THALASSAEMIA IN BANGLADESHDr.Dr Waqar Ahmed Khan MBBS M Phil                  Khan.MBBS,M.PhilProfessor of PathologyBangla...
Bangladesh-D    B    Bangladesh-Demographic Data        l d h          hi D t   Area: 1,47,570 sq.km. or 57,295    sq.mil...
HEALTH SYSTEM• Health services provided through public  and private sectors       p• Public sector provides out patient,in...
HEALTH SYSTEM• Health,Nutrition & Population Sector         ,               p  Programme to reduce (2003-2011)• 1 MMR  1.M...
EPIDEMIOLOGY• WHO Data• Beta trait 3%• Hb E trait 4%• Our Data• Beta trait 4.1%• Hb E trait 6.1%
EPIDEMIOLOGY• The most common abnormal Hb seen is  Hb E Hb S and Hb H occasionally seen
EPIDEMIOLOGY• Wide carrier variation in carrier status• In Chittagong 48 tribal children were  screened 42% were E trait a...
EPIDIEMIOLOGYExpected total number of beta thalassaemia born annually -1040              yExpected total number of Hb E b ...
EPIDEMIOLOGY• No data regarding the number of              g      g  thalassaemic patients.• There is no patient’s registr...
Carrier status in different divisions of Bangladesh(n-686)DivisionDi i i       No tested             N t t d     Beta trai...
Hb Elect/HPLC in Dhaka Shishu  Hospital 30/7/98-31/12/11Hb ELECTROPHORESIS/HPLC   10928NORMAL                    5147BETA ...
DIAGNOSTIC FACILITIES• Cell counter widely available• Hb Electrophoresis available in private  hospitals and l b t i i bi ...
BLOOD TRANSFUSION•   General picture•   Voluntary non-rumeration blood 29 4%              non rumeration       29.4%•   Re...
BLOOD TRANSFUSION• Blood Transfusion is not free of charge.• It costs about $9.00 to purchase blood• from blood bank centr...
Blood transfusion for       thalassaemic patients• 60% of blood collected are utilised for  thalassaemic patients.        ...
Blood Transfusion• Patients are also admitted in hospitals and  treated by blood transfusion in most public           y   ...
IRON CHELATORS• All the three chelators are available in big  cities and imported .Government has                p  exempt...
DRUGS USED IN                 BANGLADESHCENTRE         Deferiprone               D f i         Desferroxami D f           ...
Mutation analysisThe following results are obtained from 111 samples thatwere sent to Dr Mary Petrou in the UK to observe ...
Mutation patternIVS 1-5(G-C)    101        74.4%Fr 41-42 (   41 42 (-     5          4.5%                           4 5%TT...
MutationIVS 1-130(G-C) 2                1.8%619bp deletion   2              1.8%                                1 8%Codon ...
Viral infection in multi-transfused          patients in DSHTCNo. of       HbsAg     HCV         HIVtransfused            ...
Mymensingh Medical College and           HospitalNo of       HbsAg             HCV                 HIVtrransfused positive...
EXPERT THALASSAEMIACENTRES IN BANGLADESHNAME                                        NODHAKA SHISHU HOSPITAL THALASSAEMIA C...
Dhaka Shishu (Children)       Hospital
DHAKA SHISHU HOSPITAL THALASSAEMIA CENTER
Bangladesh - Current Situation in Control Strategies and Health Systems in Asia
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Bangladesh - Current Situation in Control Strategies and Health Systems in Asia

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Thalassaemia in Bangladesh by Dr. Waqar Ahmed Khan, MBBS, M.Phil who is Professor of Pathology, Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital and President of Dhaka Shishu Hospital Thalassaemia, Dhaka, Bangladesh.

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Bangladesh - Current Situation in Control Strategies and Health Systems in Asia

