1. Human health at Risk: The Case of Cholera in Bangladesh
Ross Edgeworth
Disaster & Development Centre

2. The Impact of Cholera
BANGLADESH

5. 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

7. 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

8. Macro Environment Low Elevation High humidity and temperature
Heavy seasonal rainfall and seasonal flooding
Concentration of population near to aquatic environment
Self-Care Bangladesh 2008

9. Socio-economic Situation
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

10. Concentration of population near
to aquatic environment

11. 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

12. Diarrheal Disease Outbreak
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

13. Impact of Disease 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

14. Epidemic Preparedness

15. 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)

16. Keys to Success? 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

17. Summary of Case Studies
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