Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey.

BACKGROUND: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. METHODS: A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. RESULTS: A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and adhesive capsulitis (1.4%, 0.9-1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. CONCLUSIONS: The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Histopathological types in adult nephrotic syndrome.

In Bangladesh, there are very few studies about biopsy proven adult Nephrotic syndrome (NS) with histological types and their clinical findings. To determine the histological types of glomerulonephritis (GN) in adult NS and correlate them with the clinical presentations and biochemical parameters, we studied 100 biopsies in 87 patients who underwent ultrasonography- guided renal biopsy in Rangpur Medical College and Hospital from July 2010 to June 2012. The mean age of the patients was 32.8 ± 13.2 years; male was preponderance (72.4%) and most of the patients (67.8%) came from rural areas. Membranoproliferative GN (MPGN) was the most common underlying cause that was found in 32 (36.8%) patients followed by mesangial proliferative GN in 27 (31%) patients, membranous GN in 16 (18.4%) cases, minimal change disease in four (4.6%) patients, diffuse proliferative GN in four (4.6%) patients, focal segmental GN, and focal proliferative GN in two (2.4%) patients each. High proteinuria level was found in minimal change disease, which was 7.59 ± 0.24 g/24 h (mean ± standard deviation). The most common symptoms were oliguria (92%) and edema (86.2%) followed by hematuria (dark urine) (72.4%) and hypertension (35.6%). MPGN was the most common histological type of adult NS in Rangpur.

Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study.

OBJECTIVE: To estimate the burden of rheumatic disorders in adults (age >/= 15 yrs) in Bangladeshi rural and urban communities. METHODS: The survey was carried out in a rural community, an urban slum, and an affluent urban community with samples of 2635, 1317, and 1259 adults, respectively. Through door-to-door surveys, trained interviewers identified subjects with musculoskeletal pain. A socio-culturally adapted and validated Bengali version of the COPCORD (Community Oriented Program for Control of Rheumatic Disorders) questionnaire was used. Trained internists and rheumatologists examined the positive respondents using an English COPCORD examination sheet to identify respondents with definite rheumatic disorders and to reach a diagnosis. RESULTS: The overall point prevalence of musculoskeleletal pain was 26.3%. The point prevalence estimates of musculoskeletal pain in rural, urban slum, and affluent urban communities were 26.2% (women 31.3%, men 21.1%), 24.9% (women 27.5%, men 22.6%), and 27.9% (women 35.5%, men 18.6%), respectively. Most commonly affected sites were low back, knees, hips, and shoulders in all 3 communities. The point prevalence of definite rheumatic disorders was 24.0%. The commonest rheumatic disorders were osteoarthritis of the knees, nonspecific low back pain, lumbar spondylosis, fibromyalgia, and soft tissue rheumatism. Their prevalence estimates were 7.5%, 6.6%, 5.0%, 4.4%, and 2.7%, respectively, in the rural, 9.2%, 9.9%, 2.0%, 3.2%, and 2.5%, respectively, in the urban slum, and 10.6%, 9.2%, 2.3%, 3.3%, and 3.3% in the urban affluent community. The point prevalence of functional disability was 25.5%, 23.3%, and 24.8%, respectively, in the rural, urban slum, and urban affluent communities. Among the positive respondents, 22%, 52%, and 22% reported loss of work for durations of 49.3 +/- 47.5, 50.90 +/- 103.3, and 29.25 +/- 56.5 days, respectively, within the previous year. CONCLUSION: Rheumatic disorders are common causes of morbidity, disability, and work loss in rural and urban communities of Bangladesh. Women are affected more frequently than men. Mechanical disorders are more common than inflammatory arthropathies.