Bangladeshis face rising stomach diseases due to poor food habits, health care

By SM Najmus Sakib

DHAKA, Bangladesh (AA) - A growing number of Bangladeshis are facing chronic stomach diseases due to poor food habits and health care, pushing sales of gastric and anti-acidic drugs to new records.

Gastric medicines have become the top-selling remedy in Bangladesh for the last five years while as many as 90% of residents take them without consulting a doctor, according to public health experts.

Taka 34.18 billion ($360 million) in gastric medicines was sold last year, forming a 30% growth, said a recent study by Bangabandhu Sheikh Mujib Medical University (BSMMU).

About 45% of gastric ulcers in Bangladesh are because of excessive use of gastric medications. Consuming excessive amounts of gas medicine causes calcium, magnesium, vitamin-12, and iron deficiencies, according to the report.

- Unhealthy lifestyle, food contamination blamed

Benazir Ahmed, former director of disease control at the Directorate General of Health Services (DGHS) said poor food habits and intake of contaminated food and water are among the major causes of a rising number of stomach diseases in Bangladesh.

“We use urea in rice production which can cause damage to our cell membrane and develop issues in the stomach,” said Ahmed.

Rebound acidity continues to rise in the country due to overdoses of anti-acidic drugs. Rebound acidity occurs when the stomach makes extra acid if a patient stops using medication to neutralize acidity or lower acid production, according to Ahmed.

The Bangladesh Agricultural Research Council (BARC) in a study last year found an alarming level of harmful microbes.

BARC examined 149 samples of street food in Dhaka and found more than 1,100 coliform and E-coli in each gram of the samples.

Sharadindu Kanti Sinha, assistant professor in the pharmacology department at the medical university, analyzed the anti-acidic drug selling in the recent BSMMU study. He also found poor food habits and lifestyle a major factor in the increased use of medicines.

“Food habits and lifestyle are linked to chronic stomach disease or acidity, and can gradually make it a lifelong problem. Ninety percent of people in Dhaka city face mild to serious gastric problems,” he said.

- Healthcare system needs improvement

Doctor charges are high in Bangladesh compared to the average income of residents, and physicians prescribe many unnecessary medical tests.

“In contrast, when local pharmacies give free medication, people go to buy medicine without an authorized prescription. Not only the anti-ulcer medicine, people buy antibiotics, vitamins and paracetamol in such a manner (without authorized prescription),” said Ahmed.

Taking drugs without an authorized physician can seriously raise health issues, including ulcers, cancers and osteoporosis that weaken bones, health experts warned.
Bangladesh does not have skilled and trained general practitioners to support patients in the preliminary stage.

A weak health care system can hardly manage or provide treatment to 40,000 people in a union council, the smallest rural administrative unit in Bangladesh.
The question becomes, who will take care of the people?

“General practitioners are crucial to address the situation as they are designed to help people in taking vaccines, maintain WASH or hygiene, health awareness, family planning issues and forward immediate treatment references,” said Ahmed.

Physicians see patients for 48 seconds on average, according to a global study published by the online British medical journal BMJ Open.

The current doctor-patient ratio in Bangladesh is 5.26 per 10,000, the second-lowest in South Asia, according to the World Health Organization.

About 80,0000 doctors remain unemployed due to a complex government recruitment system. And nurses are not trained to support patients -- rather they mostly do clerical jobs.

“If we double the number of nurses in the existing manner, it would not change the health care scenario,” said Ahmed, demanding that nurse be trained before they are assigned to jobs.

- Officials emphasize strict monitoring

Public health experts suggested a major initiative to reform the health care system, including monitoring pharmacies.

Robed Amin, a director at the DGHS, said there are some over-the-counter (OTC) medicines that can be taken without a prescription from pharmacies.

But he admitted that other medicines outside the OTC are being sold without an authorized prescription.

“Most of the local drug centers are not model pharmacies. If the number of model pharmacies (that check and dispense prescribed drugs) rise then such practice would be reduced,” according to Amin.

He said Bangladeshis bear 67% of out-of-pocket healthcare cost, which is a major cause of prescriptions being sold without a prescription.

Government or community hospitals in rural areas, however, provide free medicine and treatment. But patients have to go through an authorized system to avail the facility.

The Directorate General of Drug Administration is responsible to monitor pharmacies so that they do not sell medicine without an authorized prescription.

“We have regulations, rules to monitor pharmacies but the challenge remains in the implementation phase. And, who will implement those laws and regulations in the field remains complex,” he asked rhetorically, pointing to the loophole in the nation’s health care system.