Directions and Template
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care

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

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

Bangladesh
World Bank
World Bank
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy 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

Cancer
Death
(2009)
91,494
Proportion with moderate/s evere pain
80%
Ref: Global access to pain relief initiative, PPSG
Number of deaths with moderate/ severe pain
73,196
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
Colorectal
Males Femal es
Lung
Males Femal es
Male s
Prostate
(males)
27.2
29.8
3.5
4.1
4.0
4.5
8.7
30.4
1.9
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? (…Continued)
Ca-lung
Male
44.44
Female
Ca-breast
Acute myeloid leukemia 7.41
Chorio-carcinoma
Non-Hodgkin lymphoma
5.56
Adenocarcinoma
Ca-stomack
Adenocarcinoma
Ca-prostate
Ca-gallbladder
Acute lymphatic leukemia
Ca-colon and Carectum
16.13
9.68
6.45
Ca-lung
Both Sexes
Acute myeloid leukemia
Non-Hodgkin lymphoma
5.56
Ca-colon and Carectum
3.70
Ca-lung
6.45
Ca-stomach
3.70
Non-Hodgkin lymphoma
3.70
Ca-stomach
6.45
Adenocarcinoma
6.45
Ca-colon and Carectum
1.85
Acute lymphatic leukemia
6.45
Acute lymphatic leukemia
3.23
Squamous cell carcinoma
1.85
Acute myeloid leukemia 3.23
Ca-gallbladder
30.59
5.88
5.88
5.88
4.71
3.53
2.35
.35
2.35
Ca-gallbladder
Total patients=54
University of Wisconsin Pain & Policy Studies Group
Pain Policy and Palliative Care
1.85
Ca-gallbladder
Total patients=31
World Health Organization Collaborating Center for
3.23
Fibrosarcoma
Total patients=85
2.35

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
At NICRH morphine license is being worked on-8.5

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
7000 new cases of childhood cancer
2.Then among the children who start the treatment there is 30-
50% drop out 3 estimated 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
Among them ,
= Age 0-15 years were 218 only 4.0%
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 Treated
University 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?
1.
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
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy 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 (9 th 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 (9 th Surveillances)
Estimated number of HIV infected cases is 7500
Death
(2009)
Proportion with moderate/ severe pain
Number of
Deaths with moderate/ severe pain
HIV 119 50%
Source: Global Access to pain relief Initiative
PPSG
60
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.
Yes, there is a national policy on HIV/AIDS and STD related issues
2.
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
3.
Project Manager-Line Director is the task collaborator
4.
Pain relief and palliative care are included-for next plan
5.
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.
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
2.
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?
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 2011-
2015
 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

(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