Publications by authors named "Palash Chandra Banik"

22 Publications

  • Page 1 of 1

Baseline prevalence of high blood pressure and its predictors in a rural adult population of Bangladesh: Outcome from the application of WHO PEN interventions.

J Clin Hypertens (Greenwich) 2021 Nov 16. Epub 2021 Nov 16.

Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.

This cross-sectional study estimated the prevalence of high blood pressure (BP) and examined its predictors at baseline following protocol 1 (actions 1 and 2) of World Health Organization (WHO) Package of Essential Noncommunicable Disease (PEN) Interventions in a selected rural area of Bangladesh. A total of 11 145 adults (both sex and age ≥ 18 years) completed both the questionnaire and clinical measurements at the household and community clinics, respectively. We defined high BP as systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg, prehypertension (pre-HTN) as systolic BP 120-139 mmHg or diastolic BP 80-89 mmHg, and hypertension (HTN) as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg and/or anti-hypertensive drug intake for the raised BP. The prevalence of high BP was 51.2% (pre-HTN, 25.3%; HTN, 25.9%). Among them, the proportion of pre-HTN was higher among men (28.7%) while HTN was higher among women (27.4%). Other than fast food intake (pre-HTN, OR: 1.110, P = .063) and women sex (HTN, OR: 1.236, P < .001), the pre-HTN and HTN had higher odds for having same predictors as follows: age ≥ 40 years, family history of HTN, physical inactivity, central obesity, generalized obesity, and diabetes. In conclusion, the application of WHO PEN protocol 1 detected one-fourth of the rural adult population had pre-HTN and HTN respectively, and the common significant predictors of those were the age, family history of HTN, physical inactivity, generalized obesity, and diabetes.
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http://dx.doi.org/10.1111/jch.14386DOI Listing
November 2021

Malnutrition in all its forms and associated factors affecting the nutritional status of adult rural population in Bangladesh: results from a cross-sectional survey.

BMJ Open 2021 10 27;11(10):e051701. Epub 2021 Oct 27.

Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.

Introduction: The burden of malnutrition is widely evaluated in Bangladesh in different contexts. However, most of them determine the influence of sociodemographic factors, which have limited scope for modification and design intervention. This study attempted to determine the prevalence of underweight, overweight and obesity and their modifiable lifestyle predictors in a rural population of Bangladesh.

Methods: This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions in a rural area of Bangladesh to assess the burden of diabetes, hypertension and their associated risk factors. Census was used as the sampling technique. Anthropometric measurement and data on sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach. Analysis included means of continuous variables and multinomial regression of factors.

Results: The mean body mass index of the study population was 21.9 kg/m. About 20.9% were underweight, 16.4% were overweight and 3.5% were obese. Underweight was most predominant among people above 60 years, while overweight and obesity were predominant among people between 31 and 40 years. Higher overweight and obesity were noted among women. Employment, consumption of added salt and inactivity increased the odds of being underweight by 0.32, 0.33 and 0.14, respectively. On the other hand, the odds of being overweight or obese increased by 0.58, 0.55, 0.78, 0.21 and 0.25 if a respondent was female, literate, married, housewife and consumed red meat, and decreased by 0.38 and 0.18 if a respondent consumed added salt and inadequate amounts of fruits and vegetables, respectively. Consumption of added salt decreases the odds of being overweight or obese by 0.37.

Conclusion: The study emphasised malnutrition to be a public health concern in spite of the dynamic sociodemographic scenario. Specific health messages for targeted population may help improve the nutritional status. Findings from further explorations may support policies and programmes in the future.
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http://dx.doi.org/10.1136/bmjopen-2021-051701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552130PMC
October 2021

Knowledge, Attitude, Practice, and Fear of COVID-19: an Online-Based Cross-cultural Study.

Int J Ment Health Addict 2021 Aug 30:1-16. Epub 2021 Aug 30.

Department of Public Health, North South University, Basundhara, Dhaka, Bangladesh.

