Bangladesh facing crisis of some life-saving vaccines for children

by Rashad Ahamad

Acute supply shortages are denying children access to life-saving vaccines listed in the Expanded Programme on Immunisation in different parts of Bangladesh amid allegations of the delayed release of funds by the Bangladesh government.

Parents in districts such as Rangpur, Dinajpur, Bhola, Jashore, and Barishal alleged that their children were denied vaccines in designated vaccination centres in the past three months.

The government supplies all five vaccines free of charge under EPI for children aged below one year to prevent 11 life-threatening diseases.

The vaccines include pentavalent, which protects a child from diphtheria, whooping cough, tetanus, hepatitis B, and hemophilus influenza type B; BCG, which gives protection against tuberculosis, PCV against pneumonia, OPV against poliomyelitis, and MR against measles.

The government administers 14 doses of these vaccines in five sessions per year in its designated vaccination centres across the country.

Experts said that the vaccine might not give the expected protection if not administered on time.

Professor Sharmeen Ahmed, chairman of the microbiology and immunology department at Bangabandhu Sheikh Mujib Medical University, said that timely administrating of the vaccine ensures its best performance.

Mohammed Nizam Uddin, line director of the Directorate General of Health Services for Maternal Neonatal Child and Adolescent Health, said that they provided vaccine requisitions as per the rules in December but had yet to get the required number of vaccines, leading to some disruptions in the immunisation programme.

The government collects the vaccines through UNICEF in co-financing with Gavi, the Vaccine Alliance. UNICEF sources the vaccine from producers in Europe and India and supplies it to children.

Nizam said that UNICEF failed to give them the vaccine on time.

‘It is not related to the dollar crisis or unrest in the Middle East. Vaccine shipments are held by air,’ he said, adding that the government has paid UNICEF for the vaccines already.

UNICEF officials said that they used to procure vaccines for 109 countries in the world, just as they do for Bangladesh.

‘The government did not release funds for vaccines on time, which resulted in a supply problem,’ said Riad Mahmud, UNICEF’s health specialist (immunisation).

He said that the government’s fund-releasing process is complex and takes a long time.

He suggested the government make the fund release process easy, considering it a purchase of life-saving item.

The government lastly released funds for vaccine purchases in December and all the vaccines were expected to reach the country by April, officials said.

Israt Jahan, a resident of Purba Khashbag under Rangpur municipality, told New Age Rangpur correspondent that she went to  the local immunisation centre and returned without vaccinating her baby born on December 1.

According to the module, a child is required to be vaccinated within 45 days of birth, but her baby was not vaccinated even after 65 days.

Sharmeen Akter, Tazhat Union sub-health complex officer, said that they had not received an adequate supply of vaccines in the past three months.

‘If there is no supply of vaccine, I cannot help but say sorry to people and request that they come back on another day,’ she said.

Md Wazed Ali, the civil surgeon of Rangpur, told New Age on Thursday that they had been given inadequate vaccines for a long time and that there had been no supply at all in the past three weeks.

Md. Nayeem Hassan, upazila health and family planning officer at Birampur Upazila Health Complex in Dinajpur, said that those who were missing one or two doses of vaccines because of supply shortages were administered at a later day when they became available.

Niropam Sarkar Shohag, upazila health and family planning officer at Burhanuddin in Bhola, said that he had not gotten any pentavalent vaccines in the past three months, and other vaccines were also short in supply.

Bhola civil surgeon KM Shafiquzzaman acknowledged the shortage of pentavalent, IPV, and BCG vaccines in the district.

EPI programme manager SM Abdullah Al Murad said that Bangladesh needs vaccines for nearly four million children annually.

He said that they had already received some vaccines, and those would be distributed by February 15.

In the financial year 2023–24, Bangladesh estimated Tk 790 crore for vaccines, with the government contributing Tk 440 crore and the rest contributed by Gavi, Murad said.

DGHS line director Nizam Uddin said that they received a demand note from UNICEF in June but had to wait until December to release the funds due to a bureaucratic tangle.

‘We have to pay in advance for vaccines, which is a complex process and takes additional time,’ he said, adding that earlier they used to cover up supply gaps from their stock, but this year the buffer stock was low, leading to the crisis.

Published on New Age

Children in Bangladesh most vulnerable to antimicrobial resistance

by Rashad Ahamad

A 10-day-old baby girl, who is currently undergoing treatment at Bangladesh Shishu Hospital and Institute for Pneumonia, was found resistant to at least 13 antibiotics during a recent test.

The information shocked her parents as well as physicians because they had only one antibiotic to use for her treatment.

According to her test report, the infant is only sensitive against chloramphenicol but resistant to ampicillin, amoxicillin, ceftazidime, cefixime, meropenem, amikacin, ciprofloxazole, ceftriaxone, cefepime, imipenem, gentamicin, netilmicin, and levofloxacin.

Physicians said that they saw an increase in the number of infants with such antimicrobial resistance across the country in recent years.

They said that antibiotics are becoming increasingly ineffective in treatment due to the presence of resistant bacteria and viruses in human bodies.

They suspected that the infant at Shishu Hospital might get resistant germs from her mother.

Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve over time and stop responding to medicines.

They make infections harder to treat and increase the risk of disease spread, severity of illness, and even death, physicians said.

It often causes deaths in diseases like fever and dysentery as drugs do not respond to germs.

The microbiology department head of the National Institute of Laboratory Medicine and Referral Centre, Md Saiful Islam, said that antimicrobial resistance could spread among people of all ages.

He said that incomplete doses of antibiotics, unsafe disposal, and their overuse and misuse increase the resistance of bacteria against the antibiotics.

He said that lax regulation over the sale of antibiotics, self-medication, and their illegal use in animals led the country to a dangerous position.

‘We find many people insensitive to all the antibiotics since no new antibiotics have been invented in the last 30 years,’ he said.

