Lung cancer cases are on the rise in Bangladesh, with the rise in the number of smokers and air pollution levels. This inference can be drawn from the latest Hospital Cancer Registry Report that has recorded nearly a 200% rise in the country's lung cancer burden in just three years.
According to the report, unveiled earlier this month, “From January 2015 to December 2017, a total of 76,543 new patients attended the outpatient department of the National Institute of Cancer Research and Hospital (NICRH). Of them, some 35,369 had confirmed or provisional diagnosis of cancer and they were included in the final analysis."
A total of 5,887 people with lung cancer were admitted to the hospital in these three years. The figure was 1983 in 2014, as per the report, indicating a nearly 200% rise in cases in just three years. “Lung was the leading site of cancers in men followed by breast cancer in women -- 24.7% men were admitted with lung cancer and 5.2% women."
"Besides, 4,998 breast, 2,719 cervix, 1,582 oesophagus, 1,366 stomach, 1,224 liver, 1,177 lymphoma, 1,054 rectum, 884 cheek /oral mucosa and 485 gall bladder cancer patients received treatment from 2015 to 2017 at NICRH," the report stated, adding that 77.2% patients did not receive any kind of cancer treatment before attending NICRH.
On the other hand, the data of the 2014 cancer registry report showed that lung was the main site of cancers in both sexes. In 2014, the report claimed, some 27.4% women died from breast cancer in Bangladesh, while 17.9% from uterus cancer.
Experts attribute the rising cancer cases to an increase in the number of smokers and air pollution levels in Bangladesh. "Smoke from factories and exhaust from vehicles are the two leading causes of cancer in Bangladesh. Immediate steps are needed to reduce pollution," Dr Md Habibullah Talukder, head of NICRH Cancer Epidemiology Department, told UNB.
“One-third of cancer patients in Bangladesh are admitted to hospital. We don’t know about the rest of the patients. The government must take initiatives to protect people from the disease and improve treatment facilities. If a cancer is identified at the first stage, then patients will recover fast. So, awareness among people is also needed,” he added.
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According to Dr Habibullah, around 156,000 patients die from cancer in Bangladesh every year. “Every country should have a national cancer control strategy and plan of action to reduce mortality and morbidity from cancer effectively. We are still lacking these essential strategies," he said, urging the government to allocate a proper budget for the same.
Another cancer specialist at the hospital, Dr Muhammad Rafiqul Islam blamed food adulteration, environmental pollution and genetic condition too for the rise in cancer cases. “There are nearly 15 to 20 lakh cancer patients in Bangladesh, and 2 lakh cases are added to the tally every year. Around 50% of cancer patients go abroad for treatment for lack of healthcare here,” he said.
Prof Dr Sabera Khatun, former chair of Gynae-Oncology department of BSMMU, also voiced concern over the increase in the number of cancer patients in Bangladesh. “The government should create a proper database of cancer patients immediately."
The Chairman of Community Oncology Center Trust said that 99% uterus cancer patients can be cured through administration of vaccines in their teenage years. "But it is not done in Bangladesh. Women should also be made aware of uterus and breast cancers," she said.
“Some 5,69,847 women are diagnosed with uterus cancer every year worldwide and over 3 lakh succumb to the disease. In Bangladesh, some 8,068 women are diagnosed with this disease while 5,214 die from it every year, according to the International Agency for Research on Cancer," Prof Dr Sabera said.
Health and Family Welfare Minister Zahid Maleque recently said that the government planned to build a 15-storey cancer hospital in each of the eight divisions by 2022. “Adequate facilities for the treatment of cancer, kidney and heart diseases will be provided in these hospitals. At least 300 beds will be in each department. Bangladeshis won't need to go abroad for treatment," he had said.
Though there was a drop in the level of noise pollution in Dhaka during the initial days of the Covid-induced lockdown period, the brief interlude of quiet has started fading since restrictions were lifted in September.
In fact, in the last two months of 2020, the noise pollution levels in the capital increased alarmingly by an average of 10 percent, year-on-year, thus posing a serious health risk to the residents, according to a recent study.
