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 (WKLRSLD *KDQD 0RQJROLD 3DQDPD 7DMLNLVWDQThe Study Programme
for the Countermeasure for Communicable Diseases

Bangladesh-1-

JI200710 Country Report
Bangladesh

Emerging & Re-emerging Disease Control Program& Focal Point, National Rabies Elimination Center
Directorate General of Health Services
Ministry of Health & Family Welfare

Communicable Disease Control Division DGHS MHFW GPR Bangladesh-2-Country Profile• History:– 1971: Liberated from
Pakistan– 1947-1971: ruled by
Pakistan– 1757-1947: British
ruled as a part of Bengal
and Assam province ofSub-continent

Communicable Disease Control Division DGHS MHFW GPR Bangladesh-3-Geographical situation• Area: 147,570 sq.km• EstimatedPopulation:158,570,535• Population density:
1015/sq.km• Boundary:– North and West: India– South: Bay of Bengal– East: India & Myanmar-4-Religion & culture• Religion:– Muslim – 89.35 %– Hindu – 9.64 %– Buddhist – 0.57%– Christian – 0.27%– Others – 0.17%• Official language: Bangla , English is also
spoken.
• Indigenous communities have own languages
Communicable Disease Control Division DGHS MHFW GPR Bangladesh-5-Demographic and health Indicators• IMR: 36/1000 live births (SVRS)• MMR: 194/100000 live birth (BMSS)• Under-5 mortality rate (per 1000 live births) 47 (SVRS
2010)• Regd. Physician: 58,977 (HRD data sheet 2011)• Regd. Dental surgeons: 4,986 (HRD Data sheet 2011)• Regd. Nurses: 30,418 (BNC 2011)• No. of TBA 6,500 (BNC 2011)

6/24/2013

Communicable Disease Control Division DGHS MHFW GPR Bangladesh-6-

Basic Indicators• Population Growth Rate: 1.37
• Life expectancy at birth: 67.7 (SVRS
2010)• Urban population: 28% (BDP 2012)• GDP per capita: 674 US$ (WB 2011)• GDP growth rate : 5.5% (IMF FY 2011)• Adult Literacy rate: 58.6% (SVRS 2010,
BBS).
Communicable Disease Control Division DGHS MHFW GPR Bangladesh-7-

Bangladesh:
Administrative units

Division - 7
District - 64
Upazila - 492
Union– 4501
Ward - 40500

Village - 87300-8-

Organizational Chart of MoH&FW
Bangladesh-9-EPI Target diseases & Coverage
Target diseases:• Diphtheria• Tuberculosis• Tetanus• Pertusis• Poliomyelitis• Measles• Rubella• Hepatitis B• Haemophilus

Rate of Coverage (%)•BCG- 95%
•Penta-I- 99%•Penta-2- 97%•Penta- 3- 96%•Measles -96%

-10-

Commonly Prevalent Communicable Diseases
Sl. noDiseases

Diseases

Malaria

Sl.
No.
8

1
2
3
4
5

Kala-azar
Filaria
HIV/AIDS
Influenza

9
10
11
12

RabiesNipah
Anthrax
Chikungunia Fever

6
7

Tuberculosis
Leprosy

13
14

Leptospirosis
Hepatitis

Dengue-11-

Programs under CDC, DGHS
1. National Malaria Control Program
2. Filariasis Elimination and STH Control
Program
3. Kala-azar Elimination Program
4. Avian and Pandemic Influenza Control
Program
5. Emerging & Re-emerging Disease Control
Program
6. Disease Surveillance-12-SnapshotsCurrent Situation of Communicable
Diseases-13-

Malaria situation in
Bangladesh-14-

Malaria Cases and Death+ve Cases

DeathsIn 2012, Total cases 29518, Mortality -11
90,000700
84,69080,000

588

577

600
535

70,000
478

501

490

63,87362,26960,00054,22355,87354,65454,216500

59,85758,894

51,773400

48,12150,000307
40,000300
32,857228

30,000200

154
20,00047

10,000100
3736Year 2011

Year 2010

Year 2009

Year 2008

Year 2007

Year 2006

Year 2005

Year 2004

Year 2003

Year 2002

Year 2001

Year 2000--15-

Specific Objectives
1. Early diagnosis and prompt treatment (EDPT
2. Vector control
3. Strengthening surveillance system
4. Community participation and partnership withresearch and academic institutions, private sector
and NGOs
5. Strengthening program management

6. Capacity building
7. Supervision-16-

Kala-azar-17-

Endemicity of Kala-azar

Endemicity of KA in Bangladesh

Hyper endemic

Moderate endemic

Low endemic

-18-

17

Kala-azar: Trend in Bangladesh
10,000

36

40

9,379

9,000

35

8,110

8,000

7,640

7,000

24
5,799

6,892

6,113

23

25

23

23
5,920

5,000

20

4,932 4,824

16

4,283

17

4,000

4,293

15

3,806

17
14

6

3,000

3376

2

2,000

5
-

2012, cases- 14063, No mortality

Case

Year 2011

Year 2010

Year 2009

Year 2008

Year2007Year 2006

Year 2005

Year 2004

Year 2003

Year 2002

Year 2001

Year 2000

1,000
-

10

0

Year 1999

Cases

6,000

30

27

-19-

Death

(5)

VL Elimination Strategy
I.

Early diagnosis and complete case managementof Kala-azar and PKDL

II. Integrated vector management (IVM)
III. Effective disease and vector surveillance

IV. Operational research
V. Social mobilization and building awareness-20-

Filariasis

Communicable Disease Control Division DGHS MHFW GPR Bangladesh-21-

Bangladesh Burden of Filariasis• Population at risk of LF: 70
million• Endemic districts: 34 (2004)• Endemic district with
Microfilaria <1%: 15 (2007)• Endemic district with
Endemic

Microfilaria >1%: 19 (2008)

Non
Endemic• Morbidity status: 2% to 3.9%

(endemic area)
Communicable Disease Control unit DGHS MOHFW Bangladesh-22-

Goal & Objectives
Goal
To eliminate filariasis from Bangladesh by 2015
Objectives•

To reduce microfilaria or antigenaemia
prevalence below cut off point (<1%)•

To reduce morbidity

Communicable Disease Control Division DGHS MHFW GPR Bangladesh-23-

Filaria Elimination Strategy• Mass Drug Administration (MDA) : By Tab
DEC and Tab Albendazole once in a year.
• Morbidity control & Hydrocele repair.
• Social Mobilization / IEC activities.
• Community Based Morbidity Control and Kit
Box distribution• Microfilaria Survey• Transmission Assessment Survey (TAS)• Post MDA Coverage Survey• ACSM , Child to Child Education using Little
Doctor Concept-24-

Avian & Pandemic Influenza Control program
Case
No

Date ofSampleCollection

Date of test
resultwith instituteAge & Sex

H/o
Poultry
exposure

ClinicalFeatureKamalapur,

January2008

May 2008
CDC Atlanta

15 month,
Male

Yes

Fever, Cough

Recovered

Identified
as H5N1

Kamalapur,

March 14,2011

March 14, 2011, 13 month,
IEDCR
FemaleYes

Fever, Cough

Recovered

Identified
as H5N1

3

Kamalapur,

March 15,2011

March 15, 2011, 31 month,
IEDCR
Male

Yes

Fever, Cough

Recovered

Identified
as H5N1

4.

Kamalapur,

February 26,
2011

March 24, 2011, 4 Years,
Sequencing by Female
CDC Atlanta

Fever, Cough

Recovered

Identified
as H9N2

5.

Live bird
market,February 26,
2012

February 27,
2012, IEDCR

40 Years,
Male

Yes

Cough

Recovered

Identified
as H5N1

6.

Live bird
market,(South)March 04,2012

March 04,
2012, IEDCR

26 Years,
Male

Yes

Cough

Recovered

Identified
as H5N1

7.

Live bird
market,(South)March 04,2012

March 04,
2012, IEDCR

18 Years,
Male

Yes

Cough

Recovered

Identified
as H5N1

1

Location2

Details of Patient

Comments
Severity

Fate

-25-

Dengue

6/24/2013

Communicable Disease Control Division,
DGHS, MHFW-26-

6/24/2013

Communicable Disease Control Division,
DGHS, MHFW

-27-

-28-

Nipah infection••

Emerging zoonotic disease.
First recognized in a large outbreak of 276 reported
cases in Malaysia and Singapore from September 1998
through May 1999.
Agent•NiV is a highly pathogenic paramyxovirus belonging togenus Henipavirus.
•It is an enveloped RNA virus.
Incubation period: 6-11 days (average- 9), In
Bangladesh, it is 2-12 days (average- 7 days)
Transmission:•Drinking of raw date palm sap (kancha khejurer rosh)contaminated with NiV .
•Close physical contact with Nipah infected patients -29-

Nipah virus Infection:
An Emerging Viral
Zoonotic Disease-30-

Bangladesh situation of Nipah
Year

Districts

Suspect

Death

2001

Meherpur

13

09

2003

Naogaon

12

08

2004

Rajbari- 12, Faridpur – 36, Other
dist.-24

72

52

2005

Tangail

12

11

2007

Thakurgaon- 5, Kushthia -8

13

8

2008

Manikganj and Rajbari

09

08

2009

Rangpur, Rajbari

02

01

2011

Faridpur- 5, Kurigram-1,
Nilphamari-1,Lalmonirhat-1

24

18

2012

Joypurhat

662013 Feb
3

Gaibandha, Natore, Rajshahi,
Naogaon, Rajbari, Pabna,
Jhenaidah, Mymensingh

12

9
-31-

Nipah Update by 3 February 2013
Nipah Infection in 2013 (Update on 3 February, 2013)• 3 February 2013: 12 Nipah cases were identified among
them 9 died (mortality rate 75%); 3 cases are still under
treatment.
• Affected 8 districts: Gaibandha, Natore, Rajshahi,
Naogaon, Rajbari, Pabna, Jhenaidah, Mymensingh.
• Age distribution of cases are 8 months to 43 years among
them 8 are male.
• Till February, 2013, a total of 177 human cases of Nipah
infection in Bangladesh were recognized from outbreakamong them 137 (77%) died.
•In Bangladesh, there are 24 Nipah prone districts-32-

Rabies : Biggest Challenges in
Bangladesh

Photograph: Dr. Aung Swi Marma June 2012, IDH,
Dhaka

-33-

Rabies: Current Situation• Most neglected longstanding NTD.

