DiabetesScale Up SU16, 2019 – 2022

The Bangladesh D:CLARE Project [Diabetes: Community-Led Awareness, Response and Evaluation]

Background

Our DMagic trial of monthly group meetings led by lay facilitators who guided participants through a Participatory, Learning and Action (PLA) cycle focused on diabetes prevention and control in rural Bangladesh. Through a four-phase cycle, community members: 1) identified local behavioural, social and environmental threats to their health and prioritised areas for action; 2) planned strategies to address these threats; 3) implemented their chosen strategies, which typically included greater awareness-raising, local exercise groups, or lobbying markets for better access to healthy foods; and 4) evaluated the success of these strategies. Facilitators were locally recruited men and women who received one week’s training in group facilitation and in the basics of diabetes prevention and control. Using robust measurements we compared population prevalence of intermediate hyperglycaemia and diabetes between intervention and control villages. After 18 months of intervention, the prevalence of diabetes and intermediate hyperglycaemia was 65% lower in intervention villages compared to control villages. Further, among individuals identified with intermediate hyperglycaemia before the intervention, the cumulative two-year incidence of diabetes was more than 60% lower in intervention villages. The intervention is cost-effective and could save around INT$2.5 billion in health care costs annually if scaled-up nationally in Bangladesh.

Scale-up
The robust evidence of impact of our low-cost, social intervention demands replication and scale-up in Bangladesh. We propose to roll out the intervention across six Unions in Faridpur district, as well as all the control villages from our aforementioned trial. In total, the scaled-up intervention will cover a population of approximately 215,000 people.

Research
In partnership with the Diabetic Association of Bangladesh, who will be intervention implementers, UCL will lead a programme of implementation research with the following aims:

1) engage with national stakeholders to identify optimal intervention delivery mechanisms, and develop strategies to strengthen scale-up systems across Bangladesh and the region;

2) characterise PLA implementation and impact of the intervention at scale using qualitative, economic and quantitative methods;

3) describe the sustainability and lasting health impacts of the PLA intervention in former intervention (trial) communities to better understand what happens when direct involvement of the implementing partners is withdrawn and communities are left to run the intervention on their own;

4) establish the feasibility and acceptability of the PLA intervention within a different, higher-risk population in urban Bangladesh.”

Programme Team

  • Fottrell Edward University College London (UCL) United Kingdom
  • Khan Azad Diabetic Association of Bangladesh Bangladesh
  • Azad Kishwar Diabetic Association of Bangladesh Bangladesh
  • Morrison Joanna UCL United Kingdom
  • Kuddus Abdul Diabetic Association of Bangladesh Bangladesh
  • Copas Andrew University College London (UCL) United Kingdom
  • Jennings Hannah University College London (UCL) United Kingdom
  • King Carina University College London (UCL) United Kingdom
  • Haghparast-Bidgoli Hassan University College London (UCL) United Kingdom
  • Batchelor James University of Southampton United Kingdom

Funding organisations

  • DiabetesScale Up SU16
  • Bangladesh
  • 2019 – 2022

Programme contact
Ed Fottrel
e.fottrell@ucl.ac.uk