Finally, here we are: The completion of my project at ICDDR, B.
Below you will find a brief article describing the project–its development, aims and goals. The write-up is also to be featured in an upcoming Chronic Disease Newsletter published by the Center for Control of Chronic Diseases in Bangladesh (CCCDB).
Preceding the article is an album containing the powerpoint slides that were used during my final presentation. Click on the image below to view a gallery of the presentation slides, which outline and explain my project, using visuals and text.
More than three in five people will die due to chronic illness this year – a number that is steadily on the rise. According to reports published by the World Health Organization, chronic, non-communicable diseases make up the world’s number-one killer, claiming the majority of lives on the planet annually (7). Of this figure, 80 percent who are affected reside in middle and low-income countries such as Bangladesh, which has proven no exception to these trends. In fact, research has shown that the number of deaths related to chronic diseases in Bangladesh has only grown over the past decades, and will continue to pose a serious threat without proper attention (4, 8, 10).
Chronic diseases are characterized by several key traits, which include (6, 9):
- Multiple risk factors
- Require systematic, regulated treatment
- Lack a cure; in most cases they are life-long diseases
Given their nature, chronic diseases are often quite difficult and expensive to treat, especially at advanced stages. However, due to their prolonged duration and latency period, there are several opportunities for prevention of these illnesses.
This is why it is becoming evermore crucial to address this issue in Bangladesh using preventative measures; especially in rural regions, which experience higher prevalence rates due to a lack of medical resources—doctors, hospitals and medication—and poor levels of health education and awareness (2, 3).
Recent collaboration between ICDDR, B’s Public Health Sciences Department and Chronic Disease Unit has given rise to the creation of the Chronic Disease Community Health Modules as a potential form of intervention for rural communities.
The modules are designed for implementation as a workshop, consisting of a group of villagers (12~15) and one or two appointed facilitators to act as guides. Facilitators provide information and support to the villagers during the workshop, helping them understand the basics of the chronic diseases most prevalent in Bangladesh, namely Diabetes, Hypertension and Cardiovascular Diseases (5).
It has been specified that trial-runs of the project are intended to take place in Chakaria, an Upazila within the Cox’s Bazaar District. The site was chosen based on the location of ICDDR,B’s Chakaria Campus, which maintains close contact with rural villagers in the area via the local Village Health Posts that provide basic health services to the community (4). Additionally, there exist several grassroots Chronic Disease Clubs, where individuals can meet with a village doctor once a month in order to receive minimal assessment services, such as blood pressure monitoring. However, as of yet these clubs do not promote any form of chronic disease education, or further developed prevention-based intervention. This provides for a prime sample population that can be used to assess the potential benefits of the workshop, so that it may one-day be scaled-up and adjusted for use throughout various rural areas in Bangladesh.
The workshop modules focus on the primary modifiable risk factors leading to chronic disease:
- Unhealthy Diet
- Physical Inactivity
- Tobacco Use
The World Health Organization has emphasized that these three items need to be targeted as the first-line means of preventing chronic illness (9). Therefore, by providing information and tactics to navigate these risk factors, the modules may aid in spurring the community to make lifestyle changes necessary for guarding against chronic diseases.
In order to accomplish this goal, the workshop relies on ‘bottom-up’ techniques adapted from Participatory Rural Appraisal (PRA) – a method that facilitates local people to (1):
- Analyze information,
- Practice critical self-awareness
- Share personal knowledge of the community to enact a plan of action
Thus, the majority of the workshop is focused on collaborative problem-solving in the form of group discussion and activities; not only are the participants able to learn about the causes and effects of chronic diseases, but they are also encouraged to examine the underlying systems and barriers in the community that perpetuate risk. Step-by-step instructions, discussion topics, activities, and scientifically verified informational charts and data tables are all provided within the contents of the manual to help guide facilitators to achieve these results.
In total, the manual contains four modules. The first serves as an introduction to chronic disease, and the following three sections are based on each of the primary risk factors. These are outlined in further detail below.