The institute’s microbiology department conducted a nationwide genomic survey between October 2022 and May 2023 to check for antibiotic resistance among people.

Analyzing 13,350 different samples collected from 12 different healthcare centers, researchers found that 8.61 percent of people are multidrug resistant.

Among them, the highest 29.2 percent antibiotic resistance was found among people under 20, followed by 28.4 percent among 20–40 years, 24.5 percent among 40–60 years, and 17.9 percent among people above 60.

Klebsiella pneumonia, which causes pneumonia, bloodstream infections, meningitis, and urinary tract infections, was found to be resistant among the highest 30.72 percent of people, followed by Escherichia coli, which causes diarrhea.

The germ was found to be resistant in 25.15 percent of people.

Md Sayedur Rahman, a pharmacology professor at Bangabandhu Sheikh Mujib Medical University, said that some people thought they would not be resistant to antibiotics if they did no wrong in consuming antibiotics.

‘Antibiotic resistance grows in bacteria or viruses, not in the human body. Until we can stop the resistance, nobody is safe here,’ he said.

Researchers said this was creating a particular health risk for children, despite them not taking any antibiotics for the treatment of any disease.

A child can suffer forever due to this, they said.

Sayedur said that disease-spreading germs were becoming resistant to antibiotics rapidly.

He said that when an antibiotic is used against any virus or bacteria, the patient must complete the dose so that no bacteria can exist to build resistance.

Poultry farmers use the antibiotic Ciprofloxacin at their whim to protect chickens from catching colds, and when people consume the chicken’s meat, the antibiotic also enters their bodies, he said.

The national institute’s study revealed that 39 percent of people buy antibiotics without a prescription, though they are not over-the-counter drugs.

The sale of antibiotics without a prescription from registered physicians is a punishable crime, according to the Drugs and Cosmetics Act, 2023.

It is also a violation of a High Court directive issued in 2019.

In a joint study published in November 2019, the Directorate General of Drug Administration and the World Health Organization found that antibiotic consumption in Bangladesh had increased by 30.81 percent in the previous two years.

In May 2022, a DGDA survey at 427 pharmacies found that about 67.3 percent of pharmacy retailers cannot properly identify antibiotics from regular medicines because they do not have adequate knowledge of antimicrobial drugs.

The DGDA, the principal drug regulatory agency in Bangladesh, asked pharmaceutical companies in March 2022 to mark antibiotics in red and use a warning message like ‘Do not use without a prescription from a registered physician’ by December 2022 to prevent misuse of the drugs.

The DGDA had warned of stern action against companies that would miss the deadline.

Medicine retailers in local markets said that only a handful of companies, to their knowledge, have so far marketed antibiotics with new packaging, while the majority kept ignoring the DGDA directive.

DGDA spokesperson and deputy director Md Nurul Alam said that they would take legal action against the errant medicine shop owners who still sell antibiotics illegally and pharmaceutical companies that did not start using the red mark and cautionary message.

He, however, said that no drug shops or pharmaceutical companies have been fined in the past few months due to this.

He claimed that at the moment they were only creating awareness among people about the new Drugs and Cosmetics Act.

He said that pharmaceutical companies started packaging antibiotics following the DDGA directive but could not market them yet as previously distributed products were yet to be sold.

According to a Global Research on Antimicrobial Resistance estimate from April 2019, antimicrobial resistance would cause 10 million deaths per year by 2050.

Published on New Age

Dengue surge in Bangladesh feared to prolong

Hospitalisation crosses two lakh, death reaches 975

by Rashad Ahamad

Hospitalisation of dengue patients continues to increase since the 34th epidemiological week indicates a sharp rise of dengue cases across the county.

On the 34th epidemiological week (a standard method of counting weeks to allow for the comparison of data year after year), covering August 20-26, on average 2,046 dengue hospitalisation cases were reported in the country, whereas on the 38th week, covering September 17-23, the number increased to 2,879, and the number is on a steep rise during the ongoing 39th week to end on Sunday.

Epidemiologists and entomologists fear that dengue hospitalisation and the fatality cases will further increase as the virus has spread to the rural areas with rains have been forecast to continue.

They explained that aedes mosquito population will persistently multiply if rains continue for two more weeks as the weather forecast goes, prolonging the favourable temperature and humidity for mosquito breeding.

Meanwhile, the country counted a new high in hospitalisation at a total of 200,981 dengue patients since January this year, with at least eight more people died and at least 1,793 more hospitalised across the country in last 24 hours until 8:00am on Friday.

On the weekly holiday of Friday, 9,526 patients were undergoing treatment with the vector borne disease in the hospitals across the country, according to a press release of the Directorate General of Health Services.

Epidemiologist and a former director of the Institute of Epidemiology, Disease Control, and Research AM Zakir Hussain said that this year Bangladesh is experiencing the longest spell of dengue surge which will still continue.

Dengue surge will last at least two more months, feared Dr Zakir Hussain.

He said the average duration of dengue spell for Bangladesh is considered four months, but in 2022, they had a five-month spell in 2022. 

Public health expert and epidemiologist Mohammad Mushtuq Husain fears that the country is yet to reach the peak of dengue hospitalisation in the current spell.

‘When a stable infection situation prevails for four consecutive weeks and continues to decline stably, epidemiologically that is called the peak,’ he explained, adding that he did not find such peak situation as yet.

Meteorologist Monowar Hossain said the available forecasting data of the Bangladesh Meteorological Department show a very likely increase in rains in the first week of October across the country to continue till second week of the month.

Entomologists said that aedes population will not decline until nature itself intervenes to do so.

They said dengue has now overtaken the rural Bangladesh where no effective mosquito control mechanisms exist, which means aedes breeding will effectively reduce only through the monsoon setting out of the country resulting in fall of temperature and humidity.

