Healthy behaviours, treatment, and control status of diagnosed hypertension and diabetes among the government nurses and para-health professionals of Bangladesh: A cross-sectional study.

Chronic illness among health professionals (HPs) is rarely reported due to idealistic views of their role in treating and fighting diseases. This creates a gap mainly due to a lack of research on them, resulting in insufficient data at the national level, especially in Bangladesh. In this circumstance, we analyzed the data of senior staff nurses (SSNs) and para-health professionals (PHPs) to assess their healthy bahaviours, treatment, and control status of hypertension (HTN) and diabetes mellitus (DM). It was a cross-sectional study that used the census as a sampling technique. The study site was a medical university in Bangladesh located in the capital city of Dhaka. A total of 1942 government-employed health professionals working at Upazila Health Complexes participated and completed both the questionnaire and physical measurements with a response rate of 100%. Among them, 1912 (SSNs = 938 and PHPs = 974) remained for analysis after data cleaning. The prevalence of self-screening (HTN, 97.4%; DM, 81.5%), diagnosis (HTN, 20.5%; DM,15.3%), treatment (HTN, 88.7%; DM, 83.7%) and control status (HTN, 63.7%; DM, 31%) did not reveal any notable differences between SSNs and PHPs. Most of the HPs with HTN and DM failed to maintain adequate physical activity (87.4%; 86.2%), fruit and/or vegetable intake (60.7%; 59%), and healthy body weight (60.5%; 54%) respectively. Only avoidance of smoking showed a significant association with the professional categories in both hypertensives (AOR, 7.98; p = 0.001) and diabetics (AOR, 14.78; p<0.001). Although working in the field of primary health care and involved in assisting patient management, control of HTN, DM and their risk factors is not satisfactory among the SSNs and PHPs of Bangladesh. Future interventions should focus on smoking, diet, and physical activity to reduce HTN and DM in the HPs of Bangladesh.

Coping strategy among the women with metastatic breast cancer attending a palliative care unit of a tertiary care hospital of Bangladesh.

BACKGROUND: Breast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression. METHODS: This cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status. RESULT: The mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8-10) and instrumental support (median 9; IQR 6-10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p <0.001). Patients with better performance status on ECOG scale (Grade 0-2) leaned more on the positive coping strategies like instrumental support, emotional support, positive reframing and venting. CONCLUSION: Different coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life.

Satisfaction with care provided by home-based palliative care service to the cancer patients in Dhaka City of Bangladesh: A cross-sectional study.

Background and Aims: Patient satisfaction is an important quality indicator of health care service. The concept of home-based palliative care has been recently introduced in Bangladesh, but the patients' satisfaction with this care remained unexplored. This study aimed to assess the satisfaction of the cancer patients receiving this care. Methods: This cross-sectional study was conducted among 51 surviving cancer patients above 18 years of age registered under the home-based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were collected by face-to-face interviews using a structured questionnaire based on the FAMCARE P16 questionnaire from February to March 2019. Descriptive analysis was done for the sociodemographic and satisfaction-related indicators. A correlation matrix was done to see the correlation among the satisfaction indicators. Result: The majority of the patients (88.2%) were satisfied with the service provided by the home care team. Most (76.5%) of the patients were women, and the mean age was 56.25 ± 14.8 years. The median duration of getting home-based care was 4 months. Main satisfaction indicators were-assessment of physical symptoms (70.6%), providing information about pain management (70.6%), the inclusion of the family in decision making (76.5%), coordination of care between the members of the home care team (84.3%) and availability of doctors, nurses and palliative care assistants (74.5%). A high correlation was observed between satisfaction regarding the care of physical symptoms and provision of information (R = 0.814, p < 0.001). Also, satisfaction regarding the provision of information and support provided to the family is highly correlated (R = 0.722, p < 0.001). Conclusion: Despite the limitations, the overall satisfaction level of the patients regarding home-based palliative care services in Bangladesh is very high. Home-based palliative can be a solution to provide palliative care to patients who are unable to access institution-based care and improve their quality of life.

Quality of life of the cancer patients receiving home-based palliative care in Dhaka city of Bangladesh.