• Rabies transmission- mostly (99%) by dog- few by cats, Jackals, Mongoose & others•Transmission occurs by- bite,- scratch or- licking of broken mucous membrane by rabid
animal.
• The disease is nearly 100% fatal but equally preventableby modern animal bite management• 55,000 -70,000 people die from rabies annually, mostly
in Africa and Asia
-34-

Rabies: Current Situation• Annual human rabies case: >2000• Affected population is mostly school going children(<15yrs. age )• Over 85% of rabies cases rural poor people• Certain percentage of people still use the traditional
methods: Kabiraj, boidya, ohzhan, etc• Annual animal exposure: 2-3 hundred thousand• Annual animal rabies case: 25 thousands?
• Total dog population: 1.2 million (DLS 2010)– Pet: 2,12,421(17.29%)– Stray: 9,95,067(82.70%)-35-

Rabies control activities in the past
* Infrequent culling of dogs bymunicipalities/CCs– Direct biting, crushing of neck
– Injecting Mg-sulpha direct to heart– Dog bait with tab Strychnine* Limited vaccination of pet dog at
private sector* Dog bite management– Mostly by traditional healers– Vaccination- Mostly locally produced NTV- Limited use of tissue culture vaccine- Rare use of immunoglobulin-36-

Possible causes of high prevalence of Rabies
•
•
•
•
•
•
•
•
•
•
•
•

Large number of stray dogs
Many dog bites
Lack of awareness
Unplanned killing of dogs
Inaccessibility to safe and effective vaccine
Dependency on NTV
No measure for MDV and DPM
Lack of active involvement of health service
Lack of initiative of DLS
Lack of multisectoral involvement
Lack of resources
Lack of diagnostic facilities
-37-

36

Rabies Elimination Strategy of Bangladesh
Goal– Reduction of rabies by 90% within 2015
– Elimination of rabies from by 2020
Strategy
1.Advocacy, Communication and Social
Mobilization (ACSM)
2.Management of dog bite
3.Mass dog vaccination
4.Dog population management
5.Capacity building
6.Survey and Operational research-38-

Countermeasures for the Challenge
1. Establishment of National
Rabies Prevention andControl center at Infectious
Disease Hospital Dhaka in 11
Jully, 2010.
2. Introduction of tissue culture
vaccine (TCV) in intra-dermalroute for the first time in the
country.
3. Hands-on training of doctors,
nurses and paramedics
dealing with animal bites on
animal bite management and
IDRV use.
-39-

Countermeasures for rabies control
4. Development of National Guideline on
IDRV use and National Rabies
Prevention and Control Strategy
5. Formation of Rabies National Steering
Committee (NSC) and Technical
Working Group (TWG)
6. Mobilization of key stakeholders (Local
governent, Livestock department,
national & international NGOs,
agencies (WSPA, HIS, WHO, FAO, OIEetc) for Multisectoral collaborative One
Health Approach.
7. Procurement of vaccine and logistics
8. Expansion of rabies prevention andcontrol center-40-

Dog bite management started in all the64 districts of the country-41-

Rabies- Countermeasures
9. National Rabies Survey
10. International Workshop on rabies elimination in
Bangladesh
11. Piloting Mass Dog Vaccination 4 setings
12. MDV campaign in 38 district municipalities and CC
of 4 divisions
13. Piloting DPM at Raipura, Narsingdi and DCC North
14. Observation of World Rabies Day
15. Awareness raising campaign involving school
children
16. KAP survey on rabies among different
professionals of adult and school going children-42-Catching and vaccinating-43-

MDV: Satkhira District

-44-

ACSM

-45-

Bangladesh is moving towards from control
to elimination of rabies by 2020
The key challenges:
1. Fund constraints
2. Shortage of trained manpower
3. Weakness of surveillance system
4. Rabies diagnostic lab facilities-46-

Conclusion• Communicable disease burden of Bangladesh has been
experiencing shift in different dimensions– Improvement in some communicable diseases– Emergence and re-emergence of some diseases– Increasing trend of non communicable diseases• The country is demonstrating better capacity inprevention and control of communicable diseases• Research activities in relation to diseases is getting
momentum

-47-

-48-

The Study Programme
for the Countermeasure for Communicable Diseases

China

-49-

• FUJIAN, CHINA• 2013.02.05-50-

THE PEOPLE'S REPUBLIC OF CHINA

-51-

2

-52-

Current Situation in Fujian
 The number ofcommunicable disease
cases is 205145 in 2011 The number of deathcaused by communicablediseases is 229 in 2011-53-

Current Situation in Fujian
 Fujian is a highincidence(185.86/100000 ) in
Hepatitis B

-54-

5

Current Situation in Fujian Food poisoning is growing in

number(81 cases in 2011),
accounting for 11.57% of the
public health emergencies

-55-

6

Big

Challenges

 How to reduce the incidence

of infectious diseases
 How to improve theemergency response
capacity-56-

How to reduce the incidence
of infectious diseases
 Increasing fund for communicablediseases control.
 Enhancing surveillance system.
 Strengthen the management of
infectious sources, medical
observation for the close contacts,
timely vaccination.
 Strengthen health education andpublicity .
 Improve the immunization coverage.
-57-

Response to the emergencycase China has established an

emergency organization
system since 2003 after
SARS outbreak.
 The system divided into
the central and local twolevels.
-58-

Response to the emergency
case FUJIAN CDC is playing a criticalrole in responding to infectious,
occupational, or environmental
emergency incidents.
 Three networks are linkage andunity to make the most rapid
response and take appropriate
measures and plan for publichealth emergencies.
-59-

-60-

11

-61-

-62-

13

-63-

14

Fish ball

Fo tiao qiang

Won ton-64-

Ding bianbraised sea eel with soysauce

braised fish with soysauce

a prawn-65-

Radish pastries

Egg dumplings

Steamed Pork Dumplings-66-

Wuxiang rollsI really appreciate JICA that let me meet you---everyone seated here !We learn a common
language ,we study in a common room, and wecommonly have best teachers!
I believe this period with you will become aprecious memory! Thank you!

-67-

Communicable
Disease Prevention
and Control in China
Ministry of Health, P.R.China
Feb 2013, Tokyo-68-

OutlineStrategies



Challenges

Measures-69-

National strategic frame
Prioritizeddiseases

Expandedprogramme on
immunization

Diseases
Emerging
under intensive and remerging
surveillance
communicabledisease•HIV/AIDS
14 vaccines to•TB
prevent 15 kinds•Schistosom of disease-iasis•Hepatitis B•Plague•Cholera•Influenza•otherstatutory
communicabledisease
•……
-70-

•SARS
•H5N1
•Pandemic
H1N1 2009……

Policies on prioritized diseases


HIV/AIDS : Development and Implementation of“Four Frees and One Care” Policy for HIV
infections and AIDS patients.



TB: Free to patients (ss+) on DOTS treatment,
sputum test and X-rays, award local healthprofessionals to report TB cases.
-71-

Policies on prioritized diseases
Schistosomiasis:







Snails control
Checking and curing infected human andlivestock synchronously
Improved sanitation and health education

Hepatitis B:National immunization program;Prevention-based control-72-

Expanded Programme on Immunization

In 1978, 4 vaccines to prevent 6 kinds of vaccine

preventable infectious diseases (BCG, DPT, OPV
and MV) In 2002, 5 vaccines to prevent 7 kinds of vaccine
preventable infectious diseases (Hepatitis B
vaccine) Currently, 14 vaccines to prevent 15 kinds ofdisease ( hepatitis A, epidemic meningitis, etc.)-73-

Immunization schedule
Age
Vaccine
HepB
BCG
Polio
DPT

Birth

1 m

1st

2nd

dose
1 dose

dose

2 m

3 m

4 m

5m

6m

8m

18 m

2y

3y

6y

3rd dose

1st
dose

2nd
dose
1st
dose

3rd
dose
2nd
dose

4th
dose
3rd
dose

4th
dose
1
dose

DT
MR(MV)

1 doseMMR（MM, MV）

1 dose
2nd
dose

JE-a

1st doseMen-A

1st dose、2nd dose
1st dose

Men A+C
HepA-a2nddose

1 dose
1st , 2nd rd
3 dosedose

JE-I
HepA-i4y-74-

1st dose

4th
dose
2nd
dose

Influenza Sentinel Hospitals
2000年
8 网络实验室
31 哨点医院

2009年
411 网络实验室556 哨点医院

2005年
63 网络实验室
197 哨点医院-75-

the reported incidence rate ofCategory A and B (1950-2012)-76-

Challenges

East Vs West

Not optimistic

Large gap

- Ability- Quality- Measures- Academic title- Professional title- Proportion- Invested large
amounts- Large burden

Regional differences

Human resources-77-

Lack of funds

Infectious diseases are still thegreat threat to public health

In 2011, a total of 6.3 million cases and over 15
thousand deaths caused by 39 notifiable diseases
was reported



Total incidence rate was 471/100,000Total mortality rate was 1.18/100,000-78-

The current of reported incidence of class A
and B notifiable diseases with different routesof transmission from 1990 to 2012
250.00Intestinal
肠道传染病
Blood-borne and STD
血源及性传播传染病

200.00

自然疫源及虫媒传染病
Zoonotic and arthropod-borne
新生儿破伤风
Neonatal tetanus
150.00100.00

50.00
Year
2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

-79-

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

1991

0.00
1990

Reported incidence（1/105）

Respiratory
呼吸道传染病Measures

Healthy and harmonious

 Health for All
Investment
 Establish standards

Personnel

 Sustainable development

 Performance appraisal

Policy Technical training Preferential policy Improve abilities-80-Thanks for your attention!

