Health Wikipedia

Although mental health is crucial to the overall well-being of individuals, societies and the country, it is largely neglected and often overlooked in Bangladesh. World Health Organisation (WHO) has given utmost importance to promote mental health services and has been campaigning for the full incorporation of mental health in public health. But it is matter of great regret that many people including some of health professionals are very reluctant to give mental health a priority.

About 16.01 per cent adult and 18.35 per cent children are suffering from mental illness in Bangladesh. With this enormous disease burden, a very few number of mental health professionals are struggling to cope with mental disorders. There are only 120 psychiatrists in our country. Other mental health professionals (psychologists, psychiatric nurses etc) are also very limited in number.

WHO published an assessment instrument for mental health system in Bangladesh in 2007. It revealed — there are 0.073 psychiatrist and 0.00071 psychologist per 100000 populations. Total indoor beds for mental patients are only 813 against the whole population (0.58 bed/100000 people). With the lack of resources, we have many negative attitudes to the mental health issues.

WHO stated that mental health is more than the absence of mental illness, and it is vital to individuals, families and societies. Mental health is determined by socioeconomic factors, linked to behaviour. There are lots of impact on mental health from the global warming and climate change, but little crying we hear from the environmentalist on this issue.

Beside the individual disease burden, there is huge impact of mental health on social capital. The level of well being, physical health, knowledge and skill, productivity, quality of relationship, sexual satisfaction, trust, social cohesion all are integrated to mental health and ultimately linked with social capital. Good mental health is also an important resource for families, communities and nations. Mental health is a useful tool in the human rights framework.

Among the global disease burden, mental illnesses pose a bigger place than many of overemphasised physical illnesses. Our attitude towards mental health is running on the wrong track. It is time to change our attitude and false belief. Mental health concerns everyone as it is generated in our everyday lives at homes, schools and workplace. Positive mental health contributes to the social, human and economic capital of societies. To promote mental health, we all should move together.

Everyday, thousands of people undergoing major surgeries need blood transfusion. Many people suffering from various conditions like haemophilia (genetic disease that impair the body’s ability to control blood clotting), dengue, severe anaemia, blood cancer, thalaessemia need blood transfusion.

On an average, 3 to 3.5 lakh bags of blood are needed in our country every year. There is always strict advice to transfuse safe blood. But from where these amount of blood will come? Blood is not produced in a factory and yet there is no alternative source for blood. The only source of blood is human body.

Usually, blood from relative is encouraged for transfusion. But if a healthy relative of the same blood group is not available, blood from any healthy voluntary donor of that group may be transfused. In our country, people usually depend on the organisations like Sandhani, Redcresent, Badhon, Quantam etc. for safe and fresh blood. We should remember that these organisations or institutions do not manufacture blood. They are only the media to collect blood from healthy voluntary donors to provide it to the needy people. The more the voluntary donor, the more these organisations will make blood available.

Here the question comes — who can donate blood? Any person within the age group of 18-60 years with a body weight as minimum 45 kg for female and 48 kg for male and having a general well-health is an eligible blood donor. Healthy means that you feel well and can perform normal activities; your blood pressure, pulse, body temperature are normal; and you are free from any blood boarn diseases such as malaria, syphilis, gonorrhoea, hepatitis B, C, AIDS, haemophilia etc.

You may have chronic conditions like diabetes or high blood pressure; but in these cases, healthy means — you are being treated and the condition is under control. Such healthy people can donate one bag (350-450 ml) blood safely every 4 months.

After donating blood, the donor should take rest for 15-20 minutes. Routine work is absolutely fine after the initial rest. Rigorous physical work should be avoided for few hours. After resting for a while a donor should be given some liquid (fluid) to drink, such as water, ORS, milk or fruit juice. The donor needs no special diet other than a routine balanced diet. The body replaces blood volume or plasma within 24 hours.

It is very unfortunate that voluntary blood donation is still not so popular in our country. This is due to the lack of proper awareness, social movement, irrational fear and superstitions about donating blood. Some organisations are working in this field but still the number of voluntary blood donor is not keeping pace with the yearly requirement of blood.

In a study conducted by Sandhani, Dhaka Medical College Unit, it was seen that 62 percent of the population were unaware of the blood-transmitted diseases, 53 percent of people did not even know what their blood group was; 66 percent admitted that their knowledge about blood donation was not sufficient.

For the lack of adequate voluntary donors, many patients are being compelled to buy blood from professional blood donors. Such donors are more likely to carry dangerous infections and their blood is more likely to be of lower standard, as they tend to donate, better to say, trade more frequently.

In Bangladesh, mostly drug addicts sell their blood to get money to buy drugs for addiction. Usually they are under-nourished, having less haemoglobin in their blood. They also suffer from various blood transmissible diseases. So, the patient who is getting that blood, though initially may be benefited, is in risk of having many diseases.

