Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study.

The aim of the study was to determine the temporal changes in the prevalence of type 2 diabetes mellitus and its associated risk factors in a rural population of Bangladesh. A total of 4757 subjects age >/=20 years both male and female were enrolled randomly in a cross-sectional study in 1999. The same area and population was reinvestigated in 2004 following the same selection procedure, on a sample of 3981 individuals. Structural and economical changes were noted for the last 5 years in the locality. An increased prevalence of diabetes was found with 6.8% in the present survey compared with 2.3% in the earlier survey (p<0.05). Age, BMI and systolic blood pressure were found to be significant risk factors following both for FBG and for OGTT. WHR was found to be a significant risk factor for men only. A substantial agreement was observed between FBG and OGTT (kappa 0.63) compared to the previous investigation in 1999 (kappa 0.40). Differences in the indices of obesity, that is BMI, WHR and waist girth, may in part explain the increased prevalence, which in turn may explain due to fast-expanded urbanization. The state of affairs warrants immediate measures necessary to prevent the epidemic particularly in the localities that are in the transition phase from rural to semi-urban facilities.

Excitatory aminoacid neurotransmitters in schizophrenia.

The study presents for the first time the blood level of glutamate and aspartate in schizophrenic patients and in normal subjects in Bangladeshi population. The serum level of glutamate and aspartate were measured in thirty newly diagnosed schizophrenic patients and the same number of subjects matching age was taken from non-schizophrenic control. The age group of the patient was between 15 and 45 years and the male female ratio was 2.7:1. Serum concentration of glutamate (598.83 +/- 574.48 nmol/ml) was significantly higher (p < 0.001) in schizophrenic group compared to control (196.16 +/- 171.31 nmol/ ml). The serum asparate concentration was also significantly higher in schizophrenic cases (282.91 +/- 299.94 nmol/ml) as compared to control (33.89 +/- 42.68 nmol/ml, p < 0.001). The correlation coefficient between serum glutamate and asparate was significant (p < 0.001). The increased serum glutamate and asparate levels may be the causative or contributing factor in the pathogenesis and progression of schizophrenia.

Fasting cut-offs in determining the prevalence of diabetes and intermediate glucose abnormality in a non-obese population.

The study was undertaken to compare the effect of ADA and WHO criteria for screening of diabetes mellitus (DM) and intermediate glucose abnormality (Impaired fasting glucose/Impaired glucose tolerance-IFG/IGT) and to explore an acceptable fasting cut-off in a population-based study. Ten suburb villages with a population of 11,895 were selected purposively. Of the total 6235 eligible (> or = 20y) subjects, 4144 volunteered. We took height, weight, hip- and waist-girth, blood pressure and fasting blood glucose (FBG). All participants were classified into Group-1 (Gr-1: n=453) and Group-2 (Gr-2: n=3691), based on FBG above and below 5.4 mmol/l, respectively. All from Gr-1 and 610 randomized subjects from Gr-2 were investigated for oral glucose tolerance test (OGTT), HbA1c and lipids. The mean (SD) of age, body mass index (BMI) and FBG of all participants was 37.6 (15.2) y, 19.4 (2.9), and 4.7 (0.9) mmol/l, respectively. The prevalence of diabetes and IFG/IGT using American Diabetes Association (ADA) criteria were compared with WHO criteria separately in Gr-1 and Gr-2. For group-1, ADA criteria could diagnose 5.9% as diabetes and 2.1% as IFG, whereas, WHO criteria diagnosed 11.5% diabetes and 19% IGT. Likewise, in Gr-2, ADA detected much less than WHO criteria (DM: 0.3 vs. 2.3%; IFG/IGT 1.0 vs. 14.6%). We compared fasting and 2 hours post-load glucose (2-hBG) values according to percentiles. We found that 11.1 of 2-hBG corresponded with a fasting value that lies between 90 to 95th percentile, equivalent to 5.1-5.7 mmol/l. Using receiver operating characteristics (ROC) curve, we determined the cut-offs 4.6 - 5.4 mmol/l for IFG and > or = 5.5 for diabetes. Taking age and BMI into account the kappa agreements were better between the estimated cut-offs and the given 2-hBG values. The ADA cut-offs were found ineffective for screening. We proposed the modified fasting cut-offs for screening IFG and diabetes among the non-obese population.

Prevalence of type 2 diabetes in urban slums of Dhaka, Bangladesh.

This cross-sectional study was conducted to estimate the prevalence of type 2 diabetes along with its risk factors in urban slum population of Dhaka, Bangladesh. A random sample of 1555 slum dwellers of Dhaka city (age > or = 20 years) were included in the study. Capillary blood glucose levels, fasting and 2-h after 75g oral glucose load (for a selected subjects, n = 476), were measured. Height, weight, waist and hip circumferences, blood pressure and some other important socio-demographic information on age, sex, education, income, and occupation status were collected. The overall prevalence of type 2 diabetes was found to be 8.1 percent, and the prevalence for men and women were 7.7 percent and 8.5 percent respectively. Prevalence of diabetes was found to be lower following 2-h glucose values in the selected population compared to the FBG procedure. Age, sex, literacy and waist to hip ratio for men were found as significant risk factors following both fasting blood glucose and 2-h post glucose values adjusted for a number of confounding variables. Poor to moderate agreement was observed between fasting blood glucose and 2-h glucose (kappa 0.41, p < 0.001). The agreement was even poorer between impaired fasting glucose and impaired glucose tolerance. Poor agreement between FBG and 2-h BG may raise concern for the dependability of diagnostic procedures. Higher prevalence of type 2 diabetes in the urban slum may indicate an epidemiological transition due to fast urban migration and possibly urbanization. However, this issue needs further exploration.

