Cooperation among the private and public sectors will be the way forward
Before you read this article, close your eyes and think how many of your close ones suffer from raised blood pressure or diabetes. A lot? You may be surprised at how many names come to mind. The rising prevalence of hypertension and diabetes in Bangladesh is one of the biggest health care issues policy-makers face today.
Findings from the recent Bangladesh Demographic and Health Survey (BDHS) 2017–2018 indicate that three out of ten adults over age 18 have hypertension. That translates to about 30 million Bangladeshis in 2020. Almost four-fifths (23 million) of the people with hypertension are 35 years and older.
Why is that important? Because high blood pressure makes your heart work harder to pump blood to the rest of the body, and so can lead to a heart attack or heart failure.
Diabetes also poses a health system challenge. Overall, 10% of adults over age 18 -- or 11 million people -- are diabetic, according to the BDHS. Of these cases, 75% occur among people over age 35.
Because the population coping with these chronic diseases is so large, a need exists to expand the number of facilities that can provide screening, referral, and management services -- and that provide basic medicines at no charge. Further, a communications plan may be in order to remind people that prevention is the best and most cost-effective approach to dealing with these conditions. Preventive measures include following a healthy diet -- monitoring intake of salt, sugar, and fried foods -- regular physical activity, and avoidance of tobacco products.
The BDHS survey showed some interesting insight into these conditions. For example, women are more likely to be hypertensive than men. Among people over age 18, half of hypertensive women and two-thirds of hypertensive men are unaware of their condition. Of those thought to have hypertension, only 15% of women and 9% of men (1) know of their condition, (2) report that they are taking medication for it, and (3) have controlled blood pressure levels.
That figure tells us that more than two-thirds of adults taking medication for hypertension, do not have their blood pressure levels under control.
Many factors may contribute to this finding. People may not have received appropriate medicines or may not adhere to the regimen prescribed. A holistic and lifelong case management approach is needed for these conditions, and may not be working properly, as yet.
Diabetes poses similar problems. 60% of diabetic adults over age 18 are unaware they have the disease. Approximately 13% of diabetic men and women (1) know they have diabetes, (2) report that they take medication for it, and (3) have controlled blood glucose (sugar) levels. That leaves more than 87% of diabetic adults who take medication but still do not have controlled blood glucose levels.
Elevated blood pressure and uncontrolled hypertension can lead to complications such as heart attack and stroke. Raised blood glucose or uncontrolled diabetes negatively affects everybody's organs. Both chronic conditions complicate surgery and increase the possibilities of additional infections -- in addition to requiring lifelong management and large resources -- both for individuals and the national health system.
What should individuals do? The findings suggest that people over age 30 should have periodic screenings to determine if they are among those unaware of their condition. Regular screening, a healthy lifestyle, and compliance with health advice can minimize risks for people who are pre-hypertensive or pre-diabetic. Those who do test positive can institute regular monitoring and case management for their condition.
For health system managers in Bangladesh, expanding available services is an important step to take. Under the government’s non-communicable disease program, comprehensive services for hypertension and diabetes are provided in 30 upazilas, which is expected to increase to 200 upazilas in the coming years.
The government also is providing screening services to detect more cases where people do not know they have hypertension or diabetes. However, the BDHS study findings suggest that public facilities cannot cover all of the needs. A coordinated partnership between public and private facilities will be required to meet the need, especially given that most patients still depend on the private sector for their health care.
The way forward to fight hypertension and diabetes will be complex and long. It is apparent that hypertension and diabetes management must involve many sectors outside of health facilities -- agriculture for easily available nutritious foods, planners for ensuring that people have access to outdoor spaces for exercise, and technology for applications that help people track their medications and healthy lifestyles, for example. Advances in technology, empowered and educated patients, and the cooperation among all sectors -- public and private -- are the best way forward.
This article was produced by Data for Impact and Research for Decision Makers, icddr,b -- funded by the United States Agency for International Development (USAID). The opinions expressed in this article do not necessarily reflect the views of USAID or the United States government. To know more please write to [email protected]