Bangladesh is sing the 3rd stage in demographic passage that has produced a large figure of vernal population and increasing population of older population ( Razzaque et al. , 2010 ) . At present, the population of Bangladesh is 152518015 million, where per centum of the 60+ aged populations is more than 6.7 ( BBS, 2010 ) . The average age is 23.3. The life anticipation at birth is 70 old ages for the entire population ( Index Mundi, 2012 ) .
Epidemiologic passage by and large refers to the displacement from ague, infective and lack diseases to chronic, non-communicable diseases ( NCDs ) . This is normally reflected in the mortality and morbidity form. A survey done at Matlab, a rural country of Bangladesh by Karar et Al. ( 2006 ) found that in 20 old ages ( 1986-2006 ) , there has been a monolithic change in mortality profile from acute infective and parasitic diseases to NCDs, degenerative and chronic diseases. During this period there was great decrease in mortality due to diarrhea and dysentery and respiratory infections ( except TB ) and increase in mortality due to NCDs such as cardiovascular and cerebrovascular diseases and malignant tumors. It has been predicted further that the mortality due to NCDs will increase greatly in the following two decennaries whereas figure of deceases due to catching diseases will diminish. The decrease in the kid and infant mortality was explained by betterment in maternal instruction, primary wellness attention services, H2O and sanitation pattern, usage of unwritten rehydration solution and high immunisation coverage. The rise in mortality due to NCDs was explained by possible alteration in diet and lifestyle ( Karar et al. , 2006 )
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Due to demographic and epidemiologic passages, aged population has quickly increased and so has their morbidity ( Biswas et al.,2006 ) . As Bangladesh is traveling through both epidemiologic and demographic passages, there are being decreases in birthrate and mortality rates that have resulted in increased life anticipation among the population. This means there are addition in older people in the population and increase in prominence of chronic conditions among these aged. Chronic diseases normally accumulate with ripening and are presented as multiple morbidities. Multimorbidity in the same individual refers to co-occuring of assorted harmful medical conditions. Khanam et Al ( 2011 ) found higher prevalence of multimorbidity among aged ( & gt ; 60years old ) in a rural topographic point in Bangladesh called Matlab. It was about 53.8 % among the survey population. Arthritis and high blood pressure occurred the most normally. Multi-morbidity was higher in adult females than work forces and in non-poorest ( Not poorest. Socio-economic position was divided into two parts: poorest and non-poorest ) . The same survey found that multimorbdity can besides be affected by life and working environment, lifestyle form, socio-economic position, behavioural hazard factors and gender. From the prevalence rate, one can gauge the existent load in the general rural population. It shows every aged in the population is enduring from at least one chronic status.
This means the wellness sector of Bangladesh should be prepared to cover with the increasing NCD instances. Through improved diagnostic installations and better referral system, NCD patients can be helped. Health policy should be updated consequently to apportion bigger budget to ease wellness services for the aged ( Karar et al, 2009 ) .
Formal and informal attention
Survey by Biswas et Al. ( 2006 ) focused on schemes aged people use to get by in instance of unwellnesss. As perceptual experience of sick wellness and badness of unwellness varied from one aged to another, this survey revealed that aged people avoided sing a qualified physician until badness of unwellness deteriorated because of the associated cost. Even in state of affairss when these qualified physicians are consulted, there are rare follow up visits, once more due to the fiscal barrier. Therefore, aged people frequently prefer traveling to traditional therapists ( eg. Kobiraj ) . Huge trust is placed on this type of therapists ‘ interventions. Often when these interventions bear no consequence, trust is non lost and the deficiency of consequence is frequently attributed to “ ill destiny ” ( Biswas et al. , 2006 ) .
On the other manus, if the disease is assumed to be of low badness, self-care is practiced, that is place redresss are undertaken and drugs are bought over the counter at the apothecary’s shop by a household member. However determination doing procedure comes into drama if badness of the disease additions and is influenced by assorted factors such as determination about where to take the patient, who to travel with the patient and how to pull off money. Out of all these factors, the fiscal issue grabs the bigger precedence. Normally a service supplier that can guarantee flexibleness in the intervention cost and payment options is picked. Payment is done with the aid of nest eggs, loan from big kids, friends or relations or sometimes NGO and merchandising of farm animal and domestic fowl ( Biswas et al,2006 ) ..
