Bangladesh - Disease and Disease Control

Disease and disease control

Communicable diseases were the major health hazards in the 1980s. Poor nutrition and sanitation fostered the spread of infections. Infectious diseases--cholera, dysentery, diarrhea, measles, diphtheria, pertussis, tetanus, and poliomyelitis--and parasitic diseases such as malaria, filariasis, and helminthiasis-- were responsible for widespread illness and numerous deaths. Although not reported among government statistics, tuberculosis was believed to be an increasingly serious health problem, with 90,000 deaths and 110,000 new cases occurring annually. Disease in the late 1980s was most prevalent in rural areas; treatment was more readily available in the cities. A mid-1980s survey indicated that deaths due to diarrheal diseases, malnutrition, and pneumonia accounted for 16.3 percent, 13.1 percent, and 10.8 percent of all deaths, respectively. The percentages for other diseases were as follows: prematurity and birth injury (8.6 percent), cardiovascular accidents (4.5 percent), tetanus (4.4 percent), pulmonary tuberculosis (3.3 percent), measles (2.7 percent), and other causes (36.3 percent).

Young children suffered disproportionately from diseases, and they accounted for 40 percent of deaths annually. Major killers of young children were severe diarrhea and neonatal tetanus caused by unsanitary treatment of the umbilicus. Until the mid-1980s, only 3 percent of Bangladeshi children received immunization against common infectious diseases. Consequently, potentially avoidable illnesses like tetanus, pertussis, and measles accounted for nearly half of infant deaths and more than a third of childhood deaths.

By the late 1980s, a massive immunization program had eliminated smallpox, and highly effective treatments had contained cholera. Malaria, however, once thought to have been eradicated, again had became a major health problem by 1988. The ongoing malaria control program needed to be strengthened by improving indigenous scientific knowledge of the disease and by spraying wider areas with effective chemicals. Several national and international research facilities were involved in disease control research.

Noncommunicable diseases such as diabetes, cardiovascular diseases, mental illness, gastrointestinal disorders, cancer, rheumatoid arthritis, respiratory disease, and urogenital diseases were increasing in frequency in the 1980s. Cases of vitamin A deficiency causing night blindness and xerophthalmia, iron deficiency anemia, iodine deficiency, protein-calories deficiency, and marasmus also were on the increase.

Although no incidence of acquired immune deficiency syndrome (AIDS) had been reported in Bangladesh through mid-1988, the National Committee on AIDS was formed in April 1986. The committee drew up a short-term action plan that called for public awareness programs, augmented laboratory facilities, training of relevant personnel, publication of informational booklets, and health education programs.

Before the mid-1980s, disease control programs focused mainly on Western-style curative services, but the emphasis was shifting in the late 1980s toward a larger role for prevention. The government's main preventive health program--the Universal Immunization Program--was initiated in 1986 with the assistance of the World Health Organization and the United Nations Children's Fund in eight pilot subdistricts. The government aimed to provide protection through immunization against six major diseases for children under two years of age and to vaccinate women of childbearing age against tetanus. The program helped to increase the rate of full immunization of children below 1 year of age from less than 3 percent to 36.5 percent, and of children between 12 and 24 months from less than 3 percent to 55.8 percent.

In the case of maternal health care, a national program to train and supervise traditional birth attendants (dhais) was started in 1987. In addition, a long-range program to improve maternal and neonatal care, which addressed issues of health care delivery and referral on a national scale, was approved in 1987. The government in 1988 upgraded its nutrition policy-making capacity by creating the National Nutrition Council, but planning and implementation of specific programs remained insufficient. Other programs with nutrition implications include food-for-work, "vulnerable-group feeding," and vitamin A distribution programs.

Alternative systems of medicine, including the traditional Hindu ayurvedic medical system based largely on homeopathy and naturopathy, the Muslim unani (so-called "Greek" medicine) herbal medical practice, and Western allopathic medicine were available. For most villagers, the most accessible medical practitioner was the village curer (kobiraj). It is estimated that 70 percent of the rural population did not have access to modern medical facilities in the late 1980s.

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