Module 1: Assessing Health and Illness in the Community
This primary objective of the first module is to observe general perceptions of health and illness held by the community. Participants review basic information on chronic diseases, while analyzing how outlying social and physical factors influence health and risk.
• Identify the current physical, social, and health issues faced by the community; examine as a group how these issues overlap
• Discuss the basics of chronic diseases: what are they, who do they affect and how
• Assess risk among participants and within the community
Module 2: Diet and Nutrition in Maintaining Chronic Disease
The module assists facilitators to discern general dietary trends in the community, as well as assess the participants’ basic understandings of nutrition. It also provides information and techniques in order to encourage participants to follow a proper balanced diet.
• Observe dietary practices and assess dietary knowledge in the community
• Review the basics of nutrition: fruits and vegetables; fats, proteins, and carbohydrates; cholesterol and calcium; salt and sugar
• Assess participants’ learning and reinforce concepts and techniques to maintain a healthy, balanced diet
Module 3: Physical Activity and Exercise in Maintaining Chronic Disease
The module reviews the classifications and benefits of physical activity, and its role in guarding against chronic diseases. Not only do participants learn how to better incorporate balanced physical activity into their everyday lives, but they also have the opportunity to participate in a low-impact exercise session as a group for dynamic learning.
• Survey seasonal trends that may lead to increased or decreased times of physical activity
• Review the benefits of physical activity and the five keys to incorporating it into everyday life: leisure/sport, house/yard work, occupational activity, self-powered transport, avoiding sedentary activity
• Partake in a group exercise session
Module 4: Tobacco Use and Maintaining Chronic Disease
The final module is designed for in-depth evaluation of the prevalence and effects of tobacco use in the community. An overview of both the health risks of tobacco use and the benefits of quitting give participants the opportunity to discuss ways to mobilize members of the community to quit or reduce smoking and chewing tobacco.
• Uncover the root causes and influences leading to tobacco use in the community
• Review the risks, dangers, and health hazards of different types of tobacco use, including: smoking, chewing, and second-hand smoke
• Identify along the “spectrum of quitting” and discuss the personal, economic, and communal benefits to quitting tobacco use
Hopefully, the Chronic Diseases Community Health Modules will prove to be a comprehensive teaching and learning tool, growing in its potency over time. As they are now, the modules serve as a starting point for further development and refinement. As more individuals and specialists access the module—in full or in parts relevant to their work—they may provide their own contributions and feedback, continuing to enhance its effectiveness in addressing chronic disease not only in Chakaria, but eventually, throughout all of Bangladesh.
(1) Bhandari, Bishnu B. “Participatory Rural Appraisal (PRA).” Institute for Global Environmental Strategies (2003). Print.
(2) Center for Control of Chronic Diseases in Bangladesh. “Interaction between Chronic Disease and Poverty in Low- and Middle-income Countries.” Chronic Disease News 2 (Nov. 2010). Print
(3) Center for Control of Chronic Diseases in Bangladesh. “Chronic Disease Prevalence and Risk Factor Situation in ICDDR,B Health and Demographic Surveillance Sites.” Chronic Disease News 2 (May 2010). Print.
(4) ICDDR, B Periodical. “Chakaria Community Health Project Community Mobilization Toward Self-help for Health.” Glimpses 23.3 (September 2001). Print.
(5) International Center for Diarrhoeal Disease Research, Bangladesh. “Diabetes: The Emerging Epidemic in Bangladesh.” ICDDR,B Annual Report (2008): 7-10. Print.
(6) National Public Health Partnership. Preventing Chronic Diseases: A Strategic Framework. Rep. 2001.
(7) World Health Organization. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. 2008
(8) World Health Organization. Impact of Chronic Disease in Bangladesh. Chart. 2002
(9) World Health Organization. Preventing Chronic Diseases: A Vital Assessment. Rep. Geneva, Switzerland: WHO, 2005. Print.
(10) Zunaid Karar et. al 2009 – Epidemiological Transition in Bangladesh 1986-2006, Global Health Action