  1. 1. THALASSAEMIA IN BANGLADESHDr.Dr Waqar Ahmed Khan MBBS M Phil Khan.MBBS,M.PhilProfessor of PathologyBangladesh Institute of Child HealthDhaka Shishu (Children) HospitalPresidentDhaka Shishu Hospital ThalassaemiaDhaka,Bangladesh.
  2. 2. Bangladesh-D B Bangladesh-Demographic Data l d h hi D t Area: 1,47,570 sq.km. or 57,295 sq.miles. Population: 142,319,000 Birth rate:22.9 births/1000 population. l ti Infant mortality:45/1000 live births Per capita income: US$ 1700 1700. 6.1% of the total national budget is allotted to health sector. Ethinic groups: Bengali 98% Tribal and Non –Bengali Muslims 2% g
  3. 3. HEALTH SYSTEM• Health services provided through public and private sectors p• Public sector provides out patient,in patient and preventive care care.• Private provides out patient, and in patient curative care taking big share of profit
  4. 4. HEALTH SYSTEM• Health,Nutrition & Population Sector , p Programme to reduce (2003-2011)• 1 MMR 1.MMR• 2.Infant and under 5 mortality rate• 3.Malnutrition• 4 Tuberculosis 4.Tuberculosis• 5.Non-communicable diseases but not Hb• disorders.• Th l Thalassaemia i lik l t b i l d d i th i is likely to be included in the next HNPSP
  5. 5. EPIDEMIOLOGY• WHO Data• Beta trait 3%• Hb E trait 4%• Our Data• Beta trait 4.1%• Hb E trait 6.1%
  6. 6. EPIDEMIOLOGY• The most common abnormal Hb seen is Hb E Hb S and Hb H occasionally seen
  7. 7. EPIDEMIOLOGY• Wide carrier variation in carrier status• In Chittagong 48 tribal children were screened 42% were E trait and• Another screening programme in Bengali school children(110) 15% were E trait and 10% were Beta trait• I Gaibandha 2 B In G ib dh 257 Bengali women were li screened and 22% were E trait and 10% were Beta trait
  8. 8. EPIDIEMIOLOGYExpected total number of beta thalassaemia born annually -1040 yExpected total number of Hb E b tE t dt t l b f beta thalassaemia born annually -6443
  9. 9. EPIDEMIOLOGY• No data regarding the number of g g thalassaemic patients.• There is no patient’s registry patient s• It is estimated that there about 90,000 patients• 85% are Hb E beta thalassaemia thalassaemia.• There is no prevention programme at any level.• No regular awareness programme other than on International Thalassaemia Day
  10. 10. Carrier status in different divisions of Bangladesh(n-686)DivisionDi i i No tested N t t d Beta trait B t t it E t it trait HbE di dis S/D t it traitDhaka 252 8(3.1) 13(5.2)Chittagong 102 3(2.9) 3(2 9) 3(2.9) 3(2 9) 3(2.9) 3(2 9) 2(1.3) 2(1 3)Khulna 84 2(2.4) 2(2.4)Rajshahi 91 5(5.5) 15(16.5)Sylhet 96 5(5.2) 4(4.2) I(1.0) 1(1)Barisal 62 5(8.1) 5(8.0)Total 687 28(4.1) 42(6.1)
  11. 11. Hb Elect/HPLC in Dhaka Shishu Hospital 30/7/98-31/12/11Hb ELECTROPHORESIS/HPLC 10928NORMAL 5147BETA THAL MAJOR 461Hb E BETA THALASSAEMIA 1657BETA TRAIT 2048E TRAIT 1374E DISEASE 148S/D BAND 58
  12. 12. DIAGNOSTIC FACILITIES• Cell counter widely available• Hb Electrophoresis available in private hospitals and l b t i i bi cities h it l d laboratories in big iti• HPLC in Dhaka S s u Hospital C a a Shishu osp ta Thalassaemia Centre.• Limited prenatal diagnostic proced re procedure (amniotic fluid) and DNA analysis done in Medical University
  13. 13. BLOOD TRANSFUSION• General picture• Voluntary non-rumeration blood 29 4% non rumeration 29.4%• Relative blood donor 60.5%• Paid blood donor 10.4%• Ref-Blood transfusion in Bangladesh• M. D.Islam Asian J.Transfusion,2009;3(2)•
  14. 14. BLOOD TRANSFUSION• Blood Transfusion is not free of charge.• It costs about $9.00 to purchase blood• from blood bank centres.• From thalassaemia centres with blood bank facilities the cost is less.
  15. 15. Blood transfusion for thalassaemic patients• 60% of blood collected are utilised for thalassaemic patients. p• Generally packed cells are used for blood transfusion. t f i• Certain ce t es like Bangladesh Ce ta centres e a g ades Thalassaemia Samity and Red Crescent Society use washed red cells cells.• Overall about 30% of patients can afford to keep the targeted Hb levell
  16. 16. Blood Transfusion• Patients are also admitted in hospitals and treated by blood transfusion in most public y p hospitals• Patients in remote areas are deprived of even these facilities
  17. 17. IRON CHELATORS• All the three chelators are available in big cities and imported .Government has p exempted tax on these drugs.• The drugs are not available free of charge
  18. 18. DRUGS USED IN BANGLADESHCENTRE Deferiprone D f i Desferroxami D f D f i Deferasirox i COMBINED neBangladesh 66% 34%ThalassaemiaSamityThalassaemia 10% 60% 5% 25%WelfareSocietyBangladeshThalassaemiaFoundationDhaka Shishu 35% 15% 5% 45%HospitalThalassaemiaCentre
  19. 19. Mutation analysisThe following results are obtained from 111 samples thatwere sent to Dr Mary Petrou in the UK to observe thetype of mutations in Bangladesh.
  20. 20. Mutation patternIVS 1-5(G-C) 101 74.4%Fr 41-42 ( 41 42 (- 5 4.5% 4 5%TTCT)Fr-8-9(+G) 4 3.65Codon 30(G-C) 4 30(G C) 2.7% 2 7%-90(C-T) 90(C T) 3 2.7% 2 7%Codon 15(G-A) 2 ( ) 1.8%
  21. 21. MutationIVS 1-130(G-C) 2 1.8%619bp deletion 2 1.8% 1 8%Codon 30(G A) 2 30(G-A) 1.8% 1 8%/Codon 16(-C) ( ) 1 0.9%Codon 15(-T) 2 0.9% 121
  22. 22. Viral infection in multi-transfused patients in DSHTCNo. of HbsAg HCV HIVtransfused positive Positivepatients92 1(1.1%) 17(18.5%) Nil
  23. 23. Mymensingh Medical College and HospitalNo of HbsAg HCV HIVtrransfused positive positive positivepatients152 13.8% 12.5% NIL Mollah et al,jn Health popul Ntr.2003
  24. 24. EXPERT THALASSAEMIACENTRES IN BANGLADESHNAME NODHAKA SHISHU HOSPITAL THALASSAEMIA CENTRE 3000BANGLADESH THALASSAEMIA SAMITY DHAKA SAMITY,DHAKA, 3000+BANGLADESH THALASSAEMIA FOUNDATION,DHAKA 796THALASSAEMIA WELFARE SOCIETY,CHITTAGONG 700
  25. 25. Dhaka Shishu (Children) Hospital
  26. 26. DHAKA SHISHU HOSPITAL THALASSAEMIA CENTER

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