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IntroductionNutrition labeling provides nutritional information about nutrients present in a food product. It is commonly applied to packaged foods and beverages, where the information can be presented on the back or front of the pack as the nutrient declaration, nutrition and health claims, and supplementary nutrition information. Nutrition labeling is an important policy instrument for improving the nutritional quality of foods and promoting healthy diets, as it allows consumers to make informed purchasing decisions. This document review aims to provide a comprehensive overview of government-endorsed nutrition labeling policies related to nutrient declaration, nutrition claims, and supplementary nutrition information enforced worldwide.MethodsWe searched two nutrition policy databases, the Global database on the Implementation of Food and Nutrition Action (GIFNA) and the NOURISHING database, and government websites of some selected countries for the government-endorsed nutrition labeling policies published up to June 2023. We narrated the policy adopting countries' distribution by WHO regions, mode of implementation (voluntary or mandatory), and types of front-of-pack labels implemented.ResultsGlobally, we found that 95 countries have mandatory policies for nutrient declarations on packages of processed products. These include 41 countries in Europe, 19 in America, 14 in the Western Pacific, nine in Africa, seven in the Eastern Mediterranean region, and five countries from South-East Asia. Additionally, 71 countries have policies on the use of nutrient claims like “fat-free,” “excellent source,” and “fortified.” European region has the highest number of countries (37) that have rules on nutrient claims. Front-of-pack labeling (FOPL) policies have been introduced in 44 countries as supplementary nutrition information. Of these, 16 countries have adopted FOPL as mandatory, while others have implemented it voluntarily. The FOPL systems include warning labels, keyhole logo, health star rating, traffic light labeling, nutri-score, and healthy choice logos.ConclusionOver recent years, the number of countries adopting mandatory nutrition labeling policies, especially FOPLs, has increased globally. Labeling policies should be evidence-based and follow the best practices to protect consumers from unhealthy nutrients and promote healthy eating. FOPL designs need to be selected based on country-specific evidence of effectiveness and appropriateness, avoiding industry influence.

Objectives This study aimed to examine the distribution of daily salt intake across the hypertension care cascade and assess the proportional distribution of these care cascade categories across various salt consumption level.Design A population-based national cross-sectional study.Settings Data from the Bangladesh STEPS 2018 survey were used, encompassing both urban and rural strata within all eight divisions. National estimates were generated from weighted data.Participants A diverse population of 6754 men and women aged 18–69 years was included in the study.Outcome measures Daily salt consumption was estimated using the spot urine sodium concentration following Tanaka equation. Distribution of salt intake among different categories of hypertension care cascade, including hypertensives, aware of hypertension status, on treatment and under control, was assessed.Results Individuals with hypertension consume more salt on average (9.18 g/day, 95% CI 9.02 to 9.33) than those without hypertension (8.95 g/day, 95% CI 8.84 to 9.05) (p

Background: Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. Objective: Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. Methods: In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. Key Results: Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. Conclusions: NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12–e20.]

Objectives Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries.Design Two cross-sectional surveys.Setting The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria.Participants Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria.Outcome measures Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators.Results In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%).Conclusions Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs’ roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.

The World Health Organization recommended reducing one’s salt intake below 5 g/day to prevent disability and death from cardiovascular and other chronic diseases. This review aimed to identify salt estimation at the population level in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. We searched electronic databases and government websites for the literature and reports published between January 2011 and October 2021 and also consulted key informants for unpublished reports. We included studies that assessed salt intake from urinary sodium excretion, either spot urine or a 24 h urine sample, on a minimum of 100 samples in South Asian countries. We included 12 studies meeting the criteria after screening 2043 studies, out of which five followed nationally representative methods. This review revealed that salt intake in South Asian countries ranges from 6.7–13.3 g/day. The reported lowest level of salt intake was in Bangladesh and India, and the highest one was in Nepal. The estimated salt intake reported in the nationally representative studies were ranging from 8 g/day (in India) to 12.1 g/day (in Afghanistan). Salt consumption in men (8.9–12.5 g/day) was reported higher than in women (7.1–12.5 g/day). Despite the global target of population salt intake reduction, people in South Asian countries consume a much higher amount of salt than the WHO-recommended level.

