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Prevalence of Rheumatic Diseases and Associated Outcomes in Rural and Urban Communities in Bangladesh: A COPCORD Study
SYED ATIQUL HAQ, JOHN DARMAWAN, MOHAMMAD NAZRUL ISLAM, MOHAMMED ZAHIR UDDIN, BIDHU BHUSHAN DAS, FAZLUR RAHMAN, MOHAMMAD ABDUL JALIL CHOWDHURY, MOHAMMAD NOOR ALAM, TAIMUR ABUL KHAIR MAHMUD, MINHAJ RAHIM CHOWDHURY, and MOHAMMAD TAHIR
ABSTRACT. 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. (J Rheumatol 2005;32:348-53) Key Indexing Terms:
PREVALENCE
From the Rheumatology Wing, Department of Medicine, Bangabandhu Sheikh Mujib Medical University Shahbagh, Dhaka; WHO Collaborating Center, Seroja Rheumatic Center, Semarang, Indonesia; Institute of Child and Mother Health, Matuail; Chittagong Medical School, Chittagong; Upazilla Health Complex, Kurigram; Shahid Suhrawardy Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh. Supported by the Asia Pacific League of Associations for Rheumatology (APLAR); and WHO Collaborating Center, Semarang, Indonesia. S.A. Haq, MD, Professor, Department of Medicine (Rheumatology Wing), Bangabandhu Sheikh Mujib Medical University; J. Darmawan, MD, WHO-ILAR-COPCORD Coordinator, Director, WHO Collaborating Center; M.N. Islam, MD, Assistant Professor, Department of Medicine (Rheumatology Wing), Bangabandhu Sheikh Mujib Medical University; M.Z. Uddin, MD, Assistant Professor of Medicine, Chittagong Medical College; B.B. Das, MD, Junior Consultant, Upazilla Health Complex; F. Rahman, MD, Associate Professor of Epidemiology, Institute of Child and Mother Health, Matuail; M.A.J. Chowdhury, MD, Associate Professor; M.N. Alam, MD, Retired Professor; T.A.K. Mahmud, MD, Associate Professor; M.R. Chowdhury, MD, Associate Professor; M. Tahir, MD, Professor, Department of Medicine, Bangabandhu Sheikh Mujib Medical University. Address reprint requests to Dr. S.A. Haq, Aptt 3B, House 11 (Dhanmondi Terrace), Road 10, Dhanmondi, Dhaka 1205, Bangladesh. E-mail: sahaq@citech.net Submitted May 14, 2003; revision accepted September 22, 2004. |