Non-communicable diseases (NCD)

Non-communicable diseases (NCD), which are illnesses that cannot be passed from person to
person, are a major global public health issue, both in Bangladesh and elsewhere.[1] According
to a WHO survey from 2002, the most common risk factors for NCDs among the global
population are an unhealthy diet, physical inactivity, nicotine use, hazardous alcohol
consumption, overweight, elevated blood pressure, elevated total cholesterol levels, and elevated
blood glucose.[2] Urban areas consistently have higher prevalence rates for all risk variables
(Fig.1).

The growth in lifestyle-related risk factors as a result of social and economic changes is the key
cause of the epidemic of NCDs. Globalization's expanding effects have accelerated this process
in many countries. Bangladesh has been going through an epidemiological shift from
communicable diseases to NCDs, similar to many other countries. With economic growth and
improved levels of infection control and treatment, NCDs are becoming into a significant health
problem in Bangladesh. High blood pressure, diabetes, cancer, asthma, and obesity are some of
the main non-communicable diseases. Cardiovascular (heart) disease is increasingly regarded as
one of the leading causes of mortality in Bangladesh.[1] Common NCDs are becoming more
prevalent, and the majority of them have common, preventable risk factors. Thus, NCDs

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including coronary heart disease and stroke would be averted by 80%, cancer by 40%, and type 2
diabetes by 90% by identifying and preventing the risk factors.[2]

Diabetes: Diabetes has become a significant global public health issue, particularly in low- and
middle-income countries (LMICs), where more than 80% of those with the disease reside. [3]
Both urban and rural areas of Bangladesh are experiencing an increase in the prevalence of
diabetes.[4] The IDF Diabetes Atlas 5th edition predicted that Bangladesh's diabetes prevalence
would rise to more than 50% during the next 15 years, ranking Bangladesh as the eighth-most
diabetic-populated nation in the world.[5] According to a recent scoping analysis (1994–2013),
Bangladesh had a range of 4.5%–35.0% type 2 diabetes prevalence..[4] A high blood pressure
diagnosis affects one in three women and one in five men aged 35 and older, while a high blood
glucose diagnosis, a sign of diabetes, affects one in ten women and men in the same age group.
[1]

Figure 2: Bangladesh Diabetes Prevalence (% Of Population Ages 20 To 79)

According to the most recent WHO data, 40,142 fatalities from diabetes mellitus—or 5.09% of
all deaths—occurred in Bangladesh in 2017. Bangladesh is ranked 57 in the world due to its age-
adjusted death rate of 40.08 per 100,000 people.[4]

Obesity: Obesity is a chronic, diverse, and complex health condition defined by rapid weight
increase and the accumulation of body fat.[6] Overweight and obesity among children (0–12
years) and teenagers (13–19 years) are regarded as a significant public health concern globally
because they contribute to the emergence of chronic non-communicable diseases (NCDs) in
adulthood.[7] Obesity raises the risk of several severe chronic health disorders, including
metabolic syndrome, pre-diabetes, type 2 diabetes, dyslipidemia, cardiovascular illnesses, certain
malignancies, and hypertension.[8] The Bangladesh Health and Demographic Survey from 2014
found that 33% of the nation's children were underweight. But according to a recent nationwide

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epidemiological research, 3.5% of 6 to 15-year-old children were obese, 9.5% were overweight,
and 17.6% were underweight.[6]

cardiovascular disease (CVD): Globally, cardiovascular disease (CVD) is the leading cause of
death.[9] The heart and circulatory system are both impacted by CVD. CVD—which
encompasses coronary heart disease (CHD),congestive heart failure (CHF), stroke, hypertension,
peripheral artery disease, and rheumatic heart disease—is brought on by heart and blood vessel
abnormalities.[10] According to the Health Bulletin 2015, CVD and stroke together were the
leading cause of death in Upazila, District, and Medical College Hospitals in 2014, accounting
for 17.78%, 21.83%, and 16.32% respectively of all deaths.[9] According to a study conducted in
Bangladesh, stroke patients with lipid disorders had cholesterol, low density lipoprotein (LDL),
and triglyceride levels that were high in 27,93%, 21,08%, and 13,41%, respectively. In the same
study, patients with low levels of high-density lipoprotein (HDL) were found to be 42.67%.[10]
According to several research, the prevalence of CVD in Bangladesh ranges from 3.4 % to
20.9%.[9][11][12][13][14] (Table 1)

Table 1: Prevalence of coronary artery disease in Bangladesh.

Reference Year Place Age, Diagnostic No. Prevalence Type of

Year Criteria Screened (%) study
Zaman et 2007 Rural >20 Pathological Q 447 3.4; Cross-
al. [11] wave or current male 4.6, sectional
medication Female 2.7
Ahsan et 2009 Urban; Mean Not defined; 163 20.9 Cross-
al.[12] UGC age ECG and echo sectional
Employee 44.8 were used
Sayeed et 2010 Rural ≥20 1) H/O angina 768 1.85 Cross-
al.[13] plus ECG +ve; sectional
2) Post-MI with
Q or non-Q MI;
3) Diagnosis by
a cardiologist
Parr et al. 2011 Urban >25 Self-reported 8591 5.1; Cross-
[14] and Rural urban 6.0, sectional
Rural 4.7

Hypertension (HTN): Hypertension (HTN) is a significant medical and public health issue
because it is common and raises the risk of kidney and cardiovascular disease.[15] According to
the Global Burden of Disease 2010 research, high blood pressure is now Bangladesh's fifth-
leading cause of death and disability.[16] According to the Bangladesh Non-communicable
Disease (NCD) Risk Factor Survey 2010, 17.9% of total people in Bangladesh had HTN, where
18.5% of males and 17.3% of women have HTN. According to one study, hypertension affects

