Bangladesh - Pain & Policy Studies Group

International Pain Policy Fellowship,
Cohort III
Country Report
Directions and Template
Madison, Wisconsin
6-10 August 2012
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Country Report:Bangladesh
Team Members:
Rumana Dowla, MBBS, MPH, DipPallMed
Masters iin Palliative Medicine, Cardiff University, UK
Chair person,
Bangladesh Palliative & Supportive Care Foundation
Specialist, Palliative Medicine, United Hospital
Farzana Khan, MBBS, MPH
PhD in Palliative Care (Student), Lancaster University, UK
Medical Officer,
Centre for Palliative care,
Bangabandhu Sheikh Mujib Medical University
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Bangladesh
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Bangladesh
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Bangladesh
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Currency: Bangladeshi taka
Population: 150,493,658 (2011) World Bank
Capital: Dhaka
GDP: US$ 110.6 billion (2011) World Bank
Official language: Bengali
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
1. Cancer pain and palliative care
Total Cancer Patient : 24,847
Confirmed diagnosis : 18,829 cases
Male 10,847 (57%)
Female 6018 (43%)
Male
Lung 25.5%
Female
Breast 25.6%
38% constitute ca lung in male and breast and cervical cancer
female.
Ref Cancer Registry NICRH 2005-2007
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
1. Cancer pain and palliative care
Cancer
Death
(2009)
Proportion
with
moderate/s
evere pain
Number of
deaths with
moderate/
severe pain
91,494
80%
73,196
Ref: Global access to pain relief initiative, PPSG
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
a. What is the estimated prevalence and types of cancer in your country,
mortality, and the prevalence of pain?
Top causes of mortality in the NICRH, by age & sex distribution, 2010
Age standerdized incidence per 100000 persons of common cancers in Bangladesh, 2008:
Breast
(females)
Cervix
uteri
(females)
Liver
Female
s
Males
Femal
es
Males
Femal
es
Male
s
27.2
29.8
3.5
4.1
4.0
4.5
8.7
30.4
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Colorectal
Lung
Prostate
(males)
1.9
a. What is the estimated prevalence and types of cancer in your country,
mortality, and the prevalence of pain? (…Continued)
Male
Ca-lung
Female
44.44
Ca-breast
Both Sexes
16.13
Ca-lung
30.59
Acute myeloid leukemia
7.41
Chorio-carcinoma
9.68
Acute myeloid leukemia
5.88
Non-Hodgkin
lymphoma
5.56
Adenocarcinoma
6.45
Non-Hodgkin
lymphoma
5.88
Ca-stomack
5.56
Ca-colon and Carectum
6.45
Ca-stomach
5.88
Adenocarcinoma
3.70
Ca-lung
6.45
Adenocarcinoma
4.71
Ca-prostate
3.70
Non-Hodgkin
lymphoma
6.45
Ca-colon and Carectum
3.53
Ca-gallbladder
3.70
Ca-stomach
6.45
Acute lymphatic
leukemia
2.35
Acute lymphatic
leukemia
1.85
Acute lymphatic
leukemia
3.23
Squamous cell
carcinoma
.35
Ca-colon and Carectum
1.85
Acute myeloid leukemia
3.23
Ca-gallbladder
2.35
Ca-gallbladder
1.85
Ca-gallbladder
3.23
Fibrosarcoma
2.35
Total patients=54
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Total patients=31
Total patients=85
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
b. Is there a national cancer control policy, plan, or program? If so, when
did it start? What is the name of the office and person in charge? Are
objectives for pain relief and palliative care included? Is availability of
opioid analgesics specifically addressed?
There is no national cancer control policy yet,
but a plan was made by a task force made in
collaboration with Government and WHO.
Consultative meetings were held and a report
was produced, but no follow up could be find
out.
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
c. Has the government endorsed the WHO method for relief of cancer
pain? Has the government sponsored or endorsed training programs in
cancer pain relief, palliative care and the medical use of opioid
analgesics?
