Gestational Diabetes Mellitus - A Public Health Concern in Rural Communities of Nepal

BACKGROUND

Gestational Diabetes Mellitus (GDM) is in increasing trend recently. It is associated with adverse effects on both mother and fetus. Thus, diagnosis of GDM is an important public health issue. This study aimed to determine the frequency of gestational diabetes mellitus in three rural districts of Nepal.

METHODS

A hospital based study was conducted in three districts representing mountain, hill and Terai belts of Nepal during the period of July 2009 to June 2010. A total of 564 pregnant women were interviewed and tested for blood glucose as per WHO guideline Results: In Nepal, only 2.5% of pregnant women had GDM according to WHO criteria while it was 6.6% according to IADPSG criteria. Overall mean blood glucose among pregnant women was 72.1 (fasting) and 95.8 (after 2 hrs of 75 gm glucose intake) in which it was 62.8, and 75.1 in Dhading, 78.7 and 88.9 in Dhangadhi, and 98.3 and 99.3 in Solukhumbu districts respectively. Pregnant women with increased age were significantly at high risk of having GDM than those of younger women (p=0.04). There were non-significant differences in GDM by District, Ethnic group and family history of DM.

CONCLUSIONS

Gestational diabetes in the rural areas of Nepal is variable with two different criterias (2.5% vs 6.56%). Increasing age was an important influencing factor. Special attention should be given on women with increasing age. There was no significant difference in prevalence of GDM in three ecobelts of Nepal despite of altitude and cultural variability.

Risk factors of multi-drug-resistant tuberculosis in Bangladeshi population: a case control study

Despite success in tuberculosis control, multi-drug resistant tuberculosis in Bangladesh is increasing and currently multi-drug-resistant tuberculosis rate is 3.6% in new cases and 19% in re-treatment cases. This study focused on determination of multi-drug-resistant tuberculosis which is warranted for effective prevention strategy. An unmatched case control study was conducted in 2010. Purposively recruited 136 culture-proved multi-drug-resistant- tuberculosis cases and 152 cured tuberculosis patients were interviewed. Associations between exposure and outcome variables were initially tested by chi2-test, t-test. A result was considered significant at p value < 0.05. Effects of exposure variables were also assessed after adjusting for other variables by binary logistic regression models. Crude and adjusted Odds Ratio with 95% Confidence Interval was computed. Younger age (p = 0.008) and, peri-urban locality (p = 0.002) were associated with multi-drug-resistant tuberculosis. History of contact (p < 0.001) and tuberculosis in the past (p < 0.001) were four and eight times, respectively, more likely to influence multi-drug-resistant tuberculosis. Regularity [Odds Ratio 0.05; 95% Confidence Interval (0.01 to 0.39)] and always observation of treatment [Odds Ratio 0.25; 95% Confidence Interval (0.10 to 0.61)], sputum conversion [Odds Ratio 0.02; 95% Confidence Interval (0.01 to 0.08)] negatively associated with multi-drug-resistant tuberculosis. Gender and socio-economic status did not show any influence. Treatment course and sputum conversion was the best predictors. Like other developing countries adequacy of treatment is the most important exposure variable. Strengthening of control activities might contribute in preventing development of resistance in tuberculosis patients.

Health related Quality of Life with HIV/AIDS in different stages of HIV infection

Disease stages of HIV infection is one of the important predictor of Health related Quality of Life (HQoL) of the people living with HIV/AIDS. This cross sectional study was an attempt to compare the HQoL of HIV-infected patients across the three CDC stages of HIV-infection namely, asymptomatic, symptomatic, and AIDS-related conditions. A total of 82 patients, 28 in asymptomatic, 26 in symptomatic, and 28 in AIDS-related conditions, from three NGOs and one Infectious Disease Hospital (IDH) were interviewed using interviewer administered semi structured questionnaire developed by adopting "World Health Organization Quality of Life HIV BREF (WHOQOL-HIV BREF) instrument". Analysis revealed that AIDS-related conditions and symptomatic patients were experiencing significantly poorer quality of life than asymptomatic patients in the domain of physical (F=7.006, p <0.005), level of independence) F=6.552, p<0.005(, overall perception of health related quality of life (F=3.634, p<0.05) and overall general health perception (F=7.842, p<0.001).

Depression and its association with socio-demographic characteristics among type 2 diabetes mellitus patients of Bangladesh

Diabetes mellitus is being increasingly recognized as a serious global health problem and is frequently associated with co-morbid depression. A cross sectional study was conducted among 178 adult type 2 diabetes mellitus patients attending Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh to find out influence of socio-demographic characteristics for occurrence of depression among them. Data were collected through face-to-face interview. Depressive symptoms were measured using Centre for Epidemiological Studies Depression Scale. Proportion of depression was found 34.8% which included 20.2% with severe depression and 14.6% with mild to moderate depression. Both mild to moderate and severe depression were significantly more common in female, odds ratios were 2.72 (95% CI=1.13-6.53) and 5.94 (95% CI=2.49-14.20), respectively. Currently not married respondents were also suffered from higher depressive symptoms. For mild to moderate depression odds ratio was 4.38 (95% CI=1.46-13.18) and for severe depression odds ratio was 9.51 (95% CI=3.69-24.50). Among socio-demographic characteristics marital status was identified as the best predictor of depression, which was followed by education upto secondary level, female sex and primary education. Depression was identified as a significant health problem among adult type 2 diabetes mellitus patients. Its association with socio-demographic characteristics should be considered while planning therapeutic approaches for diabetic patients.

