Educational support to national health programmes has been provided by the Health Education Bureau (HEB). Emphasis has been given in recent years to school health education, hospital health education and coordination with NGOs. Constraints include the lack of a national IEC strategy, the low priority given to health education by the health services, underutilization of health education officers, and lack of opportunities for professional advancement of those working in health education. Some issues under consideration are the inclusion of a health education component in the new national health policy and strengthening of coordination between the HEB and ongoing government health programmes and NGOs.
During 1999-2000 the proportion of women attended by trained personnel during pregnancy was 33.7 %, deliveries attended by trained personnel 21.8%, and women of childbearing age currently using family planning 53.8%. In maternal health there has not been much progress. The MMR reported for 1998 is 3 per 1000 live births. The TFR declined from 4.24 in 1991 to 3.3 in 1997-99, which is still high. Based on the causes of maternal deaths, a number of project activities have been initiated to reduce maternal mortality. These include providing comprehensive reproductive health, family planning and essential obstetric care (EOC) supported by UNFPA. UNICEF assistance to EOC is implemented through the Obstetric and Gynaecology Society of Bangladesh. The WHO -assisted programme on maternal and neonatal care including EOC is managed by the government and the ICDDRB. Training and logistic supply management for MCH/FP is also being strengthened. Some of the main constraints are lack of skilled manpower, weak management capabilities and limited resources. In the future, priority will be given to more training and utilization of midwives at the peripheral level.
The proportion of infants (0-11 months) who have been fully immunized according to the national EPI schedule in 1999 was 52.8%. By individual vaccines, the proportions in 1999-2000 were as follows: DPT-70.2%, OPV-69.1%, measles vaccine 62.1% and BCG 90.0%. The percentage of pregnant women immunized with two doses of tetanus toxoid was 63.7%. Immunization services have been extended up to village level and community support is readily available. Three NIDs for polio have also been successfully implemented during the last three years. The morbidity and mortality rates of EPI-target diseases have been considerably reduced. A good opportunity is now available to utilize the already established and well known EPI outreach centres for delivery of other components of PHC as well.
The tuberculosis (TB) control programme has been integrated with the general health services. There was an increase in the case detection rate, at more than 25% compared to 2% with the earlier vertical programme. The cure rate of new cases has also increased. With the integration process, training/orientation of 26,000 health workers has been completed and cooperation between the government and NGOs involved in TB control strengthened. The directly observed treatment strategy (DOTS) was initiated for pulmonary TB patients with positive smears. The constraints have been weak supervision and monitoring and frequent transfer of trained staff. Future activities will include improving accessibility to treatment facilities by extension to union/ward level, training of family planning staff in TB control, obtaining the greater involvement of general practitioners and medical colleges, and intensification of IEC activities to promote self-reporting.
Significant changes have occured in the leprosy control programe since the second evaluation. As in the case of TB, the leprosy control programe was integrated with the general health services. There has been a decline in the prevalence of leprosy and in the deformity rate among newly detected cases. Treatment facilities for multidrug therapy (MDT) are available in 600 centres countrywide including all 460 thanas . Following integration, training/orientation was given to over 29,000 health personnel. The availability of antileprosy drugs was assured at treatment centres . The print and electronic media were utilized for IEC activities at district and thana levels. The main constraints were the same as those for TB. Future activities will include improving accessibility to treatment facilities by extension to union/ward level and intensification of IEC activities for improved self-reporting. Leprosy control is also supported by a special initiative (special action project for the elimination of leprosy – SAPEL).
The control strategy for malaria was revised and approved in 1995. The new strategy is being gradually implemented and emphasizes disease control aspects and endorses four technical elements (early diagnosis, prompt treatment, recognition of treatment failures and management of severe and complicated cases in hospitals). Emphasis is also placed on malaria surveillance, preparedness for control of malaria outbreaks/epidemics, and the introduction of insecticide impregnated bed nets. The main constraint is the reduced capacity of the core technical unit for control of vector-borne diseases to take on activities countrywide.
In Bangladesh kala-azar is a re-emerging disease since the cessation of DDT spraying operations. At least 20 million people in more than 27 districts are at risk. The estimated cumulative disease specific burden is 35,000 cases. Under the project for integrated control of vector-borne diseases, an emergency plan for the control of kala-azar was initiated in 1994-95 in 22 thanas of 11 districts (population 5 million). This has been successful and further expansion is now planned. At least 8000 kala-azar patients have been successfully treated to date. The major constraint is similar to that faced in the control of malaria.
Eighteen (18) million people in 12 districts are considered to be at risk of filariasis . A revised strategy for the elimination of filariasis is being pilot tested in one district. This strategy involves administering a single dose of ivermectin with albendazole yearly for a period of three years to the total population in the district.
Dengue has yet to become a public health problem, but in view of the high potential that exists, surveillance and preparedness capability have been strengthened.
To date 17 AIDS cases have been reported, but 13,000 cases of HIV infection are estimated. Current data available categorizes Bangladesh as a low prevalence country at present.
Acute respiratory infection (ARI) accounts for about 145,000 deaths annually among children under five years. The under-five mortality rate due to ARI was reported to be 33% (ICDDRB-1994). Forty to sixty per cent (40-60%) of outdoor visits and 30-40% of indoor admissions are attributed to ARI. The programme for the control of ARI continues to be implemented on a phased basis according to the recommended WHO strategies.
Diarrhoeal diseases continue to be responsible for much morbidity and mortality, but current strategies have considerably reduced mortality. Multisectoral partners were involved in mobilizing the community regarding correct home-based care and timely referral. The availability of ORS has increased through the formation of ORS depot holders in the community. Constraints include inappropriate use of anthelmintics and anti- diarrhoeals , especially in the private sector, and the underutilization of health facilities including ORT corners.
The incidence of measles has dramatically declined since the introduction of measles vaccine into the immunization programme. Malnutrition still remains a problem both in urban and rural areas, with the latter being more affected. Of the noncommunicable diseases, cancer and cardiovascular diseases are the leading causes of morbidity and mortality. The incidence of cancer is estimated at 200,000 per year.