-81-

The Study Programme
for the Countermeasure for Communicable Diseases

Cote Divoir-82-

COUNTERMEASURE FORCOMMUNICABLE DISEASESCÔTE D’IVOIRE (IVOIRY
COAST)
JAPAN, February 3 to February 23,
2013
-83-

Organization health Ministry• Health Administrative System composition : central level Minister office,16 management directions attached to minister
office 2 general directions• Health management directions– 6 central Directions– 22 health programs• AIDS management directions– 4 central directions– 1 AIDS programs-84-

Organization health Ministry• health Administrative system composition : middle level• 20 health and AIDS regions.
Peripherical level• 70 health and AIDS Districts.

-85-

Organization health Ministry• Health care system composition:
 primary care level• 1781 cares central.
secondary care level• 17 regional Hospital central (CHR)• 71 generals Hospitals (HG).
Tertiary care level• 4 Hospital University Central(CHU).
-86-

BASIC INDICATOR
INDICATORFIGURESArea (in 1000 sq.km)

322.462

Estimated population

20,153,000

YEAR OFREPORT

2011<Percentage of population-Under 5 years old (%)-Under 15 years old (%)-15 – 59 years old (%)-Over 60 years old ( %)

15%
41%
53%
6%

Living in urban areas (%)

49

2008

Annual growth rate (%)

2.3
3.3

2008
1998

2011

-87-

BASIC INDICATOR
INDICATORFIGURESGross national incombe per capita (ppp int.$)

1580

Population living below the poverty line (with<
1,25 $ US a day )23.3%.

YEAR OFREPORT2008
2009

Annual growth rate (%)

2.3
3.3

2008
1998

Total fertility rate (per woman)

4.6

2008

Adult mortality rate (probability of dying
between 15 and 60 years per 1000 population)Male
female

361

2008

367
354

2008
2008

-88-

BASIC INDICATOR
INDICATOR
Life expectancy at birth (years)-Total-male-femaleInfant mortality rate
(probability of dying between birthand age 1 per 1000 live births)

FIGURESYEAR OF REPORT
2008

56
55
56
83

2009

Maternal mortality ratio (per 100,000 470
live births)

2008

Under-5 mortality rate
(probability of dying by age 5 per1000 live birth)

2009

Access to improve drinking-water
sources (%)-urban-rural

119

2008
93
68
-89-

BASIC INDICATOR
INDICATOR
Health work force
Total No.and density (per 10.000
population)-physicians-Professionnal nursing-midwifefery personnel)

DATA

1/5695
1/3646
1/3717

Three leading causes of morbidity(year: )HIV (2010)
TB (2006)
Malaria (2008)

No. of cases

Rate/100,000

424 260 PLWHIV
420/100000
1343650

3.2% (2012)
747/100000
7072/100000

Three leading causes of
instituational mortality (year: )No. of cases

HIV (2006)
TB (2006)
Malaria (2006)

46 600128.3 /100 000
20 000-90-

BASIC INDICATOR
INDICATOR
Cases and death for diseases
under WHO-EPI

DATA
No. of cases

DATA
No. of cases

Diphtheria, since 1998 to 2008

00

Measles 2006

70

Pertussis, since 1998 to 2008

00

Poliomyelitis, 2008

1

0

Tetanus, 200731

ND

Tuberculosis, 2006

420/100000

747/100000-91-

BASIC INDICATOR
INDICATOR
Cases and death for diseases
under WHO-EPI

DATA
No. of cases

Gonorrhoea

ND

Hepatitis A

ND

Hepatitis B
Unspecified

ND

Syphilis

ND

Trachoma

ND

Yaws

ND

-92-

BASIC INDICATOR
INDICATOR
Cases and death for diseases under
WHO monthly CD Notes

DATA
No. of cases

DATA
No. of death

Cholera, 2007

08

01

Dengue fever/DHF, since 1998 to 2008

0

0

1020

167

13

01

Encephalitis
Influenza

Meningitis, 2008
PlagueYellow fever, 2008

-93-

BASIC INDICATOR
INDICATOR
Cases for six diseases

DATA
No. of cases

Filariasis

ND

Leshmaniasis

ND

Leprosy, 2008

998

Malaria, 2007

7029000

Schistosomiasis

ND

Trypanosomiasis, 2007

13

DATA
Rates/100,000

ND

-94-

BASIC INDICATOR
INDICATOR
Cases for following STDs

DATA
No. of cases

AIDS
Chancroid

ND

Chlamydia

ND

HerpesND

Lymphogranuloma venereum

ND

Non-gonococcal urethritis (NGU)

ND

-95-

DATA
Rates/100,000

BASIC INDICATOR
INDICATOR
Cases of hepatitis:

DATA
No. of cases

HAV

ND

HBV

ND

HCV

ND

HDV

ND

HEV

ND

-96-

DATA
Rates/100,000National Immunization calender for Schedule
Child under-5
TYPES OF VACCINESS

TIME

-BCG

birth

-DTwPHibHep6, 10, 14 weeks-OPV

6, 10, 14 weeks- yellow fever

9 months- Measles

9 months-tetanus

Pregnant woman
first contact- Vitamin A

6, 2,18, 24,30,36
weeks

-

-97-

CIBLE

Pregnant
womenImmunization coverage under 5 year
Year

2011

2010

2009

2008

2007

2000

BCG

74%

91%

95%

91%

94%

76%

DTP1

75

95

95

89

93

83

DTP3

62

85

81

74

76

62

HepB3

62

85

81

74

76

-

Hib3

62

85

81

-

-

-

yellow fever

49

69

24

50

68

55

Polio 3

81

77

58

75

61

56

Type of vaccines-98-THANKS…

-99-

The Study Programme
for the Countermeasure for Communicable Diseases

Ethiopia-100-

Presentation on Country fact sheet
COUNTRY -----------ETHIOPIAPRESENTATION ON-------- COUNTRY FACT SHEETFEB3, 2013
JAPAN/TOKYO/-101-

Table of Contents
A. Country Profile / Ethiopia
B. Basic Indicator
C. Current Situation• Organization of the Ministry• Administration of National Policy• Programs / Laws / Regulations• Major Challenges in the field of communicabledisease control
D. On-going Immunization Program
E. Production of Vaccine-102-

A.Country profile
MAP OF ETHIOPIA-103-

Different nations and nationalities-104-

Historically,
Ethiopia was ruled by successive emperors andkings, with a feudal system of government. In
1974 the military took over the reins of rule byforce and administered the country until May
1991.

• Currently, a federal system of government exists,and political leaders are elected every five years.

-105-• The government is made up of two tiers ofparliament,• the House of Peoples’ Representatives and theHouse of the Federation.
• At present Ethiopia is administratively structured
into nine regional states—Tigray, Affar, Amhara,
Oromiya, Somali, Benishangul-Gumuz, Southern
Nations Nationalities and Peoples (SNNP),
Gambela, and Harari—and two cityadministrations, that is, Addis Ababa and Dire
Dawa Administration Councils.
-106-• The highest governing body of each regional
national state is the regional council, which has
elected members and is headed by a president
nominated by the party that holds the majority ofseats.
• The regional president is assisted by heads ofvarious regional bureaus, including the regional
health bureau• Each regional state is subdivided into zones,
woredas /districts/ and kebeles.
• with 43% of the population being Orthodox
Christians, 33.9% Muslims, and 18% Protestant
Christians, with the rest following a diversity ofother faiths.
-107-• Ethiopia has great geographical diversity; its
topographic features range from the highest
peak at Ras Dashen, 4,550 metres above sea
level, down to the Affar Depression, 110
metres below sea level (CSA, 2009).
• The climate varies with the topography, fromas high as 47 degrees Celsius in the Affar
Depression to as low as 10 degrees Celsius in
the highlands.