Gender and locality differences in tobacco prevalence among adult Bangladeshis

OBJECTIVES

To determine the extent of all forms of tobacco usage in adult Bangladeshis in relation to gender and locality.

METHODS

Three annual urban and rural cross-sectional surveys were carried out between 2001 and 2003 involving a total of 35,446 adults, of whom 54.3% were female and 51.0% were rural dwellers. Data were collected through interview using a structured questionnaire.

RESULTS

The overall prevalences of smoking, chewing tobacco and gul usage were 20.5%, 20.6% and 1.8%, respectively. Current smoking and gul usage were significantly higher in males (42.2% and 2.2%, respectively) than females (2.3% and 1.5%, respectively) while chewing tobacco was more common in females (21.6%) than males (19.4%). No significant urban-rural difference was observed in smoking rate after adjusting for sociodemographic variables, while chewing tobacco was 1.5 times more likely to occur in rural residents and gul usage was 3.6 times more likely to occur in urban residents. On average a smoker consumed 9.3 sticks a day with males and rural residents smoking more.

CONCLUSIONS

Nearly a third of the population in Bangladesh use some form of tobacco. There are marked urban-rural and male-female differences. This difference is mainly accounted for by the higher prevalence of chewing tobacco in rural areas, rural female tobacco usage is close to double than the urban rate. Smoking rates were low in Bangladeshi females, more so in urban than rural areas. The tobacco awareness programme in Bangladesh might require putting emphasis on smokeless tobacco as well as smoking.

Verbal autopsy for maternal death

This cross sectional study was done in Gopalganj district from September 1997 to August 1998. To ascertain the magnitude and causes of maternal deaths and perinatal and neonatal outcome of the babies. Two hundred five in maternal deaths occurring from 1994 to 1997 were investigated by verbal autopsy. Teenager mothers had more deaths in first pregnancy. Maternal deaths increased with gravidity above 30 years. Haemorrhage and eclampsia were common causes of death. Eclampsia was prominent in primigravids <20 years while haemorrhage occurred more in multigravidas between 25-35 years of age (P = 0.029 for age, P = <0.001 for gravidity). Nearly 64% of maternal deaths occurred in postpartum period. Among live births, 45.6% babies died before their first birth day. The findings support the need of increasing the age of marriage and first childbirth, through strengthened family planning programme and ensuring skilled birth attendance during delivery. It also stresses need for communication on danger signs of pregnancy and childbirth.

Birthweight of the babies delivered by chronic energy deficient mothers in National Nutrition Program (NNP) intervention area

An operational research was done to explore the effect of targeted food supplementation by comparing the birthweight of the babies of two areas (intervention & nonintervention). This record-based study was carried out in Kapasia and Savar upazila of Dhaka division, relying on the primary organizational data of 565 mothers. In the National Nutrition Program (NNP) area only fifty percent moderate to severe malnourished [Chronic Energy Deficiency (CED) II & III] mothers were preferably targeted for onsite food support while 34 of them managed to complete the full course. The mean (±SD) BMI of the supplemented mothers were lower (16.21±0.77) kg/m2, than non-supplemented mothers in Kapasia (17.14±.82) kg/m2 and Savar 17.03±1.19) kg/m2 area. The mean (±SD) birth-weight for non NNP (Savar) category Mean (±SD) 2470±366.03 grams, for NNP (Kapasia) non-supplemented group 2720.18 (±368.63) grams and in Kapasia good supplemented group it was 2752.94 (±344.86) grams. Supplemented and non-supplemented mothers of NNP mothers were four times more likely to deliver normal birthweight babies [odds ratio with 95%CI 3.84 (2.01, 7.34)] and [odds ratio with 95%CI 3.90 (2.17, 7.01)] than mothers of control area when adjusted for sociodemographic variables. Birth weight status improved with better CED levels. Birth weight adjusted for CED status, had no significant association with food supplementation. In this study, the basic findings were food supplementation could not increase birth-weight significantly as other effects contributed to improve birthweight were removed. As fully supplemented CED III mothers gave birth almost same weighted babies in comparison to the babies of CED I mothers; the recovery from the probability of being less weighted than the current status might be considered as a potential effect of food supplementation.   DOI:  http://dx.doi.org/10.3329/bmrcb.v37i1.7794 Bangladesh Med Res Counc Bull 2011; 37: 17 – 23