabwe said financial constraints had contributed to a high incidence of mortality from non-communicable diseases in her country.

    The burden of non communicable diseases in developing countries

    Despite that and other challenges, the Ministry of Health and Child Welfare had developed non-communicable disease and alcohol control policies, which were pending approval by the Cabinet. Her Government had set up a non-communicable disease unit. As it strengthened the national response for such diseases, the Government was increasingly paying attention to mental health issues, and it had put in place a mental health policy and strategy as well as mental health indicators.

    The national anti-retroviral therapy guidelines had incorporated issues concerning early detection of non-communicable diseases as well. Additionally, the Government had overseen the integration of cancer screening and, in that connection, was promoting breast cancer screening in public and private institutions. Efforts also were under way to secure funding to carry out a survey on risk factors to non-communicable diseases. Its strategic goals focused on primary and secondary interventions, increasing treatment and research on non-communicable diseases, as well as increasing partnerships to fight them.

    The Government had taken steps to implement a related economic plan and had asked the Cabinet to create a committee on the issue.