The study aimed to measure Knowledge, Attitude, and Practice (KAP) and fear level towards COVID-19 and explore its cross-cultural variances in knowledge by sociodemographic factors among the general population of 8 different countries over 5 continents. It was a cross-sectional online survey. This survey was conducted in April 2020 among 1296 participants using the "Google Form" platform. Considering the social distancing formula and pandemic situation, we collect data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and sociodemographic factors. Overall knowledge score was 9.7 ± 1.7 (out of 12), and gender differences (female vs male: 9.8 ± 1.6 vs 9.5 ± 1.9) were significant ( = 0.008) in the bivariate analysis. Knowledge score variances were found significant in some regions by gender, marital status, and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0 ± 1.7) and Europe (9.3 ± 2.0). Despite having a high fear score (22.5 ± 5.6 out of 35), 78.35% of respondents were positively and 81.7% in a good practice level. Fear score rankings: Middle East (1st; 23.8 ± 5.5), Europe (2nd; 23.2 ± 5.8), Africa (3rd; 22.7 ± 5.0), South Asia (4th; 22.1 ± 5.7), Oceania (5th; 21.9 ± 5.8), and North America (6th; 21.7 ± 5.5). Fear and knowledge were not correlated. KAP and fear variation exist among geographical regions. Gender, marital status, and education qualification are factors in knowledge variances for some regions. KAP and fear measures can help health education programs consider some sociodemographic factors and regions during an outbreak of highly contagious disease and uplift a positive attitude and good practice.

Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-021-00638-4.
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http://dx.doi.org/10.1007/s11469-021-00638-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404540PMC
August 2021

Physicians' knowledge about palliative care in Bangladesh: A cross-sectional study using digital social media platforms.

PLoS One 2021 1;16(9):e0256927. Epub 2021 Sep 1.

Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

Introduction: Palliative care is still a new concept in many developing countries like Bangladesh. Basic knowledge about palliative care is needed for all physicians to identify and provide this care. This study aims to assess the preliminary knowledge level and the misconceptions about this field among physicians.

Methods: This cross-sectional study was conducted among 479 physicians using a self-administered structured questionnaire adapted from Palliative Care Knowledge Scale (PaCKs) on various digital social media platforms from December 2019 to February 2020. Chi-square, Fisher's extract test, and the Monte Carlo extract test was done to compare the knowledge level with the study subjects' demographic variables.

Results: An almost equal number of physicians of both genders from four major specialties and their allied branches took part in the study (response rate 23.9%). The majority (71%) of the respondents had an average to an excellent level of knowledge about palliative care, with a median score of 11.0. Although most physicians had average knowledge about the primary goals and general concepts of palliative care, misconceptions are highly prevalent. The commonly present misconceptions were that palliative care discourages patients from consulting other specialties (88.9%), refrains them from taking curative treatments (83.1%), and this care is only for older adults (74.5%), cancer patients (63%), and the last six months of life (56.4%). Age, educational qualifications, and specialties had significant relationships (P<0.05) with the level of knowledge.

Conclusion: Despite having average or above knowledge about palliative care, the physicians' prevailing misconceptions act as a barrier to recognizing the need among the target populations. So, proper education and awareness among the physicians are necessary to cross this field's barrier and development.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256927PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409647PMC
November 2021

Cardiovascular risk assessment among type-2 diabetic subjects in selected areas of Bangladesh: concordance among without cholesterol-based WHO/ISH, Globorisk, and Framingham risk prediction tools.

Heliyon 2021 Aug 5;7(8):e07728. Epub 2021 Aug 5.

Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.

Introduction: Cardiovascular disease (CVD) risk is higher among the subjects with type-2 diabetes mellitus (T2DM) in low- and middle-income countries, like Bangladesh. However, there is no relevant available online published data for this country. We aimed at assessing the 10-year CVD risk among T2DM subjects in selected areas of Bangladesh using the without cholesterol-based joint World Health Organization/International Society of Hypertension (WHO/ISH), Globorisk, and Framingham Risk Score (FRS) risk prediction tools, and also evaluating the concordance among these tools.