BACKGROUND: The concept of home-based palliative care has been recently introduced in Bangladesh, but the patients' quality of life remains unexplored. This study aimed to assess the quality of life and its determinants of the cancer patients receiving home-based palliative care in Dhaka, Bangladesh. METHODS: This cross-sectional study was conducted among 51 surviving cancer patients above 18 years registered under the home-based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data was collected by face-to-face interview using a structured questionnaire based on the "Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal)" questionnaire from February to March 2019. Descriptive analysis was done for the socio-demographic, disease and treatment related factors. Mann-Whiteney U test, Kruskal-Wallis H test, and logistic regression were done to determine the relationships between independent variables and QoL. RESULT: The majority of the patients (76.5%) were women. The mean age of the respondents was 56.2±4.8 years. Common primary sites of cancer were breast (39.2%), gastrointestinal (17.6%), and genitourinary system (23.5%). The median duration of getting home-based care was four months. The most prevalent problems were pain, sadness, feeling ill, and lack of satisfaction regarding sexual life. The majority (88.2%) of the patients had an average and above-average quality of life. Although, 92.1%patients had average or above-average social and emotional wellbeing, 60.8% had below-average physical wellbeing. Patients' marital status, belief about disease prognosis, and duration of getting home-based care had a positive influence, and age negatively influenced the quality of life. CONCLUSION: The majority of the patients receiving home-based palliative care in Dhaka city had average or above-average quality of life. However, these patients had better social and emotional wellbeing, but the physical wellbeing and symptom control were below-average according to the individual domain.

Non-communicable diseases risk factors among the forcefully displaced Rohingya population in Bangladesh.

Rohingya refugees of Ukhiya, Cox's bazar are an unaccounted group of people who form the largest cluster of refugees worldwide. Non-communicable disease (NCD) alone causes 70% of worldwide deaths every year therefore, the trend of NCD among Rohingya refugees demands proper evaluation and attention. The objective of this study was to measure the NCD risk factors among a convenient sample of Rohingya refugees. This cross-sectional study was conducted among 249 Rohingya refugees living in Balukhali and Kutupalang Rohinga Camps at Ukhiya, Cox's bazaar using a survey dataset adapted from the WHO Stepwise approach to NCD Risk Factor Surveillance (STEPS). Data was collected through face-to-face interviews with a structured questionnaire. Anthropometric and biochemical measurements were done by trained medical assistants. Descriptive analysis was applied as appropriate for categorical variables. A Chi-square test and a student t test were performed to compare the categories. In general, the findings of NCD risk factors as per STEPS survey was 53.4% for tobacco use including smokeless tobacco, 2.8% for alcohol consumption, 23.7% for inadequate vegetable and fruit intake, 34.5% for taking extra salt, 89.6% for insufficient physical activity, 44.5%for confirmed hypertension, 16.9% for overweight, 1.2% for obesity and 0.8% for high blood sugar. Some modifiable non-communicable disease risk factors such as physical inactivity, tobacco smoking, extra salt with food, and hypertension are present among the Rohinga refugees in Bangladesh. These findings were timely and essential to support the formulation and implementation of NCD-related policies among the Rohingya refugees as a priority sub-population.

Physicians' knowledge about palliative care in Bangladesh: A cross-sectional study using digital social media platforms.

INTRODUCTION: Palliative care is still a new concept in many developing countries like Bangladesh. Basic knowledge about palliative care is needed for all physicians to identify and provide this care. This study aims to assess the preliminary knowledge level and the misconceptions about this field among physicians. METHODS: This cross-sectional study was conducted among 479 physicians using a self-administered structured questionnaire adapted from Palliative Care Knowledge Scale (PaCKs) on various digital social media platforms from December 2019 to February 2020. Chi-square, Fisher's extract test, and the Monte Carlo extract test was done to compare the knowledge level with the study subjects' demographic variables. RESULTS: An almost equal number of physicians of both genders from four major specialties and their allied branches took part in the study (response rate 23.9%). The majority (71%) of the respondents had an average to an excellent level of knowledge about palliative care, with a median score of 11.0. Although most physicians had average knowledge about the primary goals and general concepts of palliative care, misconceptions are highly prevalent. The commonly present misconceptions were that palliative care discourages patients from consulting other specialties (88.9%), refrains them from taking curative treatments (83.1%), and this care is only for older adults (74.5%), cancer patients (63%), and the last six months of life (56.4%). Age, educational qualifications, and specialties had significant relationships (P<0.05) with the level of knowledge. CONCLUSION: Despite having average or above knowledge about palliative care, the physicians' prevailing misconceptions act as a barrier to recognizing the need among the target populations. So, proper education and awareness among the physicians are necessary to cross this field's barrier and development.

Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study.

