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 (upazilas; see Local Administration , ch. 4). 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.

Data as of September 1988

Health Care Facilities

The Ministry of Health and Family Planning was responsible for developing, coordinating, and implementing the national health and mother-and- child health care programs. Population control also was within the purview of the ministry (see Population Control , this ch.). The government's policy objectives in the health care sector were to provide a minimum level of health care services for all, primarily through the construction of health facilities in rural areas and the training of health care workers. The strategy of universal health care by the year 2000 had become accepted, and government efforts toward infrastructure development included the widespread construction of rural hospitals, dispensaries, and clinics for outpatient care. Program implementation, however, was limited by severe financial constraints, insufficient program management and supervision, personnel shortages, inadequate staff performance, and insufficient numbers of buildings, equipment, and supplies.

In the late 1980s, government health care facilities in rural areas consisted of subdistrict health centers, union-level health and family welfare centers, and rural dispensaries. A subdistrict health center in the mid-1980s typically had a thirty-one-bed hospital, an outpatient service, and a home-service unit staffed with field workers. Some of the services, however, were largely nonoperative because of staffing problems and a lack of support services. Health services in urban areas also were inadequate, and their coverage seemed to be deteriorating. In many urban areas, nongovernment organizations provide the bulk of urban health care services. Programming and priorities of the nongovernment organizations were at best loosely coordinated.

A union-level health and family welfare center provided the first contact between the people and the health care system and was the nucleus of primary health care delivery. As of 1985 there were 341 functional subdistrict health centers, 1,275 rural dispensaries (to be converted to union-level health and family welfare centers), and 1,054 union-level health and family welfare centers. The total number of hospital beds at the subdistrict level and below was 8,100.

District hospitals and some infectious-disease and specialized hospitals constituted the second level of referral for health care. In the mid-1980s, there were 14 general hospitals (with capacities ranging from 100 to 150 beds), 43 general district hospitals (50 beds each), 12 tuberculosis hospitals (20 to 120 beds each), and 1 mental hospital (400 beds). Besides these, there were thirty-eight urban outpatient clinics, forty-four tuberculosis clinics, and twenty-three school health clinics. Ten medical college hospitals and eight postgraduate specialized institutes with attached hospitals constituted the third level of health care.

In the mid-1980s, of the country's 21,637 hospital beds, about 85 percent belonged to the government health services. There was only about one hospital bed for every 3,600 people. In spite of government plans, the gap between rural and urban areas in the availability of medical facilities and personnel remained wide. During the monsoon season and other recurrent natural disasters, the already meager services for the rural population were severely disrupted.

Source: Bangladesh Country Study, Library of Congress