A World Bank report released in 2021 said that dengue cases increase when the temperature ranges between 25C and 35C with a peak at 32C, mentioning that the spread of dengue vectors is not possible without the right temperature.

On Friday, 31 out of 44 weather stations run by the Met Office recorded the maximum temperatures range between 32.8C and 37C, while the minimum temperatures between 23C and 28C with over 76 per cent humidity.

The WB report noted that the capacity of mosquitoes to transmit dengue fever has increased by 9.5 per cent globally since 1950 due to changing climatic conditions.

Meteorologist Monowar Hossain said weather record shows with changes occurring in the weather pattern, winters are coming later than the usual time in the country.

In terms of both dengue deaths and hospitalisations, Bangladesh this year broke all previous records.

In the past 23 years since 2000, Bangladesh recorded a total of 243,744 dengue hospitalisation and 814 deaths.

Of them, in the first dengue outbreak in 2000, Bangladesh reported hospitalisation of 5,551 patients and 93 deaths, according to the DGHS data.

Dengue hospitalisations had been reported at 28,429 and 62,382, respectively, in 2021 and 2022, when the outbreak in the country caused 105 and 281 deaths respectively.

This year, 2,00,981 patients were hospitalised with 975 died, higher than the total of 22 years, as recorded in the last eight months and 29 days.

A total of 566 dengue patients were hospitalised in January, 166 in February, 111 in March, 143 in April, 1,036 in May, 5,956 in June, 43,854 in July, and 71,976 in August, according to the DGHS press release.

At least six people died of dengue in January, three in February, two in April, two in May, 34 in June, 204 in July, and 342 in August. No deaths were recorded in March.

In last 29 days of September, a total of 382 dengue patients died with 77,173 patients admitted to the hospitals, marking September as the deadliest month ever.

Bangladesh wastes public money in the name of dengue control

by Rashad Ahamad

Dengue fatalities and hospitalizations have been increasing in the capital city every year, despite the two city corporations in Dhaka increasing budgetary allocations for mosquito control regularly.

Analyzing Dhaka South City Corporation’s budget documents, the DSCC spent Tk 152 crore in the past seven years on buying mainly insecticides and machines for killing mosquitoes.

This year, the city corporation also allocated Tk 40 crore for mosquito control in the 2023–24 financial year, up from Tk 35 crore in 2022–23.

Meanwhile, Dhaka North City Corporation spent Tk 280 crore during the same period while allotting Tk 84 crore for the 2023–24 financial year, which was Tk 53 crore in 2022–23.

However, dengue fatality and hospitalization have been increasing in the city despite the hike of the budget for killing mosquitoes which the experts said is a waste of public money.

Entomologists and health rights activists said that the two city corporations mostly wasted this money on wrong and ineffective methods, resulting in an ever-increasing number of cases and fatalities this year.

In January, after inspecting the mosquito control program of the city of Miami in the United States, DNCC mayor Md Atiqul Islam acknowledged that the method used so far in fighting mosquitoes in the capital city was wrong and a waste of public money.

He announced that the city corporation would follow a new method, but speaking to New Age on Tuesday, he admitted to his failure.

Over the years, the two city corporations in Dhaka used to spray larvicide in the morning to kill mosquito larvae and do fogging to kill adult mosquitoes.

Officials said that in fogging, DNCC uses Malathion and DSCC uses a mixture of Deltamethrin and Malathion, and both city corporations use temephos, an organophosphate larvicide used to treat water infested with disease-carrying insects, including mosquitoes, for spray.

Atiq explained that he wanted to introduce BTI, or Bacillus thuringiensis israelensis, a naturally occurring soil bacterium that can effectively kill mosquito larvae present in water, this year but was forced to suspend it after a scandal in import.

DNCC last week suspended the use of BTI after its importer, Marshal Agrovet Chemical Industries Ltd., falsely claimed its product was manufactured by a Singapore-based chemical plant.

DSCC chief health officer Fazle Shamsul Kabir said that they had been using the same insecticide in the same manner over the years and had increased their budgetary allocation for better action against the vector.

Entomologists said that the anti-mosquito drive was faulty, unrealistic, and unscientific, adding that mosquitoes developed resistance to the larvicide and adulticide after repeated use.

Former president of the Zoological Society of Bangladesh and an entomologist, Manjur Ahmed Chowdhury, said that what the city corporations were doing here to control mosquitoes was against the basic principle of vector management, and as a result, dengue deaths and infections were on the rise.

‘What the city corporations are doing is institutional cheating on city dwellers, who pay tax for killing mosquitoes,’ he said.

He also said that frogs, ducks, fish, and so many other things also yielded no results over the years and suggested the city authorities find effective measures immediately to prevent further transmission of the dengue virus.

Janashasthaya Sangram Parishad president Faiezul Hakim Lala alleged that corruption in two city corporations prevented them from getting the desired result in mosquito control efforts.

‘Due to the unaccountability and corruption, the situation turned much worse,’ he said.

Faiezul, also a physician and political activist, found that dengue fatalities had been increasing as mosquitoes developed resistance due to repeated use of the same insecticide over the years.

DSCC chief health officer Fazle Shamsul Kabir, however, denied allegations of wasting public money and rather blamed the public for their lack of awareness of mosquito breeding.

‘If there were no city corporations, the situation would have been much worse,’ he claimed.

Against this backdrop, the Directorate General of Health Service reported 14 deaths and 1,594 hospitalizations on Friday, a weekly holiday when most hospitals did not report to the authorities.

With this, 277 people died of dengue this year and 110,224 people were hospitalized, both a record since official counting began in 2000.

DGHS reported 28,429 dengue hospitalizations and 105 deaths in 2021, which in 2022 reached 62,382 hospitalizations and 281 deaths.