Background: In Bangladesh, there is a scarcity of nationally representative data on the burden of chronic obstructive pulmonary disease (COPD). Methods: To estimate the COPD prevalence in rural settings, this cross-sectional, population-based study was conducted in all eight administrative divisions of Bangladesh, and involved adults aged 40 years and above. By using multi-stage random sampling, 2,458 individuals were enrolled. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were used to diagnose COPD based on post-bronchodilator lung function, while additional participant data was gathered through computer-assisted personal interviews. Results: A 2% COPD prevalence (95% CI: 1.45, 2.55) was found in the study sample with a statistically significant difference between males (2.7%; 95% CI: 1.8, 3.6) and females (1.2%; 95% CI: 0.59, 1.81). Increasing age significantly inflated the odds of having COPD irrespective of sex (OR: 1.03; 95% CI: 1.00, 1.05; P value < 0.05). Furthermore, prevalence of COPD was higher among manual workers, cigarette smokers, and those that used the indoor kitchen and did not have a primary education. Sex-based analysis showed that smokeless tobacco consumption was significantly associated with COPD occurrence among males (OR: 2.14; 95% CI: 1.05, 4.37; P value < 0.05), but not females. Further, using an indoor kitchen increased the odds of developing COPD by 400% among female participants (OR: 4.39; 95% CI: 1.37, 14.10; P value < 0.05). Conclusion: This study provides a comprehensive sex-based estimation of COPD prevalence among rural population and imparts significant contribution to the growing database on COPD prevalence in Bangladesh.

Tobacco use in Bangladesh has been high, but there is no report on community-level intervention to reduce tobacco use. The aim of this article is to report the experience of eight years of community intervention to reduce tobacco use in a rural area of Bangladesh. We have done four householdbased surveys (2006, 2008, 2012, and 2014) in Ekhlaspur village of Chandpur district. One man and one woman aged ≥18 years from each of 600 households were selected for each survey randomly to monitor tobacco use in this village concomitant with community interventions. The intervention package included yard meetings, health facility-based counselling, observance of the world no-tobacco days, and periodic lectures in schools. Chi-square for linear trend analysis was done to examine declining trends of prevalence of tobacco use. There were 953 to 1015 participants, approximately half being men in each survey. Their mean age was 44 to 45 years in all surveys. A decline in tobacco use has been observed from 58.8 in 2006 to 43.4% in 2014 (Ptrend=0.000). There has not been any perceivable change in smoking in women because it was either zero or close to zero across surveys. A similar trend was observed in age groups, educational achievements, and hypertension (Ptrend=0.000). Smoking in men declined from 58.3 to 35.2% (Ptrend= 0.000). Community interventions in a sustainable manner can reduce tobacco use in rural communities of Bangladesh. BSMMU J 2022; 15(3): 157-161

Objective This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh.Design A population-based cross-sectional survey.Setting A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012–2013.Participants 418 community living residents aged 40–59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study.Outcome measures The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion.Results The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67).Conclusion Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.

Abstract Background Developing strategies aimed at reducing behavioral risk factors and hence the prevalence of non-communicable diseases (NCDs) is a major challenge to the policy makers today. Like the same age group worldwide, the prevalence of obesity, unhealthy dietary habit, physical inactivity, smoking and alcohol intake is high among the adolescents of Bangladesh. Studies showed promising results of an early intervention at adolescent age in reducing the likelihood of NCDs at adult age. So, this study is designed to implement a behavior change intervention and evaluate the effectiveness of the intervention in reducing the behavioral risk factors of NCDs among the adolescents of Bangladesh. Methods A before-after designed intervention study will be conducted in two randomly selected secondary schools- one will be selected randomly as intervention school and the another as control school. A baseline survey will be conducted among the students of both schools by a pre-tested questionnaire to attain their current status of knowledge, attitude and practices related to NCDs. Afterward, students will be enrolled in the intervention group who will meet the eligibility criteria from the intervention school. The intervention will be given through a health promotion session to a group of students, not more than 25 at a time, by trained facilitators. A post-intervention end line survey will be conducted among all the participants from both schools using the same questionnaire 3 months after the baseline survey. Discussion An intervention has been developed based on some principals of two psychosocial theory- Motivational Interview and Social Cognitive Theory. Emphasis will be given on motivating the adolescents towards a healthy lifestyle, supporting self-efficacy to be changed, guiding self-regulatory ways along with facilitating desired changing process by empowering them with choices about the preventive measures of NCDs. This intervention is expected to increase awareness by equipping the adolescents with specific knowledge and skills and thus, facilitate an eventual change in their practiced risk behaviors. Besides, this intervention will address multiple behaviors at a time, and will be delivered to a group of adolescents, to attain the cost-effectiveness and thereby making it more realistic in the resource-poor context of Bangladesh. Trial registration ClinicalTrials.gov NCT03975335, registered on 01.06.2019. Retrospectively registered.

