Presentation at 3rd GRF One Health Summit 2015 Session OH Approaches For Sustainable Development

1. One Health Bangladesh
A Professional Initiative to Transform One Health Agenda
to One Health Movement in Bangladesh
Dr. Khaleda Islam
MMEd (UK), MPH, MBBS
Principal Scientific Officer
Institute of Epidemiology, Disease Control & Research (IEDCR)

2. The Ebola Epidemic in West Africa:
The Largest & Longest: Shook the World
Photo Courtesy: WHO/C. Banluta
Lessens:
‘No single control
intervention is, all
by itself, sufficiently
powerful to bring an
Ebola epidemic of
this size &
complexity under
control’

3. Bangladesh: Struggling with
Emerging, Re-emerging & High Impact Infectious Diseases
Zoonotic
Diseases
Vector Borne
Parasitic
Vector Borne
Viral
Influenza
Nipah Malaria Chikungunia Seasonal
Anthrax Filariasis Dengue Avian
Rabies Leishmaniasis Japanese
Encephalitis

4.  1948: Published report of anthrax in animals
 1949 -1986: Both animal & human anthrax
periodically reported
Anthrax in Bangladesh

5. August 2009:
A cutaneous anthrax
outbreak was
detected, after 25 yrs
of no reported
human outbreaks

6. Anthrax Outbreak
in Bangladesh
 Since then anthrax outbreaks
repeatedly been reported from
different parts of country

7. Bangladesh:
Struggling with Nipah
Possible contamination by bats in the clay pot
collecting date palm sap.
Photo Courtesy: WHO
 2001- 1st identified Nipah encephalitis outbreak
 2001-2014
 Case – 209,
 Death – 160
 CFR – 77%

8. Bangladesh: High Rabies Endemic Country
Estimated no. of human cases/ million
population/ year
Estimated no. of human
rabies cases/year
13 2,000 –2,500
Estimated number of human rabies per year
Source: WHO 2012
‘Strategic Framework for Elimination of Human Rabies Transmitted by Dogs in the South-East Asia Region’

9. Chikungunya in
Bangladesh  2006: Tested 400 samples, no positives
 2008: 1st identified Outbreak
 2009: Continued

10. 5551
2430
6232
486
3934
1048
2200
466
1153
474 409
1359
671
1749
375
1507
0
1000
2000
3000
4000
5000
6000
7000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Dengue in Dhaka
Number of Cases per year in Dhaka
 1960 – ‘Dhaka Fever’
 2000 - Re-emerged
 Occurring every year
 Extending its geographical range
 A major public health concern
0 0 2 2 1
15
156
727
604
0
100
200
300
400
500
600
700
800
2007 2008 2009 2010 2011
2012 2013 2014 2015
Monthly Distribution in Dhaka

11. One Health Bangladesh- Professional Organization Formed
 With this backdrops, lead Public Health organization (IEDCR, ICDDRB, CVASU, )
started discussion about One Health approach
 Gradually they were joined by
 professionals, (Public Health Specialists, Veterinarians, Environmentalists, Agriculturists etc.),
 Civil Society,
 Academia (DU, BAU etc.)
 NGOs (BRAC)
 December 2007 – ‘One Health Bangladesh’ formed
 National Coordination Committee formed

12. The Vision
The consequences of emerging, re-emerging & high
impact infectious diseases are minimized
through institutionalizing One Health Approach,
so contributing to food security, food safety
& a healthy population in thriving ecosystem

13. IEDCR
Started working as Secretariat of One Health Bangladesh
http://www.iedcr.gov.bd

14. One Health Bangladesh:
Strategic Framework
 Formulated ‘Strategic framework for One
Health approach to infectious diseases in
Bangladesh 2012’
 Endorsed by MoH&FW, MoF&L & MoE&F
 Adopted multi-sectoral, multi –disciplinary
approach to combat emerging, re-emerging &
high impact infectious diseases at human
animal interface, to ensuring food safety &
food security

15. Components of
Strategic Framework
Wildlife & Ecology
Institutional
governance &
Program
Management
Coordinated
Surveillance
Coordinated
Outbreak
Investigation &
Response
Applied
Research
Network &
Partnership
Strategic
Communication
& Advocacy
Capacity Building
Behavioral,
Social &
Economic Aspect
of Disease
Has got 9 components

16. One Health Bangladesh - Initiatives
 Extensive OH advocacy, communication
& connectivity
 Involving government in driving seat
 Promote OH strategy through existing
programs
 Need assessment & capacity
development
 Collaborative research
 Membership drive – life Member 81

17. 8th National Conference
 Conducted on March 29-31, 2015
 Registered participants: 385
 Participants were very divers representing
 Ministries
 International organizations
 Universities
 UN organization: FAO, WHO, UNICEF
 Donors: USAID
 International representatives from different organizations
 Diplomats

18. Achievements

19. A collaborative investigation team for Outbreak
Investigation & Response
• Institute of Epidemiology, Disease
Control and Research (IEDCR)
• Department of Livestock
• ICDDR,B
• CDC
• Epidemiologists
• Clinicians
• Veterinarians
• Anthropologists

20. One Health Workforce
Introduced MPH & MVH (One Health & Biosecurity) in collaboration with
Massey University New Zealand –
 1st cohort - 6 students
FETP with US CDC- Affiliated with DU as MSc in Applied Epidemiology
 1st cohort - 5 students
 2nd cohort – 5 students

21. Anthrax
 Orientation of field workers
 Advocacy meetings - local
leaders, public
representative & other
professionals
 Inter-ministerial co-
ordination Livestock anthrax
vaccination intensified
 Mass media campaign
 Training of Health Workforce

22. Death Due to Dengue in Dhaka: Decreased
5551
2430
6232
486
3934
1048
2200
466
1153
474 409
1359
671
1749
375
1507
93
44
58
10
13
4
11
0 0 0 0
6
1 2
0
4
0
10
20
30
40
50
60
70
80
90
100
0
1000
2000
3000
4000
5000
6000
7000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Year wise Dengue Case & Death in Dhaka City
Case Death

23. Death Due to Rabies Decreased
167 166 165
154
104
109
88 86
97
0
20
40
60
80
100
120
140
160
180
2006 2007 2008 2009 2010 2011 2012 2013 2014
Recorded Death in National Rabies Prevention & Control Center (NRPCC)

24. MDV
Cox’s Bazar Municipality

25. Challenges
 Many ministries involved who will be in driving seat
 MoH&FW, MoF&L, MoA, MoE&F
 Coordination among stakeholders
 Lack of experience in One Health Approach
 Different objectives
 Different lines of authority
 Different professional backgrounds

26. Unique Country Context

27. One of the
Densely
Populated
Country
Traveling during
a Festival

28. The Worst Victim of
Climate Change

29. Community: very
close to livestock

30. Food Safety & Food Security Issues
Food Safety Food Security
Unintentional Pesticide Poisoning Availability – Purchasing Power
Food Adulteration Access – Natural & Artificial Block
Food Contamination Use – Ignorance, Culture, Practice
Food borne illness

31. Filling the Gap
Technical Support with full time staff to run One Health secretariat
SOP for coordination among different stakeholders
Institutional collaboration to develop One Health Workforce

32. Way Forward
We look forward to have a full functional secretariat
with designated staff & some budget to coordinate
multi-sectoral approach of ‘One Health Bangladesh’
As this is the crucial driving force to improve public
health status of Bangladesh

34.  Population : 152 million
 Land area : 130,168 km2
 Population density : 1168/km2
Source: BBS, Population & Housing census 2011