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Diabetic Association of Bangladesh supports Unite for Diabetes

17 Nov 2006 14:41

In 2007, the International Diabetes Federation (IDF) estimates that 3.8 million or 4.8% of people living in Bangladesh will have diabetes. By 2025, that number is expected to grow to 7.4 million or 6.1% of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in 2025. At that date, 80% of all diabetes cases will be in low-and-middle income countries.

The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO predict that the number of women in the world with diabetes will double in less than 20 years. In Bangladesh the number of women with diabetes will grow from the current 2 million to 4 million by 2025. During the same period, men with diabetes will rise from 1.8 million to 3.4 million .

Mirroring trends across the region, the urban population with diabetes in Bangladesh is expected to increase dramatically over the next 20 years. This is due to a combination of urbanization and migration from rural to urban areas.

Professor AK Azad Khan
Professor AK Azad Khan, Secretary General of the Diabetic Association of Bangladesh

‘Unite for Diabetes’ reporter Kerrita McClaughlyn spoke with Professor AK Azad Khan, Secretary General of the Diabetic Association of Bangladesh, recently to find out how the association provides care for people living with diabetes and how his organization plans to help in the fight against the diabetes epidemic.

Q: Why does Bangladesh want a UN Resolution on diabetes?
People all over the world, especially in developing countries, have the impression that diabetes is a disease of the rich. That is NOT the case. Diabetes is rising faster in developing countries like Bangladesh. There are many reasons for the increases, but a key reason is that lifestyles are changing faster in developing countries.

This change is related to urbanization and globalization. You can’t stop it, it is part of civilization. What is of concern is that with this increased urbanization people are getting less physical exercise. Even if they want to exercise, there’s less space to do that. Workplaces, schools and colleges have few or no facilities for physical activity.

The Diabetic Association of Bangladesh (DAB), established in 1956 with the initiative of Late National Professor Dr M Ibrahim, has a declared motto – look after all people with diabetes irrespective of their ability to pay, status or other factors. We have developed several institutions/projects and inspired a large number of affiliated associations all over the country to fulfil the mission.

Diabetic Association of Bangladesh (DAB)

DAB is a democratic and transparent organization. We are not donor dependent and we are self-reliant. We develop infrastructure through partnerships with the government.  We provide services to the affluent and to people who don’t have diabetes and through a policy of cross-financing, and then we help those living with diabetes with the surplus capital that we generate.

BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) is the central institute of DAB which provides comprehensive diabetic healthcare to the people. It is a unique creation of the Diabetic Association of Bangladesh. The institute has:

Decentralized model

DAB adopted a decentralized model and has spread care throughout the country. There are 54 Affiliated Associations in Bangladesh – almost one in every district. They are all affiliated to the DAB. They have to follow certain standards - they must be democratic, transparent, must be run by social workers, and must be non-for-profit. In that way we have been able to create comparatively excellent diabetes awareness.

Bangladesh is a developing country, but in terms of awareness of diabetes we are far ahead of some developed countries. We are well aware of the need to act to soften the possible impact of the diabetes epidemic.

Primary Prevention Program

This program makes people aware of type 2 diabetes and helps them understand that it is 65% preventable. Death does not have to be painful and premature.
The program also puts pressure on regulatory bodies to provide schools with sports programmes. Bangladesh is densely populated which makes it difficult just to find space for exercise. However, creative solutions can be found. For example through sharing; four or five schools can share football grounds.

Manpower Development

Manpower development is a priority of DAB and it is done through formal and informal program. The formal programs include regular postgraduate courses and diplomas in basic and clinical sciences under University of Dhaka and a Certificate Course by DAB following a distance learning method (the Distance Learning Program or DLP). In undergraduate sector DAB runs a medical college- the Ibrahim Medical College. DAB is also on the way to establishing a degree giving Institute – the Bangladesh Institute of Health Sciences (BIHS). The hospital for this institute is now under construction under Netherlands-Bangladesh cooperation. Informally DAB provides training in almost all health related disciplines to personnel from private as well as public sectors.

Q: Can you tell me a little more about the work that DAB does?

DAB is something people wouldn’t expect – it’s more than a typical diabetes association. Usually the main task of other Diabetic Associations is ‘advocacy’ and they work as a pressure group for the policy makers and heath care providers in addition to creating awareness among people. In contrast, apart from its role in advocacy and awareness, DAB (and its affiliates) is the major provider of diabetes care in Bangladesh and, in fact, the largest overall comprehensive health care provider in the country next to the public sectors. We are perhaps looking after 20% of all people with diabetes in Bangladesh and are hoping to cover 50% by 2020.

We are also trying to make the Government Health Services aware of the need for high quality diabetes care. Through the DAB, we are ensuring that diabetes and endocrinology are included in the courses taught at medical colleges. We have successfully convinced the Ministry of Health to create posts for endocrinologists in 7 of the 13 government medical colleges. These include two assistant professors at the University of Dhaka and five other posts outside of Dhaka.

Research is another area where DAB puts great emphasis and this is unlike many other associations particularly in developing countries. Research is a tool for generation of context-based knowledge and also generation of skilled manpower. Recognizing the contribution of DAB in this sector, the World Health Organization has declared BIRDEM as a Collaborating Centre for Research on Prevention and Control of Diabetes. The major areas of research in BIRDEM are: plant materials as a source of antidiabetic agents, etiopathogenesis of diabetes in Bangladeshi population, nutritional values of local food materials and epidemiology of diabetes mellitus. BIRDEM hosts a number of researchers from home and abroad in these research areas.

Q: How will the UNR help?

In developing countries, healthcare is geared towards episodic care. This needs to change to a chronic care model that integrates the healthcare system, the community, and self-management support. A United Nations Resolution on diabetes will help change this mind set.

The UN Resolution would be a tremendous help in raising awareness. It would make our job easier. It would also make policymakers, donors, and civil society aware of the problem. Many in developing countries with diabetes face discriminations in getting jobs. Awareness could go a long way towards ending this.

We need to make sure people know that type 2 is, to a large extent, preventable. The future need not be gloomy; a full and healthy life is possible with diabetes. That is a very important message for all affected by diabetes.

The developing countries typically focus on communicable diseases. Non-communicable diseases like diabetes have been neglected. More attention is required urgently before these countries are overwhelmed by the diabetes epidemic. 

 

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