Abstract

Inequalities in undiagnosed diabetes mellitus among adult population in Bangladesh: Evidence from Demographic and Health Survey

Mohammad Rifat Haider, PhD, MPS, MHE, MBBS¹, Biplab Datta, Assistant Professor², Rajat Das Gupta, MPH, MBBS³, Sabrina Karim, PhD, MPH, MBBS³ (1)University of Georgia, (2)Augusta University, (3)University of South Carolina

APHA 2022 Annual Meeting and Expo

Introduction: Prevalence of diabetes mellitus (diabetes) increased in Bangladesh over last decade from 9.8% to 12.8%. About two-third of the diabetic population is unaware of their condition and only one-third of those who are aware receive regular treatment. This study aims to assess the prevalence and determinants of undiagnosed diabetes and to examine the extent of socioeconomic inequalities in undiagnosed diabetes among adult Bangladeshi population (≥18 years).
Methods: Nationally representative Bangladesh Demographic and Health Survey 2017-18 data was used for this study. Undiagnosed diabetes was defined as having blood glucose level ≥7 mmol/dl and was never told by the health professionals to have diabetes. Univariate, bivariate, and multiple logistic regression analyses were performed. Concentration Index were estimated to assess socioeconomic inequalities in the prevalence of undiagnosed diabetes.
Results: Out of total 775 diabetic adults, four-fifth (80.6%) were undiagnosed. In the adjusted model, older age, overweight/obesity, female gender had less odds of being undiagnosed. Overall concentration index demonstrates that poor patients were disproportionately affected by undiagnosed diabetes (Concentration Index: --0.106, Standard Error (SE) of Concentration Index: 0.037; P-value=0.003). The poor(Q1)-to-rich(Q5) ratio of 1.2 also shows that poorest diabetic patients were less aware of their diabetic condition than their richest counterparts.
Conclusion: Blood glucose level should be checked in every routine encounter with health facilities to prevent the future complications related to diabetes. Targeted awareness building campaign should be adopted to enhance blood glucose testing among adults from poor wealth quintiles in Bangladesh.

Abstract

A qualitative exploration of the cultural and medical landscapes of breast cancer in Ghana

Kimberly Gorton, MSPH Student¹, Rebeca A. Michael¹, Debbie Mangortey², Emmanuel Kofi Bondah², Henry Okorie Ugorji², Yvette Eyram Avorgbedor², Charles Arhinful, Medical Practitioner ³, Edward Kofi Sutherland, Medical Practitioner ², Rebecca Acquaah-Arhin, Medical Practitioner³, L. Scott Benson, MD, PhD¹, Lisa H. Gren, PhD¹, Caren J. Frost, PhD¹ (1)University of Utah, (2)Ensign College of Public Health, (3)Volta River Authority Hospital

APHA 2022 Annual Meeting and Expo

Context: Managing breast cancer has been especially challenging in low- and middle-income countries (LMICs). Further understanding about how women and men perceive the causes and impact of breast cancer in LMICs is needed. Public health issues including the increasing incidence and presentation of breast cancer at lower ages, and the lack of a population-based cancer registry made Ghana an ideal location for this study.
Methods: The purpose of this qualitative phenomenological study was to determine how women and men perceived the causes and impact of breast cancer on adults living outside of urban centers in Ghana. We conducted individual interviews (n=46) in four communities in the Eastern Region of Ghana. These locations were strategically chosen to include rural and peri-urban areas where access to biomedical care was limited, to include populations not readily accessed through already published research studies. Convenience sampling was employed, and community entry was facilitated by Community Health Nurses and Queen Mothers.
Results: This study clarified how women and men understood breast cancer. Four common themes emerged from the interviews with the women (n=26): reaction to potential diagnosis, lack of a clear discussion about stigma, causes of breast cancer, and connections to healthcare systems. Three common themes emerged from the interviews with the men (n=20): understanding breast cancer risk, causes of breast cancer, and diagnosis of breast cancer being synonymous with death. We expanded the existing classifications of breast cancer causes (internal and external conflict) to include a new category (personal behaviors).
Conclusion and discussion: While other researchers have noted similar issues surrounding breast cancer attitudes, knowledge, and understanding, our study identified a new classification – personal behaviors – as a community belief about the causes of breast cancer. Engaging community leaders is one important strategy for addressing the cultural and medical landscapes that currently limit access to screening, detection, and treatment of breast cancer in Ghana.