A study was done by National Malaria Elimination Program of Bangladesh . Draft analysis was done by Md Mosiqure Rahaman- the Epidemiologist by using EPI info

1. Glucose-6-phosphate dehydrogenase deficiency in people
living in malaria high endemic districts of Bangladesh
Dr.Rahaman
Dr.Md Mosiqure Rahaman Bitu
Epidemiologist,
NMEP

2. Physiology of G6PD
Dr.Rahaman
Glucose-6-phosphate
6-Phosphogluconate
+NADPH+H+
In case of G6PD deficiency
Inadequate Supply of
NADPH
Reduced Hb oxidation
G6PD Enzyme

3. G6PD Deficiency Global Scenario
Dr.Rahaman

4. Objective of the Study
General Objective: To generate the evidence for decision
making on the need for G6PD testing in the treatment of
malaria
Specific Objective:
• To determine the status of G6PD among the population living
in malaria risk areas of Bangladesh
• To categorize the status of G6PD among the population
living in malaria risk areas of Bangladesh
• To assess the socio demographic feature among the risk
population
Dr.Rahaman

5. Sample Size & Method
A cross-sectional study with 600 samples were under-taken to estimate
the population prevalence of G6PDd in 3 malaria endemic districts of
Bangladesh using CareStart™ G6PD Biosensor. Hemoglobin level of each
patient will be measured by portable hemoglobin meter.
In each district, 2 high endemic upazilas were selected from each district
based on the district health records in coordination with Brac .Then 1
unions were randomly selected from each upazila. A sampling frame
will be prepared from HHs list and 100 HH were selected randomly from
each union. Among the HHs sample were collected following the
inclusion and exclusion criteria. Each upazila team will comprise 1
medical technologist, 1 data collector and 1 field staff supervised by
Research Assistant. Each team collected data from 10 respondents each
day and data collection will be completed by 25 days. Data will be
analyzed in Epi info and the result will be plotted according to WHO
classification of G6PD deficiency. Analysis done by EPI-Info software
Dr.Rahaman

6. Instrument Used
Dr.Rahaman
Care Start G6PD Biosensor Hemoglobin Meter

7. WHO Classification
Dr.Rahaman

8. Age Distribution
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9. Geographical Distribution
Dr.Rahaman
Frequency Percent Valid Percent
Cumulative
Percent
Bandorbon 201 33.1 33.1 33.3
Khagrachori 199 32.8 32.8 66.1
Rangamati 206 33.9 33.9 100.0
Total 607 100.0 100.0
District

10. Sex Distribution
Dr.Rahaman

11. Ethnicity Distribution
Dr.Rahaman-Epidemiologist-NMEP

12. Educational Status
Education Frequency Percent
Cum.
Percent
Wilson 95%
LCL
Wilson 95%
UCL
B.A 27 4.88% 4.88% 3.38% 7.01%
B.B.S 2 0.36% 5.24% 0.10% 1.31%
B.S.C 1 0.18% 5.42% 0.03% 1.02%
H..S.C 1 0.18% 5.61% 0.03% 1.02%
H.S.C 69 12.48% 18.08% 9.98% 15.49%
J..S.C 1 0.18% 18.26% 0.03% 1.02%
J.S.C 119 21.52% 39.78% 18.30% 25.13%
M.A 13 2.35% 42.13% 1.38% 3.98%
M.S.C 1 0.18% 42.31% 0.03% 1.02%
P.S.C 127 22.97% 65.28% 19.65% 26.65%
Pre Schooling 102 18.44% 83.73% 15.43% 21.89%
S.S.C 90 16.27% 100.00% 13.43% 19.58%
TOTAL 553 100.00% 100.00%
Dr.Rahaman

13. Occupational Status
Occupation Frequency Percent
Cum.
Percent
Wilson
95% LCL
Wilson
95% UCL
Business 53 8.73% 8.73% 6.74% 11.24%
Fermar 57 9.39% 18.12% 7.32% 11.97%
House Wife 214 35.26% 53.38% 31.56% 39.14%
Labour 31 5.11% 58.48% 3.62% 7.16%
Service 76 12.52% 71.00% 10.12% 15.39%
Student 176 29.00% 100.00% 25.53% 32.73%
TOTAL 607 100.00% 100.00%
Dr.Rahaman

14. District Wise Status of G6PD
District * G6PD Status_RECODED
District Very Severe Severe Moderate Normal Enhance TOTAL
Bandorbon
52
25.86%
92.86%
20
9.95%
64.52%
5
2.49%
12.82%
100
49.75%
25.06%
24
11.94%
29.27%
201
100%
33.11%
Khagrachori
0
0.00%
0.00%
2
1.00%
6.45%
16
8.00%
41.03%
145
72.50%
36.34%
37
18.50%
45.12%
200
100%
32.95%
Rangamati
4
1.95%
7.14%
9
4.37%
29.03%
18
8.74%
46.15%
154
74.76%
38.60%
21
10.19%
25.61%
206
100%
33.19%
TOTAL
56
9.23%
100%
31
5.11%
100%
39
6.43%
100%
399
65.73%
100%
82
13.51%
100%
607
100%
100%
Dr.Rahaman
Chi-square df Probability
131.5398 8 0.0000