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65% of the elderly population overall, 75% of those in urban areas, and 53% of those in rural
areas.[15]

Cancer: Globally, cancer destroys more lives than all forms of malaria, HIV, and tuberculosis
combined.[17] According to the Bangladesh Bureau of Statistics (BBS, 2004), cancer is the sixth
most common cause of death in Bangladesh. The top five cancers-related organs are esophagus,
lip and oral cavity, breast, cervix uteri, lung. According to the National Institute of Cancer
Research Hospital's (NICRH), the sole tertiary-level cancer care facility in the nation, annual
report for 2007, Table 2 lists the numbers and percentages of the top five malignancies in men,
women, and both sexes. In terms of cancers, breast cancer leads the top place for women and
lung cancer for males.[17]
Men n (%) Women n (%) Both sexes
Table 2: Top five
Lung (25.5) Breast (25.6) Lung (17.3)
malignancies attending
Lymphoma (7.4) Cervix uteri (21.5) Breast (12.3)
NICRH in 2007
Esophagus (5.9) Esophagus (3.4) Cervix (9.1)
Larynx (5.4) Lung (5.6) Lymphoma (6.0)
Stomach (5.1) Lymphoma (4.1) ) Esophagus (4.6)

According to estimates from the International Agency for Research on Cancer (IARC), the
cancer death rate in Bangladesh was 7.5% in 2005 and will rise to 13% in 2030.

Figure 3: Prevalence of cancer in males (2009-2013)

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Figure 4: Prevalence of cancer in females (2009-2013)

According to IARC (2008), the top 10 cancer-related causes of death in men are lung, mouth and
oro-pharyngeal, esophageal, pharynx, stomach, larynx, colorectal, lymphoma, liver, and bladder
cancers (Fig. 3) while the top 10 cancer-related causes of death in women are mouth, cervical,
breast, oro-pharyngeal, lung, esophageal, gallbladder (Fig. 4). [18]

Ref.

1. Muhammad F, Chowdhury M, Arifuzzaman M, Chowdhury AA. Public health problems

in Bangladesh: Issues and challenges. South East Asia Journal of Public Health.
2016;6(2):11-6.
2. World Health Organization. Non-communicable disease risk factor survey, Bangladesh
2010.
3. Biswas T, Islam AS, Rawal LB, Islam SM. Increasing prevalence of diabetes in
Bangladesh: a scoping review. Public health. 2016 Sep 1;138:4-11.
4. Mohiuddin AK. Diabetes fact: Bangladesh perspective. International Journal of Diabetes
Research. 2019 Feb 24;2(1):14-20.
5. Atlas D. IDF Diabetes Atlas. 7th edn. Brussels, Belgium: International Diabetes
Federation; 2015. International diabetes federation.[Google Scholar].

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6. Banik R, Naher S, Pervez S, Hossain MM. Fast food consumption and obesity among
urban college going adolescents in Bangladesh: a cross-sectional study. Obesity
Medicine. 2020 Mar 1;17:100-161.
7. Biswas T, Islam A, Islam MS, Pervin S, Rawal LB. Overweight and obesity among
children and adolescents in Bangladesh: a systematic review and meta-analysis. Public
Health. 2017 Jan 1;142:94-101.
8. Chowdhury MA, Adnan MM, Hassan MZ. Trends, prevalence and risk factors of
overweight and obesity among women of reproductive age in Bangladesh: a pooled
analysis of five national cross-sectional surveys. BMJ open. 2018 Jul 1;8(7):1-12
9. Islam AM, Mohibullah AK, Paul T. Cardiovascular disease in Bangladesh: a review.
Bangladesh Heart Journal. 2016;31(2):80-99.
10. Muhit MA, Rahman MO, Raihan SZ, Asaduzzaman M, Akbar MA, Sharmin N, Faroque
AB. Cardiovascular disease prevalence and prescription patterns at a tertiary level
hospital in Bangladesh. Journal of Applied Pharmaceutical Science. 2012 Mar 30(3):80-
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11. Zaman MM, Ahmed J, Choudhury SR, Numan SM, Parvin K, Islam MS. Prevalence of
ischemic heart disease in a rural population of Bangladesh. Indian heart journal. 2007
May 1;59(3):239-241.
12. Ahsan SA, Haque KS, Salman M, Bari AS, Nahar H, Ahmed MK, Hoque MH, Rahman
MM, Hossain MA, Sultan MA. Detection of ischaemic heart disease with risk factors in
different categories of employees of University Grants Commission. University Heart
Journal. 2009 Aug 18;5(1):20-23.
13. Sayeed MA, Mahtab H, Sayeed S, Begum T, Khanam PA, Banu A. Prevalence and risk
factors of coronary heart disease in a rural population of Bangladesh. Ibrahim Medical
College Journal. 2010;4(2):37-43.
14. Parr JD, Lindeboom W, Khanam MA, Pérez Koehlmoos TL. Diagnosis of chronic
conditions with modifiable lifestyle risk factors in selected urban and rural areas of
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2011 Dec;11(1):1-9.
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2012 May 1;64(3):319-323.
16. Rahman MM, Gilmour S, Akter S, Abe SK, Saito E, Shibuya K. Prevalence and control
of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based
survey. Journal of hypertension. 2015 Mar 1;33(3):465-472.
17. Uddin AK, Khan ZJ, Islam J, Mahmud AM. Cancer care scenario in Bangladesh. South
Asian journal of cancer. 2013 Apr;2(2):102-104.
18. Hussain SA, Sullivan R. Cancer control in Bangladesh. Japanese journal of clinical
oncology. 2013 Dec 1;43(12):1159-1169.