Methods And Materials: In this paper, we extracted a total of 327 subjects (40-60 years aged) from an observational study with 356 subjects, excluding those with diagnosed CVDs. The subjects were selected conveniently from purposively selected respective diabetic hospitals of Pirojpur and Dinajpur districts. We used the required respective variables of WHO/ISH, Globorisk, and FRS tools to predict CVD risks. The risks were categorized as low (<10%), moderate (10-<20%), high (20-<30%) and very high (≥30%).

Results: Subjects at moderate CVD risk were much higher identified by Globorisk (37.0%) and FRS (38.8%) compared to WHO/ISH (15.3%), and the same scenarios have also been observed for high (13.5%, 19.3% and 2.4%, respectively) and very high (5.5%, 17.4% and 1.8%, respectively) risks. There was fair level of concordance between WHO/ISH and Globorisk (PABAK-OS = 0.37; 95% CI 0.33-0.42; < 0.001), and Globorisk and FRS (PABAK-OS = 0.34; 95% CI 0.30-0.39; < 0.001). And, between WHO/ISH and FRS, it was none to slight level (PABAK-OS = 0.09, 95% CI 0.04-0.14; = 0.001).

Conclusions: A significant proportion of the selected study subjects is at moderate to very high risk of developing CVDs predicted especially by Globorisk and FRS compared to WHO/ISH, indicating low concordance. With and without cholesterol-based studies can answer the problem more clearly.
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http://dx.doi.org/10.1016/j.heliyon.2021.e07728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358158PMC
August 2021

Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study.

BMJ Open 2021 03 19;11(3):e043298. Epub 2021 Mar 19.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Objective: To determine the prevalence of non-communicable disease (NCD) risk factors among nurses and para-health professionals (PHPs) working at primary healthcare centres in Bangladesh. In addition to this, we also investigated the association of these risk factors with the categories of health professions.

Design: Cross-sectional study and the sampling technique was a census.

Setting: The study site was a medical university of Bangladesh where the study population was recruited by NCD Control Programme of Directorate General of Health Services to participate in a 3-day training session from November 2017 to May 2018.

Participants: A total of 1942 government-employed senior staff nurses (SSNs) and PHPs working at Upazila Health Complexes.

Primary And Secondary Outcome Measures: The data were collected using a modified STEPwise approach to NCD risk factors surveillance questionnaire of the World Health Organisation (V.3.2). The prevalence of NCD risk factors was presented descriptively and the χ² test was used to determine the association between NCD risk factors distribution and categories of health professions.

Results: The mean age of the participants was 37.6 years (SD 9.5) and most of them (87.6%) had a diploma in their respective fields. Physical inactivity (86.9%), inadequate fruits and/vegetable intake (56.3%) and added salt intake (35.6%) were the most prevalent behavioural risk factors. The prevalence of central obesity, overweight, raised blood glucose and raised BP were 83.5%, 42.6%, 19.2% and 12.8% respectively. Overall, the NCD risk factors prevalence was higher among PHPs compared with SSNs. A highly significant association (p<0.001) was found between risk factors and the categories of health professions for tobacco use, alcohol intake, added salt intake and physical inactivity.

Conclusion: High NCD risk factors prevalence and its significant association with SSNs and PHPs demand an appropriate risk-reduction strategy to minimise the possibility of chronic illness among them.
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http://dx.doi.org/10.1136/bmjopen-2020-043298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986941PMC
March 2021

Cardiovascular disease risk factors among school children of Bangladesh: a cross-sectional study.

BMJ Open 2020 10 21;10(10):e038077. Epub 2020 Oct 21.

Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Dhaka District, Bangladesh.

Objective: Primarily, we assessed the distribution of cardiovascular disease (CVD) risk factors among school children living in urban and rural areas of Bangladesh. In addition to this, we sought the association between place of residence and modifiable CVD risk factors among them.

Design, Setting And Participants: This cross-sectional study was conducted among 854 school children (aged 12-18 years) of Bangladesh. Ten public high schools (five from Dhaka and five from Sirajgonj district) were selected randomly and subjects from those were recruited conveniently. To link the family milieu of CVD risk factors, a parent of each children was also interviewed.