Objective We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh.Design Cross-sectional study.Setting Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division.Participants A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas.Primary outcome Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure >140 mm of Hg and/or diastolic blood pressure >90 mm of Hg, and/or persons with already diagnosed hypertension.Results The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban—adjusted OR (AOR): 1.3, 95% CI: 1.0 to 1.5 and rural—AOR: 1.7, 95% CI: 1.4 to 2.1)), higher educational status (urban—AOR: 1.7, 95% CI: 1.3 to 2.2 and rural—AOR: 2.1, 95% CI: 1.5 to 3.1), inadequate physical activity (urban—AOR: 1.3, 95% CI: 1.0 to 1.7 and rural—AOR: 1.5, 95% CI: 1.2 to 1.9) and overweight/obesity (urban—AOR: 2.7, 95% CI: 2.1 to 3.3 and rural—AOR: 2.1, 95% CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural—AOR: 1.8, 95% CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95% CI: 1.0 to 2.6).Conclusion Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.

IntroductionInterventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits.Materials and methodsThe baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents.ResultsThe average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents' higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping.ConclusionThe findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group.Trial registrationTrial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.

Objective Prevention of mortality due to cardiovascular disease (CVD) through control of hypertension is a public health priority in Bangladesh. Our objective was to assess sex differences in prevalence and determinants of hypertension among adults in one rural area of Bangladesh.Study design Cross-sectional.Setting and participants From January 2014 to December 2015, we conducted a cross-sectional study of 2600 men and women aged ≥18 years located in one rural district of Bangladesh. We collected data on demographics, behavioural factors, physical measurements and health history.Primary outcome measures Our primary outcome was hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mm Hg).Results The average age of participants was 41.6 years and 53.7% were women. Hypertension prevalence was 6.9% (95% CI 5.9 to 7.9), and was significantly higher among women (8.9%) than men (4.5%). The highest prevalence of hypertension was observed among women aged ≥60 years at 21.3% (95% CI 16.6 to 26.7). A higher proportion of men with hypertension were aware of their condition (72.2%) compared with women (52.4%). Determinants of hypertension included older age, higher education, current tobacco use, increasing body mass index, and hyperglycaemia.Conclusion Our research suggests that hypertension prevalence is higher among women than men in rural Bangladesh. Sex-specific interventions should be developed to inform adults of the necessary lifestyle changes that may reduce the risk of hypertension and subsequent CVDs.

Background: Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard. Objective: The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population. Setting: Rural and urban sites from seven divisions of Bangladesh. Participants: Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis. Methods: Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used. Results: PP decreased linearly with increasing height among males (−0.11, P

Background: A nationally representative survey was carried out to determine the distribution of blood glucose and cholesterol in adult population of Bangladesh in the absence of existing data. Methods: The study adopted a multistage and geographically clustered sampling technique of households. A total of 2610 individuals (1444 men and 1166 women) aged 25–64 years were selected from rural and urban areas. Capillary blood glucose and total cholesterol levels were measured using an overnight fasting state. Results: The mean age of the participants was 41 years [standard deviation (SD), 11 years]. Half of them (49%) were from urban areas. Half of them (51%) had primary or higher education. Mean glucose was 74 mg/dL (SD 23 mg/dL). Men had higher mean glucose levels (79 mg/dL) than women (67 mg/dL). Age-standardized prevalence of diabetes (blood glucose level ≥126 mg/dL and/or use of anti-diabetic medication) was 5.5%. In men, it was almost two-and-half times (7.6%) compared with women (2.8%). It was also double in urban areas (7.8%) compared with rural areas (3.4%). Mean cholesterol level among all participants was 167 mg/dL (SD 26 mg/dL). Men and women had almost similar levels (169 mg/dL versus 166 mg/dL, respectively). Prevalence of high cholesterol level (≥240 mg/dL) was very low (1.3%) in both men (2.2%) and women (0.5%). However, the prevalence of borderline high cholesterol was substantial (5.8%) in this sample. Conclusion: The prevalence of high hypercholesterolemia is low, whereas there is a high prevalence of borderline high cholesterol and diabetes in the adult population of Bangladesh. This warrants population-based interventions to tackle this problem.

