The alarming use of tobacco in Bangladesh

Bangladesh faces serious tobacco epidemic. According to the recent Global Adult Tobacco Survey (GATS) 2009, 23 percent of adult (=15 years) currently smoke tobacco (Male 44.7 percent and Female 1.5 percent). The estimated number of current adult tobacco smokers is 21.9 million (Male 21.2 million and Female 0.7 million). The smoking rate in rural areas is slightly higher (23.6 percent) than in urban areas (21.3 percent). Half of the smokers use bidis, and the prevalence of bidi smoking in rural areas (13.5 percent) is higher than in urban areas (4.7 percent).
Among all adults, 45 percent were exposed to second hand smoking (SHS) in public places. Male (69.4 percent) are more exposed than female (20.8 percent). Restaurants (27.6 percent) and public transportation (26.3 percent) are the most common places people are exposed to SHS. Among all persons engaged in some occupation who work in indoor areas, 63 percent (11.5 million) were Exposed to SHS in indoor areas of the workplace, and among non-smokers, 75.7 percent (5.1 million) were exposed to SHS at these workplaces.
It is estimated that in Bangladesh total expenditure on cigarettes is 1.0 percent of Gross Domestic Product (GDP) and on bidis is 0.4 percent of GDP. The price of 100 packs of manufactured cigarettes as a percentage of per capita GDP is 5 percent and the price of 100 packs of bidis as a percentage of per capita GDP is 1 percent.
Fighting tobacco in Bangladesh will require a strong commitment to the World Health Organisation’s MPOWER strategies. The six MPOWER strategies are:
* Monitor tobacco use and prevention policies
* Protect people from tobacco smoke
* Offer help to quit tobacco use
* Warn about the dangers of tobacco
* Enforce bans on tobacco advertising, promotion and sponsorship
* Raise taxes on tobacco
Making MPOWER a reality in Bangladesh means effectively taxing bidis and raising taxes on cigarettes, enacting and enforcing strong smoke-free laws, and preventing and countering the advertising tactics of tobacco companies. These are proven strategies that can help avert unnecessary illness and death.
On the eve of Tobacco Awareness Month: 24-30 January, government, civil society should ramp up their efforts to curb tobacco use and raise voice to say NO to tobacco.

Dealing with male infertility

 All over the world, the problem lies solely in the men partner in about one in five infertile couples and in about another quarter of cases, both partners are responsible for the problem. Although, there is common belief of blaming only female partner are still prevail. It has been estimated that one in 20 men have some kind of fertility problem and one in every 100 men produces no sperm in their ejaculate. But fortunately, one in eight infertile men are medically treatable.
Medically untreatable sub-fertility
Three quarters of infertile men have sperm present in the semen but with subnormal value. Procedures like, intra-uterine insemination (IUI)-Inserting prepared sperm into the uterus or in-vitro fertilisation (IVF)-insemination of egg with prepared sperm in a dish, can help this group of men to overcome the situation.
Untreatable male sterility
About one in nine infertile men has no sperm in their semen. Azoospermia may be due to absent sperm production or blockage in the duct. At present no treatment is available even with modern IVF settings to treat male infertility with absent sperm production but infertility due to blockage can easily be treated by intracytoplasmic sperm injection (ICSI) in conjunction with epididymal or testicular sperm aspiration or testicular biopsy under local anaesthesia or with frozen sample. Thus this procedure is mainly indicated for male factor infertility in which the count, motility, or strict morphology is low. In a highly reputed IVF clinic has achieved cumulative pregnancy rate with ICSI around 70 percent and found no significant increase in congenital defects in ICSI babies compared to general population.
Indications for ICSI
* Oligozoospermia ( < 20 million per ml)
* Asthenozoospermia ( < 30% progressive motility)
* Teratozoospermia (abnormal shaped sperm)
* Antisperm antibodies
* Fertilisation failure after conventional IVF
* Ejaculatory disorders
* Congenital bilateral absence of vas deferens
* Obstruction of both ejaculatory ducts
* Azoospermia due to obstruction
* Failed vasovasostomy
Even if it is very stressful for an infertile man after an initial diagnosis of infertility but man have to understand that absence of sperm in the semen is not the end of the world. And at the end of the day, with the help of ever advanced technology, a man need only one healthy sperm to fertilise an egg compared to minimum 100 millions in natural conception.
So, every man has to ensure that he has at least one healthy, good swimmer sperm by practicing a healthy lifestyle so that his future desire to have a healthy baby does not turn into ashes.