In Bangladesh, aged people depend mostly on attention provided by the household members. It ‘s a common pattern for household members to look after aged individuals. Sometimes even when there ‘s a will, household members can non take proper attention of the seniors due to fiscal restraints. Furthermore, big kids of that household frequently migrate someplace else to happen work, go forthing the aged buttocks. In urban countries, this scenario is worse. Along with the work forces of the household working, there ‘s adult females ‘s engagement in labour force due to which the aged are besides neglected. ( Jesmin & A ; Ingman, 2011 ) . There is stigmatisation of Older adult females who visit male physicians ( who are n’t direct household members ) due to which adult females stay back place even when they are sick and endure even more.
From the authorities ‘s side there is meager sum of Old Age allowance and pension for the aged. This sum barely covers up intervention costs. There are institutional attentions provided by the NGOs in different parts of Bangladesh. But this are being unable to run into the increasing demands of increasing figure of the elderly people ( Hossain et al, 2006 ) . We can see that modernisation and urbanisation consequences in migration of immature grownups and inclusion of adult females labour force. Aged people are neglected. There is hapless wellness attention service for them. Financially they become weak. They begin to lose their functional ability with age and go dependent on others. But ageing is a natural procedure for which they are non responsible. Therefore it ‘s our responsibility to supply them with uttermost attention, regard and security.
Aging population and functional ability:
When we talk about functional ability of aged population, we mean if the aged individual is functionally able to execute day-to-day undertakings. We draw decisions based on physical and cognitive incompetency. But we frequently neglect the context to which the individual belongs. It ‘s environmental and socio-cultural factors. Urban and rural countries vary extremely in footings of these factors. There are besides gender differences as to certain undertakings performed by work forces and adult females are bound by societal norms and by and large do n’t overlap. Domestic work typically belongs to adult females ‘s sphere and public jobs belong to work forces ( Kabir et al. , 2001 ) . If we picture a rural context, we can understand how environment plays a function as a barrier to functional ability. Toilets are normally placed outside the place, at a distance and H2O beginning is far from lavatory. An aged individual has to travel a nearby pool or have person carry the H2O to them ( Ferdous et al. , 2009b ) . Older adult females who visit male physicians ( who are n’t direct household members ) are stigmatized ( Biswas et al.,2006 ) . Therefore there ‘s a inclination of adult females remaining place and non seeking aid. As a consequence, with clip, they become more sick and functionally disable to execute day-to-day activities. Surveies have shown aged adult females to hold higher prevalence of unwellness so aged work forces ( Kalam et al. , 2006 ) . Studies done on nutritionary position of aged people have found nutrition to play a critical function in executing day-to-day activities. Elders with hapless nutritionary position have more restrictions in their physical map than seniors who are good nourished. Good nutritionary position has been associated with better cognitive map as good. ( Ferdous et al. , 2009a ) . As the aged population is increasing in figure, it ‘s our duty to see how they can accomplish healthy ageing. There can be many suggestions like holding high alimentary diet, improved substructure like constructing inclines in infirmaries, intervention at early phase etc but whether these can or will be implemented is extremely doubtful. Bangladesh is poverty afflicted state and inspite of National Elderly Policy being present, its ends of protecting aged are inactive ( Unnayan Onneshan, 2011 ) . Poverty is beyond our control but policy is something we can take attention of. Policies integrating aged issues should be implemented and our attacks towards the ageing population should be in such a manner that this population is benefited, secured and meets demand of basic demands.
“ The Prevention of Diabetes, Bangladesh ” Plan from life class position
In the development states, there is a turning concern and consciousness of the increasing incidence of Non Communicable Diseases ( NCDs ) ( Darton-Hill et al. , 2004 ) . More than 40 % of all people with diabetes in least developed states live in Bangladesh ( Novonordisk, 2012 ) . Type 2 Diabetes Mellitus ( T2DM ) is extremely preventable and its happening can be delayed. The chief focal point of bar of this disease is largely on alteration of lifestyle forms of grownups. Behavior such as unhealthy diets and deficiency of physical activity peculiarly receives high attending. But there is immense grounds now that supports the fact that a batch of the hazards associated to T2DM arise during foetal phases of life. At this phase, these factors are characterized by maternal ‘s nutritionary position, presence or absence of diabetes and foetal and post-natal environment. This indicates that disease procedure progresss throughout life class. There are besides groundss demoing that these hazards begin during foetal phase and progresses till old age ( Darton-Hill et al. , 2004 ) . A survey on familial alterations has revealed high opportunities of diabetes being activated in the uterus. As environmental, familial and biological factors can be passed from coevals to coevals, a life class attack is hence critical to decrease this intergenerational transmittal of diabetes. ( IDF, 2011a ) .
