Pattern of Dermatological Cases Attending Skin-VD Outpatient Department in a Medical College Hospital of Bangladesh

Background: The pattern of skin diseases varies from one country to another and even from region to region of the same country. We are geographically placed in the tropical region with natural outcome of communicable diseases. We conducted this cross sectional study in a tertiary hospital of Bangladesh keeping the proposition in mind that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh. Objectives: To classify the diseases attending the Skin & VD outpatient department of Enam Medical College Hospital (EMCH) and to draw comments and recommendations on the basis of findings. Materials and Methods: All patients irrespective of age and sex attending the OPD of Skin-VD Department of Enam Medical College Hospital during a 2-year time-period (from January 2009 to December 2010) were included in the study. Structured questionnaire, check-list and face-to-face interview (whenever necessary) were used as tools of data collection. Statistical analyses were done by SPSS version Windows 11.1. Results: Total number of patients was 12100. Most of the patients were aged (>18 years; 64.28%), dominated by male (61.63%), married (56.1%), literate (71.11%), coming from far (>5 km; 63.5%) and of middle class origin (59.73%). Out of the total cases, maximum (23.42%) were diagnosed as eczema, followed by infectious diseases (17%), acne (8.69%) and psoriasis (6.36%). Conclusion: In this study we found infectious diseases to occupy the second position next to eczema and our findings nullify the proposition that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh.

Bangladesh is a densely populated country having more than 150 million people in a 144 thousand square kilometer pocket. 1 We are geographically placed in the tropical region with natural outcome of communicable diseases, notably burdened with noncommunicable and contagious diseases too. 2 If we analyze the disease profile, we find that almost 19% of total OPD patients are suffering from skin diseases. 3The pattern of skin diseases varies from Introduction 67

Pattern of Dermatological Cases Attending Skin-VD Outpatient Department in a Medical College Hospital of Bangladesh
Medical College Hospital (EMCH), Savar, Dhaka and intended to draw recommendations based on the in-depth findings on prescribers, differential diagnoses, demographical conditions including literacy and the pattern how the clients came to the health facilities.

Results
Table I shows age and sex distribution, marital status, literacy of the respondents and distance of their residence from Savar.

Discussion
This two-year long cross sectional study revealed that out of the total 12100 cases attending Skin & VD outpatient department, maximum cases (23.42%) were diagnosed as eczema.[13] This study also revealed that infectious diseases formed the second largest group (16.92%) of skin diseases.Out of 2048 infectious disease patients 452 were diagnosed as scabies which was only 3.7% of total OPD patients in Skin & VD department.Low attendance of scabies patients may be due to following socio-demographic factors.
1. OPD ticket cost is very high for low socioeconomic condition group.
2. Scabies with other infectious diseases are more prevalent among this group.This study also reveals fungal infection as the highest group of infectious diseases.The warm and humid climate of the country may account for this high incidence of fungal diseases.In this study we also found that the incidence of viral infection was relatively low (2.46%) as compared to similar studies done in Kashmir (14%) 12 , in Trivandrum (5.10%) 13 and in Pune (7.1%) 14 .This difference was due to inaccessibility of all groups of patients in private medical outdoor.We also found that herpes simplex was the commonest viral infection (29%).
The low incidence (0.13%) of Hansen's disease in this study is due to the fact that such patients mainly attend leprosy centres where the medicines (MDT) are given free of cost and these facilities are available throughout the country.Low incidence of STIs (1.98%) may be because such patients preferred to maintain privacy and attend private clinics to avoid the harassment of social oppression and stigma associated with the disease.
Based on the findings and analyses of the results of similar studies at home and abroad we like to make following recommendations to draw attention of the policy makers, specialists in Skin & VD and future researchers.
1.No case should be diagnosed blindly and categorized under gross classification, unless there is adequate proof.The blind forecasting might lead to wrong directions.
2.Not any proposition, even done by the specialists, should be taken as readymadedecision.Researcher should come forward to justify their hypothesis through scientific study and statistical findings.
3. Though a major portion of the total patients attending Skin-VD OPD is diagnosed as dermatological cases, but it cannot be confirmed blindly.Confirmation of the diagnosis of Skin-VD cases should be done very cautiously and meticulously.

3 .
A government OPD centre (UHC) is located within half km from the Skin & VD OPD of EMCH.