Impulsive noise (the noise lasts for a short duration) increased by 10-12 percent, compared with 2019, though continuous noise (lasts for longer duration) declined by 3-4 percent, as per the study conducted in November and December last.
But the study found some 15 percent less traffic in the city's roads, compared with 2019.
The use of banned hydraulic horns, (a major source of impulsive noise) has risen by 15-25 percent in the city's roads, according to the study carried out by the Centre for Atmospheric Pollution Studies (CAPS) of Stamford University.
Talking about the study, CAPS Founder and Director Prof Dr Ahmad Kamruzzaman Majumder said the overall noise pollution has increased despite the decline in traffic on the city's roads.
"The most alarming thing is that the situation will deteriorate further if the number of vehicles goes up again like the pre-Covid period," he said.
Explaining types of noise, he said the impulsive noise is induced by sudden sound like hydraulic horns and the continuous noise is induced by motorised machines, generators and such other things.
The sound level above 70 dB is considered as extreme by the World Health Organization, but the study found the highest 120-129 dB sound recorded in several places in Dhaka city, said Dr Majumder, also the Chairman of the Environment Science Department of the university.
In the 2019 study, the highest 120-126 dB sound was recorded at several points in the capital, he added.
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The women, children, pregnant women and traffic police are the worst affected by shrill sound as it exposes serious threat to their mental health, said Dr Majumder.
He said 8 percent members of traffic police are going to lose their hearing capacity permanently, while 35 percent members of the traffic police are suffering from temporary hearing problems due to acute noise pollution.
As per the Noise Pollution (Control) Rules 2006, the permissible sound level for Bangladesh is 50 decibel (dB) for daytime and 40 dB for the night in silent areas.
In residential areas, the permissible limit is 55 dB for daytime and 45 dB for the night, while it's 60 dB for the daytime and 50 dB for night in mixed areas (residential, commercial and industrial localities) and 70 dB for daytime and 60 dB for the night in commercial areas.
The WHO considers 0-20 dB as normal sound, 21-40 dB as moderate sound, 41-70 dB as mild sound, 71-90 as extreme sound and 91-120 as intolerable sound. The maximum permissible exposure time at 85 dB is 8 hours, at 100 dB is 15 minutes, at 110 dB is one minute and at 120 dB is only nine seconds, according to the WHO.
If more than 100 dB sound is exposed to anyone for a 15-minute period could result in temporary hearing loss. But the 120 dB sound could result in permanent hearing loss.
Experts say sound pollution causes mental and physical illnesses among people. It can cause high blood pressure, headache, indigestion, ulcer, and also affects sleep.
Talking about another recent study conducted in the Bangladesh Secretariat areas, Prof Majumder said the noise pollution also increased in the area even after it was declared as a 'silent zone' (no horn zone) a year ago.
The researchers measured the sound levels at 12 surrounding points of the Secretariat. The highest 128.2 dB sound was recorded at the Press Club point where the highest 126.1 dB recorded in the 2019 study.
The sound level above 70 dB (shrill sound) lasted on average for 91.99 percent time at the 12 points. Of these, the extreme sound lasted for 100 pc time at Paltan bus stand, 99.4 percent time at Zero point and 99.2 percent time at Kadam Foara point.
For Shahadat and his wife Nargis Begum, a public toilet in the Tinpatti area of Boalmari Bazar has long been home.
Shahadat relocated to Boalmari, along with his sister, after losing both his parents at an early age. At the time, he was just six years old.
"My mother died soon after my birth. At the age of six, I lost my father. With no one to take care of us in our native Pachuria area of Magura district's Mohammadpur upazila, I decided to move on. Along with my sister, I came to Boalmari," he says.
Shahadat was a chiffonnier until Boalmari Mayor Mozaffar Hossain offered him a job. "Thanks to the Mayor, I am now employed with the civic body as a daily wage city cleaner. I get Tk 180 for a day's work," he says.
His wife works as a domestic help. "I work in a couple of houses as a maid. Sometimes my employers give me food. On other days, I cook food for me and my husband outside the toilet as it stinks inside," Nargis says.