1. There is no documental evidence Bangladesh
Government has endorsed the WHO method
for relief of cancer pain
2. Doctors and nurses were sent for 6 wks from
NICRH to IPM Kerala
3. introduced WHO guideline .
4. But the Government has not yet sponsored or
endorsed training programs in cancer pain relief,
palliative care and the medical use of opioid
analgesics
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
d. Describe in brief terms the availability of pain relief and palliative care
services in the country and comment on the extent to which the needy
population has access to such services, including children. How well is
pediatric cancer pain treated? Do pediatric patients have access to
opioid analgesics in the class of morphine?
1.Sanisphere an international consultant appointed by UICC
1.
(Union against Cancer) estimated that there are approximately
7000 new cases of childhood cancer
2.Then among the children who start the treatment there is 3050% drop out 3estimated between year 2000 to 2006
3.Services for children
ASHIC Foundation
BSMMU
NICRH
4.Yes ,in these centers morphine is prescribed for pain …
ASHIC foundation has morphine license;
NICRH and BSMMU Paed Haemato-oncology
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
d. Describe in brief terms the availability of pain relief and palliative care
services in the country and comment on the extent to which the needy
population has access to such services, including children. How well is
pediatric cancer pain treated? Do pediatric patients have access to
opioid analgesics in the class of morphine?
Director General of Health Service Bangladesh supported by WHO published
and Annual Report of National Institute of Cancer Research Hospital in 2005
Total number of patients
=7516
Paediatric Patients
= Age 0-15 years were 218 only 4.0%
Among them ,
Boys =139
Girls=79
64.2% of these cases constituted- Lymphoma
-Retinoblastoma
-Leukemia
Sanisphere Int. Conducted a study funded by UICC( Union Against Cancer )5
According to their study approximately there are
New cases
Diagnosed cases
Treated
Fully
UniversityTreated
of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
= 7000 per year
=1000-1500per year
=700 patients
=350-500 patients
d. Describe in brief terms the availability of pain relief and palliative care
services in the country and comment on the extent to which the needy
population has access to such services, including children. How well is
pediatric cancer pain treated? Do pediatric patients have access to
opioid analgesics in the class of morphine?
During the practicum stay at BSMMU Haemato-oncology Department
the following cases were seen commonly and listed in order of
frequency almost similar to the USA list discussed earlier.
1.Acute Lymphoblastic Leukemia(ALL)
2.Acute Myloblastic Leukemia(AML)
3.Non- Hodgkins Lymphoma(NHL)
4.Hodgkins Lymphoma (HL)
5.Wilms Tumor
6.Neuroblastoma
7.Ewings Sarcoma.
Ref:Dowla. R (2007) Observing paediaric cancer patients their
management and to ascertain role of palliative care in a hospital in
Bangladesh;
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
d. Describe in brief terms the availability of pain relief and palliative care
services in the country and comment on the extent to which the needy
population has access to such services, including children. How well is
pediatric cancer pain treated? Do pediatric patients have access to
opioid analgesics in the class of morphine?
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
e. Identify non-governmental organizations that have a focus on pain
relief and palliative care and mention their relevant activities. Is there a
national palliative care association?
Centre for Palliative Care, BSMMU – 20 beds Indoor, OPD – 6
days/week, 24 hrs Telephone service, Home care, Training
centre with BCCPM & BCCPN courses, introductory courses
for doctors, nurses, community volunteers, family members.
Next course- policy makers & DNC officers
2.
Bangladesh Palliative & Supportive Care Foundation – 4 inpatient bed, mainly homecare;24 hour telephone service
Caregiver training,awareness program,nurses course
,Gpfocus
3.Amader Gram – ,OPD ,home-care ,cellphone based reporting
4.Ashic paediatric palliative care foundation – 6 beds
5.National Cancer Research hospital – 4 beds
6.Shanti oncology & Palliative Care – 2 beds
7.Delta Medical College & Hospital – 4 beds
1.
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
2. HIV/AIDS pain and palliative care
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
a. What is the estimated prevalence of HIV/AIDS in your country, mortality
and the prevalence of pain?
