Prevalence of non-communicable disease among displaced Rohingya in southern Bangladesh: a first look at a persecuted ethnic minority from Myanmar

BACKGROUND

In Cox's Bazar, Bangladesh, 860 356 Rohingya living in refugee camps have experienced decades of persecution. Little is known about disease burden in this population.

METHODS

A retrospective review of deidentified electronic health records (EHR) of 51 270 Rohingya attending two primary health clinics in Kutupalong and Balukahli from October 2017 to October 2019 was performed. A novel EHR system named NIROG was used for patients' medical records'.

RESULTS

Females comprised 53.8% of patients. The median age of females was 25 y and for males it was 19 y. Prevalence of adult hypertension and diabetes was 14.1% and 11.0%, respectively. Also, 16.6% of children aged <5 y had moderate or severe acute malnutrition, while 36.6% were at risk of malnutrition. Body mass index (BMI) analysis showed that 34.4% of adults were underweight. Females were more likely to be hypertensive, diabetic, overweight/obese and malnourished. BMI had a statistically significant positive correlation with fasting blood glucose levels and systolic blood pressure.

CONCLUSIONS

The use of a portable EHR system was highly effective at providing longitudinal care in a humanitarian setting. Significant proportions of the adult population appear to have hypertension or diabetes, pointing to a critical need for management of chronic non-communicable diseases (NCDs). The findings of the current study will help stakeholders to plan effective prevention and management of NCDs among displaced Rohingya and other displaced populations.

The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination

In January 2021, the United States Medical Licensing Examination (USMLE) announced the permanent suspension of their Step 2 Clinical Skills (CS) examination. Launched in 2004, the Step 2 CS examination was intended to ensure that physicians entering graduate medical education possess the necessary information gathering, clinical reasoning, and communication skills necessary to provide patient care. Although the requirement that doctors pass a clinical skills examination as a condition of licensure likely improved some elements of medical education and physician practice, the Step 2 CS examination was deeply unpopular among many medical students since its inception. The demise of USMLE Step 2 CS provides an opportunity to re-examine the test’s value and incorporate improvements in future iterations. However, doing so requires a clear understanding of why the test was so vigorously challenged. Here, we review the history of clinical skills examinations used for medical licensure in the United States and highlight the persistent concerns regarding Step 2 CS’s cost, value, validity, and lack of examinee feedback before proposing future improvements to address each concern.