Morbidity a state of illness, or the number of cases per year of certain diseases in relation to the population in which they occur. Morbidity may refer to general prevalence of diseases in the population also. Bangladesh has a very high population density. Mothers and children together make up about three-fifths of the population of the country. It is among these groups that disease and death take their highest toll, although in a large measure, these are preventable. Compared to developed countries, both infant and maternal mortality ratios are higher in Bangladesh.

Various social, cultural, environmental and economic factors, as well as availability of healthcare services profoundly affect the health and nutrition of the mothers and their children. Moreover, early marriage and high fertility expose the mothers prematurely to mental and physical stresses, leading to deterioration of health. Most patients receive limited or no medical attendance and, in case of death, post-mortem autopsies are done only in very rare and unusual situations. Causes of morbidity or death are usually assessed through alternative source of information like the 'verbal autopsy', a description of symptoms and events preceding the event.

The prevalence of morbidity in Bangladesh varies by age groups, gender and urban/rural residence. The male infant morbidity is slightly higher than the female infant morbidity but female morbidity is much higher in the reproductive ages. Morbidity of children (both male and female) of age group 1-4 is around 200 per 1000 and of age group 5-14, it is 86, while morbidity of age group 15-29 is 90 for male and 135 for female population. Corresponding figures for male and female population of age group 30-49 are 162 and 216 and of age group 50-59 are 220 and 307 respectively. Maternal morbidity ratio (MMR) is around 450 per 100,000 live births. MMR is the highest in the age group 15-19 years. Nearly 40 percent of women of reproductive age suffer from chronic or residual morbidity. Morbidity in both urban and rural areas is higher for females and this may be due mainly to the fact that most women often do not report minor illnesses.

Common diseases in Bangladesh include diarrhoea, dysentery, worms infection, measles, diphtheria, whooping cough, tetanus, pulmonary tuberculosis, polio, asthma, pneumonia, jaundice, typhoid, dyspepsia/gastritis, malaria, meningitis, rabies/ hydrophobia, eye infection, peptic ulcer, common cold and scabies. Burns and injuries also cause morbidity. Prevalence rate for all diseases other than heart diseases is higher in rural destitute households compared to non-destitute ones. The group of maternal diseases includes diseases common to the women as well as those associated with their reproductive health. Among female members of destitute households 13 per thousand female members suffer from maternal diseases.

The incidence of disease among adults of both sexes is different from that among the children. Among the adults, Dyspepsia/peptic/gastric ulcer has the highest prevalence followed by fever/PUO, and these are more prevalent among adult females. Females of age group 15-49 suffer less from high blood pressure and heart disease than males of the same age group. Women are less prone to asthma, respiratory diseases, pneumonia and tuberculosis. Common diseases contracted by both male and female at the old age (60+) are rheumatic fever, asthma, ulcer, fever and acute respiratory infection. Disease pattern in the urban areas is different from that in the rural areas. Chicken pox, viral fever, high blood pressure, diabetes and heart disease are more common in urban areas.

In the absence of proper care in time, morbidity leads to chronic illness, disability, and even death. A recent survey of 347,150 rural people revealed that 4,447 of them were disabled and among them 2,456 were male, 1,991 female.

Following are some of the facts that illustrate morbidity situation in Bangladesh. Of the male population in the country, 69 out of every 10,000 suffer from nightblindness because of unbalanced food intake and poor knowledge about the food that contain vitamin A, and 10/10,000 cases are blind. The corresponding figure for female population is 72/10,000 and 21/10,000 respectively. Malaria, although non-existent for several years due to extensive malaria eradication programme, emerged as a serious problem in early 1990s and many people died of the disease. The number of cases went down in 1996, but certain areas, such as chittagong hill tracts and teknaf, still remain endemic. The cases of leprosy in the country were estimated to be about 40,000 in 1996. Tuberculosis has been reduced substantially by effective immunisation programme among the younger age groups, but it still prevails among the older population and is more prevalent among males. Entire population of the country is exposed to risk of contracting goitre because of iodine deficiency and poor micro-nutrient content in soil. In 1993, around 50 percent of population of age group 5-11 years had visible symptoms of goitre. Iodine deficiency also caused 1.8 million cases of mental impairment, which has remained practically unnoticed.

Some of the other diseases now receiving increased attention are reproductive tract infections (RTI) and sexually transmitted diseases including contracting human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Sero-epidemiological surveys indicate a low prevalence of HIV/AIDS in Bangladesh. Facilities for pathological tests are extremely limited. Department of Virology, bangabandhu sheikh mujib medical university (BSMMU) and icddr,b are the only places where appropriate tests are done. According to BSMMU, 79 HIV positive cases were detected in the hospital in 1996 although UNFPA estimates suggest that there had been about 20,000 Hiv infected cases in the country in that year. However, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the number of HIV-positive individuals was estimated at 12,000 in 2007 in Bangladesh. [Md Shahadat Hossain]