Primary And Secondary Outcome Measures: Distribution of CVD risk factors was measured using descriptive statistics as appropriate. Again, a saturated model of binary logistic regression was used to seek the association between place of residence and modifiable CVD risk factors.

Results: Mean age of the school children was 14.6±1.1 years and more than half (57.6%) were boys. Overall, 4.4% were currently smoker (urban-3.5%, rural-5.2%) with a strong family history of smoking (42.2%). Similar proportion of school children were identified as overweight (total 9.8%, urban 14.7%, rural 5%) and obese (total 9.8%, urban 16.8%, rural 2.8%) with notable urban-rural difference. More than three-fourth (80%) of them were physically inactive with no urban-rural variation. Only 2.4% consumed recommended fruits and/ or vegetables (urban-3.1%, rural-1.7%). In the adjusted model, place of residence had higher odds for having several modifiable CVD risk factors: current smoking (OR: 1.807, CI 0.872 to 3.744), inadequate fruits and vegetables intake (OR: 1.094, CI 0.631 to 1.895), physical inactivity (OR: 1.082, CI 0.751 to 1.558), overweight (OR: 3.812, CI 2.245 to 6.470) and obesity (OR: 7.449, CI 3.947 to 14.057).

Conclusions: Both urban and rural school children of Bangladesh had poor CVD risk factors profile that demands further nation-wide large scale study to clarify the current findings more precisely.
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http://dx.doi.org/10.1136/bmjopen-2020-038077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580045PMC
October 2020

Cardiovascular disease risk factors among school children of Bangladesh: a cross-sectional study.

BMJ Open 2020 10 21;10(10):e038077. Epub 2020 Oct 21.

Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Dhaka District, Bangladesh.

Objective: Primarily, we assessed the distribution of cardiovascular disease (CVD) risk factors among school children living in urban and rural areas of Bangladesh. In addition to this, we sought the association between place of residence and modifiable CVD risk factors among them.

Design, Setting And Participants: This cross-sectional study was conducted among 854 school children (aged 12-18 years) of Bangladesh. Ten public high schools (five from Dhaka and five from Sirajgonj district) were selected randomly and subjects from those were recruited conveniently. To link the family milieu of CVD risk factors, a parent of each children was also interviewed.

Primary And Secondary Outcome Measures: Distribution of CVD risk factors was measured using descriptive statistics as appropriate. Again, a saturated model of binary logistic regression was used to seek the association between place of residence and modifiable CVD risk factors.

Results: Mean age of the school children was 14.6±1.1 years and more than half (57.6%) were boys. Overall, 4.4% were currently smoker (urban-3.5%, rural-5.2%) with a strong family history of smoking (42.2%). Similar proportion of school children were identified as overweight (total 9.8%, urban 14.7%, rural 5%) and obese (total 9.8%, urban 16.8%, rural 2.8%) with notable urban-rural difference. More than three-fourth (80%) of them were physically inactive with no urban-rural variation. Only 2.4% consumed recommended fruits and/ or vegetables (urban-3.1%, rural-1.7%). In the adjusted model, place of residence had higher odds for having several modifiable CVD risk factors: current smoking (OR: 1.807, CI 0.872 to 3.744), inadequate fruits and vegetables intake (OR: 1.094, CI 0.631 to 1.895), physical inactivity (OR: 1.082, CI 0.751 to 1.558), overweight (OR: 3.812, CI 2.245 to 6.470) and obesity (OR: 7.449, CI 3.947 to 14.057).

Conclusions: Both urban and rural school children of Bangladesh had poor CVD risk factors profile that demands further nation-wide large scale study to clarify the current findings more precisely.
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http://dx.doi.org/10.1136/bmjopen-2020-038077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580045PMC
October 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Health-related quality of life and its predictors among the type 2 diabetes population of Bangladesh: A nation-wide cross-sectional study.

J Diabetes Investig 2021 Feb 3;12(2):277-285. Epub 2020 Aug 3.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.