-108-• Djibouti, Eritrea, the Republic of the Sudan, theRepublic of the Southern Sudan, Kenya, andSomalia border the country.
• There are three principal climates in Ethiopia:
tropical rainy, dry, and warm temperate. Maximum
and minimum average temperatures vary acrossregions of the country• Generally, the mean maximum temperature ishighest from March to May and the mean minimum
temperature is lowest from November toDecember. (MOI, 2004).
-109-• Ethiopia is an agrarian country and agriculture
accounts for 43 percent of the gross domestic
product or GDP (CSA, 2009). Coffee has long been
one of the main export items of the country;
however, other agricultural products are currently
being introduced on the international market.
• Between 1974 and 1991 the country operated acentral command economy but has since moved
toward a market-oriented economy.
• Currently, the country has one commercial and two
specialized government owned banks and 14 privately
owned commercial banks, one government-owned
insurance company and eleven private insurancecompanies. There are also 30 micro-financing
institutions established by private organizations (NBE,2010).
-110-

• the economy has grown in real GDP at a rate of
11 percent per annum in the past five years.
With an average population growth rate of 2.6
percent, the GDP growth rate translates to an 8.4
percent growth in average annual per capita
income. This rapid growth is the result of• diversification and commercialization of smallscale agriculture, expansion of non-agricultural
production in services and industry, capacitybuilding and good governance, off-farm
employment especially through small
enterprises, and investment in infrastructure(MOFED, 2010).
-111-

National health profile:• The major health problems of the country are largely
preventable communicable diseases and nutritional
disorders. More than 90% of child deaths are due topneumonia, diarrhoea, malaria, neonatal problems,
malnutrition and HIV/AIDS, and often as a
combination of these conditions.
• Following the change of government in 1991, the
new Government of Ethiopia put in place many
political and socio-economic transformation
measures. Among these,• it developed a first national health policy, which was
followed by the formulation of four consecutive
phasesofcomprehensive
HealthSectorDevelopment Plans (HSDPs), starting from 1996/97-112-

• The policy and the first HSDP were based on
critical reviews of prevailing national healthproblems and a broader awareness of newly
emerging health problems in the country.
• the core of the health policy are democratizationand decentralization of the health care system• developing preventive, promotive and curative
components of health care; assurance ofaccessibility of health care for all parts of the
population• encouraging private and NGO participation in
the health sector.
-113-

• During the past fifteen years, the Federal Ministry of
Health has built an impressive framework for improving
the health for all, including maternal and neonatal
health. This has included a wide range of strategies such as• Reproductive Health Strategy (2006),• Adolescent and Youth Reproductive Health Strategy(2006)• and the Revised Abortion Law (2005).
-114-

• There are also strategies on free service for key
maternal and child health services (Health Care
Financing Strategy)• training and deployment of new workforce offemale Health Extension Workers (HEWs) for
institutionalizing community health care withclean and safe delivery at Health Post (HP) level,
and• deployment of Health Officers (HOs) with MSc
training in Integrated Emergency Obstetric andSurgery (IEOS) skills-115-

B. Basic indicators
1. Area (in 1000 sq. km)
2. Estimated Population(,000s)
3. Percentage of population- Under 15 years old(%)- over 60 years old(%)

1.1million
73.8 million

4. Living in urban areas(%)
5. Annual growth rate(%)

16.1%
2.6%

46.3
6

6.Total fertility rate(per woman) 4.8 children/women-116-

Adult mortality rate
• (probability of dying between 15 and 60 years per1000 population)
4.5
7.

8. Life expectancy at birth (years)- Male50.9- Female
53.5
9. Infant mortality rate
• (probability of dying between birth and age 1 per1000 live births)
59

10. Maternal mortality ratio (per 100,000 live births)
676
-117-

11. Under-5 mortality rate

• (probability of dying by age 5 per 1000 live birth)88
12. Access to improve drinking-water sources (%)- Urban area
94.5
- Rural area
41.7
13. Immunization coverage among 1-year-olds (%)- BCG
90- Polio 3 times
84.3/- Measles
81.5- DPT 3 times
84.3

HepB3
-Hib3

84.3
84.3
-118-

14. Three leading causes of morbidity (Year: )• -malaria
17%• -diarrhoea

8%• -pneumonia
7%
15.Three leading causes of institutional mortality (Year2012 )• -Lower Respiratory Infections

128,305• -Diarrheal Diseases

124,015• -Stroke

54,816-119-16. Health workforce• (total No. and Density (per 10,000 population)- Physicians
1:24841- Professional Nursing and midwifery
personnel
1:11000-120-

C.current situation•••Specialized
Referral Hospital•••• District Hospital
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Regional
Laboratory
Regional Health bureau

Zonal Health Department

District/Woreda Health
OfficeHealth Center-121-

2. Admenstration of national policy
Federal Ministry Of Health:• Expand Health service delivery• Establish & administer referral hospital & laboratory andresearch institutions.
• Set Health service delivery standards• Accreditation & certification of health professionals• Design strategies on communicable diseases prevention
and control
Regional Heath Bureau:• Similar to the federal Ministry of Health in the context of
the regional health priorities
Zonal Health Department&woreda convert contextualy andmostly are implementers-122-

3.Program laws
Malaria• By 2015, achieve malaria elimination within specificgeographical areas with historically low malariatransmission• By 2015, achieve near zero malaria death in the remaining
malarious areas of the country• By 2020, achieve elimination of malaria across the country• By 2015, achieve malaria elimination within specificgeographical areas with historically low malariatransmission• By 2015, achieve near zero malaria death in the remaining
malarious areas of the country• By 2020, achieve elimination of malaria across the country-123-Tuberculosis• The DOTS Strategy & the STOP TB Strategy:- WHO
recommended a more comprehensive TB control
strategy in 2006 based on previous DOTS and DOTSplus experiences. This new strategy is called the Stop
TB Strategy
Hiv/Aids• The Strategic Framework for the National Response
to HIV/AIDS in Ethiopia for 2001-2005 focuses on
reducing the transmission of HIV and associatedmorbidity and mortality, and its impact on
individuals, families, and society at large.
• The strategy is built on four issues: multisectoralism,
participation, leadership, and efficient management(including adequate monitoring and evaluation).
-124-

4.Major chalanges of comunicabledisease• Poor recording, reporting & documentation ofcommunicable diseases• Inadequate laboratory facilities to confirm
communicable diseases.
• Shortage of trained & skilled manpower• Shortage of resources /Material & Financial/• The surveillance system is not electronically
networked• Low community awareness on communicablediseases-125-

D. On going imunization program• Polio• Measles• Pentavalent/ Tetanus,• Pertusis,Diphtheria• Hepatitis B, & Pneumonia/
• BCG
• TT
• PCV /Pneumococcal Vaccine/-126-E.Production of vaccine
vaccines are donated by internationalorganizations & imported from othercountries
• BCG
• TT
• Pentavalent• Measles• PCV• Polio-127-

•
THANKS TO•
JICA TOKYO•
JAPAN MINSTRY OF HEALTH AND WELFARE•
JAPAN GOVERNMENT•
Ms KATO Megumi/organizer contact• Finally to all participants for their attention-128-

The Study Programme
for the Countermeasure for Communicable Diseases

Ghana

-129-

COUNTRY REPORT ON
COMMUNICABLE DISEASES IN
GHANA

-130-

OUTLINE OF PRESENTATION• Map of Ghana• Brief description of Ghana• Basic indicators• Health indicators• Administration on national policy,
decentralization• Management structure of the KBTH
• Challenges to the control of CDs-131-

GHANA IN WEST AFRICA-132-

MAP OF GHANAFLAG OF GHANA

Kente Weaving-133-

King of Asante in Palanquin

GHANA• The Republic of Ghana, formerly the Gold
Coast, is a West African country bordering the
Gulf of Guinea.
• Boundaries: Burkina Faso to the north,
Côte d'Ivoire to the west
Togo to the east.
Coastline on the Gulf of Guinea,
part of the Atlantic Ocean.
-134-

GHANA• Ghana is about the size of the United Kingdom• It has an area of 238,533 sq. kilometers• Gained independence on the 6th March 1957
from Britain• Became a Republic-1960• The capital of Accra is located along thesoutheastern coast.
• Official language is English-135-

GHANA• Ghana has a tropical climate, warm andcomparatively dry along the southeast coast, hot
and humid in the southwest, and hot and dry in
the north.
• Its terrain is mostly low plains with a plateau in
the south-central area.
• Its highest point is Mount Afadjato• 10 regions: the Northern, Upper West, Upper
East, Volta, Ashanti, Western, Eastern, Central,
Brong-Ahafo, and Greater Accra.
-136-

GHANA• Ghana’s largest lake, Lake Volta, is also theworld's largest artificial lake.
• There are two main seasons in Ghana: the wet
and the dry seasons-Northern Ghana experiences its rainy seasonfrom March to November-Southern Ghana experiences the season from
April to mid-November.
-137-

GHANA

Mole park

Kakum
Park

Boti falls-138-

GHANA

Cape- Coast Castle-139-

GHANA-140-

GHANA• Largest ethnic group is the Akan.
• CHIEF EXPORTS: Gold, cocoa, timber, tuna,bauxite, aluminum, manganese ore,diamonds, Crude oil.
• CHIEF IMPORTS: petroleum, foodstuffs-141-

BASIC INDICATORSINDICATOR
Area (in 1000 sq. km)

FIGURES

Estimated Population

24,658,823

238,533

Percentage of population Under 15 years
old (%)
38.3%
Percentage of population
65+ years old (%)
Living in urban areas (%)

4.7%

Intercensal growth rate (%)

2.5%

-142-

51%

INDICATORFIGURES
Total fertility rate (per woman)

2008,GDHS

4.0

Adult mortality rate
(probability of dying between 15 and 60 years per1000 population)
317

