Nutrition
Nutritional deficiencies persist in vulnerable groups (pregnant women, children; general and in emergencies). Field staff are not conversant with existing guidelines to improve nutritional deficiencies.

Health and Environment

Air pollution: ARI and other respiratory diseases form the largest share of the reported disease burden in Bangladesh; In rural households the use of bio mass as cooking fuel is the main cause of indoor air pollution; Vehicular air pollution is a major cause of respiratory distress in Urban Bangladesh

Water Supply and Sanitation: The water supply coverage in Bangladesh stands at approximately 97 %. However, the safety of water for human consumption is often suspect: a recent WHO/SEARO study concluded that no SEAR country has an adequate national programme of drinking water quality and surveillance. In recent years the problem of arsenic contamination of ground water has further caused large sections of the population to risk exposure due to the absence of alternative safe water supply solutions. Also, large differences in quality of service occur between rural, peri-urban and urban areas, causing risk of substitution with sources of poor quality.
Sanitation coverage in the country is estimated at around 40%, with wide differences between rural and urban areas. Effective water supply and

sanitation coverage in Bangladesh is significantly lower than the above-mentioned estimates. Especially, the rapidly growing urban centres need support aimed at developing sustainable water and sanitation systems.
Substantial further investment in water supply and sanitation infrastructure, and greater sector efficiency, are needed to achieve the Millennium Development Goals (MDG) for water supply and sanitation and other closely related MDGs for child mortality and other health issues, and poverty alleviation.
Attention needs to be given to improve understanding of the contribution of poor water supply, sanitation and hygiene to the national burden of disease. School health needs strengthening as a vital point of intervention for life-skills education for sanitation and hygiene, and for helminthes control and nutrition.
The Government of Bangladesh has taken up a multi-year programme on total sanitation starting in October 2003. In 2003 water quality surveillance in some 120 towns has been re-started. Together with continued laboratory strengthening, an overall surveillance programme covering bacteriological and chemical parameters needs developing.
With frequent natural disasters visiting Bangladesh, collaboration between the water supply, health and disaster preparedness sectors should lead to a greater response capacity to deal with interruptions in water supply and sanitation.

Arsenicosis: Arsenic contamination of ground water is directly affecting the health of some 30-35 million people in Bangladesh, through ingestion of arsenic contaminated tube well water. Government efforts to address the health, water supply engineering, and fiscal consequences are now gathering steam. However, a lot of capacity building, continued monitoring, research and development of safe alternative sources and approaches for patient identification and management will be required to slow down and eventually overcome the health consequences of the arsenic crisis.

Urbanisation: Unbridled urban growth and proliferating slums are leading to serious risks to well-being and health of the urban population. Partnership between local government authorities and citizens (groups) for development of infrastructure and improvement of primary health care services in combination with awareness raising on health and environment linkages and targeted action to improve and promote community-based water supply, sanitation, shelter, management of solid and hazardous (incl. clinical) waste, air quality management, etc. is proving a promising way forward.

Health and Environment/Vulnerable population groups: People living in flood-prone areas and urban slums, the poor, disabled persons and the elderly, children and adolescents are affected proportionally more by poor environment and infrastructure. Special attention and advocacy is needed to ensure that health risks are reduced, access to services is established and sustained, and economic and educational opportunities are created.
Climate change is affecting Bangladesh disproportionately. Increased risks due to vector-borne diseases, flooding and air quality will need to be assessed.
Casual labour, industrial and agricultural workers work long hours in exhausting and often dangerous conditions. Occupational health risks in particular in the non-formal sector need attention. Risks related to the use of chemicals and radiation sources in industry and society at large should be reduced through proper licensing, training and public information.

Food Safety
Poor food hygiene is a major cause of regular disease and discomfort. Adulteration of foodstuffs is rampant. There is a lack of appreciation by general public for food safety. Collaboration with sector agencies for consumer education is critical. The Institute of Public Health needs to build further capacity and make the sanitary inspectors more effective communicators and regulators.

Emergency Preparedness and Response (EHA)
Bangladesh has in place a well-developed emergency preparedness infrastructure, with many agencies providing support to emergency preparedness and humanitarian assistance in times of the regularly occurring emergencies. Progress has been made in EPR in the last few years, in particular through the publication of guidelines, protocols and standard operating procedures on best public health practice in humanitarian emergencies. Further orientation and institutional capacity building of the health sector for emergency preparedness, health risk assessment, vulnerability reduction as well as disaster mitigation are critical to ensure that the adverse health consequences of frequent emergencies and disasters that are prevalent in the country do not offset the long-term health development gains in the country and that public health risks of natural as well as other human induced disasters are substantially reduced.

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