OBJECTIVE: To determine the prevalence of non-communicable disease (NCD) risk factors among nurses and para-health professionals (PHPs) working at primary healthcare centres in Bangladesh. In addition to this, we also investigated the association of these risk factors with the categories of health professions. DESIGN: Cross-sectional study and the sampling technique was a census. SETTING: The study site was a medical university of Bangladesh where the study population was recruited by NCD Control Programme of Directorate General of Health Services to participate in a 3-day training session from November 2017 to May 2018. PARTICIPANTS: A total of 1942 government-employed senior staff nurses (SSNs) and PHPs working at Upazila Health Complexes. PRIMARY AND SECONDARY OUTCOME MEASURES: The data were collected using a modified STEPwise approach to NCD risk factors surveillance questionnaire of the World Health Organisation (V.3.2). The prevalence of NCD risk factors was presented descriptively and the χ² test was used to determine the association between NCD risk factors distribution and categories of health professions. RESULTS: The mean age of the participants was 37.6 years (SD 9.5) and most of them (87.6%) had a diploma in their respective fields. Physical inactivity (86.9%), inadequate fruits and/vegetable intake (56.3%) and added salt intake (35.6%) were the most prevalent behavioural risk factors. The prevalence of central obesity, overweight, raised blood glucose and raised BP were 83.5%, 42.6%, 19.2% and 12.8% respectively. Overall, the NCD risk factors prevalence was higher among PHPs compared with SSNs. A highly significant association (p<0.001) was found between risk factors and the categories of health professions for tobacco use, alcohol intake, added salt intake and physical inactivity. CONCLUSION: High NCD risk factors prevalence and its significant association with SSNs and PHPs demand an appropriate risk-reduction strategy to minimise the possibility of chronic illness among them.

Cardiovascular disease risk factors among school children of Bangladesh: a cross-sectional study.

OBJECTIVE: Primarily, we assessed the distribution of cardiovascular disease (CVD) risk factors among school children living in urban and rural areas of Bangladesh. In addition to this, we sought the association between place of residence and modifiable CVD risk factors among them. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was conducted among 854 school children (aged 12-18 years) of Bangladesh. Ten public high schools (five from Dhaka and five from Sirajgonj district) were selected randomly and subjects from those were recruited conveniently. To link the family milieu of CVD risk factors, a parent of each children was also interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES: Distribution of CVD risk factors was measured using descriptive statistics as appropriate. Again, a saturated model of binary logistic regression was used to seek the association between place of residence and modifiable CVD risk factors. RESULTS: Mean age of the school children was 14.6±1.1 years and more than half (57.6%) were boys. Overall, 4.4% were currently smoker (urban-3.5%, rural-5.2%) with a strong family history of smoking (42.2%). Similar proportion of school children were identified as overweight (total 9.8%, urban 14.7%, rural 5%) and obese (total 9.8%, urban 16.8%, rural 2.8%) with notable urban-rural difference. More than three-fourth (80%) of them were physically inactive with no urban-rural variation. Only 2.4% consumed recommended fruits and/ or vegetables (urban-3.1%, rural-1.7%). In the adjusted model, place of residence had higher odds for having several modifiable CVD risk factors: current smoking (OR: 1.807, CI 0.872 to 3.744), inadequate fruits and vegetables intake (OR: 1.094, CI 0.631 to 1.895), physical inactivity (OR: 1.082, CI 0.751 to 1.558), overweight (OR: 3.812, CI 2.245 to 6.470) and obesity (OR: 7.449, CI 3.947 to 14.057). CONCLUSIONS: Both urban and rural school children of Bangladesh had poor CVD risk factors profile that demands further nation-wide large scale study to clarify the current findings more precisely.

Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh.

BACKGROUND: Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh. OBJECTIVES: This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting. METHODS: This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40-70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) "with" and "without" cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (κ), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1). RESULTS: The "without" cholesterol version showed 79% concordance against the "with" cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (κ = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the "without" cholesterol version showed higher agreement (κ = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to "with" cholesterol version (κ = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (≥10%) cases was similar for both the versions of WHO/ISH risk charts. CONCLUSION: In a low-resource setting, the "without" cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.

Effectiveness of health education-based conventional intervention method to reduce noncommunicable diseases risk factors among rural population.