Published on New Age

Dengue deaths, cases rise in Bangladesh despite growing spending

by Rashad Ahamad

Dengue fatalities and hospitalisations have been increasing in the capital every year, despite the two city corporations in Dhaka increasing budgetary allocations for mosquito control regularly.

According to the documents available, Dhaka South City Corporation spent at least Tk 152 crore in the past seven years on buying mainly insecticides and machines.

The city corporation also allocated Tk 40 crore for mosquito control in the 2023–24 financial year, up from Tk 35 crore in 2022–23.

Dhaka North City Corporation spent Tk 280 crore during the same period while allotting Tk 84 crore for the 2023–24 financial year, which was Tk 53 crore in 2022–23.

Entomologists and health rights activists said that the two city corporations mostly wasted this money on wrong and ineffective methods, resulting in an ever-increasing number of cases and fatalities.

In January, after inspecting the mosquito control programme of the city of Miami in the United States, DNCC mayor Md Atiqul Islam acknowledged that the method used so far in fighting mosquitoes in the capital city was wrong and a waste of public money.

He announced that the city corporation would follow a new method, but speaking to New Age on Tuesday, he admitted to his failure.

Over the years, the two city corporations in Dhaka used to spray larvicide in the morning to kill mosquito larvae and do fogging to kill adult mosquitoes.

Officials said that in fogging, DNCC uses Malathion and DSCC uses a mixture of Deltamethrin and Malathion, and both city corporations use temephos, an organophosphate larvicide used to treat water infested with disease-carrying insects, including mosquitoes, for spray.

Atiq explained that he wanted to introduce BTI, or Bacillus thuringiensis israelensis, a naturally occurring soil bacterium that can effectively kill mosquito larvae present in water, this year but was forced to suspend it after a scandal in import.

DNCC last week suspended the use of BTI after its importer, Marshal Agrovet Chemical Industries Ltd., falsely claimed its product was manufactured by a Singapore-based chemical plant.

DSCC chief health officer Fazle Shamsul Kabir said that they had been using the same insecticide in the same manner over the years and had increased their budgetary allocation for better action against the vector.

Entomologists said that the anti-mosquito drive was faulty, unrealistic, and unscientific, adding that mosquitoes developed resistance to the larvicide and adulticide after repeated use.

Former president of the Zoological Society of Bangladesh and an entomologist, Manjur Ahmed Chowdhury, said that what the city corporations were doing here to control mosquitoes was against the basic principle of vector management, and as a result, dengue deaths and infections were on the rise.

‘What the city corporations are doing is institutional cheating on city dwellers, who pay tax for killing mosquitoes,’ he said.

He also said that frogs, ducks, fish, and so many other things also yielded no results over the years and suggested the city authorities find effective measures immediately to prevent further transmission of the dengue virus.

Janashasthaya Sangram Parishad president Faiezul Hakim Lala alleged that corruption in two city corporations prevented them from getting the desired result in mosquito control efforts.

‘Due to the unaccountability and corruption, the situation turned much worse,’ he said.

Faiezul, also a physician and political activist, found that dengue fatalities had been increasing as mosquitoes developed resistance due to repeated use of the same insecticide over the years.

DSCC chief health officer Fazle Shamsul Kabir, however, denied allegations of wasting public money and rather blamed the public for their lack of awareness of mosquito breeding.

‘If there were no city corporations, the situation would have been much worse,’ he claimed.

Against this backdrop, the Directorate General of Health Service reported 14 deaths and 1,594 hospitalisations on Friday, a weekly holiday when most hospitals did not report to the authorities.

With this, 277 people died of dengue this year and 110,224 people were hospitalised, both a record since official counting began in 2000.

DGHS reported 28,429 dengue hospitalisations and 105 deaths in 2021, which in 2022 reached 62,382 hospitalisations and 281 deaths.

Mayor Atiqul Islam’s adviser Kabirul Bashar identified three reasons—global warming due to climate change, weakness in mosquito control initiatives, and indifference of mass people—behind the record high dengue deaths and hospitalisations.

He said that the anti-mosquito drive was wrong and not effective for various reasons.

‘Authority is not doing according to my advice, and as an adviser, I cannot do anything in the field,’ he added.

Published on New Age

Diarrhoea patients on the rise amid heatwaves in Bangladesh

by Rashad Ahamad

The number of diarrhoea patients is on the rise in Dhaka and adjacent districts, with a large number of them taking medical care from the hospital at the International Centre for Diarrhoeal Disease Research, Bangladesh in the capital.

According to ICDDR,B data, 777 diarrhoea patients received treatment from the centre’s hospital on Wednesday whereas the average daily number of patients receiving treatment in the past year was less than half of the figure.

Data also showed that 578 patients with loose motion were given care at the hospital on Saturday, 613 patients on Sunday, 676 patients on Monday while the number reached 732 on Tuesday.

The centre’s associate scientist Monira Sharmin said that a large proportion of the diarrhoea patients visiting the hospital this season were adult.

‘We usually get 70 per cent children and 30 per  cent adult diarrhoea cases throughout the year, but now we are getting some 50 per cent adult patients,’ she said, adding that both categories of patients increased in number.

A significant number of patients, she noted, are visiting the hospital from Mirpur, Keraniganj, Narayanganj among other areas in the capital and outside the capital.

Public health expert and former vice-chancellor of Bangabandhu Sheikh Mujib Medical University Professor Nazrul Islam said that high temperature facilitates the rapid growth of the water-borne bacteria, viruses or parasites in food and drink items and their consumption causes diarrhoea.

According to the World Health Organization, Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms.

Infection is spread through contaminated food or drinking-water, or from person to person as a result of poor hygiene, it further says.

Professor Nazrul advised people to maintain caution about food and drink in order to avoid the disease.

