Due to epidemiological transition, the global disease profile is changing at an astonishingly fast rate with a special pace in low and middle income countries like Bangladesh. This is resulting in the changing pattern of mortality and morbidity causes, which are shifting towards more death and disabilities due to chronic and Non Communicable Diseases (NCDs) than that of communicable and infectious diseases. Along with high death toll, NCDs are also identified as major cause of disability, resulting in disability adjusted life years (DALYs) and quality adjusted life years (QALYs).
There are many risk factors for developing NCDs, some of which are modifiable and some are non-modifiable. The most important modifiable risk factors for developing NCDs are: unhealthy diet and excessive energy intake, physical inactivity and tobacco use. All these causes are expressed through the intermediate risk factors i.e. raised blood pressure, raised level of blood glucose, abnormal blood lipids, overweight and obesity. All NCDs, combined with its intermediate risk factors, have direct costs of health-care resources and non-medical goods and the services consumed in the treatment of NCDs are enormous for even developing countries let alone developing countries like Bangladesh.
Now if we look at the status of NCDs in Bangladesh, among the top 25 cause of death, 12 are directly due to NCDs. A hospital based registry yields the fact that yearly 84,074 people get admitted by various types of cancer of which 53,710 dies. Among all cancer patients about 24.1% male suffers from lung cancer while 23.7% and 22.8% female suffers from breast cancer and cervical cancer respectively. The prevalence for diabetes (≥ 20 years) is 7% rurally and 14.2% in urban areas. One precursor for developing diabetes is metabolic syndrome and around 3% rural female suffers from metabolic syndrome. On the other hand cardio vascular diseases, hypertension and stroke cause around 12.5% (2.4% heart attack/MI, 3.6% stroke and 6.5% other cardio vascular complications) of the total death. Among rural population (≥ 18 year) 13% (9.8% male and 15.6% female) suffers from hypertension (140/90 mm hg). And annually around 5.9% population gets admitted to hospitals due to various COPD’s (except Asthma) and these various COPD’s causes around 3% of the total death. In case of risk factors, the percentage of sedentary lifestyle is 43% rurally and 90% in urban areas. Among total population (>15 year), 43% uses any kind of tobacco (either smoking or chewing or both) and in rural areas 6.5% females and in urban areas 50% female and 31% male are obese.
Even though maternal mortality declined from 322 in 2001 to 194 in 2010, a 40% decline in 9 years in our country, yet 21% maternal deaths occur as a result of cancer – another non communicable disease.
Within the aforementioned context, Eminence has taken NCDs as its one of core thematic areas and works for the prevention, control and management of NCDs.
Currently Eminence is implementing a community based life style modification intervention along with adherence to medicines among diagnosed NCD patients for delay NCD complications. This project is being implemented among population living with middle income families. The invention has three channels, i) Satellite Clinic, ii) Health Education and iii) Home Visit. Eminence has the monthly household level NCD information from registered patients since 2006. The project is being implemented within a urban context in Mirpur area of Dhaka among 10000 population.
Along with the community based NCD project, Eminence is also implementing a Slum based NCD prevention project, which is basically a health education project by which Eminence aims to prevention of NCDs among slum population. The invention has two channels, i) Satellite Clinic and ii) Health Education. This project is being implemented in very densely population slum in Mirpur area of Dhaka.
Eminence believes that, one of the main avenues of preventing NCDs is through sensitizing worksites of Bangladesh. Thus Eminence is conducting “Corporate Health Camp” in top level corporate houses where the Eminence team identifies and collects information about cardiac diseases precursors from officials working in corporate houses. Till date Eminence has successfully collected information from more than 500 officials working in seven (7) top level corporate houses.
Eminence believes that the success of any project greatly lays on relationships, partnerships and networking. Thus Eminence formulated a forum on November 16, 2009 titled “Non Communicable Diseases Forum (NCD-F)” with the objective to create a platform to ensure the participation of civil society organization (CSO) members, key stakeholders, NCD prevention and control workers, activists, media and mass communication workers and act as the policy advocate to prevent and control NCD in Bangladesh. Eminence works as the secretariat of NCD-F.
Providing palliative care and strengthening the care givers of patients suffering from NCDs, is another of Eminence’s venture. Thus Eminence has started the process of counseling session to the care givers of patients suffering from NCDs in six tertiary level specialized hospitals. This project is being recognized as “Hospital Leadership Program”, where Eminence aims to create leaders in hospitals.