Life

expectancyat-Total
-Male

birth

-Female2007(years)
61.45
60.22
62.73
2011

Infant mortality rate
(probability of dying between birth and age 1 per1000 live births)
50/1000
2008, GDHS
Maternal mortality ratio (per 100,000 live births)
375/100,000 2008, GDHS
Under-5 mortality rate
-143(probability of dying by age 5 per 1000 live birth)

BASIC INDICATORS- INDICATORFIGURES

12. Access to improved drinking-water sources (%)- Urban area
93.0%
- Rural area
76.6%
13. Health workforce (total No. and Density) per 10,000
population)-Physicians( 1:10,423)- Professional Nursing and midwifery personnel(1:1,077)-144-

2008, GDHS

2010,
Ghana
Health Service

BASIC INDICATOR
14. Immunization coverage among 1year-olds (%)-BCG
98%-Polio3times
91%-Measles91%- Rubella
Not known 2011
WHO,
- DPT 3 times
91%
UNICEF- HepB3
91%
Estimates- Hib391 %-145-

BASIC INDICATOR• Three leading causes of morbidity• - Malaria• - Upper respiratory tract infections• - Diarrhoeal diseases• Three leading causes of institutional mortality• - Malaria• - HIV related conditions• -Anaemia-146-

BASIC INDICATOR• Number of cases of HIV/AIDS patients is
225, 478• prevalence of HIV in the general population –1.5%.
• prevalence of HIV among pregnant women –
2.1%

-147-

-148-ADMINISTRATION ON NATIONAL
POLICY, DECENTRALIZATION-149-

-150-

-151-

-152-KORLE-BU TEACHING HOSPITAL• Korle-Bu Teaching Hospital is the largest hospitalin Ghana.
• The number one referral hospital for the country
and sometimes from the West Africa sub-region.
• 2000 Bed capacity• average attendance- 1500 OPD patients per dayand• 150 admissions per day.
• The hospital has over 4000 staff.
-153-

KORLE- BU TEACHING HOSPITAL• The compound houses the University of
Ghana Medical School, a Nursing training
school, School of Hygiene, School of Allied
Health Sciences, the University of Ghana
Dental School, students and health workers
accommodation.

-154-

Challenges with the control ofcommunicable diseases• Inadequate human resource capacity toinvestigate and control Cholera outbreaks.
• Lack of standardized protocol for investigating
and controlling Cholera.
• Delayed response in dealing with outbreaks ofcommunicable diseases in the hospital andsurrounding communities• Poor compliance to infection prevention andcontrol practices by health staff and patients• Weak surveillance system for hospital acquired
infections eg MRSA
-155-

CHOLERA IN GHANA-156-

OUTLINE• Introduction• Summary of cholera in Ghana• Cholera in Korle-bu Teaching Hospital• Steps used in investigating the outbreak• Challenges with the control of cholera• Action plan for countermeasure-157-

CHOLERA• INTRODUCTION• Cholera is an acute intestinal infection caused byingestion of food or water contaminated with thebacterium Vibrio cholera.
• Has a short incubation period• Produces an enterotoxin that causes a copious,
painless, watery diarrhoea.
• Vomiting also occurs in most patients• Can lead to severe dehydration and death-158-

CHOLERA• INTRODUCTION• Most persons infected with V. cholerae do not
become ill, although the bacterium is present intheir faeces for 7-14 days.
• When illness does occur, about 80-90% of
episodes are of mild or moderate severity and are
difficult to distinguish clinically from other typesof acute diarrhoea.
• Less than 20% of ill persons develop typicalcholera with signs of moderate or severe
dehydration.
-159-

CHOLERA IN GHANA• A total of 5,518 cases with 57 deaths• case fatality rate of 1.0 %• cases reported from 30 districts in sevenregions between the period of 1st January to
2nd September 2012.

-160-

CHOLERA IN KORLE-BU TEACHING
HOSPITAL• 583 cases have been recorded from JanuarySeptember, 2012 during the period.
• September 1st to 13th witnessed a sharp rise in
the number of severe diarhoea/cholera casesof 146.
• There were a total number of 5 deaths overthe period.

-161-

CHOLERA IN KORLE-BU TEACHING
HOSPITAL•

Fig 1: Comparison of weekly trends in severe diarrhoea/cholera for 2011 & 2012

-162-

CHOLERA IN KORLE-BU TEACHING
HOSPITAL
Fig 2: Location of severe/cholera cases by specific communities from January –September, 2012-163-

Steps used in investigating theoutbreak
1. Establish the existence of an outbreak
2. Verify the diagnosis
3. Define a case
4. Implement Infection prevention and control
measures5. Describe data by time, place, person
6. Communicate findings
7. Health education-164-

Challenges with the control of cholera• Inadequate human resource capacity to investigate andcontrol Cholera outbreaks.
• Lack of standardized protocol for investigating andcontrolling Cholera.
• Delayed response in dealing with outbreaks of cholera
in the hospital and surrounding communities• Poor compliance to infection prevention and control
practices by health staff, patients and relatives• Lack of a proper holding bay for patients with cholera.
• Insanitary conditions-165-

Transporting an individual with cholera-166-

Cholera bed-167-• JAPAN has always been interested incontrolling communicable diseases!
• Beneficiary countries are grateful.

-168-

-169-

-170-

• THANK YOU FOR YOUR ATTENTION-171-

The Study Programme
for the Countermeasure for Communicable Diseases

Mongolia-172-

Country report of Mongolia

National Center for Zoonotic Diseases,National Center forCommunicable Diseases
Ministry of Health, Mongolia-173-

Mongolia Today
Geography

13

-174-

Background• Demography: Total population 2.8 million (2011)• Livestocks: 36.3 million (2011)• Territory: 1564.1 km.square• Density: 1.57 million km²/per person, lowest density inthe world• Administration: 21 provinces and capital city, with
343 soums• Climate: Desert and continental, temperature: as low as-45°C to -50 °C in winter and 25 ° to 30 °C in thesummer-175-

Rural and urban population, 2011
• 43.1% live in
Ulaanbaatar• 24% live in aimag
centers• 32.9% live in rural
areas including soum
centers and baghs,
2011

-176-

Demographic indicator, 2011
Life expectancy

Percentage population• Under 15 years old-27.2%• Under 60 years old-72.8%

Annual growth rate-1.9%
Average life expectancy of the population
Mongolia was 68.32 years• Women-73.76• Men-64.68-177-

-178-

Demographic indicator, 2011
Infant mortality rate-16.3
per 1000 life births

Under-5 mortality rate-20.0
per 1000 life births

Maternal mortality rate-48.2 per 100.000
life births-179-

Health workforce, 2005-2011

Per 10.000 population, 2011:
Doctors-28.5
Nurses and midwives-59.2--180180-

Major Programm forCommunicable Diseases• Subprogram on control and prevention of vaccine preventabledisease.
• Subprogram on control and prevention of tuberculosis.
• Subprogram on control and prevention of intestinal infections• Subprogram on control and prevention of infectious disease
with natural foci and zoonosis.
• Subprogram on control and prevention of HIV, AIDS, STI.
• Subprogram on control and prevention of viral hepatitis-181-

Leading cause for morbidity and mortality,
2001-2011
Leading morbidity:
1.Diseases respiratory diseases
2.Diseases of the digestive system
3.Diseases of the genitourinary system

Leading mortality:
1.Diseases of the circulatory system
2.Tumour and neoplasm
3.Injuries, poisoning and otherconsequences of external causes-182-

Diseases under WHO monthly report
Cholera outbreak, 1996:
178 confirmed cases, 12 deaths (CFR=6.7%)
Tick borne encephalitis,
2008-2012:
Confirmed cases-48
CFR-0

Human cases of TBDs,
2008-2012:-183-

Diseases under WHO monthly report
Plague, 2008-2012:
Confirmed cases-5
CFR-0

Khuvsgul
Uvs
Bayan-Ulgii

BulganKhentii

ZavkhanPrevalence ofplague risk
territories

Selenge

Arkhangai

DornodUlaanbaatar
Tuv

Khovd
Govi-Altai

Govisumber

Sukhbaatar

UvurkhangaiDundgovi
Bayankhongor
Dornogovi
Umnugovi

Active foci of plague-184-

Active foci of plague,
probability of morbity

High risked foci of plague,high probability of morbity

Diseases under WHO monthly
reportNo of cases

Rate 100.000

No of Death

Tuberculosis

3985

143

111

Viral Hepatitis

14612

528

20

Hepatitis A

13612

490

Hepatitis B

749

27

Hepatitis C

152

25

Hepatitis D

701

25

-185-

Cases for following STD
No of cases

Gonorrhoea

5159

Syphilis

4268

AIDS

17

Rate 100.000

1

-186-

Immunization Programmes• Name of Target Diseses
1. Tuberculosis
2. Hepatitis B
3. Polio
4. Measles
5. Mumps
6. Rubella
7. Diphteria
8. Tetanus
9. Hemaphilis influenza B• Type of Vaccines
1. BCG-98,9%
2. HEP B-98,9%
3. OPV-99,2%
4. Pentavalent-99,2%
5. MMR-98,1%
6. DT