ICDDR,B officials urged diarrhoea patients to take treatment at nearby healthcare facilities where the treatment can be afforded in a short time. Immediate interventions are important for patients to avoid any complexity for late treatment due to traffic jam, they said.

A residential building security guard Rafiqul Islam was admitted to the hospital in the morning as he had started having loose motion since night.

Rafiqul, 42, said that he drank water collected from a Dhaka Water Supply and Sewerage Authority tap at Shewrapara in the capital.

An electrician named Shihab Uddin said that he had been suffering from diarrhoea since Tuesday. He drank water from a roadside restaurant’s water jar.

Physicians advised people not to take antibiotics without prescription from a registered physician because a wrong use of an antibiotic might cause harms in the long run.

Monira Sharmin said that they were conducting a research on a random basis and found that a significant number of cases were visiting them with diarrhoea due to rotavirus and the E. coli bacteria infection.

Physicians also said that they found some patients infected cholerae bacteria in Dhaka and elsewhere.

ICDDR,B officials said that every year the number of diarrhoea patients increased in summer compared to others seasons of the year.

The Bangladesh Meteorological Department on Thursday recorded the maximum temperature at 33.3 degrees Celsius and the minimum temperature at 30.7C in Dhaka while the country’s maximum temperature was recorded at 38.6C in Saidpur.

Physicians suggested drinking water after purifying it. Water can be purified by boiling or using medicines. Personal hygiene is also another important issue, they said.

They also suggested that diarrhoea patients should drink oral saline adequately along with normal food until they fully recover.

‘Oral saline is a medicine and it should be mixed with water accurately,’ said physician Monira as she observed that many people hardly followed the rules.

Health service officials in different districts said that they were getting reports of higher diarrhoea patients but the situation was not out of control.

Local hospitals were providing service to an additional number of patients with limited resources. 

Published on New Age

Anti-tobacco law falls flat in Bangladesh as smokers swap cigarette for vapes

by Rashad Ahamad

The government’s move to make Bangladesh free from tobacco by 2040 is unlikely to achieve the target due to the availability of e-cigarettes that lure youngsters into tasting the new products.

From small street corner shops to e-commerce sites, the alternative source of nicotine is mostly targeted at youths, with its use being on the rise against the backdrop of the existing tobacco products control act that has no provision for heated tobacco.

‘We are working towards amending the prevailing tobacco control act to incorporate and ban electronic nicotine delivery system or vaping,’ said National Tobacco Control Cell coordinator Hossain Ali Khondoker.

Bangladesh has ‘Smoking and Tobacco Products Usage (Control) Act, 2005,’ amended in 2013. Under the law, the government controls the use of tobacco but there is no provision for heated tobacco.

‘The drafted copy in this regard is now at the cabinet division for final remarks. In the drafted law e-cigarette has been proposed to be banned,’ said Hossain.

Public health campaigners said that e-cigarette spread fast in the country misguiding youths that it was not harmful to health while many others promoted it for quitting smoking.

According to Bangladesh Medical Association’s former president and public health expert Rashid E Mahbub, nicotine can be in any form and all of them are harmful.

Tobacco companies spread disinformation to satisfy their own interests and the government tolerates it for revenue, he pointed out.

Sector insiders said that different forms of nicotine were introduced to Bangladesh in 2012 when it was like a fashion among the rich section of society.

Later the tobacco companies had run attractive campaigns for tobacco products since 2016 and its popularity spiked, they observed.

ABM Zubair, executive director of PROGGA (Knowledge for Progress), a Bangladesh-based anti-tobacco research and advocacy organisation, said that they demanded that the government control the heated tobacco since it was getting popular.

According to the anti-tobacco activists, the government made a move in 2019 finally; four years went by since then, but it failed to finalise any mechanism to address the issue.

A recent study titled ‘Bangladesh Tobacco Industry Tactics for Novel Product Expansion’ revealed that 78 percent vaping shops opened in the capital in the past five years.

A Dhaka University PhD student Ehsanul Haque and green activist Syed Saiful Alam conducted the study and found that 32 e-cigarette brands are from multinational tobacco companies.

The World Health Organisation has already declared e-cigarettes harmful and many countries including India, Sri Lanka, Thailand, and Singapore have banned vaping.

An expatriate Ashraful Islam, 40, used to smoke since he was 18. After he returned home from South Arica in 2019 he started vaping to quit smoking.

‘I am now addicted to vaping,’ he admitted.

Like him, many started e-cigarette and became addicted to it.

Public health campaigners said that it could be similar or worse than conventional cigarettes.

According to physicians, the electronic nicotine delivery system is harmful to public health that causes lung disease, stroke, COPD and heart diseases directly apart from the risk of many other diseases including 20 types of cancers.

Association for Prevention of Drug Abuse founding president professor Arup Ratan Choudhury said that vaping had become a gateway to drug addiction.

‘Many youths who come to drug rehabilitation centres were found to be using e-cigarettes first,’ he added.

‘Those using vape for quitting cigarettes are smoking doubly and are getting addicted.’

Bangladesh Cancer Society professor Golam Mohiuddin Faruque argued that e-cigarette was undoubtedly injurious to health which contained dangerous chemicals.

The Bangladesh Cancer Society study on the economic cost of tobacco found that tobacco caused the early death of nearly 1,26,000 people in Bangladesh in 2018, accounting for 13.5 percent of all deaths in the country.

In 2018, the total economic cost of tobacco-related death and disease in Bangladesh was Tk 305.6 billion, or 1.4 percent of the nation’s GDP of that year, according to the study.

There are currently about 1.5 million adults suffering from tobacco-attributable illnesses.

More than 61,000 children below 15 are suffering from diseases caused by exposure to secondhand smoke.

Compared to never users, tobacco users have a 57 percent higher risk of developing a tobacco-related disease, as per the study report.

