Progress report: t he national LF and STH programme in Bangladesh

1. Progress report:the national LF and STH programme in Bangladesh By Dr. Rouseli Haq Program Manager Filariasis Elimination STH Control Program, DGHS, MoHFW 2014 RPRG Meeting WHO Region

2. Background Information • Geography and Population • 155 Million (WHO) • 142 Million (2011 National Census) • Tropical Rainforest (Ecological zones)

3. Divisions : 7 Districts : 64 Sub-districts (Upa-zila): 485 Unions: 6,766 Wards (3 in each union) Villages : 87,316 Municipalities :223 Political & Health Administrative Divisions:

4. LF Burden Bangladesh • Population at risk: 70 million at baseline • Total no of endemic districts: 34 • Mf rate baseline: 10.8% (Range >1% to 15%) • Estimated morbidity status: 2% to 3.9% (in endemic districts) • Total no of districts requiring Mass Drug Administration (MDA): 19 • MDA using Albendazole and DEC started: in 2001 • MDA scale-up to reach all districts: in 2008 • MDA to be stopped in 18 districts by 2014 September.

5. MAP

6. Lymphatic filariasis (LF) in Bangladesh LF parasitic species: Wuchereria bancrofti Main mosquito vector: Culex quinquefaciatus Estimated burden: 70 million at risk

7. National programme overview

8. PC Programme Financing • Contributors to the 2013 programme costs (and rough estimate of contributions by each if available):

9. PC programme achievements 2013

10. Progress Towards LF Elimination

11. Progress Towards STH scale up *Coverage =

12. PC coverage, 2013 *65% for LF and 75% for STH **reported coverage was verified by coverage survey or similar independent activity

13. Impacts of MDA in Sentinel Sites (LF)

14. PC Monitoring and Evaluation • Fifteen supervision trips in each round has performed by the staff from the National Program in order to better supervise the management of the De-worming week at all lower levels primary school • Identify problems for implementation of MDA and facilitate problem solving • Ensure the child awareness on the De-worming week • Observe ingestions drugs among the eligible children’s • Observe any adverse affect and reports to take necessary action.

15. Three Tires of Supervision For STH

16. PC Monitoring and Evaluation • SAE protocol It is in place and being used, and managed within NTD programme. SAE is included in preparation of PC intervention.

17. LF Transmission Assessment Survey to stop MDA • Justification for stopping MDA without TAS in the above IU s N/A • Integrated assessment of STH considered? N/A

18. LF Transmission Assessment: Forecasting *sum of the total sample size required for each EU assessed;

19. Integrated Vector Management(LF) • Describe any activities targeted to control LF vectors (including those conducted by other programmes) N/A • Describe monitoring and evaluation of such activities

20. LF MMDP – Strategy

21. LF MMDP – monitoring and evaluation

22. Best Practices • MDA done among 35 million populations of 19 districts with >80% coverage. • 7,908 Lymphoedema patient s were trained on morbidity control management. • 20,000 Kit Box were distributed among Lymphoedema patients of 10 districts. • Training of Doctors, District & Upa-zila manager, Paramedic, Health worker, Formal/ informal leaders, Teachers, NGOs workers, Medical Technologist were conducted. • Social awareness through IEC activities- • i) Advocacy meeting • ii) Audiovisual- Documentary spot, duco-drama, TV spot, Radio jingel • iii) Advertisement through Mass media- Newspaper, Radio, Television • iv) Poster, leaflet, festoon, Bill board, Newsletter, Training module etc. • 15 districts stopped MDA in 2011, 2012 & 2013 other 4 districts is ready for stop MDA in 2014 s a part of elimination of the disease.

23. Challenges and “Issues” for LF • Strengthening IEC program • Evaluation of non endemic district • Developing sustainable surveillance • Capacity building-Human resource, training • Strengthening monitoring and evaluation • Morbidity control by using Community Clinics as Bangladesh has very good Primary Health Care (PHC) infrastructure • Funding for Community Clinic, home based morbidity control programme • New technology for morbidity control and expansion of program with involving NGOs, Volunteers • Elimination of Lymphatic Filariasis through MDA by 2015

24. Challenges and “Issues” for STH • Reaching “out of School” ,working , street children • Lack of awareness due to inadequate IEC activities • Mass Psychogenic illness during de-worming week • Improvement of water, sanitation, and hygiene and health education through school based approach for parasite control • Coordination with partners working on STH control

25. Programme Plan

26. PC medicine request for 2015