Aims/introduction: We aimed to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh.

Materials And Methods: This nationwide cross-sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade-off value set. The predictors were determined using multinomial logistic regression analysis.

Results: The mean EQ-5D-5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as "average" HRQoL. Overall, 64% of respondents had a "problem" at least in one of the dimensions of the EQ-5D-5L, and the burden of reported "problems" was higher among women (70%). Among the five dimensions, the highest reported "problem" was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged <30 years) showed a higher burden of anxiety/depression (95%) compared with the rest of the population. The specific predictors of average/good HRQoL (odds ratio >1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years.

Conclusions: The majority of Bangladesh's type 2 diabetes patients had an "average" HRQoL based on the EQ-5D-5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.
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http://dx.doi.org/10.1111/jdi.13331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858106PMC
February 2021

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study.

BMJ Open 2020 02 28;10(2):e034058. Epub 2020 Feb 28.

Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Objective: To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.

Design, Setting And Participants: This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.

Primary And Secondary Outcome Measures: Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.

Results: Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.

Conclusion: A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.
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http://dx.doi.org/10.1136/bmjopen-2019-034058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050319PMC
February 2020

The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study.

Inj Prev 2020 10 20;26(Supp 1):i83-i95. Epub 2020 Feb 20.

The George Institute for Global Health, New Delhi, India.

Background: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.

Methods: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.

Results: Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes.

Conclusions: There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.
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http://dx.doi.org/10.1136/injuryprev-2019-043484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571364PMC
October 2020

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh.

Indian Heart J 2019 Mar - Apr;71(2):155-160. Epub 2019 May 3.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), 125/1 Darus Salam, Mirpur-1, Dhaka 1216, Bangladesh. Electronic address:

Objectives: There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting.

Methods: This cross-sectional study recruited 265 postmenopausal women aged 40-70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the 'noncommunicable disease risk factors survey Bangladesh 2010'. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis.

Results: Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist-hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = -1.044, p < 0.001), and metabolic equivalent of tasks (β = -0.171, p = 0.003) showed a significant association with AIP.

Conclusion: High AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.
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http://dx.doi.org/10.1016/j.ihj.2019.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620423PMC
January 2020

Agreement between 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Seventh Report of the Joint National Committee Guidelines to Estimate Prevalence of Postmenopausal Hypertension in a Rural Area of Bangladesh: A Cross Sectional Study.

Medicina (Kaunas) 2019 Jun 26;55(7). Epub 2019 Jun 26.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh.

Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. This cross-sectional study recruited 265 postmenopausal women of 40-70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen's Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch's approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.
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http://dx.doi.org/10.3390/medicina55070315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681048PMC
June 2019

Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh.

Indian J Public Health 2019 Apr-Jun;63(2):101-106

Honorary Professor, Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Background: Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh.

Objectives: This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting.

Methods: This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40-70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) "with" and "without" cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (κ), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1).

Results: The "without" cholesterol version showed 79% concordance against the "with" cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (κ = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the "without" cholesterol version showed higher agreement (κ = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to "with" cholesterol version (κ = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (≥10%) cases was similar for both the versions of WHO/ISH risk charts.

Conclusion: In a low-resource setting, the "without" cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.
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http://dx.doi.org/10.4103/ijph.IJPH_178_18DOI Listing
December 2019

Effectiveness of health education-based conventional intervention method to reduce noncommunicable diseases risk factors among rural population.

Cardiovasc Diagn Ther 2019 Feb;9(1):30-34

Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.

Background: Noncommunicable diseases (NCDs) are the major public health challenges that can be averted through prevention and control of behavioral risk factors. The study aimed to assess the effectiveness of health education-based conventional intervention method to reduce NCD risk factors among a selected rural population of Bangladesh.

Methods: A quasi-experimental study was conducted among 80 adults of Basulia village. Cluster sampling technique was used to grasp the participants. A baseline pre-test was done, followed by health education intervention in terms of awareness creating and warning messages containing leaflets on NCD risk factors. A weekly leaflet was provided to the participants throughout 3 months followed by post-test. World Health Organization STEPS instrument was used for data collection. Paired t-test was done to see the significance of the intervention.