Background Tobacco use is an important risk factor for non-communicable diseases (NCD) and 43.3% adult use tobacco on regular basis in Bangladesh. Many patients continue to use tobacco even after diagnosis of NCDs indicating lack of awareness and appropriate cessation support. Present study was done to investigate the pattern of tobacco use among NCD patients in an urban population in Dhaka city, Bangladesh. Methods A cross sectional study was done in a middle class urban population of Dhaka city in 2013. Household survey was done to collect information on demography, lifestyle, personal habits, and disease history. Information on tobacco use of all adult residents aged 25 years or more were collected from household head by a structured questionnaire. Household members having history of ischemic heart disease (IHD), stroke, hypertension and diabetes were identified and corroborated by presence of physician's record. Results In total information of 43,727 individuals was collected and data of 23,731(54.3%) respondents aged 25 and above were analyzed for the present study. Among the respondent's overall tobacco use were 29.6% (smoking 19.1%, smokeless tobacco 12.3%). Smoking and smokeless tobacco user among male were 36.9%, 8.5% and among female were 0.3%, 16.4% respectively. Among the respondents 29.7% were diagnosed case of one of the major NCDs (21.9% were hypertensive, 12.9% were diabetic, 6.4% had IHD and 2.7% had history of stroke). Among NCD patients 35.5% continued to use tobacco even after diagnosis. 35.3% hypertensive patients, 32.1% diabetic patients, 36.3% IHD patients and 34.5% stroke patients were tobacco user respectively. Conclusions Tobacco use was highly prevalent in urban male population. Large number of hypertensive, diabetic, IHD and stroke patients of urban population continue to use tobacco. Measures should be taken for control of tobacco use at population level as well as NCD patients should be intervened effectively for tobacco cessation.

Background Bangladesh has very high tobacco use rate. Various efforts by the Government and non-government organizations are being made to reduce the tobacco consumption both at national and local levels. However, information is scare about the impact of these efforts on tobacco consumption in Bangladesh. Methods Ekhlaspur Center of Health (ECOH), non-government health service provider in a village has been conducting anti-tobacco campaigns for awareness raising and tobacco cessation program through community health workers since 2008. Two cross-sectional surveys in 2011 and 2013 with similar methods were done to see the changes in tobacco use in the village. Field interviewers visited all households of the village and randomly selected one adult aged 20 years or more from each household as respondents. Both smoking and smokeless tobacco use habit were obtained by an interviewer administered questionnaire. Results Over all prevalence of tobacco use were 47.7% and 34.6% in 2011and 2013 respectively. Prevalence of smoking declined to 12.7% in 2013 from 22.7% in 2011. Smokeless tobacco uses also declined to 23.9% in 2013 from 30.0% in 2011. In men smoking prevalence reduced to 24.0% in 2013 from 36.1% in 2011. In men smokeless tobacco uses increased to 19.5% in 2013 from 14.6% in 2011 where as in female reduced to 28.1% in 2013 from 29.4% in 2011. Conclusions Tobacco use decreased markedly in this rural community through aggressive anti-tobacco campaigns. Changes are likely to reflect the impact of continuous anti-tobacco campaign by local NGO as well as national government efforts.

Background and challenges to implementation Bangladesh is one of the high tobacco consumption countries of the world. Global Adult Tobacco Survey (GATS), Bangladesh 2009 shows that 44.7% of men and 1.5% of women smoke, while 26.4% of men and 27.9% of women use smokeless tobacco. According to GATS, 68% of smokers and 48% of smokeless tobacco user wanted or planned to quit tobacco in past 12 months. Clinic based tobacco cessation service is available only in few urban settings.A community based tobacco cessation program utilizing community health workers (CHW) has been initiated in a rural setting from 2014. Intervention or response Two CHWs of a non-government (NGO) health care provider ECOH were trained to deliver cessation advice during courtyard meetings as a part of their regular health promotion activities in a village. Courtyard meetings were conducted involving 20 to 25 members of several households in regular intervals covering the whole village in a month. CHWs delivered the messages regarding the ill effects of tobacco use and encouraged identified users to quit. Subsequently, those who agreed or showed an intention to quit were followed through a mobile phone call after two weeks and subsequently after two and six months. Results and lessons learnt During the program period of 18 months, 196 (Men 92, Women 104) tobacco users were registered from 26 courtyard meetings. Mean (±SD) age of the participants was 42±17.6. Among them smoking tobacco (ST) user were 78 (40%, all men), while smokeless tobacco (SLT) user were 118 (60%, men 17, women 101). At six-month follow-up, overall tobacco quit rate was 8.1%. Number (%) of SLT quitter 13 (11%), among them 9 (8%) were women and 4 (23%) were men. For ST 3(3.8%) men were quitted. Conclusions and key recommendations Brief advice through CHW in courtyard meeting can be an effective cessation method of quitting SLT for the rural community in Bangladesh.