Diabetes and impaired fasting glycemia in a rural population of Bangladesh.

OBJECTIVE: To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a rural population of Bangladesh. RESEARCH DESIGN AND METHODS: A cluster sampling of 4,923 subjects >/=20 years old in a rural community were investigated. Fasting plasma glucose, blood pressure, height, weight, and girth of waist and hip were measured. BMI and waist-to-hip ratio (WHR) were calculated. Total cholesterol, triglycerides, and HDL cholesterol were also estimated. We used the 1997 American Diabetes Association diagnostic criteria. RESULTS: The crude prevalence of type 2 diabetes was 4.3% and IFG was 12.4%. The age-standardized prevalence of type 2 diabetes (95% CI) was 3.8% (3.12-4.49) and IFG was 13.0% (11.76-14.16). The subjects with higher family income had significantly higher prevalence of type 2 diabetes (5.9 vs. 3.5%, P < 0.001) and IFG (15.6 vs. 10.8%, P < 0.001) than those with lower income. Employing logistic regression in different models, we found that wealthy class, family history of diabetes, reduced physical exercise, and increased age, BMI, and WHR were the important predictors of diabetes. Total cholesterol, triglycerides, and HDL cholesterol showed no association with diabetes and IFG. CONCLUSIONS: The prevalence of diabetes and IFG in the rural population was found to be on the increase compared with the previous reports of Bangladesh and other Asian studies. Older age, higher obesity, higher income, family history of diabetes, and reduced physical activity were proved significant risk factors for diabetes and IFG, whereas plasma lipids showed no association with diabetes and IFG. Further study may address whether diabetes is causally associated with insulin deficiency or insulin resistance.

Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis.

Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children. The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci. Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh. We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat. From them we selected 2175 children, who were suffering from tonsillo-pharyngitis. This cross sectional study was conducted during March-December 1999. All statistical analysis was done by using statistical package SPSS windows version 8. The mean (SD) age of the children was 11.1 (3.3) years. Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children. Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G. These findings demonstrated the predominance of group G followed by A infection among school children. Therefore special attention should be paid not only to group A but also to group G. Further studies to determine prevalence of M serotypes are necessary.

Effect of hilsa (Tenualosa ilisha) fish in hypercholesterolemic subjects.

Tenualosa ilisha is a popular, tasty fish found in the rivers of Bangladesh round the year. The fish is rich in oil which provides mainly 16:0 and 18:1 fatty acids but also a little of w-3 polyunsaturated fatty acids (w-3 PUFAs). The present study was undertaken to evaluate the effect of eating hilsa fish in hypercholesterolemic subjects. The fish was indeed found to have hypocholesterolemic effect in subjects who had hypercholesterolemia. After 10 months of eating 100g hilsa fish per day, serum total cholesterol level fell from 285.1 to 244.6 mg/dl (14.2% decrease) in the hypercholesterolemic subjects. But the difference was not statistically significant (p < 0.05). The fall in total cholesterol was exclusively due to fall in LDL-cholesterol. Serum triglyceride, serum HDL-cholesterol increased in the experimental subjects by 12.5%. On the other hand, serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride levels were not changed in control subjects. Both in control and experimental subjects there were no changes in body weight and blood pressure during the study period. The results indicate that hilsa fish, although it is fatty and contains cholesterol, but it may reduce blood cholesterol level in hypercholesterolemic subjects.

Psychosomatic effects of permanent sterilization.

A follow-up study of 300 tubectomy and 300 vasectomy cases was conducted in the urban, semiurban and rural areas of Mymensingh district. Psychosomatic effects of these individuals were recorded through interviews using a pretested questionnaire. Results indicated that illiterate, economically insolvent and persons having children up to 2 to 3 years of age were the clients. Growing size of the family was the main concern for adopting sterilization. Professional motivators were found more effective in motivating vasectomy cases. In both groups there was no significant change in libido. In case of vasectomy 99% were found sexually active by the 30th post-operative day while 52% of the tubectomy cases were sexually active by the six weeks of post-operative days. From this study it appears that further in-depth study might be necessary in probing more insight of the psychosocial basis of sterilization and effects thereof.

Under five's morbidity & mortality in Dacca Medical College Hospital & morbidity pattern at P.G. hospital & Lionhati Health Project.

The present study was carried out in OPD of PGH, LHP., ID and OPD of DMCH in an attempt to identify the major determinants of health, nutritional and environmental problems which are being faced by children below age five in the urban and rural areas of Bangladesh. The mean age of the children who suffer from infectious disease are between 2-3 years old. Children between 1 and 2 year suffer from acute disease and die frequently. Female children attend less in these centres than the fellow male children. Due to socio-economic reasons, traditional joint family system is changing to nuclear type. Static health care institutions are less utilised by rural people. Educated fathers seek care quickly. Low income groups attend more in DMCH (OPD). Mean family size above 6. The sleeping rooms are overcrowded. Immunization is not popular in rural areas. Rural women receive less care related to pregnancy, childbirth and puerperium. Height and weight of these children however, are similar to the national nutrition survey results. The leading cases of morbidity and mortality are from infectious diseases. The study gives an account of health status of rural and urban community.