Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh
October
Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh
Lal B. Rawal 0 1 2
Tuhin Biswas 0 1 2
Nusrat Nausheen Khandker 0 2
Shekhar Ranjan Saha 0 2
Mohammed Mahiul Bidat Chowdhury 0 2
Abdullah Nurus Salam Khan 0 1 2
Enamul Hasib Chowdhury 0 2
Andre Renzaho 0 2
0 Funding: AR is supported by an Australian Research Council Future Fellowship FT110100345. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
1 International Centre for Diarrhoeal Disease Research , Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka , Bangladesh , 2 James P Grant Schools of Public Health, BRAC University , Dhaka , Bangladesh , 3 The University of Queensland, Long Pocket Precinct , Indooroopilly Queensland , Australia , 4 Western Sydney University Locked Bag 1797, Penrith, NSW Australia
2 Editor: Fakir M. Amirul Islam, Swinburne University of Technology , AUSTRALIA
Despite one-third of the urban population in Bangladesh living in urban slums and at increased risk of non-communicable diseases (NCDs), little is known about the NCD risk profile of this at-risk population. The aim of the study was to identify the prevalence of the NCD risk factors and the association of NCD risk factors with socio-demographic factors among the adults of urban slums in Dhaka, Bangladesh.
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Competing interests: The authors have declared
that no competing interests exist.
Background
Method
Result
A cross-sectional study was conducted among adult slum dwellers (aged 25 and above)
residing in three purposively selected urban slums of Dhaka for at least six months
preceding the survey. The risk factors assessed were- currently smoking, fruit and vegetable
intake, physical activity, hypertension and body mass index (BMI). Information on
selfreported diabetes was also taken. A total of 507 participants (252 females; 49.7%) were
interviewed and their physical measures were taken using the WHO NCD STEPS
instrument.
The overall prevalence of NCD risk factors was: 36.0% (95% CI: 31.82±40.41) for smoking;
95.60% (95% CI: 93.60±97.40) for insufficient fruit and vegetable intake; 15.30% (95%
CI:12.12±18.71) for low physical activity;13.70% (95% CI: 10.71±16.92) for hypertension;
22.70% (95% CI: 19.31±26.02) for overweight or obesity; and 5.00% (95%: 3.20±7.00) for
self-reported diabetes. In the logistic regression model, the clustering of three or more NCD
risk factors was positively associated with younger age groups (p = 0.02), no formal
education (p <0.001) and primary education level (p = 0.01), but did not differ by sex of the
participants, monthly income and occupation.
Conclusion
All NCD risk factors are markedly high among the urban slum adults. These findings are important to support the formulation and implementation of NCD-related polices and plan of actions that recognize urban slum populations in Bangladesh as a priority sub-population.
Introduction
The global burden of non-communicable diseases (NCDs) is increasing rapidly as a result of a
number of factors, such as economic development and related erosion of traditional food
practices (increase in the intake of processed foods high in fat, salt and sugar) and change in
cultural norms (increase in the use of tobacco and alcohol), decline in the physical activity, and
increase in the sedentary lifestyles [1, 2]. These risk factors are often accelerated by rapid and
unplanned urbanization [
3, 4
]. Globally, almost two-thirds of total deaths occur due to NCDs
[1]. The 2014 NCD Global Status report showed that, of the 58 million deaths that occurred
worldwide in 2012, 38 million were due to NCDs (almost two thirds), comprising mainly of
cardiovascular diseases, cancers, diabetes and chronic lung diseases [1]. More than 40% of
NCD deaths (16 million) were considered as premature deaths since they died before reaching
average life span of 70 years. Almost three quarters of all NCD deaths (28 million) and the
majority of premature deaths (82%), occurred in low and middle-income countries (LMICs).
NCD burden and associated inequalities will continue to increase in the next two decades.
For example, while Asia and Africa still remain mostly rural (48% and 40% of their respective
populations living in urban areas), these two regions are urbanizing faster than any other
regions; and by 2050 it is projected that64% and 56% of their respective populations will be
living in urban area [
5
]. Recent studies show that NCDs and their risk factors, especially body
mass index and cholesterol levels rise rapidly in tandem with rapid urbanization [
4, 6
].
Like other LMICs, Bangladesh is also experiencing rapid urbanization. Urban population
has increased exponentially, from21.3 million in 1990 to 53.1 million in 2014, and projected to
reach 112.4 million by 2050 [
5
]. Almost one-third of the urban population lives in the slums,
which are (...truncated)