Background: Recent prevalence data on rheumatic fever (RF) and rheumatic heart disease (RHD) are lacking in Bangladeshi population. Aim: We have done this national level cross-sectional survey to determine the prevalence of RF and RHD in Bangladeshi children. Methods: Samples were drawn from three out of seven divisions of Bangladesh from both urban and rural areas. Trained and experienced enumerators visited households to suspect cases of RF or RHD in 5–19 years children by asking structured questions on symptoms and signs of RF and RHD (n = 56,827). Then trained doctors again took history and examined them for RF/RHD. RF was defined according to the Modified Jones Criteria 1992. Doppler echocardiography was done to confirm the diagnosis in all suspected cases of RF/RHD. Results: A total of 36 RF cases (new and old) and 16 Doppler echocardiography confirmed RHD cases were identified. Prevalence of RF and RHD was 0.9 per 1000 (95% confidence interval: 0.7–1.2) while prevalence of RF was 0.6 per 1000 (95% CI: 0.4–0.9) and RHD 0.3 per 1000 (95% CI: 0.2–0.5). Conclusion: Observed prevalence of RF and RHD indicates that RF/RHD is disappearing from Bangladesh. However, studies using new technology of portable echocardiographic screening are needed.

The aim of this study was to determine the association between periodontal diseases and ischemic heart disease among 30 exercise tolerance test (ETT) positive and 30 ETT negative of ischemic heart disease patients attending the National Heart Foundation Hospital and Research Institute. The presence of gum swelling for the two groups were statistically significant. The results revealed that 80% ETT positive and 23% ETT negative respondent had gum bleeding, 53% ETT positive and 7% ETT negative had ulceration of gingiva. Furthermore, severely inflamed with spontaneous bleeding was found in 53.3% ETT positive and 6.7% negative respondents. It can be concluded that oral hygiene should be promoted as a part of prevention of ischemic heart disease.

Aim/objectives: The study aimed to validate the Rose Angina Questionnaire (RAQ) to detect coronary heart disease (CHD) by comparing with cardiologists' diagnoses in Bangladesh. Methods: Patients aged 40–75 years attending to two cardiac hospitals were diagnosed as either CHD positive or CHD negative by cardiologists. The RAQ was used to reclassify them into CHD positive [RAQ] and CHD negative [RAQ]. Findings: There were 302 CHD positive [cardiologists] and 302 CHD negative [cardiologists] individuals. The RAQ reclassified 194 individuals as CHD positive [RAQ] and 409 individuals as CHD negative [RAQ]. Therefore, the RAQ had 53% sensitivity and 89% specificity. There was no difference in sensitivity and specificity during subgroup analyzes by age and gender; the sensitivity was higher among people from lower socio-economic status. Conclusion: The RAQ, having moderate sensitivity but high specificity to detect CHD, can be used to screen individuals at risk of CHD in large-scale epidemiological surveys.

BACKGROUND: Most epidemiological studies exploring the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) have been in Western populations, and have focused on SLT products used in those countries. Few studies come from South Asian countries. Our objective was to determine the association between SLT use and CHD among non-smoking adults in Bangladesh. METHODS: A matched case-control study of non-smoking Bangladeshi adults aged 40-75 years was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Community controls, matched to CHD cases, were selected from neighbourhoods, and hospital controls were selected from outpatient departments of the same hospitals. The Rose Angina Questionnaire (RAQ) was also used to re-classify cases and controls. RESULTS: The study enrolled 302 cases, 1,208 community controls and 302 hospital controls. Current use was higher among community controls (38%) compared to cases (33%) and hospital controls (32%). Current use of SLT was not significantly associated with an increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63-1.19), or when hospital controls were used (adjusted OR 1.00, 95% CI 0.63-1.60), or when both control groups were combined (adjusted OR 1.00, 95% CI 0.74-1.34). Risk of CHD did not increase with use of individual types except gul, frequency, duration, past use of SLT products, or using the RAQ to re-classify cases and controls. There was a significant association between gul use and CHD when both controls were combined (adjusted OR 2.93, 95% CI 1.28-6.70). CONCLUSIONS: There was no statistically significant association between SLT use in general and CHD among non-smoking adults in Bangladesh. Further research on the association between gul use and CHD in Bangladesh along with SLT use and CHD in other parts of the subcontinent will guide public health policy and interventions that focus on SLT-related diseases.