Epidemiological transition in Bangladesh

Emerging pattern of morbidity : Impact on mortality, health & epidemiological transition in the context of Bangladesh MD.Mahir faysal Department of Population Sciences University of Dhaka Abstract Bangladesh, like many transitional nations is straddling the demographic and epidemiological transition. It is now experiencing the late expanding stage of demographic transition where fertility is getting lower to reach the decreased level of mortality that means it has already decreased its mortality. Again Bangladesh is now also experiencing the third stage of epidemiological transition which is age of degenerative & man-made diseases. The changing pattern of diseases & causes of death are raising new challenges which are essential to provide need based healthcare delivery to the population. This paper will focus the trend & changing pattern of morbidity & its impact on mortality, health & epidemiological transition in the context of Bangladesh

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Table of Contents 1. Introduction…………………………………………………………………………..…….…2 2. Current situation of morbidity in Bangladesh………………………………………..….……2 3. Differentials of morbidity in Bangladesh 3.1 Proportion of morbidity by asset quintile……………………………………..…..….3 3.2 Proportion of morbidity by division & sex………………………………..…....…...3 3.3 Rural urban differentials of morbidity in Bangladesh………………………......…. 3 3.4 prevalence of morbidity by age group………………………………………..…......4 4. Main causes of death in Bangladesh………………………………………………...…....…. 4 4.1 Top 10 causes of death by residence……………………………………..…...…….5 5. Trend of morbidity over the years in Bangladesh………………………………………….. 5 6. Trend in crude death rates in Bangladesh……………………………………………….....…6 7. Rank & disorder of the diseases: shifting from communicable to non communicable pattern……………………………………………………………………………………...……6 8. Linkup the pattern of mortality, epidemiological & health transition in the context of Bangladesh …………………………………………………………………………………..….7 9. Conclusion………………………………………………………………………………..…..8

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1. Introduction Bangladesh, like many transitional nations is straddling the demographic and epidemiological transition. According to Hayes & Jones (2015) it is now experiencing the late expanding stage of demographic transition where fertility is getting lower to reach the decreased level of mortality that means it has already decreased its mortality. Again Taylor (2012) claims that Bangladesh is now also experiencing the third stage of epidemiological transition which is age of degenerative & manmade diseases. The changing pattern of diseases & causes of death are raising new challenges which are essential to provide need based healthcare delivery to the population. This paper will focus the trend & changing pattern of morbidity & its impact on mortality, health & epidemiological transition in the context of Bangladesh 2. Current situation of morbidity in Bangladesh

28,3

7,5 7,3

6,7

4,5 4,2 3,5 2,6 2,3 2,2

2,1 1,8

1,8 1,5

1,4 1,4

1,2

1

1

Source: GoB 2013 This figure shows that morbidity due to communicable disease is surely has little effect nowadays. Morbidity due to communicable diseases have now taken over by the different type of non- communicable diseases such as-diabetes, dysentery, high blood pressure, peptic ulcer, arthritis and fevers of different sorts. In Bangladesh non-communicable diseases are now the highest leading causes for morbidity. As the figure shows the proportion of disease occurrence of all ages, 28.3% are morbid due to fevers, 7.5% are due to arthritis, 7.3% to peptic ulcer, 6.7% to high blood pressure, 4.5% to dysentery, 4.2% to diabetes, 3.5 % to diarrhea, 2.6% to acute respiratory infection respectively. On the other hand many communicable diseases are causing little morbidity as shown in the figure. Such as 2.2% are morbid due to conjunctivitis,1.4% to measles , 1.4% to whooping cough,1.2 % due to influenza respectively

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3. Differentials of morbidity in Bangladesh 3.1Proportion of morbidity by asset quintile

asset quintile % 30 20

21,7

21,5

20,3

18,7

17,8

lowest

second

middle

fourth

highest

10 0

Source: GoB 2013 Proportion of most of the diseases was higher among persons with lowest asset quintile and usually it had a decreasing trend among the people with upper asset quintiles. According to the health survey non-communicable diseases like diabetes, high blood pressure and cancer shows a opposite scenario. The proportion of diabetes was 41.9% among persons of the highest asset quintile and in the lowest asset quintile it was 10.3%. Proportion of high blood pressure and cancer among persons of highest asset quintile was 32.4% and 32.6% respectively where it was among lowest quintile 20% & 15.8 & respectively. 3.2 Proportion of morbidity by division & sex

Division Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Source : GoB 2013

Proportion of morbidity % Total Male 4.9 4.4 14 13.9 34.7 34.8 15.1 14.7 12.5 12.5 13.8 14.6 4.8 5.2

Female 5.4 14.1 34.7 15.5 12.5 13.2 4.5

Table shows that the total morbidity, 34.7% were in Dhaka division which was highest and in Sylhet it was lowest 4.8%& also Barisal 4.9% . In Dhaka, Rangpur and Sylhet division male were reported more morbidity compared to female. 3.3 Rural urban differentials of morbidity in Bangladesh According to the Government of Bangladesh (2013) prevalence of morbidity per 1000 population says that Arthritis, peptic ulcer and high blood pressure had prevalence of 14.8, 14.2 and 10.1 per 1000 population respectively in rural areas. But in urban areas, prevalence of high

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blood pressure was 20.2 and that of diabetes was15.6 per 1000 population. Prevalence of high blood pressure in urban areas was almost double of that in rural area. Diabetes in urban area also occurred almost three times higher than that in rural area. Prevalence of asthma & heart disease were also higher in urban areas compared to rural areas. Interesting thing is that all of these are non communicable diseases. But communicable diseases like Dysentery, Diarrhea, and Malaria. Tuberculosis is not found in significant level in both urban & rural as well as in national level. 3.4 Prevalence of morbidity by age group 600 500 400 300 200

476,3 365,4 234,3

100

96,1

110,1

15-29

05-14

0 60+

50-59

30-49

179,9 01-04

253,6