3RDWORKSHOP ON CONSOLIDATING

NEWBORN SCREENING EFFORTS IN

THE ASIA PACIFIC REGION

February 25-27, 2012

Holiday Inn Manila Galleria
Philippines
 COUNTRY REPORT :
BANGLADESH

Prof. Fauzia Moslem

Bangladesh Institute of Health Sciences, Dhaka

and
Prof. Mizanul Hasan
Institute of Nuclear Medicine & Ultrasound, Dhaka.
INTRODUCTION

 Bangladesh is a small country in the south

east Asia with a large population of 160
million.
 The Annual birth rate of the country is still
quite high (24 per thousand) with a total
number of about 3.5 million birth per year.
 So far newborn screening is concerned, this is
a big challenge for a developing country.
INTRODUCTION

 Newborn screening started in Bangladesh in

the year of 1999 under a regional project of
IAEA.
 Since then the program is continuing with
completion of a few successful IAEA and
National projects.
 Now the country is heading for an universal
program.
COUNTRY UPDATE

 A pilot project under the Government’s

Annual Development Program (ADP) which
started in 2007, completed in December 2011.
 The Government spent about U$ 1.5 million
for this project.
 The project included different components
including sample collection and analysis.
Some Major Activities of ADP
Project
 Set up of laboratories
 Foreign & Local instruments
 Books & Furniture
 Chemicals
 Sample collection & analysis
 Public awareness program
 Workshop / meeting etc.
 Publications
Screening Update

 Condition Screened – CH
 Areas Covered – 12 corners of the country
 Sample Collection Centres – 75
 No. of Laboratories – 6
 Methods - RIA & DELFIA (PerkinElmer)
 Coverage for 2011 – 2%
 Policy on resident blood spots – storage in
A/C room, No new policy.
Summary of CH Screening
(2007-2011)
No. of No. of No. of No. of
Screening unsatis- screening diagnosed
factory Positive CH cases
samples samples (Incidence
rate)
220,232 7320 1204 96
(3.69%) (0.54%) (1:2295)
CURRENT STATUS

Some considerable progresses have been

achieved after the Cebu and Manila Workshop
on “Consolidating Newborn Screening Efforts in
the Asia Pacific Region” held in 2008 and 2010
respectively.
NATIONAL NEONATAL HEALTH STRATEGY AND
GUIDELINES FOR BANGLADESH, OCTOBER 2009
Update at the Ministry of
Health
 So far the NBS program in Bangladesh was a
project of Bangladesh Atomic Energy
commission under Ministry of Science &
Technology.
 The program was looked after by Nuclear
Medicine people who have a long experience
of dealing thyroid disorder.
 The Paediatricians & Obstetricians were
associated as a supporting partner.
Update at the Ministry of
Health
 This is a good news that from January 2012,
Ministry of Health & Family Welfare
(MOHFW) has taken up the program.
 This we consider a great achievement of the
past pilot project.
 Now following the guidelines of the national
neonatal health strategy, MOHFW has
started activity to screen newborns for
detection of congenital hypothyroidism.
Update at the Ministry of
Health
 The screening program under MOHFW has
been included under the heading of
management of non-communicable diseases.
 This is a big program of the Health Ministry
funded by local & donor agencies.
 However NBS is a completely new program
for the ministry and probably it will take
sometime to gear up.
Update at the Ministry of
Health
 The MOHFW has chalked out some initial
activities for NBS for the period January –
June 2012.
 These mainly include some awareness
program for their people including public
awareness program.
 Some limited screening will also be done in
collaboration with nuclear medicine people.
Update at the Ministry of
Health
 It is expected that in the next financial year
which will start from July 2012, the MOHFW
will allot some big budget for newborn
screening.
 Discussion is going on to set some
preliminary program for starting NBS under
the ministry.
Update at the Country Level

 Three seminars were organized in 2011 in

Dhaka which were attended by doctors,
paramedics and govt. officials.
 Two training programs were also organized
for nurses.
 A new TV advertisement was released in the
national TV which seems have more effect on
the people.
Update at the Country Level

 A good awareness regarding newborn screening

especially for congenital hypothyroidism has
been created.
 Now the doctors are more concerned about
congenital hypothyroidism and they are
detecting much more cases than before.
 Many a parents are coming directly to our
laboratory for screening of their babies.
 A few private laboratories are showing interest in
newborn screening program.
Update at the Regional Level

 Bangladesh is trying to maintain a good

cooperation in the regional and international
level for development of NBS.
 The country is joining and presenting its NBS
data in various regional level meetings.
 After the 2nd workshop of present working
group meeting in Philippines, we joined the 7th
ISNS Meeting in Bali, Indonesia from 3-5 October
2010.
 Also attended another meeting in Finland in June
2011 organized by PerkinElmer.
Update at the Regional Level

 A society has been formed leading by India

(Prof. Satish Deopujari) for the members of
the SAARC countries for promotion of
newborn screening in south Asian region.
 There was a meeting of the society in Dhaka
in last October 2009.
 However no definite activities could be
noticed since then.
PROGRAM ISSUES

 We can say that Bangladesh is entering into

second phase of newborn screening under
the umbrella of MOHFW.
 The Health Ministry will have to face many
new challenges to start the program.
 However they have a good networking
system and once started, it is hoped that the
thing will be quickly geared up.
PROGRAM ISSUES

 The MOHFW is giving priority on awareness

program and training of their manpower first to
start newborn screening.
 Since they have wide network up to the root
level, the coverage of screening will be hopefully
increased fast.
 It may be mentioned here that the present child
immunization coverage in Bangladesh is >90%.
 MOHFW will use that experience to implement
NBS program.
LABORATORY ISSUES

 At present MOHFW has no separate newborn

screening laboratory. However, the existing
pathological laboratories under the ministry
will be used.
 The already established 6 screening labs.
under Nuclear Medicine will also give service
to them.
 The QA issues will be ensured.
 Central Newborn Screening Authority
Director General

Director Director Director Director

Quality Control Clinical Procurement Finance

6 regional Lab
Manager

Clinical Officer
QC Officer 1. Pediatricians
Technical officers 2. Endocrinologist
Technical Staffs 3. Nuclear Physician
4. Obstetricians

Peripheral Collection Centers

 Central Newborn Screening Authority
Director General

Director
Director Procurement
Clinical

6 regional Lab
Manager

Clinical Officer
QC Officer 1. Pediatricians
Technical officers 2. Endocrinologist
Technical Staffs 3. Nuclear Physician
4. Obstetricians
 Collection Centre

Hospital Delivery Home delivery

Nurses Health Assistant
Health Assistants Health Worker
Cord Blood/Heal Prick Cord Blood/ Heal prick
Collected on Filter paper Collected on Filter paper

Supervisor THO

Regional Laboratory
Sample Analysis and Reporting
Database Preparation

Clinical Officer
Recall
Treatment
Follow Up
PRESENT NOTABLE SUCCESS

 Formulation and adaptation of a national

neonatal health strategy and guidelines –
2009.
 Successful completion of a 5 year pilot project
– 2011
 Starting of newborn screening by the
Ministry of Health - 2012
CONCLUSION

 We know newborn screening is not just a

screening test. It has got other important
components.
 In last one decade we could not give equal
emphasis to all the components.
 Now we stand in a position and hopefully
newborn screening in Bangladesh will be in a
better shape in days to come to save our children
from physical & mental retardation.
THANK YOU