Prevalence of Non-communicable diseases among the pregnant women in selected three teagardens of Sreemongol Upazila in Moulvibazar district

This study assessed the prevalence of non-communicable diseases among 86 pregnant women in three randomly selected teagardens in Sreemongol, Moulvibazar, finding significant rates of gestational diabetes (12.7%), underweight status (28%), and pregnancy complications (16.5%) to inform future community-based surveillance models.

The Gist

Imagine a group of women working in the lush, green tea gardens of Sreemongol, Bangladesh. For generations, the focus of their healthcare has been on the "big emergencies" of pregnancy: making sure the baby is born safely and the mother survives childbirth. It's like having a fire department that only shows up when the house is already burning down, but never checks the smoke detectors or the electrical wiring.

This study decided to look at the "smoke detectors" and the "wiring" before the fire starts. It asked: Are these pregnant women developing silent, long-term health problems (Non-Communicable Diseases or NCDs) that could hurt them and their babies, even if they aren't in immediate danger?

Here is the story of what they found, broken down into simple terms:

1. The Hidden Guests (The Health Problems)

The researchers invited 86 pregnant women from three tea gardens to a health check-up. They were looking for three specific "hidden guests" that often sneak into a pregnant body:

• High Blood Pressure (Hypertension): Like a garden hose with the water turned on too high, straining the pipes.
• Gestational Diabetes (GDM): Like a sugar overload in the body's engine, where the system can't process the fuel (sugar) correctly during pregnancy.
• Weight Issues: Being too thin (underweight) or carrying too much extra weight (overweight).

The Surprise:
Even though these women live in rural, hard-working communities, they found that 1 in 8 women (12.7%) had Gestational Diabetes. That is a surprisingly high number for a rural area. They also found that 1 in 3 women (28%) were underweight, while 1 in 10 (11%) were overweight.

It's a "double burden": some women are too weak to carry the baby, while others are carrying too much extra weight, and a significant number have their blood sugar spiking.

2. The Broken Compass (The Lack of Knowledge)

Imagine trying to navigate a forest without a map. That is what these women were facing.

• 6 out of 10 women didn't even know what "Non-Communicable Diseases" were.
• They didn't realize that high blood sugar or high blood pressure during pregnancy could make the baby sick or cause the mother to get diabetes later in life.
• It's like driving a car with a flat tire, but the driver thinks everything is fine because the engine is still running.

3. The Missing Tools (The Healthcare Gap)

This is the most critical part of the story. The researchers went to the tea garden clinics to see what the doctors and midwives were actually doing. They found a startling gap between what should happen and what was happening.

• The Blood Sugar Test: This is the most important test for finding diabetes. Yet, in the clinic records, only about 1 in 3 women had their blood sugar checked.
• The Counseling: Even when they did check, almost no one was told, "Hey, your sugar is high, here is what you need to eat to fix it."
• The Blood Pressure: Less than half of the women had their blood pressure measured during their visits.

It's like going to a mechanic for a car tune-up, and they only check the oil but ignore the brakes, the tires, and the engine light, even though the car is making a weird noise.

4. Why This Matters

The study found that while the government has great plans on paper to help mothers, the "on-the-ground" reality in these tea gardens is different. The clinics are still focused on the "emergency" part of pregnancy (delivering the baby) and have forgotten the "preventive" part (checking for diabetes and high blood pressure).

The Analogy:
Think of pregnancy as a long journey.

• The Old Way: The health system only had a tow truck ready for when the car broke down at the destination.
• The New Need: We need to give every driver a map, check the tires before they leave, and teach them how to drive safely so the car never breaks down in the first place.

The Bottom Line

The study concludes that we need to change the game. We can't just wait for emergencies.

• Simple Tests Work: Midwives and community health workers can easily check blood sugar and blood pressure with simple tools.
• Education is Key: We need to teach these women that their health matters before the baby is born, not just during delivery.
• Partnerships: Local NGOs and community groups need to join forces with the government to set up regular "health camps" in the tea gardens.

In short: These women are working hard in the tea gardens, but their health is being overlooked. By catching these "silent" diseases early, we can ensure that both the mother and the baby arrive at the finish line healthy and strong.

Technical Summary

1. Problem Statement

Non-communicable diseases (NCDs) such as hypertension, diabetes, and obesity are emerging as a major cause of morbidity and mortality in Bangladesh, accounting for approximately 61% of deaths. While maternal health programs in Bangladesh have historically focused on reducing maternal mortality through Emergency Obstetric and Newborn Care (EmONC), there is a significant gap in addressing the rising burden of NCDs among pregnant women.

