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Our achievements in non-communicable disease research

We have documented the growing burden of non-communicable disease in Bangladesh and begun to identify effective interventions.

Examples of our achievements include:

Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) 

The multi-country Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) study is a cluster randomised trial that evaluated the effectiveness of the multi-component intervention among 2,550 individuals with hypertension living in 30 rural communities in Bangladesh, Pakistan and Sri Lanka between 2016 and 2019. The COBRA-BPS trial reveals that regular home visits by community healthcare workers to monitor patients’ blood pressure (BP) along with lifestyle coaching to them could effectively control high blood pressure. The study has found promising results in controlling high blood pressure among hypertensive patients through a low-cost health intervention carried out by community health workers in rural settings in South Asia. The COBRA-BPS multi-component strategy was found cost effective and this can be scaled up the low-income and middle-income countries where community health workers are present.

The study also revealed that, among hypertensive individuals, 58.0% had uncontrolled BP, off them highest found in Pakistan, and then Sri Lanka and Bangladesh. It suggested improving access and adherence to antihypertensive medications in disadvantaged populations in rural South Asia. The study also explored high prevalence of Chronic Kidney Disease (CKD) and cardiometabolic multimorbidity among the rural South Asian hypertensive individuals. The study also revealed three major care pathways of hypertension treatment, management and control in rural Bangladesh. Seek specialized hospitals for acute care, private hospitals/local pharmacy for nonacute symptoms, and incidental hypertension identification while being treated for another condition. 

Publications:

  1. Finkelstein EA, Krishnan A, Naheed A, Jehan I, de Silva HA, Gandhi M, Lim CW, Chakma N, Ediriweera DS, Khan J, Kasturiratne A. Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka. The Lancet Global Health. 2021 Mar 19
  2. Jafar TH, Gandhi M, De Silva HA, Jehan I, Naheed A, Finkelstein EA, Turner EL, Morisky D, Kasturiratne A, Khan AH, Clemens JD. A community-based intervention for managing hypertension in rural South Asia. New England Journal of Medicine. 2020 Feb 20;382(8):717-26.     
  3. Jafar TH, Jehan I, de Silva HA, Naheed A, Gandhi M, Assam P, Finkelstein EA, Quigley HL, Bilger M, Khan AH, Clemens JD, Ebrahim S, Turner EL; for COBRA-BPS Study Group, Kasturiratne A. Multicomponent intervention versus usual care for management of  hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial.Trials. 2017 Jun 12;18(1):272. doi: 10.1186/s13063-017-2018-0. 

LIVING trial Lifestyle InterVentIon iN Gestational diabetes trial

  • The LIVING trial was a research study designed to determine whether involvement of women with recent gestational diabetes in a specific “lifestyle” programme could bring about improvements in physical activity and diet that would result in preventing the risks of future diabetes.
  • After enrolling 1823 participants from three countries including Bangladesh, India and Sri Lanka, we found that a small proportion (8.8%) had developed diabetes within the first year after child-birth, and amongst the remainder, about one-quarter developed worsening of their blood sugar levels over the next 14 months, on average (Life style intervention group: 25.5%, Usual care group: 27.1%).   
  • While participation in the lifestyle programme was good, this was delivered in a different way than originally intended because of COVID, and we did not find that the programme reduced worsening of glucose levels.   

Publications:

  1. Tandon N, Gupta Y, Kapoor D, Lakshmi JK, Praveen D, Bhattacharya A, Billot L, Naheed A, de Silva A, Gupta I, Farzana N et al. Effects of a lifestyle intervention to prevent deterioration in glycemic status among south asian women with recent gestational diabetes: a randomized clinical trial; JAMA Netw Open 2022 Mar 1;5(3):e220773. doi: 10.1001/jamanetworkopen.2022.0773.
  2. Tewari A, Praveen D, Madhira P, Josyula LK, Joshi R, Kokku SB, Garg V, Rawal I, Chopra K, Chakma N, Ahmed S, Naheed A., Pathmeswaran A, Godamunne P, Lata AS, Sahay R, Patel T, Gupta Y, Tandon N, Naheed A, Patel A and Kapoor D; Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study. Front. Glob. Womens Health. 2020 Nov27;1:587607.
  3. Gupta Y, Kapoor D, Josyula LK, et al. A lifestyle intervention programme for the prevention of Type 2 diabetes mellitus among South Asian women with gestational diabetes mellitus [LIVING study]: protocol for a randomized trial. Diabet Med. 2019;36(2):243-251. doi:10.1111/dme.13850

MENTHOL Trial (Feasibility of Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children with Autism Spectrum Disorders in an Urban Population in Bangladesh)

This is a pilot study for assessing the feasibility of integrating mental health services for the mothers of children with ASD in the special schools and improving the skills of mothers for child care through a home-based training program.

The study introduced an intervention package in two purposively selected special schools in Dhaka city comprising a psychosocial support centre and training the mothers to take better care of their children. A trained female psychologist was deployed at the counselling centre. One educational psychologist with advanced training in ASD care (special educator) provided training to the intervention mothers to enhance their skills for child care at home and followed up at home every month. The packaged intervention was implemented over a 4-6 months period. The feasibility of the intervention was assessed quantitatively and qualitatively through a pre-post intervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of the mental health services and maternal training. The study shows a promising result, and the main paper has been submitted in the Global Mental Health Journal.

Publication:

  1. Naheed A, Koly KN, Ahmed HU, Akhter S, Uddin MJ, Fawzi MC, Chandir S, Mannan M, Hossain S, Nelson C, Munir K. Implementing a mental health care program and home-based training for mothers of children with autism spectrum disorder in an urban population in Bangladesh: Protocol for a feasibility assessment study. JMIR research protocols. 2017 Dec 14;6(12):e8260.