“ The primary bar of diabetes, Bangladesh ” is a plan by the World Diabetes Foundation, partnering with Diabetes Association of Bangladesh ( DAB ) . The plan ran for 4 old ages 10 months ( January 2007-October 2011 ) .The aim of the plan was “ toA define and pilot schemes for lifestyle intercession in the primary bar of diabetes in Bangladesh and to develop guidelines for a long term National Diabetes Prevention Programme ” ( hypertext transfer protocol: //www.worlddiabetesfoundation.org/composite-1144.htm ) . The plan will be intricately discussed from a life class position in the undermentioned subdivisions.
The chief focal point of this plan was on lifestyle intercessions. They produced six cusps that described stairss of bar of diabetes at different degrees of society. The degrees targeted were single, household and friend, social/cast degree, wellness service supplier, employer and media. Messages about hazard factors of diabetes were recorded and used during preparation Sessionss. Folk vocalists, school instructors and spiritual leaders were involved in presenting messages. Doctors, community counsellors, employees and employers were trained in diabetes awareness and lifestyle intercessions. Around 87 pupils took portion in diabetes educator plan ( where the pupils got trained on educating others about diabetes and the associated life manner intercessions ) . All these activities suggest that the focal point has been on grownups. Though it has non been mentioned which hazard factors this plan considered, but trusting they have included the three most common behavioural hazard factors such as fleshiness, deficiency of physical activities and smoke. Numerous surveies have shown these hazard factors to be associated with type 2 diabetes.
From Fig. 1 ( Annex ) it can be seen that in big life, the hazard is the hazard that accumulates from foetal life, babyhood and childhood, adolescence. This accrued hazard is a cumulative hazard, which
means the effects are even getter and damaging. The figure besides shows that the hazard really begins before construct of the life. Therefore, intercessions should be focused on female parents be aftering to gestate, aboard concentrating on every phase of the life of a individual from foetal to adult. This plan has non focused on pregnant female parents, allow entirely pre-conception phase.
For prepossession stage, the adult females could be educated that gestation can move as a hazard factor for the development of diabetes. They could be advocated to take balanced nutrition and chorus from smoking. They could besides assist their spouses to halt smoke. In gestation stage, there could be intervention sing consumption of appropriate nutrition. There could be intervention sing direction of gestational diabetes to decrease the transference of T2DM to the foetus. Mothers with gestational diabetes and the 1s with kid of low birth weight could besides be suggested to hold follow-up check-ups ( IDF, 2011b )
There were no intercessions for babyhood and childhood period in this plan every bit good. As portion of this plan, sole breastfeeding could be promoted for the first six months. Mothers could be educated and supported on appropriate nutrition for their babies. For school traveling kids, exercising and healthy feeding could be promoted ( IDF, 2011b ) . This plan besides did n’t integrate intercessions aiming the adolescence. Adolescents are of import group of people who pattern unhealthy feeding, physical inaction and take a sedentary life manner. Smoking among striplings is really popular among Bangladesh. They besides should hold been a mark of this bar plan. Surveies have shown that the age of oncoming of diabetes has shifted from working age group to striplings. Therefore more adult females that belong to reproductive age group are holding diabetes and their gestations are being complicated by diabetes ( International Diabetes Federation, 2011b ) . Therefore lifestyle intercessions should hold been applied to this population. Healthy diets and consciousness about smoke could be promoted at schools and through educational plans. Alongside anti-smoking plans, awareness sing illicit drug usage and intoxicant could be built up every bit good. Adolescents could be good informed about the effects of devouring intoxicant. To battle drug usage, kids and striplings could be informed about the physical, psychological and societal effects of utilizing drugs. Both striplings and grownups could be taught ways to construct assurance and ego regard, which can authorise them to state “ no ” to drugs ( WHO, 1999 ) .
At every phase of life, there could be strong accent on physical activity. Lack of it, along with other factors, can predispose an person to T2DM. It has besides been shown to cut down gestational diabetes ( Dornhorst et al. , 1998 ) . The plan could promote physical exercising in kids by suiting it in the school course of study and household activities. Besides supportive environments could be helped to be built for all ages to prosecute in physical activity.
Some life class factors such as socio-economic can non be changed. Behavioral hazard factors can be changed. This plan should hold aimed at all the phases of life class theoretical account to be able to cover wider population and range greater success in forestalling diabetes.