In a research conducted in our country, 22 percent of the professional donor was found having Syphilis and 29 percent having Hepatitis-B. A study conducted in BSMMU showed that 60.1 percent of the patients suffered from hepatitis, who got transmitted unscreened blood from professional donors.

Again, many patients fail to get any kind of blood, not from voluntary donors, not from professional donors even. Voluntary donors’ safe blood and professionals’ unsafe blood collectively fail to fulfill the yearly requirements of Bangladesh.

If only 1% of the population donate blood once a year (though a healthy donor can donate blood 3 times a year safely), the yearly collection stands a satisfactory number which may fulfil the requirement smoothly.

Mathematically it is an easy task but it does not happen in reality. We all need come forward to save thousands of lives dying due to the shortage of blood.

With the advent of Valentine’s Day on this Sunday, millions of people are planning to give special gifts to their beloved. People sent flowers, red hearts, anonymous cards and offer a candle-lit dinner to surprise their valentines. On this Valentine’s day, you can make an exception by giving the greatest gift — a healthy heart that lasts forever. With little changes in your lifestyle that keep your heart healthy you can offer the big gift.

Research has shown that the leading cause of heart disease is related to behavioural choices such as eating habits, exercise, tobacco use, alcohol consumption and stress.

Maintaining a healthy body weight is crucial for the prevention of coronary heart diseases. Physical exercise even walking is good for heart. Blood pressure should be checked at regular interval and focus on lowering pressure by decreasing salt and low calorie diet. Alcohol, tobacco products and secondary exposure to tobacco smoke are important driving force behind heart diseases. We should make pledge to avoid it on this very occasion.

Following a heart healthy diet rich in vegetables, fruits and whole-grains are equally important. Consume fish, especially oily fish, at least twice a week. Limit your intake of saturated fat and minimise your intake of beverages and foods with added sugars.

On this Valentine’s Day, you can make the outstanding decision to change your lifestyle to give your beloved one, a healthy heart that creates love for life time.

Mental health is deeply influenced by external social and environmental factors. Along with physical illness, it is now well evident that extreme climatic events can cause significant psychological stress with long-lasting effects on anxiety levels and depression.

There would be more devastating permanent mental health impact on the survivors like a child, who has to face the burden of pain and stress of losing his or her family members.

Ironically, the issue is overlooked very often and the effects of climate change on mental health are relatively missing in most discussions on climate change. But experts feared that rapid change in the climate is likely to fuel up the current rising trends of mental illness.

UNFCCC 4th report on global warming stated that there is a direct association between the presence of major mental illness like acute psychosis and schizophrenia in tropical countries.

Extreme climate change events like heat stoke which manifest as delirium and other neuro-psychiatric syndromes characterised by altered consciousness to agitation, restlessness, unconsciousness and even death. Heat stroke has already caused deaths among heavy workers and rickshaw pullers in Bangladesh.

A study conducted by Jain S (2001) demonstrated the association between presence of acute psychosis, schizophrenia, mood disorders and obsessive compulsive disorders with post viral infections which is set to increase with the climate change. Post viral infection is one of the important risk factors for damaging fetal brain in the intrauterine period which causes many developmental and mental disorders among children in future.

Major population displacement after an extreme climatic event would cause social disruption, unemployment, social conflicts, mental unrest and economic burden and uncertainty as we see in Haiti following a massive earthquake.

All these factors are associated with increased prevalence of mental disorders like anxiety, depression and stress disorders. Besides, increase salinity of water in the coastal area would hamper food production which results in malnutrition and child developmental disorders.

The extreme events cause immense psychosocial stress especially among vulnerable groups like children, women and elderly. A survey among Asian Tsunami affected population by WHO revealed that 30-50% of population suffered from moderate to severe form of mental disorders.

Natural disasters have shown to result in increased domestic violence due to frustration and anger. Flood is a common natural calamity in Bangladesh. A study in the state of Orissa in India concluded that mental disorder like depression and Post Traumatic Stress Disorders (PTSD) were increased among post flood affected population after one year.

Drought is another serious consequence of climate change which causes food scarcity, hunger and malnutrition. Drought contributes to mental agony and depression among farmers due to financial hardship which increases suicide rate among them. Suicide rate was highest among farmers in drought found in an Australian study.

A recent report of Climate Change Cell of Department of Environment of Bangladesh mentioned that the annual incidence of mental disorder was 22431 per year which was higher than that of Dengue (3305 per year). It indicates the need for prioritisation of mental health in the health component of National Adaptation Programme of Action for climate change of Bangladesh.

Very often, women in Bangladesh present to a doctor’s room when their diseases have already progressed to a grave condition and need aggressive treatment. Sometimes, physicians have very little to do with a woman when she comes at the end stage of a fatal disease like cancer. With simple and inexpensive screening tests, women can prevent a range of deadly diseases like cancer, glaucoma, complications of diabetes etc. and help remain heal and hearty.

