Transcript Human health at Risk: The Case of Cholera in Bangladesh

Human health at Risk:
The Case of Cholera in
Bangladesh
Ross Edgeworth
Disaster & Development Centre
The Impact of Cholera
BANGLADESH
Bangladesh at a Glance
• Worlds most populated country (153 million)
• One third of country under water on annual
basis
• Considered world’s most disaster at-risk country
• 83% live on < $2 per day, 41% < $1 per day
• 20 Physicians per 100,000 people
• Public & Private health care expenditure = 4.1%
GDP
• Less than 40% have access to basic
government health facilities
Cholera in Bangladesh
• Highest rates in the world (120,000 patients
p/year)
• > 30,000 cases in Dhaka in 2002
• Seasonal variation – epidemics often follow
floods and cyclones
• Long history of cholera surveillance and research
• Cholera vaccines first trialled in Bangladesh, ORS
developed in Bangladesh, low cost technologies –
sari filter
Macro Environment
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Low Elevation
High humidity and temperature
Heavy seasonal rainfall and seasonal flooding
Concentration of population near to aquatic environment
Self-Care Bangladesh 2008
Socio-economic Situation
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High population density
High levels of absolute poverty
Majority of households dependent on agriculture
High number of households without access to
sanitation facilities
• Environmental population displacement
Concentration of
population near
to aquatic environment
ICDDR,B
• Bangladesh Research Organisation
• Established in 1960 as cholera
research laboratory
• Global leader in health research
• Development of ORS
• Two Hospitals in country
• Global leader in diarrhoeal disease management
Diarrheal Disease Outbreak
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Heavy monsoon caused severe flooding
Contaminated water supply
Over 14 million people displaced
Unprecedented surge in the number of
patients visit Dhaka Hospital
• 1,000 patients per day
Impact of Disease
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43,359 patients (July –September 2007)
34% had culture confirmed cholera
84% of the cholera patients had severe dehydration
93% of the patients required intravenous fluids for
their management
• 75% of cholera patients
presented within 24 hours
of diarrhoea onset
Epidemic Preparedness
Cholera Management in Bangladesh
Severe dehydration treated through IV drips
Correction of
Dehydration and
Hypovolemic shock
Promotion of ORS
No deaths due to
Dehydration
(13,000 lives saved)
Keys to Success?
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Over 40 years experience
Tailored equipment and staff expertise
Ongoing research and surveillance
Quick assessments, rapid treatment
Cholera disease risk and knowledge widely
disseminated at local level
• Disease risks and vulnerability remain
prominent
Summary of Case Studies
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Risk and vulnerability to cholera disease
Impact of poverty (all three countries)
Impact of living conditions (all 3)
External conditions, displacement (Moz, Bang)
Climate change & ecological factors (All 3)
Political context (Peru)
Cultural beliefs