Both are now pinning hopes on Prime Minister Sheikh Hasina's ambitious Ashrayan-2 project that aims at eliminating homelessness in Bangladesh
Hasina virtually distributed pucca houses to some 66,189 landless and homeless families under the project as a gift from her government in Mujib Borsho, marking the birth centenary of Bangabandhu Sheikh Mujibur Rahman, the Father of the Nation, on Saturday.
"But to be frank, we don't know if the government is going to give us a house," Nargis says.
However, Boalmari upazila Nirbahi Officer Jhotan Chanda says that the couple are likely to get a free pucca house under the Ashrayan-2 project.
With the government getting ready to roll out the much-sought Covid-19 vaccination programme anytime soon, health experts think it should adopt a go-slow policy and proceed with caution as vaccinating millions of people ensuring safety is a daunting task.
As the country did not join the phase-three trial of any corona vaccine, they warned that the large-scale vaccination against the deadly virus will face a serious setback if the campaign begins hurriedly with any negative note for lack of scientific preparations.
The experts suggested carrying out a dry run at some hospitals for a specific period to understand the best way to administer the vaccine, identify the loopholes in logistics and training, assess the preparations and know other necessary things that will be required during the mass inoculation programme.
Besides, they said, the government should launch a vigorous campaign following an effective communication strategy to dispel people’s misconception and apprehension about the vaccination.
On Thursday, the Indian government sent 20 lakh doses of corona vaccine as a gift to Bangladesh while three crore doses bought from Serum Institute of India (SII) will arrive here in phases.
Preparing people for vaccination
Talking to UNB, public health expert MH Chowdhury (Lenin), chairman of the medicine department at the Health and Hope Hospital, said it is a very challenging and tough job to safely distribute the vaccine doses among people.
“The first challenge is to prepare people mentally to receive the vaccine. We’ve seen in newspapers that 23 elderly people died in Norway after vaccination while two vaccine recipients died and several hundred others fell sick in India. These media reports are spreading some sort of panic among people. So, we must have a mechanism to create a positive attitude among people about the vaccine,” he said.
He said the UK, India and some other countries could not reach their vaccination target for many reasons. ”So, we’ll have to carry out a dry run or short-term trial of the vaccine in a planned way to identify the challenges and problems the government may face during the mass vaccination. It’ll also help us remove the barriers and achieve perfection.”
Security at vaccination centres
Dr Lenin said the government should deploy an adequate number of law enforcers in all the vaccination centres to deal with any possible chaotic situation, irregularities and abuse of power. “Taking a lesson from corona test scams, the government must send out a strong message that it won’t tolerate any kind of irregularity and abuse of power over the vaccination.”
He said vaccine recipients should be given a leaflet or guideline about what should they do if any reaction or side-effect develops among them.
Besides, an expert medical team should be kept at every vaccination centre to attend the vaccine takers if any immediate complication or side-effect develops among them
The health expert said every person should remain under the observation of a medical team for at least one hour after receiving the vaccine. “If anyone falls sick after the vaccination, he/she must be given proper treatment so that no negative impression is created among people about the campaign.”
Launching vaccination drive under EPI
Dr Lenin opposed the formation of immunisation committees at district and upazila levels headed by DCs and UNOs as he feared that it may cause some sort of problems and lack of communication between the administration and the vaccine providers.
He said the vaccination activities should be carried out by Expanded Programme on Immunisation (EPI) headed by civil surgeons and upazila health officers under the supervision of the Directorate General of Health Services (DGHS).
“The government has taken macro plans for the vaccination campaign, but some micro plans are also necessary to administrate the vaccine. The manpower in the EPI has the skills to implement these micro plans,” the expert said.
Online registration may not be effective
Dr Lenin said people, aged between 55 and 65, should be given the vaccine on a priority basis as the mortality rate among this group is very high. “But, I think, it’s the most challenging job to make the right lists of possible vaccine recipients based on priority".
Besides, he said, the government is going to launch an online registration drive using an app on January 26. “But many people, especially the elderly one and those living in rural areas, in our country are not friendly to technology. So, online registration will be difficult for them.”