-187-

Immunization schedule
schedule

Birth 23
4
92
dose Month months months months years
withi
n the
24
hours

BCG

1

HEP B

1

OPV

1

5valent

2

3

4

1

2

3
1

MMR
DT

-188-

7
years

15
years

1

2

2

Immunization Programmes
Type of vaccines

Dose

No of Immunized Persons

BCG/Japan

1

70576

HEP B/Korea

1

69802

OPV/Belgium

470506/66938/66514/66334

Pentavalent/Gavi

366940/66514/66308

MMR/India

262061/60433

DT/India2-189-

Production of vaccine (Rabies)
Name of vaccines

Tissue culture vaccine for rabies

Method production

Goat’s brain tissue vaccine

Name of factory

Institution of Public health research

Amount of production

150 liter

Sufficient to meet theYes, because need to develop the CCVs

needs

(cell culture vaccines)-190-

Vaccines zoonotic diseases, from othercountries№ Name of vaccine

Which country

1 Cell culture rabies vaccine

Russia2 Live spore vaccine for anthrax (STI)

Russia3 Dry live plague vaccine

Russia, Kazakhstan

4 Tick borne encephalitis inactivatedvaccine5 Yellow fever vaccine

Russia-191-

RussiaVaccination against zoonotic diseases in 2012

Anthrax vaccine

3527 vaccinated people;
1031 of them for I and II doses and2496 for repeatedly doses

Plague vaccine

total 22639 vaccinatedRabies vaccine

4100 vaccinated and 104 people
received rabies serum treatment(rabies immunoglobulin)

TBE vaccine

9671 vaccinatedYellow fever vaccine 100 vaccinated-192-

The Study Programme
for the Countermeasure for Communicable Diseases

Panama-193-

COUNTRY REPORTPANAMA-194-

Data from Panama

Panama is located in the Central American isthmus between Costa
Rica and Colombia at 7 to 10ª north latitude and 77-83ª west
longitude with an S shape .
It has an area of 75,517 square kilometers with a length of 772
km and 60 to 177 km in width. Its borders also run with the
Caribbean Sea and the Pacific Ocean.
-195-

Distribution of Landscape
40% forests and 500 rivers-196-

ETHNIC GROUPS-197-

INDICATORS
Indicator

Data

Year

Population

3,723,821

2011

Living in urban areas

2,383,245 (64%)

2011

Living in rural areas

1,340,576 (26%)

2011Life expectancy at birth

77.9 Fem= 80.86
Male=75.18

2011

Percentage of population

Under 15y/o =28.7%
Over 60y/o =9.9%

2011

Annual growth rate (%)

1.7

2011

Total fertility rate

2.4

2011

-198-

INDICATORS
Indicator

Data

Year

Infant mortality rate
Per 1000 alive births

13.2

2011

Maternal mortality rate
Per 10,000 alive births

8.1

2011

Under 5 y/o mortality rate
Per 1000 alive births

0.9

2011

Adult mortality rate
per 1000

4.69

2011

Expenditure in health8.3 % of TGI

Immunization coverage

90%

2011

Health workforce
physicians and nurses

10,295

2011

-199-

Public Health System
Secretary of Health (MINSA)- regulatory , policy maker andprovides healthcare for unemployed population or not.(open to
everyone )Social Security System (CSS)- healthcare for employed individuals
with benefits regimen for family members- wife, children andparents ; maternity and sick leave benefits and pension plan .
Insured and family members – 2,800,000

Institute for Drinking Water provision and Sewage Disposal(IDAAN)
Gorgas Memorial Center for Health Studies (ICGES)
Environment Authority (ANAM)
Food Safety Authority (AUPSA)
Urban and Household Waste Management (AAUD). Source: Felicia Tulloch
-200-

MD

HEALTH SYSTEM MINSA – CSS, 2010
III LEVEL HOSPITALS:
5INSTITUTES:2REGIONAL HOSPITALS :16
HOSPITALS:
12POLICENTERS:
6POLICLÍNICS:
26
HEALTH CENTERS:188ULAPS:
14
CAPPS:
23
HEALTH SUB CENTERS:
119
HEALTH POSTS :480
UNDER CONSTRUCTION : 5 HOSPITALS CAPPS- 15 ULPS -16 ( FY=2013)

TOTAL: 909-201-

Source: Felicia Tulloch MD

VACCINATION PROGRAM
AGE GROUPVACCINES

COVERAGE

1 Y/O

BCG, POLIO,PENTAVALENT, MORE THAN 85 %MMR, ROTAVIRUS,
HEPATITIS A, NEUMOCOCO,
INFLUENZAUP TO 5 YEARSREINFORCEMENT MMR,POLIO, HEPATITIS A ,DPT

MORE THAN 85%

10 Y/0 GIRLS

PAPILLOMA VIRUS (recent)
TdAP

40%
65.4%

PREGNANT

Tdap

46.9%

MORE THEN 60 Y/O

INFLUENZA , NEUMOCOCO

78%

HEALTHCARE WORKFORCE

INFLUENZA, TDAP,NEUMOCOCO, MMR ,HEPATITIS B, HEPATITIS A

90% for Tdap

SELECTEDVARICELLA, YELLOW FEVER-202-

Leishmaniasis
Distribution of cases in 2010 (3221
cases.
By region
Caribbean- 71% of cases mostly in
Bocas del Toro (800 cases) Cocle(1034), Colon (300 )• Current situation• Important public healthproblem predominantly
the cutaneous form
• In 2010, the statistics
department reported
3221 cases, in 2011 2175 cases• These were distributedin the 14 regions

In 2011 --2175cases-203-

COMMUNICABLEDISEASES

TBC

AIDS

DiseaseCases (2011)

Risk groups

Tuberculosis

1594

Inmates, indigenous TAES, F/U,
pop, HIV/ AIDS,

HIV /AIDS

796

Heterosexuals,
Homosexuals,
Bisexuals, Verticaltransmission

Regulatory law ,Mass media
information,
specially forcarnival ,Post exposure
prophylaxis

Farmers,

Active search,blood bank testing(12,315 cases
between 19842011)

Trypanosomiasis

61 (increasing)

Dengue fever

3,882

-204-

Programs

Mass media
information,
fumigation ofbreeder areas,

DENGUE
3882 CASES IN 2011

• 2012- 1107 CASES RATE : 30.7:100,000•
SEVERE =6 DEATHS= 0-205-

THANK YOU-206-

The Study Programme
for the Countermeasure for Communicable Diseases

Tajikistan-207-

Country Report - Republic of Tajikistan
A. Country Profile. Tajikistan is a sovereign, democratic, law-governed, secular republic.

Tajikistan located in southwestern area of Central Asia and it is total area 142.600 km2.
Dushanbe is the capital of RT since 1924.
State borders - Length: 700 kilometers from west to east 350 kilometers from north to south.
In the west and north, Tajikistan has borders with Uzbekistan (910 kilometers) and Kyrgyzstan(630 kilometers); in the south – with Afghanistan (1030 kilometers and in the east – with China(430 kilometers)

Language: Most of Tajikistan's population belongs to the Persian-speaking Tajik ethnic group,
who share language, culture and history with Afghanistan and Iran. The majority of the
population (2000 census) are Tajiks (79.9%), speaking in the Tajik language, in addition, about
17% of the population is Uzbek, Kyrgyz (1.3%) and less than 1% - Russian. Most of Tajikistan's
population is Muslim.
Religion: The vast majority of the population in Tajikistan (95 -99%) are Sunni Hanafi school ofthought (which formalized from 2-nd of April 2009). Currently, the country has approx. 3000
mosques, of which 259 are cathedral. In Gorno-Badakhshan Ismaili religious minority there,
which has a history of X-XI centuries. In 2009, the Ismaili Centre was opened in the capital of
the country . In Tajikistan, 85 registered non-Muslim religious communities. Among them are
the bulk of Christians (Orthodox b.ch.), and there are 5 communities of Baptists, two Roman
Catholic parish, a community of Seventh Day Adventists, Jehovah's Witnesses and Lutherans.
The two communities have come from the South Korea Song Min church.
After independence, Tajikistan suffered from a devastating civil war which lasted from 1992 to
1997. Since the end of the war, newly established political stability and foreign aid have allowed
the country's economy to grow. The primary sources of income in Tajikistan are aluminium
production, cotton growing, selling dried fruit, agriculture (crops, Livestock) and remittancesfrom migrant workers. Nearly one million Tajik men worked abroad in 2009 (IOM).
Climate: continental January from +22C (Pyandj) to -61C (Laje Bulunkul),June from -8C (Lake
Bulunkul) to +45C (Pyanj)
Geography: Tajikistan is mountainous with heights above sea level varying between 300 and
7495 meters. Mountains belonging to the highest ranges of Central Asia make up 93% of thetotal area of the country. There is the Fergana valley in the northin the northwest and the central
parts there are the Tukmenian, Zaravshan, Hissar and Alay mountain ranges. The southeast
boasts the impressive Pamir range (its highest mountain, the Somanids Peak or former
Communism Peak, with an altitude of 7495 metres, is one of the highest summits of the world);
while the southwest has the Vakhsh, Hissar and other valleys.
-208-

Tajikistan’s high mountains accommodate great supplies of ice and snow. The line of perpetualsnow is situated at height between 3500 and 3600 meters in the west and rises up to 5800 metersin the east. The total area of the glaciers in Tajikistan covers more than 8476 square kilometres.
There are over the thousand registered glaciers with a length of more than 1.5 kilometers.
Sixteen glaciers (such as Fedchenko and Grumm- Grzymailo glaciers) have length of more than
16 kilometers.
Lake and rivers. There are about 947 rivers longer than 10 kilometers with a total length of morethan 28500 kilometers. The rivers account for 60% of all hydro-resources of central Asia.
There are some 1300 lakes with a total surface area of 705 km. Karakul, Sarez and Yashikul are
the largest expanses to have been created naturally. The lakes are mainly located at height of3500 meters.
Flora. The Tajikistan’s flora abounds in wild fruit-bearing trees and in numerous species ofplants, which are widely used by the population.
Fauna. Tajikistan boasts some 80 species of mammals, more than 365 kinds of birds, 49 kindsof reptiles, 40 kinds of fish, 10 thousands of various insects. One can observe such predators assnow leopards, lynx, bears, hyenas, otters, wolves, foxes and martens, as well as deer and rockgoats.
Natural resources. Tajikistan is also richly endowed with mineral deposits. Currently, more than
400 deposits have been identified, 100 of which are being exploited. Some 40 kinds of mineralraw materials are being extracted, such as fossil minerals, ores and non-metallic. The estimatedtotal geological coal reserves amount to some four billion tons. Eighty percent is coking coal.
Deposits have been discovered for many rare and precious metals such as zinc, lead, bismuth,
molybdenum, tungsten, gold, silver, antimony, mercury and fluorite, as well as gas andpetroleum, among others.
Environment: current issues: increasing levels of soil salinity; industrial pollution; excessive
pesticides; natural hazards: characteristic of spring and autumn mudflows, earthquakes
Education: Tajikistan has a high rate of literacy due to the old Soviet system of free education,with an estimated 99.5% of the population having the ability to read and write.
GDP: The level of GDP per capita - 2,19 thousand dollars (in 2010).

