Food Safety and Health

eISSN 2617-0094

Volume 1 Issue 1 February 2021 Pages 1–4

Bangladesh Society for Safe Food

doi: 10.5455/fsh.2021.21 www.bssf-bd.org

Short Communication

Management of non-communicable disease patients in Bangladesh during the

COVID-19 pandemic
Mohammad Mahmudur Rahman1, Tasnima Haque2, Md Monzur Rahman Bhuiyan3, and Md Anowar Hussain4

Department of Medical Biotechnology, Bangladesh

1
Keywords: Non-communicable disease, COVID-19, Management, Bangladesh, Pandemic.
University of Health Sciences, Dhaka, Bangladesh.
2
BIHS General Hospital, Dhaka, Bangladesh.
3
AICHI Hospital Ltd. Uttara, Dhaka, Bangladesh.
Faculty of Public Health, Bangladesh University of
4

Health Sciences, Dhaka, Bangladesh.

Introduction
Article History
Received: October 12, 2020 COVID-19 emerged in December 2019 in Wuhan, China, and still endures.
Accepted: February 19, 2021 It is the reason for the large number of morbidity and mortality worldwide
Published Online: XX
[1,2]. As of 20 May 2020, there have been nearly five million positive cases
and more than 0.3 million deaths [3]. Clinical reports have confirmed that
non-communicable diseases (NCDs), including diabetes, heart disease,
hypertension, respiratory diseases Chronic obstructive pulmonary disease
(COPD/bronchial asthma), and cancer, are predominantly present among
aged individuals, upsurge susceptibility to coronavirus disease 2019 [4].
High numbers of mortality in COVID-19 is linked to either one or more of
these NCDs [5,6]. In addition, tobacco smoking and drinking alcohol perhaps
increase the risk of susceptibility to COVID-19. The countrywide lockdown
and transport bans along with a lack of strategies for operative structural
management of NCDs during the COVID-19 pandemic can hinder efforts to
mutually contend with this epidemic [7]. Additionally, in developing countries
like Bangladesh, where 67% of all deaths are due to NCDs [8] and due to the
substandard healthcare system, the challenge of upholding steadiness of care
in NCD patients during the COVID-19 pandemic attains massive importance in
the context of patient health outcomes and maintaining public health ethics.
Common NCD risk factors, viz. tobacco smoking, physical inactivity,
unhealthy diet, harmful use of alcohol, high blood pressure, overweight/obesity,
elevated blood sugar level, and high blood lipids, are also transitional metabolic
risk factors for NCDs [9]. In Bangladesh, NCDs are already a solemn and crucial
public health issue. An investigation conducted in 2013 [10] demonstrated
that around 75% of the population are susceptible to two or more avoidable
NCD risk factors; in addition, 23% of the adult population are hypertensive
and 5% are diabetic, resulting in early deaths and/or physical disabilities.
© 2021 The authors. This is an Open Access article distributed under
the terms of the Creative Commons Attribution 4.0 Licence (CC-BY) These untimely deaths and disabilities due to NCDs cause adverse financial
Correspondence: and social consequences in individuals at the social and the national level [11].
Mohammad Mahmudur Rahman ( maahmud@gmail.com) Considering the scenarios, the World Health Organization (WHO) supported
 Department of Medical Biotechnology, Bangladesh University
of Health Sciences, Dhaka, Bangladesh.
the Government of Bangladesh in implementing multi-sectorial action plans
How to cite: Rahman MM, Haque T, Bhuiyan MMR, Hussain MA.
for deterrence and management of NCDs from 2018 to 2025, concerning
Management of non-communicable disease patients in Bangladesh approximately 30 ministries and agencies [9,11]. However, these timely
during the COVID-19 pandemic. J Food Saf Health. XXXX;XX(XX):XX– initiatives are futile as NCD patients are highly susceptible. The countrywide
XX. doi:XXXXX
Food Saf Health, 1(1):1–4, February 2021
lockdown and transport bans have worsened the
situation as most of the NCD patients are unable to pay
regular visits to their physicians. In addition, a large
number of hospitals, clinics, and healthcare centers
limit their services to prevent COVID-19 infections, and
some are closed down due to the COVID-19 infection of
healthcare workers.
Cumulative Challenges in NCDs and COVID-19
Management in Bangladesh
Bangladesh is a country of limited resources. These
glitches in the management of NCD patients encompass
questions associated with the lack of incessant medicine
availabilities, diagnosis, and allied clinical inactivity
or the failure to adequately strengthen treatment for
patients during a special situation like the COVID-
19 pandemic which requires special attention. It is
known that NCD patients require regular follow-up and
monitoring by trained healthcare professionals. Another
issue is that the number of trained professionals for
NCD-related conditions is few in Bangladesh. Moreover,
due to a lack of transportation, healthcare manpower
infected by SARS-CoV-2, lack of protective devices