First HIV Case in the country in 1989
Bangladesh –low prevalence<1% among most risk population(MRP)
In general population <1%
Among IDUs 5.3% in Dhaka city (9th Surveillances)
Estimated number of HIV infected cases is 7500
HIV Epidemiology 2011
New HIV infected 445
New AIDS cases 251
Death 84
Under ART 810
Cumulative cases as of 2011
Total reported cases 2533
Total AIDS cases 1101
Total death :325
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
a. What is the estimated prevalence of HIV/AIDS in your country, mortality
and the prevalence of pain?
First HIV Case in the country in 1989
Bangladesh –low prevalence<1% among most risk population(MRP)
In general population <1%
Among IDUs 5.3% in Dhaka city (9th Surveillances)
Estimated number of HIV infected cases is 7500
HIV
Death
(2009)
Proportion
with
moderate/
severe pain
Number of
Deaths with
moderate/
severe pain
119
50%
60
Source: Global Access to pain relief Initiative
PPSG
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
b. Is there a national AIDS policy, plan, or program? If so, when did it
start? What is the name of the office and person in charge? Are
objectives for pain relief and palliative care included? Is availability of
opioid analgesics specifically addressed?
1.
2.
3.
4.
5.
Yes, there is a national policy on HIV/AIDS and STD related
issues
Name of the office: National AIDS/STD Programme (NASP)
National AIDS/STD Programme (NASP) is one of the wings
of Directorate General of Health Services (DGHS) under the
Ministry of Health & Family Welfare (MOHFW) responsible for
coordinating with all stakeholders and development partners
involved in HIV/AIDS programme activities throughout the
country.
http://www.bdnasp.net
Project Manager-Line Director is the task collaborator
Pain relief and palliative care are included-for next plan
Availability of opioid analgesic is not specifically addressed
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
b. Is there a national AIDS policy, plan, or program? If so, when did it
start? What is the name of the office and person in charge? Are
objectives for pain relief and palliative care included? Is availability of
opioid analgesics specifically addressed?
1.
2.
3.
1.
2.
There are different programs
Serving most at risk population and general population
Under the national responses the Govt of Bangladesh has program following
packages
-sex workers packages
-Injecting drug user packages
-Men who have Sex with Men (MSM)
People living with HIV (PLHIV) packages
Opioid Substitution therapy (OST) ,Methadone project under process with NAS
World Bank
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
c. Has the government endorsed the WHO method for relief of HIV/AIDS
pain? Has the government sponsored or endorsed training programs in
pain relief, palliative care and the medical use of opioid analgesics?
1. The government has endorsed the WHO
method for relief of HIV/AIDS pain
2. The government has not sponsored or
endorsed training programs in pain relief,
palliative care and the medical use of
opioid analgesics related to this.
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
d. Describe in brief terms the availability of pain relief and palliative care
services in the country for HIV/AIDS patients and comment on the extent
to which the needy population has access to such services, including
children. How well is pediatric pain treated? Do pediatric patients have
access to opioid analgesics in the class of morphine?
1.
2.
3.
4.
ICDDRB – 6 beds
Jagori- OPD & counselling services
Awareness is lacking
Many NGOs are working in this field
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
Bangladesh
Bangladesh has a strong political history and commitment to the
HIV response
The national Strategic Plan for HIV and AIDS Responses for 20112015
Basic approaches
-DIC and IHC based services
-Peer Education
-Outreach Services
Harm Reduction
-Capacity Building
-Advocacy and Communication
Community participation and self help group
Referral HIV prevention services
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
3. Opioid availability
(This information, to the extent that it is available, should be
obtained from the national office for narcotics control, i.e.,
the “Competent Authority,”[1] and from pain and palliative
care programs.) See Country Profiles at
http://www.painpolicy.wisc.edu/internat/countryprofiles.htm
1] United Nations.
Competent National Authorities Under the International Drug Control
Treaties, 2006. New York, NY: United Nations; 2007.
http://www.youtube.com/watch?v=hK2OVonGRDI&feature=related
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care