-209-

A. HEALTH INDICATOR
1
2
3

4
5
6
7
8

9

Indicator
Area (in 1000 sq. km)
Estimated Population(,000s)
Percentage of population- Under 15 years old(%)- over 60 years old(%)
Living in urban areas(%)
Annual growth rate(%)
Total fertility rate� (per woman)
Adult mortality rate (probability of dying
between 15 and 60 years per 1000
population)
Life expectancy at birth (years)
Total
Male
FemaleInfant mortality rate (probability ofdying between birth and age 1 per 1000
live births)

Year
2011
2010

Data
142,6
7564,5source/reference
http://stat.tj/
http://stat.tj/

2010
2010
2010
2010

35,6
7,6
26,4
101,2
3,7

MedstatMedstatMedstathttp://stat.tj/

2010

4,2

2009

72,8
70,5
75,3

http://stat.tj/
http://stat.tj/
http://stat.tj/

2010
2011
2003

34,0
18,3
65,0

http://stat.tj/
Medstat
MIKI-2005

2011

38,1

2010
2009

45,0
20,0

Under-5 mortality rate (probability ofdying by age 5 per 1000 live birth)

2011
2010
2003

23,3
20,9
79,0

Brass-metod
Access to improve drinking-water
sources (%)
Urban area

2010

50,0

2010
2005
2010
2005

70,0
94,5
93,0
42,1
61,0
64.7 (access toclean water)

10
Maternal mortality ratio (per 100,000
live births)

11

12

Rural area

Access to improved sanitation (%)
Urban area

non-210-

MedstatMedstat
MIKI-2005
Results of survey on infant, childand maternal mortality in the
Republic of Tajikistan in 2010,
http://stat.tj/en/publication/results/

SSESS
MIKI-2005
SSESS
MIKI-2005

Rural area
13

Health workforce (total No. and Density(per 10,000 population)
PhysiciansProfessional Nursing
midwifery personnel

14

Immunization coverage among 1-yearolds (%)
BCG
Polio 3 times
Measles
RubellaDPT 3 times
HepB3
HHZ3

15

16

17

Three leading causes of morbidity(Year: )Сумма ОКИОВГТВ (new cases)
TB (No. of active cases)
TB (No. of active new cases)
ОРВИ
ГРИИП
пневмония
Three leading causes of institutionalmortality (Year -2010)
All CDОКИ (уст, токсикоинф, вирусн)пневмония
ТВCases and death for six diseases under
WHO-EPI
Diphtheria
Measles
Pertussis
Poliomyelitis

avialable
nonavialable

2010
2010
2010
2010
2010
2010

15412
209
35126
46,1
4022
5,3

Medstat

2009
85
2005
95
2009
93
2005
79
2009
97
2005
86
2009
97
2005 NA
2009
93
2005
82
2009
93
2005
69
2009
93
Data
No. ofcases
Rate/100,000
66671
888,9
10138
135,2
5353
71,4
5959
78,5

Medstat
MIKI-2005
Medstat
MIKI-2005
Medstat
MIKI-2005
Medstat
MIKI-2005
Medstat
MIKI-2005
Medstat
MIKI-2005
Center of Immunization

13837

181,7
126,7

2831423774,8
16623
221,6
7408
98,8
No. ofcases
No. of death
92523
138
63142
28
7679
34
5391
86
No. ofcases
No. of death
1
0
0
0
1
0
12
0
90
1
-211-

MedstatMedstat

SSESS
SSESS
SSESS
http://stat.tj/
http://stat.tj/
Medstat
SSESS
SSESS
SSESS

SSESS
SSESS
SSESS
SSESS

SSESS
SSESS
Center of Immunization
SSESS
SSESS

18

19

20

21

22

Tetanus
Tuberculosis
Cases for diseases under the WHOannual CD Bulletin
Gonorrhoea
Hepatitis A
Hepatitis B
Unspecified
Syphilis
Trachoma
Yaws
Causes and death for six diseases
under WHO monthly CD Notes
CholeraDengue fever / DHF
CCHF-2011
Encephalitis
Influenza (2010)
Meningitis (2010)
PlagueCases for following six diseases
Filariasis
Leishmaniasis
Leprosy
Malaria
Schistosomiasis
Trypanosomiasis
Cases for following STDs
AIDS (2010/all)
HIV (2010/all)
Chancroid
Chlamydia
HerpesLymphogranuloma venereumNon-gonococcal urethritis (NGU)
Hepatitis, (%)
Cases of hepatitis (all)：
HAV
HBV
HCV
HDV
HEV
Unknown

457
4
5391

9
0
86

No. of cases
401
9631
265

SSESS
SSESS
SSESS

360
380
N/A
N/A
No. of
cases
0
N/A
15
N/A
16695
23
0
No. of
cases
N/A
40
0
106
0
0
No. ofcases
41/57
1004/2857

SSESS
Medstat

No. of death
0

SSESS

2

SSESS

1
0
0

SSESS
SSESS
SSESS

0,5

SSESS

1,4

SSESS

Rate/100,000

Rate/100,000
1,8/2,5
13,2/37,6

No. ofcases
Rate/100,000
10083
132,4
9631
126,5
265
3,5
84
1,1
N/A
9
0,1

-212-

Center of Immunization
SSESS
SSESS

MedstatMedstat

SSESS
SSESS
SSESS
SSESS
SSESS

B. ADMINISTRATION ON NATIONAL POLICY
C-1. Regarding the system and process of decision making in national health care policy,
especially in the field of CDC, please outline division of responsibility at the national, regional
and local levels.
 Everyone has the right to health. Each within prescribed by law, enjoy free medical carein public health facilities. Other forms of medical care are determined by law (TheConstitution of the RT, Article 36).
 Guide the health of the population in the Republic of Tajikistan shall state executive
bodies in accordance with the laws of the Republic of Tajikistan. Ministry of Health of
the Republic of Tajikistan led health in the country, the activities of republican
institutions, research and education the public health system, analyze, develop policies
and strategies, protect public health and health care together with the executive power is
exercised by a co-ordination and control the organs and institutions of the public healthsystem for the quality of health-care, medication assistance departmental agencies,
institutions, private health care system and are responsible for the development andhealth (Article 5 Law of the Republic of Tajikistan “About Public Health Protection”).
 The competence of the Government of the Republic of Tajikistan in the field of sanitaryand epidemiological safety of the public include:-definition of the unified state policy in ensuring Sanitary - Epidemiological Safety (Article 4 of
Law of the Republic of Tajikistan "About Sanitary and Epidemiological Safety").
The competence of the Ministry of Health of the Republic of Tajikistan in the field of sanitary epidemiological safety of the public include:-realization of a unified state policy in ensuring Sanitary - Epidemiological Safety;-development and long-term forecasts and programs in the field of sanitary and epidemiologicalsafety; Development of draft laws and other regulations in the field of sanitary andepidemiological safety of the public in the prescribed manner; Public-health - epidemiologicalregulation; ……. (Article 5 of Law of the Republic of Tajikistan "About Sanitary andEpidemiological Safety").
 The competence of local authorities in ensuring Sanitary - Epidemiological Safetyinclude: Control over the observance of sanitary norms and regulations of the Republic of
Tajikistan in the field of sanitary - epidemiological safety;……….. (Article 6 of Law of
the Republic of Tajikistan "About Sanitary and Epidemiological Safety").
 State sanitary and epidemiological supervision by the State Sanitary and Epidemiological
Service of the Republic of Tajikistan (Article 43 of Law of the Republic of Tajikistan"About Sanitary and Epidemiological Safety").