for the healthcare workers, and the financial crisis
of individuals providing healthcare services to these
patients are becoming a challenge for the nation. The
real-time scenario is difficult to even express in words.
In case of some of the NCD patients presenting with a
worsening health status to the hospitals, like a heart
failure, the patient coming with severe breathlessness
and cough, healthcare workers are scared to admit the
patient on two grounds: number one, lack of personal
protective equipment and number two, due to the fact
that other patients may get infected as they do not
know or cannot confirm whether the patient is COVID-
19-positive or not. Furthermore, patients sometimes
mislead doctors by giving false information or hiding
information to get treatment. Lack of test facilities is
causing failure of hospital triage systems to separate
COVID-19 patients from non-COVID-19 patients. At the
same time, Bangladesh is yet to formulate a step-by-
step national guideline and helpline numbers for NCD
patients.
Although some online digital intervention projects
have started like the Ibrahim calling card and video
consultation for diabetic patients, it is not even covering
1% of the total diabetic patients. As private hospital
outdoors and clinics are in a dilemma to provide
treatment as they are worried about self-protection, the
NCD patients’ care is going lower day by day. Therefore,
it can be said that COVID-19 is causing an indirect barrier
for treating NCD patients. In the near future, statistics
2
might show a high mortality rate of NCD patients due to
lack of healthcare service. As days progress, the number
of healthcare workers getting infected by SARS-CoV-2
is increasing alarmingly, whereas Bangladesh already
has a lack of trained manpower in the healthcare
sectors. According to the WHO [12], Bangladesh holds
3.05 doctors and 1.07 nurses per 10,000 population.
Additionally, two-thirds of these doctors are working
in the public sector. There is no guideline or emergency
contingency plan to use these two-third trained doctors
from the private sector to manage this crisis. Moreover,
it is understandable that underprivileged patients
are in vulnerable stages due to the inability to meet
their treatment-related requirements. Healthcare
policymakers and management are enforcing the control
of COVID-19 that may critically underestimate the
prevailing health requirements of the utmost susceptible
NCD patients. Almost every effort realizing the pandemic
situation is obligatory to the stringent lockdown and
social distancing to avoid infected people approaching
the susceptible population. Likewise, in Bangladesh,
the government has declared a temporary closure of
outpatient and inpatient services in certain hospitals and
healthcare facilities due to the infection of healthcare
personnel, as well as the fact that some of the facilities have
been transformed into dedicated COVID-19 hospitals
[13]. Yet, millions of NCD patients across Bangladesh
are reliant on the healthcare system for treatment
replenishments that are required for the management of
their ailment during their lifetime. Mostly, government
hospitals provide to a substantial part of NCD patients
who do not have other options of obtaining treatments.
Private healthcare facilities are present at urban level
and costly for all patients. Some Non Government
Organization (NGOs) and community clinics also cater
to the services for the socioeconomically disadvantaged
people [14]. Socioeconomic disadvantaged patients are
susceptible to lack of treatments and adversative health
consequences; however, the issue can be predominantly
worsened during the ongoing pandemic condition due
to the loss of work and earnings associated with the
interruption in their typical sources of treatment and
medicine access. Therefore, any additional expenses
levied on such patients can reach a disastrous level.
Non-adherent NCD patients have a diverse advanced
risk of complications due to under controlled disease.
However, when attending to a patient and providing
treatment is unintended, and due to difficulties of
accessing or meeting of costs of medication, it specifies
a catastrophe to maintain the value of distributive
fairness through equitable dispersal of resources.
Persistent initial healthcare can be a valued alternative
stopgap for procuring continuous care and treatments
Food Saf Health, 1(1):1–4, February 2021
for NCD patients appurtenant to underprivileged
conditions. However, a considerable number of primary
healthcare facilities in Bangladesh have a substandard
infrastructure, which is not favorable to upholding
the substantial distancing prerequisite of at least 1 m
between people [14]. These include limited resting
and line up facility, and the inadequate entry and exits,
particularly at a time of higher patient load, and futile
infection preventive measures. These circumstances
