Epidemiological transition in rural Bangladesh, 19862006 Zunaid Ahsan Karar 1 *, Nurul Alam 2 and Peter Kim Streatfield 2 1 South Asia Human Development Sector, The World Bank/Dhaka, Bangladesh; 2 Health & Demographic Surveillance Unit, ICDDR,B, Dhaka, Bangladesh Background: For understanding epidemiological transition, Health and Demographic Surveillance System plays an important role in developing and resource-constraint setup where accurate information on vital events (e.g. births, deaths) and cause of death is not available. Methods: This study aimed to assess existing level and trend of causes of 18,917 deaths in Matlab, a rural area of Bangladesh, during 19862006 and to project future scenarios for selected major causes of death. Results: The results demonstrated that Matlab experienced a massive change in the mortality profile from acute, infectious, and parasitic diseases to non-communicable, degenerative, and chronic diseases during the last 20 years. It also showed that over the period 19862006, age-standardized mortality rate (for both sexes) due to diarrhea and dysentery reduced by 86%, respiratory infections by 79%, except for tuberculosis which increased by 173%. On the other hand, during the same period, mortality due to cardiovascular and cerebrovascular diseases increased by a massive 3,527% and malignant neoplasms by 495%, whereas mortality due to chronic obstructive pulmonary disease and injury remained in the similar level (1213% increase). Conclusion: The trend of selected causes of death demonstrates that in next two decades, deaths due to communicable diseases will decline substantially and the mortality due to non-communicable diseases (NCDs) will increase at massive proportions. Despite Matlab’s significant advances in socio-demographic indicators, emergence of NCDs and mortality associated with it would be the major cause for concern in the coming years. Keywords: epidemiological transition; mortality; verbal autopsy; cause of death; Matlab; Bangladesh Received: 16 November 2008; Revised: 6 April 2009; Accepted: 27 May 2009; Published: 19 June 2009 H ealth transition has been one of the most important features of demographic changes in the twentieth century. It is a complex process comprising demographic, epidemiological, and health care transitions that manifested in rising life expectancy at birth due to changes in the fertility, mortality, and morbidity profile of a population (1, 2). The general shift from acute infectious and deficiency diseases to chronic non-communicable diseases (NCDs) is usually referred to as the epidemiological transition, which reflects changes in the pattern of mortality, particularly in relation to the cause of death (COD), as well as changes in morbidity (3). Over five decades or so from 1950, Asia has witnessed a dramatic demographic and epidemiological transition, affecting the population growth rate, expectation of life, and health systems (4). It has significant implications for the environmental, economic, social, and health conse- quences in national level, especially for the developing countries. The World Health Organization (WHO) forecasts that in the next two decades there will be dramatic changes and transitions in the world’s health needs, as a result of epidemiological transition. At present, lifestyle and behavior are linked to 2025% of the global burden of disease, which would be increasing rapidly in poorer countries (5). Moreover, NCDs are expected to account for seven out of every 10 deaths in the developing regions by 2020, compared with less than half today. Injuries, both unintentional and intentional, are also growing in importance and by 2020 could rival infectious diseases as a source of ill-health (5). For understanding demographic and epidemiological transitions, Health and Demographic Surveillance Sys- tem (HDSS) plays an important role in developing and resource-constraint setups where accurate information on vital events(e.g. births, deaths) and COD is not available. The primary objective of this study was to assess existing level and trend of mortality by causes of deaths for people living in rural Bangladesh. In this paper, the authors analyzed COD data from a rural demographic and health surveillance area, collected through standard verbal autopsy (VA) tools, for the period 19862006. The (page number not for citation purpose) æ ORIGINAL ARTICLE Global Health Action 2009. # 2009 Zunaid Ahsan Karar et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Global Health Action 2009. 1 DOI: 10.3402/gha.v2i0.1904