icddr,b’s Response to the Ongoing Massive Diarrhoea Outbreak in Dhaka and Matlab

20 APR 2022

icddr,b is an international health research institution based in Bangladesh. Since 1960s, it has been operating two diarrhoeal disease hospitals in Dhaka and Matlab, Chandpur in Bangladesh. icddr,b Dhaka Hospital is the world’s largest diarrhoeal disease hospital that treats more than 160,000 patients annually, while it’s Matlab Hospital treats about 50,000 patients. These hospitals experience two seasonal peaks of patients every year – one in the premonsoon period and another in the post-monsoon season. The pre-monsoon peak usually begins in late March/early April. However, this year, the hospitals started receiving a historical record-high number of patients on a single day since the second week of March.

Earlier, only in 2018 and 2007, icddr,b Dhaka Hospital treated more than 1,000 patients a day in its sixty years of history. In late March 2022, the daily patient count for Dhaka Hospital exceeded 1,300 per day. From 1 March 2022 until 10 April 2022, Dhaka Hospital treated more than 42,000 patients, and Matlab Hospital treated over 8,300 patients. All the patients are treated absolutely free of charge.

In order to manage the historical record-high number of patients icddr,b has initiated several immediate steps.

TREATING THE ACUTELY ILL PATIENTS

A visit to the Emergency area of the Dhaka Hospital shows how busy the place is with sometimes two patients arriving every minute in a state of shock due to severe dehydration. This is a condition that can be fatal if not treated immediately. Doctors and nurses run from one bed to another to provide the much needed intravenous fluids and other treatment. Patients who present with other complications are shifted to the ICU for appropriate care.

STRENGTHENING CAPACITY

icddr,b hospitals maintain a motto of turning no patient away. As soon as the number of patients started to increase, two temporary tents were installed to increase the capacity of Dhaka Hospital from taking care of 350 patients per day to about 1,400 patients. It also expanded its logistics and human resources support to match the growing demand. The Dhaka Hospital assigned 30 doctors from different studies and projects, including five from the Severe Acute Respiratory Infections Treatment Centre (SARI ITC) in Teknaf, and recruited another four on a temporary basis. Additionally, the Hospital recruited 41 nurses on a temporary basis and assigned 8 nurses from different studies. Other health workers and support staff have also been recruited on a daily basis. Similarly, Matlab Hospital has also engaged doctors and nurses primarily responsible for maternal and child health care in the treatment ofdiarrhoeal patients. Additional beds and logistics were also arranged in Matlab Hospital.

UNDERSTANDING THE CAUSE

In addition to looking at the patient’s demographic data, icddr,b runs a surveillance system based on a 2% systematic random sample of all patients regardless of their severity of illness. The demographic, aetiologic, clinical, and therapeutic aspects of these patients are studied in detail. Like in the past outbreaks, organisms such as V. cholerae, Enterotoxigenic Escherichia coli (ETEC), Rotavirus, and Campylobacter are driving this ongoing outbreak. Based on the immediate assessment of all available data, it was assumed that a number of factors could have triggered this early outbreak of the diarrhoeal disease, including poor quality of water and food, poor hygiene practices, and rising environmental temperature which is favourable for these pathogens’ rapid reproduction.

STRENGTHENING WATER QUALITY

At the early onset of the outbreak, icddr,b reached out to the Dhaka Water Supply and Sewerage Authority (WASA) and shared the location details from where most patients are coming with acute watery diarrhoea (AWD). The WASA took up the matter very seriously and increased chlorination among other measures.

STRENGTHENING CLINICAL MANAGEMENT OF DIARRHOEA IN PUBLIC HOSPITALS

In partnership with the Communicable Disease Control (CDC), Directorate General of Health Services (DGHS), Bangladesh, icddr,b has initiated training of trainers’ programme on Diarrhoeal Disease Clinical Case Management. Two training courses have already been completed with more than 48 physicians from 36 public health facilities in and around Dhaka city. In the case of Matlab, the Civil Surgeon of Chandpur and Upazila Health and Family Planning Officer toured to Matlab Hospital. Subsequently, they have strengthened diarrhoea management in Chandpur General Hospital and Upazila Health Complexes. Additionally, a team of 20 physicians from different public health facilities led by the Superintendent of Chandpur General hospital were provided hands-on training on diarrhoeal disease management.

ENGAGEMENT OF LOCAL GOVERNMENT INSTITUTIONS

icddr,b facilitated a visit of the Chief Health Officers of the Dhaka North City Corporation (DNCC) and Dhaka South City Corporation (DSCC) to the hospital and updated them on the ongoing outbreak. Both the City Corporations took the matter urgently and seriously. They agreed to begin an awareness campaign on diarrhoea prevention, engaging local Commissioners. They will also engage their hospitals (Dhaka Mahanagar and Shishu Hospital, Ayurvedic College Hospital) in clinical case management.

ORAL CHOLERA VACCINATION

icddr,b in partnership with the CDC, DGHS working to roll out an oral cholera vaccine (OCV) campaign as part of the National Cholera Control Plan in various parts of the city. Communication has started with the World Health Organization (WHO), Global Task Force on Cholera Control (GTFCC), and other stakeholders to bring OCV doses from the global stockpile of the vaccine. Subsequently, 2.3 million people will be vaccinated starting in May 2022. 

AWARENESS-RAISING

icddr,b has been running an extensive awareness campaign through mainstream media. More than several hundred TV and Print reports were facilitated. Special diarrhoeal disease management at home and prevention related awareness messages have also been disseminated through social media channels.

icddr,b senior management has been monitoring the situation in real-time and extending whatever support is required to manage the patients at its hospital. Many of its research physicians and staff have been mobilised to the hospital. More than 42,000 patients (of which 20% are children) have been treated so far since the second week of March, of which a significant percentage of patients are suffering from deadly severe dehydration resulting from acute watery diarrhoea. However, within 24 hours majority of the patients are becoming stable and are sent back home. An analysis of the 2018 diarrhoea outbreak revealed that if the facilities of the Dhaka Hospital were not available, more than 17,000 patients would have died (Hasan T, et al. 2021). Therefore, both Dhaka and Matlab Hospitals save the lives of thousands of patients every year during the outbreaks.

icddr,b HOSPITALS NEED YOUR SUPPORT NOW MORE THAN EVER

icddr,b Hospitals have been overwhelmed with historical record high number of patients. Currently we are treating 1,300 patients per day, which has surpassed our capacity forcing us to erect two make-shift tents inside our campus to cater service for a record number of patients. The daily average cost of treating this patients is about USD50,000. In order to meet the growing cost, we are appealing to individuals and businesses to kindly support us and donate to our life-saving hospitals. Donations can be made from Bangladesh and abroad and applicable for income tax rebate.

Link for the donation: https://donate.icddrb.org/