Genetic counseling in the context of Bangladesh: current scenario, challenges, and a framework for genetic service implementation

Abstract

With the advancements in genetics and genomics in the twenty-first century, genetic services have become an integral part of medical practices in high-income and upper-middle-income countries. However, people living in low and lower-middle-income countries (LICs and LIMCs), including Bangladesh, are rather underprivileged in receiving genetic services. Consequently, genetic disorders are emerging as a significant public health concern in these countries. Lack of expertise, high expense, the dearth of epidemiological data, insufficiently updated medical education system, poor infrastructure, and the absence of comprehensive health policies are the main factors causing people living in these countries not having access to genetic services. In this article, the authors took benefit from their professional experience of practicing medical genetics in the area and reviewed existing literature to provide their opinions. Particularly, it reviews the current knowledge of genetic disorders' burden and their causative factors in Bangladesh. It focuses on why providing genetic services is challenging in the context of the country's cultural and religious sentiment. Finally, it proposes a physician-academician collaborative framework within the existing facility that aims to tackle the challenges. Such a framework could also be useful for other LICs and LMICs to address the challenges associated with providing genetic services.

Identifying the current status and future needs of clinical, educational, and laboratory genetics services in Pakistan: a web-based panel discussion

“…A similar approach could be considered for Pakistan, where a shorter diploma program in a subspecialty could be made available to increase the genetics expertise in certain areas, such as cancer, or prenatal. Hosen et al ( 2021 ), proposes a framework for the implementation of genetic services for Bangladesh and other low to middle-income countries that relies on collaboration between local and international medical professionals, laboratorians, researchers and counselors. The proposed framework is similar to the current situation in Pakistan, where, in a more informal manner, various healthcare providers, researchers and laboratorians are working together in an attempt to provide clinical genetics services when possible.…”

Constructing human genetic disease database in Bangladesh

“…Among non-infectious diseases, genetic diseases and congenital malformations are quite common. Since there is neither systematic genetic testing nor well-developed expertise for counseling nationwide, most genetic diseases in Bangladesh remain undiagnosed and have become a significant health burden [10] . Through extrapolating from the worldwide prevalence of genetic diseases, it is presumed that there are many patients with genetic diseases in Bangladesh.…”

“…Moreover, the curriculum for a primary medical degree (MBBS) does not cover adequate knowledge in genetics, so medical professionals in rural areas may have limited knowledge and access to the new technologies for detecting a genetic disease [10] . A genetic disease database should also contain all the possible symptoms of the diseases.…”

Appropriate Means to Vulgarize the Human Cytogenetics

“…It is well known that chromosomal disorders are a significant cause of premature death or often lifelong disability [4] [5] [6] [7].…”

“…There are also other factors such as the insufficiency and obsolescence of equipment, lack of qualified human resources and fundings [4] [8] [11]. All these problems therefore prevent the patient to benefit from adequate care and adapted genetic counseling [5] [7]. In view of the aforementioned difficulties, a question arises.…”