Results: Men were dominator (60%), and the mean age of the participants was 37.1±13.8 years. Significant pre- and post-test differences were found for decreasing the number of smoking tobacco sticks daily (11.1±5.9 and 7.4±2.9; P=0.016) along with the frequency of smokeless tobacco use daily (6.7±3.6 and 4.3±1.7; P=0.005), increasing the servings of fruit and vegetables intake daily (3.3±0.8 and 4.9±1.1; P=0.046), decreasing the amount of added salt intake daily (1.2±0.5 and 0.8±0.5 teaspoon; P<0.001), and also increasing the total weekly metabolic equivalent (MET) of physical activity (3,756±4,094 and 4,002±4,249; P=0.046). In terms of percentage of the risk factors, all were reduced except tobacco use.

Conclusions: A fair positive interventional effect of health education messages using conventional method has been evinced for all NCD risk factors.
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http://dx.doi.org/10.21037/cdt.2018.10.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382656PMC
February 2019

Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal.

Indian Heart J 2018 Dec 10;70 Suppl 3:S20-S27. Epub 2018 Mar 10.

Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Background: As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal.

Methods: We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software.

Results: Mean age of the participant was 42.5 ± 13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation.

Conclusion: A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.
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http://dx.doi.org/10.1016/j.ihj.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309148PMC
December 2018

Physical activity levels and associated cardiovascular disease risk factors among postmenopausal rural women of Bangladesh.

Indian Heart J 2018 Dec 19;70 Suppl 3:S161-S166. Epub 2018 Sep 19.

Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), 125/1 Darus Salam, Mirpur-1, Dhaka, 1216, Bangladesh. Electronic address:

Objectives: The role of physical inactivity in relation to cardiovascular disease (CVD) among postmenopausal women is understudied. The main objective of this study was to measure the physical activity levels (PALs) and evaluate its relation to other CVD risk factors among postmenopausal rural women of Bangladesh.

Methods: A cross-sectional study was conducted among 265 postmenopausal women aged 40-70 years who visited the outpatient department of a primary health-care center situated in the village Karamtola of Gazipur district. A pretested modified questionnaire of STEP-wise approach to Surveillance (STEPS) of noncommunicable disease risk factors was used to collect data on sociodemographic and lifestyle factors. PAL was determined by the Estimated Energy Requirement (EER) equation of the Dietary Reference Intakes (DRIs) Committee, and association with CVD risk factors was examined by Spearman's rank correlation.

Results: More than half (58.1%) of the postmenopausal women were identified as sedentary with high prevalence of central obesity (73.2%) among them. CVD risk factors including age (r = -0.228, p < 0.01), age at menopause (r = -0.129, p < 0.05), duration of menopause (r = -0.183, p < 0.05), 2-h plasma glucose (r = -0.148, p < 0.05), total cholesterol (r = -0.138, p < 0.05), low-density lipoprotein cholesterol (r = -0.122, p < 0.05), and triglyceride (r = -0.168, p < 0.01) showed a significant as well as inverse association with Metabolic Equivalent of Task (MET) of physical activity.

Conclusion: Low PAL and significant inverse correlation with various CVD risk factors demand interventions to maintain higher PAL among postmenopausal women of Bangladesh.
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http://dx.doi.org/10.1016/j.ihj.2018.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309711PMC
December 2018

Prevalence and clustering of cardiovascular disease risk factors in rural Nepalese population aged 40-80 years.

BMC Public Health 2018 05 31;18(1):677. Epub 2018 May 31.

Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.

Background: Cardiovascular diseases (CVD) are the main cause of mortality in low- and middle-income countries like Nepal. Different risk factors usually cluster and interact multiplicatively to increase the risk of developing acute cardiovascular events; however, information related to clustering of CVD risk factors is scarce in Nepal. Therefore, we aimed to determine the prevalence of CVD risk factors with a focus on their clustering pattern in a rural Nepalese population.