1. Breast cancer
Diagnosis in the early stages is crucial for breast cancer like other cancers. Mammograms are used as an ideal screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge. A woman should have a mammogram done within 40s. Onwards, they should get an annual screening for early detection, experts recommended. Any discomfort or pain in the breast should be investigated throughly and must not be neglected. Any unusual discharge should be checked out right away. Sometimes doctors recommend ultrasonography and low-dose x-ray can also detect disease at early stage and used as screening tools.

2. Cervical cancer
Cervical cancer is top ranked killer cancer in Bangladesh. It occurs in the cervix, a part of the uterus that extends into the vaginal cavity. Routine screening can find it early, when it is highly curable. It can also find abnormal precancerous cells on the surface of the cervix so they can be removed before they turn into cancer. Doctors recommend VIA (Visual Inspection of Cervix using Acetic Acid) which is given free of cost in the government settings and Pap test to screen for cancer of the cervix. The screening test should start as early as women enter in reproductive age. For better protection FDA approved vaccine cervical cancer vaccine is available in our country; it confers immunity against HPV virus that causes cancer.

3. Osteoporosis and fractured bones
Osteoporosis is a condition in which bones become weak and fragile. It is caused by bone loss, which accelerates in women after menopause. A test called Dual Energy X-ray Absorptiometry (DXA) can measure bone mineral density and detect osteoporosis before fractures occur. It can also help predict the risk of future bone fractures. Bone density testing is recommended for all women 65 years of age and older. It is also recommended for middle-aged women younger than 65 who have risk factors for osteoporosis.

4. Cholesterol levels
A high level of LDL cholesterol (bad cholesterol) is a major factor that increases the risk of developing heart diseases. Doctors screen for problems with cholesterol by using a fasting blood lipid profile. Management decisions are based on the results.

5. Type 2 Diabetes
Measuring the fasting blood glucose and two hours after breakfast are used to screen for diabetes. Experts also recommend another tests called HbA1C. If a woman is healthy and have a normal risk of diabetes, she should have the test done every two years starting at age 45; with higher risk, one should start testing earlier and more frequently.

6. Colorectal cancer
The majority of colon cancers develop from colon polyps that are growths on the inner surface of the colon. A colonoscopy is a common screening test for colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. If a woman is at average risk, screening usually starts at age 50.

7. Glaucoma
Glaucoma is a condition that can result in blindness due to damage to the optic nerve. People older than age 50, family history of glaucoma, personal history of eye injury and steroid use are risk factors for glaucoma. For healthy individuals without increased risk, routine screening every two years is recommended for people under age 40. For those between 40 to 54 years, testing should be done every one to three years. From age 55 to 64, testing should be done every one year, and for those over 65, every six to 12 months.

Despite significant improvement in medical science in recent decades, mothers and their babies in the third world countries like Bangladesh are still at risk during the perinatal period, which covers pregnancy, delivery and the postpartum.

Babies born too early are more likely to die than that of born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families and for health and social services.

Perinatal health includes care for both mother and their new born babies. But we often forget about the care of the mothers during and after delivery. However, maternal deaths are less than babies. This is a tragic event as a significant proportion of these deaths are associated with substandard care.

When we talk about paediatrics (child care), it only deals with children. And the obstetricians deal with mothers only. But we need to set up a sturdy bridge in between these two separate entities. It is impossible to think about healthy child without healthy mother. In fact, perinatal science deals with a unique two in one health delivery system.

Bangladesh has made a significant progress in reducing maternal and infant death in recent years. This has been possible because of strong leadership of the Ministry of Health and Family Welfare (MOHFW) in creating a supportive policy environment, technical and financial commitment of donors and UN agencies, active engagement of professional bodies and academic institutions. National Neonatal Health Strategy has already been prepared by the MOHFW. Now we need to operationalise the recommendations outlined in the strategy and begin to roll out the crucial interventions needed to prevent unnecessary deaths.

Immediate and early postnatal care for mothers and newborns is one such crucial intervention. Most of maternal and newborn deaths occur within the first three days of childbirth. Therefore we need to deliver the services to them in those crucial days.

Neonatal sepsis (infection of the newborn) is the single largest contributor to neonatal mortality. We need to ensure that the health service providers at community level can prevent, detect and manage sepsis when it occurs. Now operation research is underway to see the feasibility of different approaches in order to determine the best way to deliver this service to the majority of the newborns who are born at home.

We need to strengthen the policies, guidelines and service providers’ capacity to ensure that the neonates and the mothers are not left without care. Unless we can scale up these services to reach the primary level of health system, we will not be able to attain the Millennium Development Goals by 2015. We need to create additional posts of neonatologists and obstetricians at the district hospital level as a starting point.

Prof M Shahidullah.