Published on New Age

Privates do brisk business as machines in public hospitals out of order

by Rashad Ahamad

Essential medical equipment in many government hospitals across the country remains out of order, hampering the treatment of patients as they are compelled to take costly diagnostic services from private facilities.

According to hospital officials, among the heavy machines, including electrocardiography, X-ray and CT scan machines, some have already become unrepairable while the authorities have been asked to get the rest repaired but they are taking a long time.

Directorate General of Health Services officials said that the situation in both specialised hospitals and upazila health complexes across the country was similar.

For instance, according to Professor Nizamul Haque, director of the National Institute of Cancer Research and Hospital at the capital’s Mohakhali, the hospital has eight units of heavy medical equipment to provide radiotherapy and brachytherapy, but five of the six radiotherapy machines are out of order — some for years — while one of the two brachytherapy machines is running with the other being out of order.

Director HM Saiful Islam of the Sher-e-Bangla Medical College Hospital in Barishal said that several months after a number of machines in the hospital went out of order some were repaired but the MRI machine was still out of order.

‘I have informed the authority to replace or repair it,’ he said.

Pabna General Hospital assistant director Omor Faruqe Mir said that the hospital’s X-ray machine had been out of order for months while ECG cannot be performed in the hospital due to the lack of paper.

Director Shaikh Abu Shahin of the Shaheed Sheikh Abu Naser Specialised Hospital in Khulna said that one MRI and one CT scan machines remained out of order though each alternative to both the machines was functional.

‘I hope that the CT scan machine will be repaired soon, but the MRI machine is irreparable,’ he said.

According to DGHS director for hospitals Sheikh Daud Adnan, repairing is a continuous process.

While some machines are repaired, others are often added to the out-of-order stock, he said, adding that it is an unending process.

But the problem is, he said, some machines take months to repair while some a few days.

‘When it takes much time, it causes public suffering while the hospitals have to manage many patients with limited equipment,’ he added.

He criticised the lengthy administrative process for repairs like other processes of the government. ‘While some machines are repaired,  some others of the same hospital go out of order,’ he said.

Including all types of equipment in all hospitals across the country, the DGHS director for hospitals said, dysfunctional machines would number about 3,500.

There are more than 250 public hospitals across the country.

The DGHS has recently compiled a list of out-of-order heavy healthcare machines, including CT scan machine, MRI machine, digital X-Ray machine, ventilator, pulse oximeter and bio-chemical analyser.

According to the list, nine types of heavy machines, numbering more than 350, in 84 healthcare facilities, including specialised hospitals, medical college hospitals and district Sadar Hospital remained dysfunctional.

Of them, 106 machines were beyond the scope of repair.

The National Electro-Medical Equipment Maintenance Workshop and Training is the designated government agency working to repair medical equipment after its warranty period.

 NEMEMW’s technical manager for repair Md Masud Hasan said that they were working to repair more than 1,000 dysfunctional medical machines by the April deadline.

He noted that if machines went out of order during the ‘warranty period’ it was the responsibility of the supplier to repair the machine.

Directors of different hospitals said that as many suppliers made delays in repairing their machines public suffering was prolonged.

Dhaka University Health Economics Unit professor Syed Abdul Hamid said that when diagnostic facilities in government hospitals remained out of order it increased the out-of-pocket healthcare expenditure as people were forced to buy the service from private facilities.

Due to a flawed procurement process and illegal practices, he went on to say, many low-quality machines are imported to the country and such machines go out of order soon.

‘The government must bring transparency and accountability in the medical equipment procurement process,’ he said.

Not only patients do suffer but also doctors face difficulties in ensuring healthcare in hospitals due to the malfunction of machines.

According to a recent study, conducted by Bangabandhu Sheikh Mujib Medical University, 59 per cent upazila-level hospitals in Bangladesh lack X-ray services and 41 per cent lack blood transfusion facilities while there is no medical officer posted in 63 per cent of the hospitals.

On January 23, the study unveiled that some 88.2 per cent of the upazila health complexes do not have ultrasonography facilities.

According to suppliers and hospital authorities, the price of an X-ray machine ranges from Tk two lakh to Tk 20 lakh while an MRI machine costs Tk one crore to five crore and a radiation machine Tk 20 crore to 50 crore.

Public hospitals charge, their staff said, from Tk 100 to Tk 500 for an X-ray and from Tk 200 for each session of therapy while private facilities, according to their staff, take Tk 1,000 to Tk 3,000 for an X-ray and Tk 4,000 to Tk 8,000 for a session of therapy.

Health minister Zahid Maleque was called for comment but he did not receive the phone calls.

However, while addressing a meeting with the top divisional health officials, civil surgeons and superintendents of district hospitals at the M Abdur Rahim Medical College Hospital in Dinajpur on February 19, he said that the government hospitals were given machines to conduct tests for diseases, but most of the machines either remained damaged or were lying dysfunctional for years while patients had to go for tests in small clinics.

‘Every hospital has been provided with necessary machines in accordance with its capacity, but the machines remain dysfunctional for years. Machines worth crores of taka have been lying dysfunctional for years in government hospitals while even in small clinics various medical tests are conducted smoothly. Why do machines only in government hospitals lie dysfunctional for years? Why not in private clinics?’ he asked.

He warned of tougher actions if machines needed to be reinstalled earlier than the expiry dates suggested.

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Bangladesh’s plan to phase out clay bricks falls flat

by Rashad Ahamad

The government’s plan to phase out clay bricks and replace them with concrete blocks by 2025 to save topsoil and stop air pollution has fallen apart as the agencies concerned are indifferent to implementing it.

In 2019, the ministry of environment, forests, and climate change adopted the plan to phase out bricks.

According to the plan, the blocks were to replace bricks in 10 per cent of the government’s construction and renovation works by 2019–2020, 20 per cent by 2020–21, 30 per cent by 2021–22, 60 per cent by 2022–23, 80 per cent by 2023–24, and 100 per cent by 2024–25.

