Cover Story: Health
Year of the Bugs
Syed Zain Al-Mahmood
|Bird Flu and Swine Flu rocked Bangladesh.
From the swine flu pandemic to infants dying of renal failure after ingesting contaminated paracetamol syrup, health crises made the headlines with depressing regularity in 2009. The first shock was the reappearance of avian flu, which brought Bangladesh's poultry industry to its knees.
Avian influenza (“bird flu”) is an infectious disease of birds caused by type A strains of the influenza virus. The infection can cause a wide spectrum of symptoms in birds, ranging from mild illness, which may pass unnoticed, to a rapidly fatal disease that can cause severe epidemics.
Avian influenza viruses do not normally infect humans. However, there have been instances of certain highly pathogenic strains causing severe respiratory disease in humans. In most cases, the people infected had been in close contact with infected poultry or with objects contaminated by their faeces. Nevertheless, concern that the virus could mutate to become more easily transmissible between humans, caused health authorities to crack down.
Tens of thousands of chickens were culled in Bangladesh after avian flu was detected on farms in Savar in January. Health officials took samples and tests confirmed the presence of the H5N1 strain of flu and so the chickens were all culled to prevent the virus spreading. Bangladesh was hit by bird flu in February 2007 with more than one million birds slaughtered. The second major outbreak was in November 2008 when 10,000 birds were culled in a two-month period. As a result of past experience, the government reacted swiftly when the flu broke out again in January 2009, with poultry owners complaining of a knee-jerk reaction. Experts say the disease has severely hurt Bangladesh's poultry industry, which is one of the world's largest, producing 220 million chickens and 37 million ducks annually. Bangladesh reported its first confirmed human case of bird flu in May last year, but the 16-month-old baby who contracted the virus recovered.
In July, Bangladeshis proved themselves perfectly capable of manufacturing health crises without the help of microbes when five pharmaceutical companies were accused of producing and marketing paracetamol syrup containing Diethylene glycol, a toxic solvent, usually used in plastic, rubber, textile and leather industries. 25 children aged between one and five died after being given paracetamol syrup produced by Rid Pharmaceutical Company of Brahmanbaria BSCIC area. After an investigation the government stopped the operations of the five pharmaceutical companies.
Viruses reclaimed the headlines when swine flu began to sweep the globe in mid 2009. After the death toll topped 2500, The World Health Organization (WHO) declared a pandemic of H1N1 swine flu on June 11, 2009. The announcement meant the swine flu virus spreads from person to person in a sustained manner globally and is unlikely to fizzle out. The last pandemic -- the Hong Kong flu of 1968 -- killed about one million people.
Bangladesh is particularly at risk because of population density and weakness of healthcare infrastructure, say experts. Lack of awareness among the mass populace could see a rapid rise in the number of fatalities. The unusually congested state of Dhaka city increases the threat of H1N1 influenza, with the slum areas especially vulnerable. However, the threat seemed to fizzle out as winter approached. Beleaguered epidemiologists heaved a sigh of relief as the rate of infection dropped dramatically. Once again a deadly virus seemed to have self-limited its outbreak.
Major challenges remain for Bangladesh in 2010. According to the World Health Organisation, virtually all population growth over the next 30 years will be in urban areas, signaling that urbanization is here to stay. It is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like smoking, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks. With cities like Dhaka, Chittagong, Sylhet and Khulna seeing explosive growth, urbanisation is a challenge that Bangladesh has to face sooner rather than later.
According to the WHO, the urban poor suffer disproportionately from a wide range of diseases and other health problems, and include an increased risk for violence, chronic disease, and for some communicable diseases such as tuberculosis and HIV/AIDS.
The major drivers, or social determinants, of health in urban settings are beyond the health sector, including physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities.
The public health care system of Bangladesh lacks in human resource, technology and materials. More than five thousand posts of doctors are vacant; there are lack of beds and medicine in hospitals. According to the latest Bangladesh Demographic and Health Survey, only 51% of Bangladeshi women see a medically trained provider at least once during their pregnancy.
Experts say urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents.
If the health care facilities in the urban areas are inadequate, they are nothing short of woeful in rural areas. State-run facilities in the villages and Thanas are facing acute shortages of doctors, nurses and technicians, and many people resort to traditional healers as a result. There is a huge inconsistency between the number of healthcare personnel in urban and rural areas, according to the Directorate General of Health Services. Of the 90,000 public healthcare personnel positions in the country, 18,000 are currently vacant, including the posts of about 5,500 doctors, according to the Health Ministry. The appalling inadequacy of health care in Bangladesh is reflected by the fact that the country has about 48,000 registered doctors to serve its 145 million people.
The statistics paint a grim picture. Maternal deaths remain amongst the highest in the world at 320 per 100,000 live births (2007). Experts say Bangladesh is off track to meet the Millennium Development (MDG5) target of 143 by 2015. However, Bangladesh is on track to reach MDG 4 -- reducing child mortality. Infant mortality has declined from an average of 65 deaths per 1000 live births in 2004 to an average of 52 by 2007. 82% of children between 12-23 months are fully vaccinated. Despite this significant progress, 1 in 15 children die before they reach their 5th birthday.
HIV prevention work has reduced the high risk behaviours of sex workers and Injecting Drug Users (IDU) and prevalence of HIV and AIDS has remained at a low level overall. However, HIV prevalence rates amongst IDUs have risen significantly since 1998. According to a survey carried out by international development agencies, the overall HIV prevalence in 2006 was 0.9%, with the highest rate of HIV prevalence reported amongst male IDUs in one community in Dhaka (at 7%). This indicates for the first time that HIV has exceeded 5% in any one group, and that Bangladesh has moved from a low-prevalence country to one with a concentrated epidemic.
Heath risk due to climate change is a major challenge for Bangladesh. In 2010-2020 Bangladesh must build resilience and adapt against the effects of climate change; encourage low-carbon growth and promote more domestic and international engagement and political commitment to address climate change. According to the UK’s Department for International Development, over 30 million people do not have access to adequate supplies of safe drinking water, 36% of the rural and urban population. Lack of safe drinking water, limited access to useable latrines and poor hygiene remain major challenges in Bangladesh.
Experts say that a commitment is required at the highest levels to redirect resources to priority interventions, thereby achieving greater efficiency. How Bangladesh faces the healthcare challenges in the new decade will have a major bearing on what progress the country ultimately makes on the Millennium Development Goals.
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