July 30, 2020
Caring for people with diabetes in Bangladesh during COVID-19
The number of COVID-19 cases is increasing rapidly in a population with a high prevalence of diabetes.
By Bishwajit Bhowmik, Akhtar Hussain, AK Azad Khan
The COVID-19 pandemic continues to impact economies and health systems severely across the world. Many countries have reported diabetes as a significant contributor to deaths and complications among people infected by the virus. Despite the obvious differences in terms of impact and transmission – acute vs chronic, communicable vs non-communicable – COVID-19 and diabetes have more in common than initially thought.
Evidence has shown that people with diabetes are more vulnerable to the severe effects of the virus. In Bangladesh, the number of people infected is increasing rapidly in a population that already has a high prevalence of diabetes. Over 8 million people are estimated to be living with diabetes in the country and a similar number are at high risk of developing type 2 diabetes. Bangladesh has reported over 234,000 cases of COVID-19 and recorded 3083 confirmed deaths in hospital from the virus. The actual number in likely to be much more. The numbers emphasise the importance for people living with diabetes to take all the recommended precautions to avoid the virus and to have access to the health care required to manage their condition.
Over 8 million people are estimated to be living with diabetes in Bangladesh.
The role of the Diabetic Association of Bangladesh (BADAS)
In developing countries, diabetes is widespread but there is a lack of organised care for this and other chronic conditions. Professional and civil society associations often help fill this gap.
In Bangladesh, the Diabetic Association of Bangladesh (BADAS) has created a sustainable model of health care for people with diabetes and the general population. BADAS is looking after more than half of all people with diabetes in the country and hopes to increase this to 75% by 2022. The Association currently manages over 100 institutions, ranging from small to large hospitals, that provide primary, secondary and tertiary care across all disciplines. BADAS employs over 1500 physicians and nurses, 118 health educators and more than 2,000 lab technicians to provide comprehensive care throughout the country.
In the context of the COVID-19 crisis, the association has taken a number of initiatives to protect people with diabetes and healthcare workers from the virus.
Ensuring continuation of care: All BADAS hospitals and healthcare centers have continued to provide uninterrupted access to services throughout the pandemic.
Protecting healthcare facilities: All hospitals and clinics have limited the risk of potential infection by separating screening and waiting areas for suspected cases; providing hand-hygiene stations for healthcare workers, patients, and visitors; limiting the number of visitors and regularly disinfecting their premises.
Protecting health workers: Over 1000 health professionals in Bangladesh have been infected with COVID-19. BADAS has tackled the issue by providing personal protective equipment (PPEs) to all employees and delivering training to ensure proper use; training health personnel to spot the symptoms of a potential COVID-19 infection; making case definitions and decision-flow diagrams available for reference at screening stations; and developing multilingual guidelines on COVID 19 and diabetes for health professionals and people with diabetes.
All BADAS hospitals and healthcare centers have continued to provide uninterrupted access to services throughout the pandemic.
Facilitating digital care: In 2018, BADAS established a call center – the “Ibrahim Helpline” – to save patients time and improve access to health care. During COVID-19, people with diabetes have been encouraged to use this service to limit the need to visit hospitals and clinics. At the time of writing, over 2000 people, mainly living with diabetes, have accessed this free service in the previous two months. Video consultations with specialists/consultants have also been introduced.
Facilitating diagnosis: Laboratories to analyse and process COVID-19 samples were initially only available in a few Government Hospitals. Following the Government’s decision to also allow these labs in private hospitals, BADAS started two COVID-19 RT-PCR laboratories, one in the capital Dhaka and the other in the suburbs. BADAS has also established collection stations for samples in and around Dhaka, and, with affiliated diabetes associations, in district towns throughout Bangladesh. Two dedicated COVID-19 wings have also been set up to provide health care at an affordable cost.
Advocating for people with diabetes: BADAS has been working closely with the Government of Bangladesh to help manage the crisis, and with local and international pharmaceutical companies to ensure the uninterrupted supply of diabetes medicines and supplies. Free insulin is available for the most vulnerable through social welfare programmes and all BADAS pharmacies remain adequately stocked.
Promoting community awareness: A large multi-stakeholder community awareness platform – “COVID and Diabetes – Our Initiatives” – has been developed. It features:
COVID-19 is posing many risks and challenges for people with diabetes in Bangladesh. BADAS is working diligently to help them and their caregivers. Further assessments are needed to gauge the effectiveness of our efforts, but we hope they will receive the attention of health policy-makers, health professionals, and governments.
Dr Bishwajit Bhowmik, Prof Akhtar Hussain and Prof Azad Khan represent the Centre for Global Health Research, Diabetic Association of Bangladesh; Prof Hussain also represents the Faculty of Health Sciences, Nord University, Norway and is President-Elect of the International Diabetes Federation