Methods: A community-based cross-sectional study was conducted among residents aged 40 to 80 years in Lamjung District of Nepal in 2014. A clustered sampling technique was used in steps. At first, four out of 18 wards were chosen at random. Then, one person per household was selected randomly (n = 388). WHO STEPS questionnaires (version 2.2) were used to collect data. Chi-square and independent t-test were used to test significance at the level of p < 0.05.

Results: A total 345 samples with complete data were analyzed. Smoking [24.1% (95% CI: 19.5-28.6)], harmful use of alcohol [10.7% (7.4-13.9)], insufficient intake of fruit and vegetable [72% (67.1-76.6)], low physical activity [10.1% (6.9-13.2)], overweight and obesity [59.4% (54.2-64.5)], hypertension [42.9% (37.6-48.1)], diabetes [16.2% (14.0-18.3)], and dyslipidemia [56.0% (53.0-58.7)] were common risk factors among the study population. Overall, 98.2% had at least one risk factor, while 2.0% exhibited six risk factors. Overall, more than a half (63.4%) of participants had at least three risk factors (male: 69.4%, female: 58.5%). Age [OR: 2.3 (95% CI: 1.13-4.72)] and caste/ethnicity [2.0 (95% CI: 1.28-3.43)] were significantly associated with clustering of at least three risk factors.

Conclusions: Cardiovascular risk factors and their clustering were common in the rural population of Nepal. Therefore, comprehensive interventions against all risk factors should be immediately planned and implemented to reduce the future burden of CVD in the rural population of Nepal.
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http://dx.doi.org/10.1186/s12889-018-5600-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984400PMC
May 2018

Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh.

BMC Health Serv Res 2017 Aug 22;17(1):586. Epub 2017 Aug 22.

James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.

Background: Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh.

Methods: This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization.

Results: The mean (±SD) age of participants was 52 (±10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P < 0.002), education (P < 0 .001) and income (P < 0.001). The median travel and waiting time at the facility was 30 and 45 min respectively. More than one-third (37%) of the participants checked their blood glucose monthly. Most patients were satisfied regarding the family (55%) and hospital (67%) support.

Conclusion: T2DM patients had average knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income.
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http://dx.doi.org/10.1186/s12913-017-2542-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567438PMC
August 2017

Total cardiovascular risk for next 10 years among rural population of Nepal using WHO/ISH risk prediction chart.

BMC Res Notes 2017 Mar 7;10(1):120. Epub 2017 Mar 7.

Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality globally. Primary prevention of CVD based on total CVD risk approach using WHO/ISH risk prediction chart would be more effective to stratify population under different risk levels, prioritize and utilize the scarce resources of low and middle-income countries. This study estimated total 10-year CVD risk and determined the proportion of population who need immediate drug therapy among the rural population of Nepal.

Methods: A community based cross-sectional study conducted among 345 participants aged 40-80 years in rural villages of Lamjung District of Nepal. They were selected randomly from total eighteen wards. Data were collected using WHO STEPS questionnaires. WHO/ISH risk prediction chart for SEAR D was used to estimate total cardiovascular risk. Chi-square and independent t-test were used to test significance at the level of p < 0.05 in SPSS version 16.0.

Results: Of the total participants, 55.4% were female. The mean age (standard deviation) of the participants was 53.5 ± 10.1 years. According to WHO/ISH chart proportions of low, moderate and high CVD risk were 86.4%, 9.3%, and 4.3%, respectively. Eleven percent of participants were in need of immediate pharmacotherapy. Age (p = 0.001), level of education (p = 0.01) and occupation (p = 0.001) were significantly associated with elevated CVD risk.

Conclusion: A large proportion of Nepalese rural population is at moderate and high CVD risk. Immediate pharmacological interventions are warranted for at least one in every ten individuals along with lifestyle interventions. Both population-wise and high-risk approaches are required to minimize CVD burden in the future.
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http://dx.doi.org/10.1186/s13104-017-2436-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341399PMC
March 2017
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