• Specific Context: Teagarden communities in Bangladesh are often marginalized, with limited access to healthcare and lower socioeconomic status.
• The Gap: There is a lack of data regarding the prevalence of NCDs (specifically Gestational Diabetes Mellitus [GDM], hypertension, and abnormal BMI) in these specific rural/semi-rural populations, and a lack of integration of NCD screening into routine Antenatal Care (ANC).

2. Methodology

• Study Design: A facility-based cross-sectional study.
• Setting: Three randomly selected teagardens in Sreemongol Upazila, Moulvibazar district, Bangladesh. The study was conducted between July and December 2019.
• Participants: 86 pregnant women attending ANC services at the selected teagarden facilities.
  • Inclusion: Pregnant women seeking ANC.
  • Exclusion: Severely ill women or those unwilling to participate.
• Sampling: Purposive sampling based on feasibility and prior literature.
• Data Collection:
  • Face-to-face interviews using a pre-tested semi-structured questionnaire.
  • Clinical assessments (Blood Pressure, Anthropometry).
  • Review of ANC records.
  • Screening Protocol:
    • GDM: Single-step 75g Oral Glucose Tolerance Test (OGTT). Positive cut-off: 7.8–11.0 mmol/L.
    • Hypertension: Standard BP measurement.
    • Nutritional Status: Body Mass Index (BMI) calculation.
• Data Analysis: Descriptive statistics (univariate and bivariate) using SPSS Version 24.
• Ethics: Approved by the CIPRB Ethical Review Committee; informed consent was obtained from all participants.

3. Key Contributions

• Contextual Evidence: Provides the first specific data on NCD prevalence among pregnant women in the teagarden communities of Moulvibazar, a population often overlooked in national health surveys.
• Service Delivery Audit: Highlights the critical disconnect between national NCD guidelines and actual clinical practice in these facilities, specifically regarding the lack of counseling and systematic screening.
• Dual Burden Identification: Documents the coexistence of undernutrition (underweight) and overnutrition (overweight/obesity) within the same vulnerable demographic.

4. Key Results

A. Sociodemographic Characteristics

• Age: Mean age was 23 years (range 15–45); 40% were aged 20–24.
• Education: Low literacy levels; >55% had education below primary level.
• Obstetric History: 47.2% were primigravida (Gravida 1).
• Pregnancy Duration: Mean duration was 18.8 weeks; 49.8% were in the 13–<24 weeks range.

B. Prevalence of NCDs

• Gestational Diabetes Mellitus (GDM): 12.7% of women tested positive (7.8–<11 mmol/L). An additional 1.9% had pre-existing diabetes (≥11.1 mmol/L).
• Hypertension: Only 1.7% (2 women) were identified with high blood pressure. However, 24.5% had low blood pressure.
• Nutritional Status (BMI):
  • Underweight (<18.5): 28.0%
  • Healthy Weight: 60.9%
  • Overweight (25–29.9): 11.1%
• Knowledge: 66.6% of women had no knowledge regarding NCDs or their complications.

C. Antenatal Care (ANC) Service Gaps

Observation of ANC records revealed significant deficiencies in NCD management:

• Screening: Only 31.3% of cases had blood sugar test information recorded; only 45.8% had blood pressure measured.
• Counseling: Only 4.2% of women received any information related to NCDs. Zero cases received counseling on NCD risk factors.
• History Taking: Family history of diabetes was asked in only 31.3% of cases.
• Referrals: No cases were referred for laboratory sugar testing, and no capillary/urine sugar tests were performed during the observed visits.

5. Significance and Implications

• Epidemiological Shift: The study confirms that the "epidemiological transition" (rise of NCDs) has reached marginalized rural populations like teagarden workers, with a GDM prevalence (12.7%) comparable to or higher than national rural averages.
• Systemic Failure: The findings indicate that current ANC protocols in these facilities are failing to integrate NCD screening. The focus remains on emergency obstetric care, missing opportunities for early detection of metabolic disorders.
• Policy Recommendations:
  • Integration: NCD screening (BP, BMI, Glucose) must be made a mandatory, routine part of ANC in primary health facilities.
  • Task Shifting: Community health workers and midwives should be trained to perform simple screening and counseling.
  • Community Surveillance: A community-based surveillance model involving local NGOs and government health managers is proposed to improve follow-up and periodic screening camps.
  • Education: Urgent need for health education campaigns to improve NCD awareness among pregnant women in these communities.

Conclusion: The study concludes that while the prevalence of hypertension was low, the burden of GDM and the dual burden of malnutrition are significant. The lack of provider counseling and systematic screening represents a critical gap that, if unaddressed, will lead to increased maternal and neonatal morbidity and future type-2 diabetes risks.