How Bangladesh took on a global killer with the world’s only diarrhoeal disease hospital

In Dhaka, Bangladesh, two-month-old Sammiya flops lifelessly in her mother’s arms, her eyes glazed over.

She is suffering from diarrhoea. This may not sound life-threatening – for most of us (in the West) diarrhoea is unpleasant, it might ruin a holiday or mean a few days off work at worst – but for many people across the world it is a killer.

Globally, a child under five dies every two minutes as a result of diarrhoea: 500,000 a year. Sammiya will not be one of them. She is being treated in the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka, the only diarrhoeal hospital in world, which treats 220,000 patients a year.

As the birthplace of cholera – one of the biggest and deadliest causes of diarrhoea – Bangladesh has a lot of experience in dealing with diarrhoeal disease and, more recently, of doing so successfully.

Rather than a disease itself, diarrhoea is the symptom of an infection. In the ICDDR,B clinic in Dhaka, for example, around 20 per cent of the patients come in suffering from cholera, and the rest from rotavirus, shigella, salmonella and e-coli.

Globally, rotavirus is the most common cause of diarrhoea. Understanding how such diseases are spread long baffled doctors. In the 1800s when epidemics of cholera started to break out around the Bay of Bengal they were blamed on ‘miasma’: noxious particles in the air.

Only in the 1880s did scientists discover that the bacteria which causes cholera is waterborne – thriving in salty water. “It then took a hundred years, until the 1980s, for them to find out why – because it lives in algae,” says Dr Sirajul Islam, explaining how cholera epidemics occur twice a year: when the algae bloom in the pre- and post-monsoon seasons.

From the swampy water the cholera bacteria finds it ways into human’s systems through consumption. It is then passed along in what is known as the faecal oral route: human faeces (containing the bacteria) contaminates water which is then consumed by another person.

Most of the diarrohea-causing infections are spread this way. In rich countries faecal contamination is rare, but in the developing world surprisingly, or perhaps unsurprisingly, it is common. With nastier bugs causing diarrhoea, deaths are also more frequent.

“Cholera is not like other diarrhoeal diseases,” says Dr Firdausi Qadri “you can lose 50 per cent of your body weight in a very short space of time, hours: people often arrive here with barely traceable pulses.”

Less than 50 years ago whole villages would be wiped out by cholera epidemics. The other factors that make diarrhoea deadlier in developing countries are access to adequate healthcare, the individual’s immunity and general health.

In countries where malnutrition effects large swathes of the population, for example, and where people live in overcrowded dirty conditions, immune systems are weaker, particularly among children.

Death from diarrhoea, as such, becomes a real risk. Since 2005, however, the global mortality rate among children under five, as a result of diarrhoea, has dropped by 40 per cent, and overall by around 20 per cent. Some regions have seen bigger reductions, for example south east Asia saw a 65 per cent reduction. Bangladesh leads the pack, though.

According to statistics from the World Health Organization (WHO), in 2003, diarrhoea killed more than 560 per million in Bangladesh. By 2013 this had been reduced to 145, and last year to three: a 95 per cent reduction. A wander around the ICDDR,B hospital in Dhaka explains some of this success.

Patients, divided into three wards depending on the severity of their illness, lie in neat rows of cholera cots – hospital beds with holes in the centre and buckets beneath – which allow nurses and doctors to accurately assess how much water they have lost and replace it.

 

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