BACKGROUND: Noncommunicable diseases (NCDs) are the major public health challenges that can be averted through prevention and control of behavioral risk factors. The study aimed to assess the effectiveness of health education-based conventional intervention method to reduce NCD risk factors among a selected rural population of Bangladesh. METHODS: A quasi-experimental study was conducted among 80 adults of Basulia village. Cluster sampling technique was used to grasp the participants. A baseline pre-test was done, followed by health education intervention in terms of awareness creating and warning messages containing leaflets on NCD risk factors. A weekly leaflet was provided to the participants throughout 3 months followed by post-test. World Health Organization STEPS instrument was used for data collection. Paired t-test was done to see the significance of the intervention. RESULTS: Men were dominator (60%), and the mean age of the participants was 37.1±13.8 years. Significant pre- and post-test differences were found for decreasing the number of smoking tobacco sticks daily (11.1±5.9 and 7.4±2.9; P=0.016) along with the frequency of smokeless tobacco use daily (6.7±3.6 and 4.3±1.7; P=0.005), increasing the servings of fruit and vegetables intake daily (3.3±0.8 and 4.9±1.1; P=0.046), decreasing the amount of added salt intake daily (1.2±0.5 and 0.8±0.5 teaspoon; P<0.001), and also increasing the total weekly metabolic equivalent (MET) of physical activity (3,756±4,094 and 4,002±4,249; P=0.046). In terms of percentage of the risk factors, all were reduced except tobacco use. CONCLUSIONS: A fair positive interventional effect of health education messages using conventional method has been evinced for all NCD risk factors.

Prevalence and clustering of cardiovascular disease risk factors in rural Nepalese population aged 40-80 years.

BACKGROUND: Cardiovascular diseases (CVD) are the main cause of mortality in low- and middle-income countries like Nepal. Different risk factors usually cluster and interact multiplicatively to increase the risk of developing acute cardiovascular events; however, information related to clustering of CVD risk factors is scarce in Nepal. Therefore, we aimed to determine the prevalence of CVD risk factors with a focus on their clustering pattern in a rural Nepalese population. METHODS: A community-based cross-sectional study was conducted among residents aged 40 to 80 years in Lamjung District of Nepal in 2014. A clustered sampling technique was used in steps. At first, four out of 18 wards were chosen at random. Then, one person per household was selected randomly (n = 388). WHO STEPS questionnaires (version 2.2) were used to collect data. Chi-square and independent t-test were used to test significance at the level of p < 0.05. RESULTS: A total 345 samples with complete data were analyzed. Smoking [24.1% (95% CI: 19.5-28.6)], harmful use of alcohol [10.7% (7.4-13.9)], insufficient intake of fruit and vegetable [72% (67.1-76.6)], low physical activity [10.1% (6.9-13.2)], overweight and obesity [59.4% (54.2-64.5)], hypertension [42.9% (37.6-48.1)], diabetes [16.2% (14.0-18.3)], and dyslipidemia [56.0% (53.0-58.7)] were common risk factors among the study population. Overall, 98.2% had at least one risk factor, while 2.0% exhibited six risk factors. Overall, more than a half (63.4%) of participants had at least three risk factors (male: 69.4%, female: 58.5%). Age [OR: 2.3 (95% CI: 1.13-4.72)] and caste/ethnicity [2.0 (95% CI: 1.28-3.43)] were significantly associated with clustering of at least three risk factors. CONCLUSIONS: Cardiovascular risk factors and their clustering were common in the rural population of Nepal. Therefore, comprehensive interventions against all risk factors should be immediately planned and implemented to reduce the future burden of CVD in the rural population of Nepal.

Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal.

BACKGROUND: As a low-income country, Nepal is experiencing cardiovascular diseases as an emerging health problem. However, studies are lacking on the risk factors of cardiovascular diseases in peri-urban communities; where the socio-demographical transition is in progress. Therefore, this study aimed to identify the prevalence and socio-demographic distribution of cardiovascular disease risk factors in one of the peri-urban communities in Kathmandu, Nepal. METHODS: We conducted a cross-sectional study in Sitapaila Village Development Committee, Kathmandu from February 2014 to February 2015. Altogether, 347 adults from 18 to 70 years of age were selected randomly. Data were collected through modified WHO STEPS questionnaire for non-communicable disease (NCD) risk factors survey and analyzed in SPSS V.16.0 software. RESULTS: Mean age of the participant was 42.5 ±â€¯13.2 years. Majority of them were female (n = 206; 59.4%), one-third (34%) represented Brahman and Chetri, and over a quarter (29.1%) did not attend school. Cardiovascular disease risk factors included smoking (17.6%), alcohol consumption (29.4%), insufficient fruit and vegetables intake (98%), insufficient physical activity (21.0%), obesity (15.3%), hypertension (34.4%), diabetes (10.5%), and high triglyceride levels (10.8%). They were significantly associated with different socio-demographic characteristics: smoking with gender, age groups and education level; alcohol consumption was with gender, age groups, ethnicity and occupation; insufficient physical activity with gender, age groups and occupation; hypertension with gender, age groups, ethnicity, education level and occupation. CONCLUSION: A high prevalence of cardiovascular disease risk factors and their disproportional distribution among the study population indicated an inevitable risk of cardiovascular events in near future.