are perhaps to be emphasized during stage 3 or 4
transmission of COVID-19. Patients with NCDs possibly,
therefore, endure to be at tenacious risk of COVID-
19 while appearing at primary healthcare clinics or
community clinic for procuring their health provisions.
This challenges the principle of no debasement to people
by omission to avoid superfluous introduction to the risk
of illness.
Proposed Restorative Measures
Considering the challenges of contending with
combined NCDs and COVID-19, some sustainable
corrective steps need to be taken immediately.
Feasibility of the proposed restorative measures needs
to be explored. A simple way can be designating well-
known private hospitals or healthcare facilities of every
municipality as NCD centers and allowing government
hospitals to take care of the COVID-19 cases. At the same
time, allowing an offline platform for NCD patients to
get help from doctors as in village areas not everyone
has the facility or know how of the complex online
healthcare services. Private public partnerships like
community clinics can be used as NCD primary care
centers for the time being. Preventing NCD patients
from the patients with flu-like sicknesses or suspected
COVID-19 cases is critical for their safety. This would
also guarantee higher generosity while plummeting the
risk of irreverent non-maleficence. However, running
designated NCD centers can be challenging due to the
risk entangling the congestion of patients. From this
perspective, evaluating the probability of outpatient
management that reduces the risk of nosocomial
infection among NCD patients need to be measured by
those in charge of each healthcare center. Rostering of
duty doctors in attending patients can be an option as a
number of suspected COVID-19 patients are hiding their
symptoms and illness to get NCD treatment. A set of
healthcare workers in a center can attend NCD patients
for 7 days in a row and then go for isolation for 14 days.
During these 14 days, another two sets of workers will
carry out their duties. In addition, evolving equitable
resolutions for demographical NCD management
during pandemic can be an option. Providing extensive
drug replenishments for chronic NCDs at functional
3
healthcare centers has to be addressed. Longer refills
of drugs and medicine require the adequate supplies
in the locality. As there is no ban on medical stores
and pharmacies, people can easily get their required
medicine. Alternatively, NGOs, healthcare volunteers,
and workers can also contribute to the home delivery
of essential medicines to the vulnerable NCD patients,
and those wanting mobility and community support.
Telemedicine (through audio-visual, internet-based,
and telephonic medium) can be powerful tools for the
stipulation of medical consultation to the patients with
NCDs alternative to the physical appointments for the
adjustment of their drug management, clarification of
diagnostic investigations, and observance provision.
Conclusion
In conclusion, the failure to allude and appropriately
unravel the constraints in attaining satisfactory levels of
management and care of NCD patients during the COVID-
19 pandemic signifies a dead public health consideration.
The state also emphasizes an exceptional connection of
public health ethics. The development of any applicable
health strategy must evade abandonment and constrict
focus on this extremely susceptible population for the
accomplishment of their critical health requirements.
Finally, the statements presented in this article are that
of the authors and do not reflect the official policy of the
institute or organization the authors belong to.
Conflict of interest
Author Md Monzur Rahman Bhuiyan was employed
by the private hospital (AICHI Hospital Ltd.). The
remaining authors declare that the research was
conducted in the absence of any commercial or financial
relationships that could be construed as a potential
conflict of interest.
Authors’ contributions
MMR and TH conceived the study with input
from SHC and MMRB. MMR led the project regarding,
literature collections, analysis, and writing with the
help of TH, SHC, and MAH. MMR, TH, and SHC produced
the first draft of the manuscript; MMRB and MAH put
in efforts regarding writings and corrections of the
manuscript. MMR and TH finalized the manuscript after
necessary corrections and obtaining suggestions from
all authors. MMR supervised all the works from the
beginning to the end. All authors did read and agreed
unanimously to submit the manuscript.
Funding
No financial disclosures were reported by the
authors of this paper.
Food Saf Health, 1(1):1–4, February 2021
Acknowledgments
The authors thank and acknowledge all healthcare
workers including doctors, nurses, assistants and the
law and enforcement authorities for their diehard
efforts to manage the COVID-19 pandemic conditions in
Bangladesh.
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