The expert said the government should think about the alternative ways and use the public representatives and community clinics for making the proper lists of the possible vaccine recipients.
Carrying out trials
Prof Dr Mohammed Atiqur Rahman, a respiratory medicine expert and the treasurer of BSMMU, said the vaccine must be administrated with ensuring all the necessary safety and precautionary measures so that no negative impression is created.
“The government should not be in a hurry to begin the vaccination programme at the mass level. I think we should first conduct some trials at different hospitals where doctors and nurses are available with other preparation to look after the vaccine recipients in case of any sudden side effect,” he said.
Atiq said those elderly people and patients who have comorbidities should not be selected for the vaccination at the initial or trial stage. “There’s some sort of confusions among people about taking the vaccine. So, the government should be very careful in starting the mass campaign. We should earn people’s confidence through successful trials before launching a mass inoculation campaign.”
Briefing on vaccination
Abu Jamil Faisel, one of the members of the Public Health Expert Divisional Advisors' Group, said the government is taking various preparations for making the vaccination campaign a success. “But these are not enough as we don’t have previous experience of such a large-scale mass inoculation. We also did not allow the phase-three trial of any vaccine. So, it’ll be difficult to achieve perfection for lack of experience, no matter how much preparation we’ve taken and how much people we’ve trained.”
He said the government must communicate with people through a mass campaign and disseminate information about the merits and demerits of the vaccine.
“The ministers, politicians and other authorities concerned should not make any unguarded remarks on the vaccine that may create confusion among people. We must convince people to receive the vaccine through motivation.”
Faisel said the government should get ready to tackle any negative campaign and propaganda against the vaccine. “There should be a regular briefing by the DGHS on the vaccination programme and thus remove people’s confusion by giving them the necessary and right information."
Faisel said public representatives, imams, alem-ulema and NGO activists should be engaged in the vaccination drive to encourage people to receive the jabs.
Prime Minister Sheikh Hasina on Saturday inaugurated the distribution of homes among 66,189 landless and homeless families across the country under the Ashrayan-2 Project as part of the government’s pledge to provide houses to all landless and homeless families during “Mujib Borsho”.
Hasina virtually distributed pucca houses to some 66,189 landless and homeless families under the project as a gift from her government in Mujib Borsho, marking the birth centenary of Bangabandhu Sheikh Mujibur Rahman, the Father of the Nation.
Apart from the pucca houses, the poor families got ownership papers of two decimal land parcels from the Prime Minister, who launched the distribution process virtually from her official residence Ganobhaban. All the houses have been constructed on Khas land.
The government has constructed 66,189 houses at a total cost of Tk 1,168 crore. Each unit has two rooms, a kitchen, a toilet and a veranda, constructed at a cost of Tk 1.75 lakh.
Another 100,000 houses will be distributed among the poor next month.
Besides the Ashrayan Project, the PMO will rehabilitate 3,715 homeless families in 743 barracks in 44 villages across 36 upazilas of 21 districts during the Mujib Borsho.
The PMO prepared a list of 885,622 families in 2020, of which 293,361 are landless and homeless, while 592,261 have just 1-10 decimal land parcels but no housing facility.
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The Ashrayan Project rehabilitated some 320,058 landless and homeless families between 1997 and December 2020.
On the other hand, the Ashran-2 project (July 2010-June 2022) aims to rehabilitate 250,000 more landless, homeless and displaced families, at a cost Tk 4,840.28 crore. It has so far rehabilitated 192,277 poor families across the country.
A total of 48,500 landless and homeless families have been rehabilitated in barracks while 143,777 having own land (1-10 decimals but unable to construct houses) in semi-barracks, corrugated iron-sheet barracks and specially designed houses.
The government is arranging accommodation for the homeless and also the landless families under Ashrayan-2 project, a housing project run by the PMO. The government has enlisted 293,361 homeless and also landless families as well as 592,261 homeless families throughout the country.
The Prime Minister joined the inauguration programme virtually from her official residence Ganobhaban and got connected with 492 upazilas across the country.