-213-

C-2. ORGANIZATION CHART OF YOUR MINISTRY
Ministry of Health of the Republic of Tajikistan, the Minister

Vice-Minister of Health of the
Republic of Tajikistan

Vice-Minister of Health of the
Republic of Tajikistan

Management of the organizationof health services for mothers,
children and family planningManagement of the organizationof health services

Chief Medical Officer, Deputy
Health Minister of the Republicof Tajikistan

Sanitary-Epidemiological
Department

Management science, medical
and pharmaceutical education

Emergency department andemergency medical care

Department of Pharmacy andMedical Equipment

C-3. MAJOR PROGRAMMES / LAWS / REGULATIONS
Please outline major program(s), laws(s), and regulation(s) for CDC currently in effect in yourcountry.
１．Malaria. The country has implemented "Program to combat tropical diseases (malaria) in
the Republic of Tajikistan for 2006-2010": has taken the necessary administrative rulings anddeveloped normative and legislative base; was created logistical base for the planning of malariainterventions, including the budget; prepared by the appropriate personnel in order to strengthen
human resources; have strengthened the preventive and care services, especially in the early
diagnosis and appropriate standards of examination and treatment; have been developed
mechanisms for early case detection, rapid response to outbreaks and prevent abnormal
situations associated with malaria; enhanced surveillance system for malaria; designed anddeveloped components of the entomological surveillance of malaria; carried out theoretical andpractical research on the characteristics of the epidemiology of malaria in Tajikistan, drug
resistance P. malariae; improved system for monitoring and evaluation of interventions.
Approved a new National programs aimed at achieving a break of malaria in the Republic of
Tajikistan, 2011 - 2015 years. The program aims to break the local malaria transmission and its
elimination in the Republic of Tajikistan in 2015 and maintaining epidemiological territories
where its transmission has been interrupted earlier.
The number of new malaria cases registered during 1994-2009
35000
29794
30000

25000

19064

19351
20000

16561
13493

15000
11387
10000
6160

6103
5000

5428
3577

2410

2309

0

-214-

1344

635

318

153

2. Tuberculosis. The DOTS strategy was introduced in 2002 in Dushanbe. Coverage of theintroduction of increased annually and by 2007 had reached 100 percent. In accordance with thepreliminary results of the study of drug resistance (DRS), Tajikistan can have one of the highest
rates of drug-resistant TB in the world. The main challenges for TB control are limited humanresources and weak laboratory capacity. Tajikistan has received increasing support for testing
drug sensitivity and drug resistance surveillance to anti-TB drugs (1st and 2nd row).

TB in the Republic of Tajikistan, 1997-2010 years

6000

5353
4634

No. of all cases

5000

4945 4776

4111 4043
4000
3064
3000

3283
All

2481
1829 1977

2000

Under 15 y

1218 1334
743

1000

41

98

143

92

125

245

285

257

300

275

367

344

274

406

0
1997с.1998с.1999с.2000с.2001с.2002с.2003с.2004с.2005с.2006с.2007с.2008с.2009с.2010с.

1. Law of the Republic of Tajikistan "About protect the population from tuberculosis"(22/12/2006 № 223)
2. The National Program for the protection of population from tuberculosis for the period 20102015yy. Until 2015 year will achieve the following goals:• At least 85% cure of the total number of newly diagnosed patients.
• The incidence and deaths reduced by 50% compared with 1990 levels for Tajikistan - thismeans: reduce the incidence rate at 41.0 per 100,000. (or below); reduce the rate of deaths by 7.0(or later), per 100,000 population, including TB / HIV. In 2009, the mortality rate was 5.9 per
100,000 population.
3. HIV/AIDS. In April 1997, under the Government established a National Coordinating
Committee for AIDS. Since 1993, the Decision of the Supreme Council was commissioned in
the RT Law "On prevention of AIDS."In the country conducted sentinel surveillance among
IDUs, SW, pregnant, prisoners.

The number of new HIV cases registered during 2005-2010
1200
1004
1000
800
All

600
373

400
167

200
9

34

27

41

11

431

migrant workers

189

162
121
48
35
20

45

38

62

0
2000с 2001с 2002с 2003с 2004с* 2005с. 2006с. 2007с. 2008с. 2009с. 2010с.

-215-

1. Law of the Republic of Tajikistan on Combating HIV / AIDS (Two time: 27/12/1993;
28/12/2005, № 150)

2. The National Programme on HIV / AIDS in the Republic of Tajikistan for 2011-2015
Programme on HIV / AIDS is based on strategies for poverty reduction in Tajikistan for theperiod 2010-2012, the UN Development Assistance Framework for Tajikistan for 2010-2015 andthe National Strategy for Health of the Republic of Tajikistan for the period 2010-2020.
The purpose of the Program: In accordance with the Millennium Development Goal number 6,2015 to stop the spread of HIV / AIDS by providing universal access to prevention, treatment,
care and support. The main strategic directions:
1) Create a legal environment that contribute to achieving universal access to prevention,
treatment, care and support.
2) Implementation of prevention programs and access for all population groups, especially themost vulnerable to HIV prevention services.
3) The provision of antiretroviral therapy, treatment of opportunistic diseases such as
tuberculosis, palliative care and providing care for HIV - infected.
4) Integration of HIV into primary health care in order to improve access, reduce stigma andimprove quality of care.
5) Reduction of stigma and social development support for PLHIV.
6) Improved oversight, monitoring, evaluation of preventive control, improved surveillance ofHIV.
C-4. PROBLEMS IN THE FIELD OF CDC
Please outline the problems concerning human, institutional, and financial resources ofcommunicable diseases control in your country.
Communicable diseases control problems in our country:
1. Weak legislative base
2. Poor funding
3. Lack of qualified personnel
4. Inadequate technical equipment
5. Geographical remoteness of possible infectious foci from the administrative centers

C-5. Influenza (Pandemic (H1N1) 2010)
1. Please describe the current situation and influenza (Pandemic (H1N1)2011) in yourcountry.
The first H1N1 case was registered in June 2009 года, within the period 2009- 2011 intotal 4 lethal cases were registered, of which 3-pregnant women and 1 with chronic
coronary disease. Totally, 149 H1N1 cases were detected in 2009 - 2011 throughsentinel sites surveillance

2. Please describe strategy to control influenza (Pandemic (H1N1)2011).

-216-

On 1st of October, 2009 the Government the Republic of Tajikistan have adopted a National
plan on prevention pandemic flu in the country.
The purpose of this plan is to prevent the spread of highly pathogenic strain viruses of pandemic
influenza H1N1 (H5N1) in the Republic

1. Epidemiological surveillance and preventive measures of the public health system
2. Pandemic risk reduction, vaccination strategy and use of antiviral drugs
3. Medical care, including emergency care of medical facilities
4. Communication and social support for population

C-6. REPORTS ON SURVEYS/PROJECTS OF CDC
Please bring to Japan a report on any survey / project concerning Communicable Diseases
Control which have been accomplished in your country in the past four years, if one exists.
We realized projects:
1. M&E of intestinal infections/ISTC/
2. Improving the system of surveillance of brucellosis/FAO.
3. ILI/ Improving the system of surveillance/WB/WHO

C. CURRENT IMMUNIZATION PROGRAMMESNational Program of Immunization of the Republic of Tajikistan at 2011-2015.
TB
Polio
Measles,
whooping
hepatitis B
Name of Target
Rubellacough,
Diseases
Type of Vaccines
Schedule of
Immunization

Age of Target
Population
Number of Target
Population
Number of
Immunized
persons
Rate of Coverage(%)-2010
OthersBCG
V:3-5 days
after birthR:
6,16
years*

diphtheria,
tetanusHib, DPT
V: 2, 3 and 4
monthsPolio
V:At birth,
2.3 and 4
monthsR:12month
see above

MR
V:12 months
R: 6 years

7616400

7616400

7616400

7616400

7616400

98

95

97

93

98

see above

Hep B, Hib
V: 2, 3 and 4
months

R: 16-23 months
see above*no vaccine-217-

see abovesee aboveD. DOMESTIC PRODUCTION OF VACCINE
Has your country produced any vaccines in the past 5 years?
( X) No( ) Yes Please specify;
E. OVERSEAS PRODUCTION OF VACCINE
1. What kinds of vaccines are donated by international organizations? And in whatquantities are they received?
not acceptable
2. What kinds of vaccines are imported from other countries?
1. BCG, Polio, DTP, HepB - delivered by JICA from France, Belgium, Canada, India, South
Korea
2. Hib - delivered by GAVI from Switzerland, South Korea
3. MR, PT - purchased by the Government of the Republic of Tajikistan from Switzerland,
Bulgaria, India-218-

出典：平成 24 年度 JICA 集団研修カントリーレポート

平成 24 年度 JICA 集団研修「感染症対策行政」

Japan International Corporation of Welfare Services (JICWELS) was established with the sanction of
the Minister for Health, Labour and Welfare in July 1983 and implements international technicalcooperation programmes with purpose of contributiing to the promotion of health and social welfare
activities in the friendly nations.
Japan International Corporation of Welfare Services (JICWELS)
Toranomon YHK Bldg. 4F, 2-3-20, Toranomon
Minato-ku, Tokyo 105-0001 JAPAN
Phone: +81-(0)3-6206-1137
Fax: +81-(0)3-6206-1164
http://www.jicwels.or.jp

公益社団法人国際厚生事業団（JICWELS）は、国際的な保健・福祉分野の国際協力に貢献することを目的として、1983 年（昭和 58 年）7 月 7 日に厚生省（現厚生労働省）から社団法人の認可を受け設立されました。開発途上国の行政官研修や WHO フェローの受入れ、調査
企画や研究開発並びに情報の交換及び広報活動など、海外諸国との国際交流活動を推進しています。

広報活動委員会〒105-0001
東京都港区虎ノ門 2-3-20 虎ノ門ＹＨＫビル 4 階
電話 03-6206-1137（事業部） Fax03-6206-1164
http://www.jicwels.or.jp-219-