15. Distribution of G6PD by Ethnicity
Ethnicity * G6PD Status_RECODED
Ethnicity
Very
Severe
Severe Moderate Normal Enhanced TOTAL
Bengali
23
10.27%
41.82%
11
4.91%
35.48%
20
8.93%
54.05%
137
61.16%
34.42%
33
14.73%
40.24%
224
100%
37.15%
Non-
Bengali
32
8.44%
58.18%
20
5.28%
64.52%
17
4.49%
45.95%
261
68.87%
65.58%
49
12.93%
59.76%
379
100%
62.85%
TOTAL
55
9.12%
100%
31
5.14%
100%
37
6.14%
100%
398
66.00%
100%
82
13.60%
100%
603
100%
100%
Dr.Rahaman
Chi-square df Probability
6.6831 4 0.1536

16. Sex Distribution & G6PDDeficiency
Dr.Rahaman
Sex * G6PD Status_RECODED
Sex Very
Severe
Severe Moderate Normal Enhance TOTAL
Female 23
7.12%
41.07%
17
5.26%
54.84%
15
4.64%
38.46%
216
66.87%
54.14%
52
16.10%
63.41%
323
100%
53.21%
Male 33
11.62%
58.93%
14
4.93%
45.16%
24
8.45%
61.56%
183
64.44%
45.86%
30
10.56%
36.59%
284
100%
46.79%
TOTAL 56
9.23%
100%
31
5.11%
100%
39
6.43%
100%
399
65.73%
100%
82
13.51%
100%
607
100%
100%
Chi-square df Probability
10.3216 4 0.0353

17. G6PD Status by Age Group
AgeRECODED * G6PD Status_RECODED
Age_RECO
DED
Very
Severe
Severe Moderate Normal Enhance TOTAL
5-25Y
26
(10.74%)
(46.43%)
19
(7.85%)
(63.33%)
18
(7.44%)
(47.37%)
148
(61.16%)
(37.19%)
31
(12.81%)
(38.27%)
242
(100%)
(40.13%)
25-45Y
24
8.96%
42.86%
7
2.61%
23.33%
18
6.72%
47.37%
181
62.54%
45.48%
38
14.18%
46.91%
268
100%
44.44%
45-65Y
6
6.45%
10.71%
4
4.30%
13.33%
2
2.15%
5.26%
69
74.19%
17.34%
12
12.90%
14.81%
93
100%
15.42%
TOTAL
56
9.29%
100%
30
4.98%
100%
38
6.30%
100%
398
66.00%
100%
81
13.43%
100%
603
100%
!00%
Dr.Rahaman

18. Histogram of Hb(gm/dl)
Dr.Rahaman

19. G6PD Status
Dr.Rahaman

20. Relationship between Hb level & G6PD
Dr.Rahaman

21. Relationship between Hb level & G6PD
Dr.Rahaman
G6PD Status Pearson Correlation 1 -.208**
Sig. (2-tailed) 0.000
N 607 607
Hb level(gm/dl) Pearson Correlation -.208** 1
Sig. (2-tailed) 0.000
N 607 607
**. Correlation is significant at
the 0.01 level (2-tailed).

22. Relationship between Age & G6PD
Dr.Rahaman

23. G6PD Defeciency
G6PD
Status_RECO
DED
Frequency Percent Cum. Percent
Wilson 95%
LCL
Wilson 95%
UCL
Very Severe 56 9.23% 9.23% 7.17% 11.79%
Severe 31 5.11% 14.33% 3.62% 7.16%
Moderate 39 6.43% 20.76% 4.74% 8.66%
Normal 399 65.73% 86.49% 61.87% 69.40%
Enhanced 82 13.51% 100.00% 11.02% 16.46%
TOTAL 607 100.00% 100.00%
Dr.Rahaman

24. Graph Showing the G6PD Status
Dr.Rahaman

25. Summery of Result
• Around 20.76% of sampled population in the 3 malaria high
burden districts are very severe to moderate level of G6PD
deficiency according to WHO classification
• Significant geographical variation exists among the 3
districts where Bandarban the district with highest malaria
prevalence have also the highest burden of deficiencies
• Variation also exists between male and females and also
among bengalis and non-bengalies
• 80% sampled population are normal or enhanced level of
deficiencies
• Hemoglobin level negatively co-related with G6PD status
• Highest deficiencies observed among the age group of 5-
25Years of age
Dr.Rahaman

26. Recommendations
• Include of G6PD testing in national malaria treatment guideline
• Determine level of the health care system where G6PD testing and PQ
administration should be Introducing/expanding a G6PD testing system
at country level
• Develop plan for pilot implementation and progressive scale-up.
• Cross-checking the result of this study by using qualitative method
• Behaviour change communication for demand creation among health
care providers and patients
• Pharmacovigilance to strengthen monitoring of Primaquin
administration in combination with other Acute Hemolytic Anaemia-
inducing medicines in G6PD-deficient patient
Dr.Rahaman

27. Dr.Rahaman