research studies, health ministry data, hospital data, insurance data, and international resources, but such data may not all be of equal quality. “We need to identify gaps and data needs,” he said, “but also to identify the tradeoffs between quality and pragmatism.”
Bangladesh is fortunate in having a number of sources of data on chronic diseases, said Tracy Pérez Koehlmoos, of the ICDDR,B, although she added that they are “perhaps not collected with the rigor we would like to see.” Sources include reporting data from public hospitals; specialty hospital reports; a survey of risk factors and burdens in six cities (Angeles et al., 2008); standardized data collected using the World Health Organization’s (WHO’s) Stepwise Approach to Surveillance (WHO-STEPS)1 and published research literature.
These data are valuable but do not provide a complete picture, Koehlmoos said. There are no national registries for cancer, for example, although cancer specialty hospitals and medical schools do report some data, which are included in a biennial health report. The specialty hospitals, she added, are “quite strong” but have mostly “worked in isolation rather than thinking about [chronic diseases] as a common issue that needs to be addressed by the whole health system.” The Urban Health Survey data, although they do not cover the whole country, are quite useful because Bangladesh’s population is heavily concentrated in urban areas. Koelhmoos expressed the hope that the next round of the Demographic and Health Survey will provide more data on chronic diseases and risk factors. Also, there has also been a recent “explosion” of primary and secondary studies related to Non-Communicable diseases in Bangladesh, she added.
Bangladesh also has health and demographic surveillance sites run by the ICDDR,B.2 For 40 years, ICDDR,B has followed the lives of more than a quarter of a million people, collecting data about their health, employment, marriages and divorces, and other indicators, Koehlmoos said, which has helped to document the rapid growth in Bangladesh’s mortality rates for Non-Communicable diseases. In 1986, these diseases accounted for approximately 10 percent of all deaths in Bangladesh, but by 2006, they accounted for approximately 70 percent of deaths (Karar et al., 2009).
Bangladesh has many programs of various types to combat chronic
1 For more information about WHO STEPS, see http://www.who.int/chp/steps/en/ (accessed October 2011). Koehlmoos and presenters also cited the value of the INDEPTH network of surveillance sites; see http://www.indepth-network.org/ (accessed October 2011). A participant noted that the WHO STEPS program in Bangladesh was particularly easy to set up, in part because of the presence of the INDEPTH network.