But the use of blocks in construction work is not more than one per cent as 92 per cent of regular clay bricks and seven per cent of auto bricks are being used in construction work, according to industry insiders and the Department of Environment.

DoE officials said that none of the government agencies, including the Department of Public Works, the National Housing Authority, Rajdhani Unnayan Kartripakkha, the Education Engineering Department, and the Local Government Engineering Department, have yet to implement the guidelines in their respective construction and renovation works.

National Housing Authority member Quazi Wasif Ahmad claimed that they could not implement the guideline as the tender for their ongoing construction works was issued before the decision to use blocks was taken.

But, he said, some new projects that are now under the tender process might use blocks instead of bricks.

Officials said that over 8,000 legal and several thousand illegal brickfields are still in operation across the country, producing 3,500 crores of bricks annually. The brickfields emit several million tonnes of carbon dioxide and use 12.25 crore tonnes of fertile topsoil.

Green activists blame clay brick factories for half of the total air pollution in the capital city of Dhaka.

The air quality in Dhaka has been measured as one of the worst for the past several years due to pollution.

In 2020, the High Court issued nine-point directives, taking into cognisance a writ petition filed by Human Rights and Peace for Bangladesh. On February 1, the HC criticised the authorities concerned for their failure to take effective measures to control air pollution in Dhaka and surrounding areas despite its repeated directives.

Stamford University Bangladesh’s science faculty dean and the university’s Centre for Atmospheric Pollution Studies founder-chairman, professor Ahmad Kamruzzaman Majumder, said that some local sources, like under-construction works, vehicles, and indiscriminate road digging, were also behind the air pollution.

Bangladesh Concrete Blocks and Pavers Manufacturers Society president Md Shakhawat Hossain said that everyone was now aware of the harmful effects of bricks on the environment, health, and food safety, but there was no sincere effort to stop it and promote alternative construction materials.

According to business leaders, government agencies use nearly half of all bricks in various construction projects. As long as the government did not ensure the use of blocks, they would not be popular.

‘If we can ensure blocks use in public construction works, it will increase private use as well,’ Shakhawat Hossain said.

He added that some of the government’s rules were contradictory. Blocks manufacturers pay a higher duty than bricks manufacturers while receiving lower business loans from banks.

He said that government agencies have yet to mention the use of blocks in tender documents.

Green activists demanded the closure of illegal brickfields and the phase-out of legal clay brickfields.

They said that until the use of clay bricks could be stopped, soil degradation and air pollution would continue to increase, threatening biodiversity.

The DoE director for the air quality control wing, Ziaul Haque, said that it was working intensively with a high-powered 27-member ‘National Committee to Control Air Pollution’ headed by the cabinet secretary, and asking agencies to replace bricks with blocks.

He said that between 2019 and 2022, 1,772 mobile courts were operated to demolish 907 brickfields and that they filed 3,037 cases.

He said that some people could not trust blocks as an alternative to bricks, and as a result, bricks continued to be used.

To increase trust in blocks, the Bangladesh Standards and Testing Institution and the Housing and Building Research Institute were asked to set standards and ensure the quality of blocks, he said.

He hoped that by this year, all agencies would be using blocks.

He claimed that the government was serious about stopping air pollution because the Air Pollution (Control) Rules 2022 gazette notification was in July 2022.

However, green activists have found no impact of the new rules so far.

Kamal Mahmud, the vice president of the Real Estate and Housing Association of Bangladesh, said that the availability of blocks and workers with expertise were also deterrents to using blocks in construction.

Asked about the capacity to produce blocks to meet demand Shakhawat stated that blocks could be manufactured all year and that production could be increased based on demand.

Presently, more than 200 factories are producing blocks across the country.

Many investors have imported blocks manufacturing machines but have yet to start production, while others are running at half capacity due to low demand, said Shakhawat, adding that there is no crisis of raw materials either.

The Bangladesh Brick Manufacturing Owners Association’s joint general secretary and owner of AB Co in Dhamrai, Md Nazrul Islam admitted if the government doesn’t allow bricks, business people will be compelled to shift their businesses for their own interests.

To replace bricks with blocks, there are still challenges related to manpower and raw materials, he said.

He demanded a duty rebate and zero-interest loan to shift their business from bricks to blocks.

Published on New Age

Cancer patients on rise in Bangladesh

Lack of facilities, early detection, treatment cost key issues

by Rashad Ahamad

The number of cancer patients is on the rise in Bangladesh as the authorities have failed to take pragmatic preventive measures, with early detection remaining elusive for common people and treatment being inadequate and expensive.

Public health experts said that due to food adulteration, unhealthy lifestyles and unabated pollutions, deadly cancer is spreading in the country.

According to the latest Global Cancer Observatory estimates, Bangladesh had 1,56,000 new cancer patients and 1,09,000 died in 2020.

In 2018, the report stated, the number of cancer cases in the country was 1,50,781 and deaths from cancer 1,08,137 while the 2012 figures were 1,22,700 and 91,300 respectively.

Health rights activists said that Bangladesh is yet to have a population-based cancer registry. Disagreeing with the Globocan report, they said that the real numbers of cancer patients and deaths in the country were much higher than those quoted in the report.

They estimate that annually more than 2,00,000 people are diagnosed with cancer and only 50,000 of them get access to treatment facilities due to the lack of facilities and the massive cost of treatment.

According to Bangladesh Cancer Society President Professor Golam Mohiuddin Faruque, there are crisis of equipment as well as of manpower.

As per the WHO standard, he also said, Bangladesh needs 170 radiotherapy machines but has only 40 while 70 per cent of them are out of order.

‘We have inadequate expert-level manpower. While the manpower is insufficient, they, too, are often not posted in places where they are needed. We should appoint them in the right places so that they can serve those who need their service,’ he said.

There are more than 200 radiation-practicing oncologists and 50 medical oncologists in the country, said society leaders.

In the public sector, nine medical college hospitals in the divisional cities, are equipped for cancer treatment, and the specialised National Institute of Cancer Research and Hospital provide cancer treatment.

According to hospital sources, the hospitals have 17 radiation machines to provide radiotherapy but 11 of them are currently not in operation.

As public hospitals have inadequate machines and most of them do not work, many patients are forced to go for treatment at private facilities which are highly expensive, said practitioners.

Amid such a situation Bangladesh observes World Cancer Day 2023 today marking the second year of the three-year-long ‘Close the Care Gap’ campaign addressing the issue of equity.

During a visit to the NICRH in the capital’s Mohakhali, Khurshida Begum, 55, a resident of Keraniganj, was found seating, among scores of others, on a hospital bench with her son.

She said that doctors detected blood cancer in her in December 2022 but her treatment was yet to start.

‘I am not getting a serial number here. I have no money to take treatment at a private hospital,’ she said in tears.

She said that the hospital people now asked her to visit the hospital again two months later.

‘We struggle to ensure services for patients due to manpower shortage while, of the six radiotherapy machines at our hospital, four are out of order, only one is functioning and one will be repaired soon,’ said NICRH director Professor Nizamul Haque.

He said that the 300-bed hospital capacity was extended to 500 beds but the manpower was not increased yet.

In the three years from January 2018 to December 2020, the NICRH provided outpatient services to 83,795 patients and 35,733 of them, or 42.6 per cent, were later diagnosed with cancer.

Nizamul Haque said that the government had taken up a project to set up eight specialised hospitals in divisional cities where cancer, kidney and heart patients would get services.

The project director for the planned hospitals, Khan Mohammad Arif, said that the overall progress in the construction of the 450-bed hospitals was 22 per cent.

Cancer epidemiologist and immediate past NICRH chief Professor Habibullah Talukder Ruskin said that installing treatment facilities alone was not the solution to the cancer problem.

‘Some one-third of cancers can be prevented through awareness, education and early screening, but there is no initiative in these regards,’ he said.

He suggested expanding diagnostic facilities to all the district hospitals, which could be helpful in preventing three types of cancer — breast, cervical and oral cancers.

The government had planned to launch an HPV (human papillomavirus) vaccination campaign in 2023 to prevent cervical cancer but missed the deadline. It has set afresh 2025 for the mass HPV vaccination of teenage girls.

‘We successfully piloted HPV vaccination in 2017 in Gazipur. We are waiting for the vaccine from the vaccine alliance Gavi. As soon as it allocates it, we will start the mass vaccination across the country,’ said Expanded Programme on Immunization deputy programme manager Tanvir Hossen.

Cancer Awareness Foundation Bangladesh general secretary Mohammad Masumul Haque stressed a national population-based cancer registry, as, he mentioned, the actual number of cancer patients is a must to adopt a proper plan of action on prevention and treatment of the illness.

Though the government had drafted a plan of action for 2007–12 to control cancer but the plan was not implemented.

‘A national cancer control policy is a must, on the one hand, while a unified message should be worked out to raise public awareness in this regard, on the other,’ he said.

Cancer physicians emphasised a healthy lifestyle, tobacco control, safe food and weight control to prevent cancers.

In order to rein in the cost of cancer treatment, Masumul Haque advised profit regulation on cancer medicine and treatment costs, in addition to introducing health insurance.

He went on to say that the National Cancer Control Council, headed by the health minister, was formed but was not active.

According to radiation oncologist Professor Syed Md Akram Hussain, cancer treatment is costly across the whole world but it is more expensive in Bangladesh.

The government, he added, might give special subsidies to cancer patients towards costs, including transportation and medicine expenses.

He further said that cancer treatment facilities in Bangladesh were mainly Dhaka-centric, emphasising that there must be such facilities at the district level so that patients can get easy excess to treatment.

He suggested free medicine for poor patients and strict control over the pricing of drugs.

According to doctors, early detection of cancer holds a high likelihood of cure but unfortunately most of the cancer patients in Bangladesh are detected at the third or fourth stage of the disease, resulting in high fatality rates.

In the private sector, 10 hospitals have radiation therapy facilities while some others have some partial diagnostic and treatment facilities and six of them are in the capital.

Dhaka University Institute of Health Economics professor Syed Abdul Hamid said that the treatment of a single cancer patient needed approximately Tk 6,39,000 annually.

He pointed out that the additional costs of cancer care are more than that of the core treatment.

Cancer treatment at a public facility in Bangladesh requires Tk 25,000 for a radiotherapy session, Tk 20,000 for a chemotherapy session and Tk 60,000 for a surgical procedure.

Each of the sessions at private hospitals costs Tk 1,50,000 to Tk 3,00,000.

Physicians further said that establishing a cancer treatment facility was a costly affair in terms of one-time investment as a machine costs Tk 20 to 30 crore.

The cost of treatment includes expenses for consultation, diagnosis, surgical or therapeutic procedures, drugs and injections and transport and accommodation for the patient and attendants.

Health rights activists said that government regulation of price and providing adequate facilities could ensure treatment for more patients. They asked the government to cut the out-of-pocket healthcare expenditure.

The Health Economics Unit of the health ministry reported that the out-of-pocket health expenditure in Bangladesh, one of the highest in the world, was Tk 68.5 in a Tk 100 expenditure.

As treatment costs are high and facilities are inadequate, many people die without proper treatment, said experts.

The health department data show that some 67 per cent of the deaths from illnesses in Bangladesh are caused by non-communicable diseases like cancer, cardiovascular diseases, diabetes, high blood pressure, chronic kidney conditions and breathing problems.

Published on New Age