Director’s Report 1998 hallmarked both achievements and new challenges for the Centre. While the Centre expanded in its project activities and financing, its core staff and budgets decreased thereby requiring major adjustments. A process of right-sizing and restructuring was agreed to by its governing Board of Trustees and initiated by the senior management team. The unprecedented flood of 1998 in Bangladesh posed new challenges to the clinical units of the Dhaka hospital and the Matlab Research and Service Centre expanding daily patient admissions to record highs. Through our epidemiological surveillance and control teams and environmental health initiatives, ICDDR,B provided outreach healthcare to numerous rural and isolated areas to control epidemics of diarrhoeal disease due to the flood. At the same time, ICDDR,B took on new initiatives and acquired new donor support from international organizations and the corporate sector. In 1998, we saw the departure of several key members of the senior management team, each of whom contributed to the growth and development of the Centre. We acknowledge with sincere appreciation the contribution of Dr. Robert Suskind who served as Director of ICDDR,B till June 1998. During his brief tenure, Dr. Suskind made several noteworthy contributions, like attracting the interest of a new major donor, the World Bank. He also provided a vision of how the Centre might be organized along the lines of scientific themes as a means of integrating the skills of the Centre’s scientists across the four scientific divisions. These contributions will have a lasting effect on the future of the Centre. We also gratefully acknowledge the Sheikh Hasina, Hon'ble Prime Minister of Bangladesh, saw contributions of Mr. Ali Mahbub as Director of first-band the patient care at the permanent facilities as well as the expanded makeshift units during the 1998 flood- the Administration and related epidemics of diarrhoeal diseases Personnel Division for almost ten years and of Syed Shamim Ahsan as Director of the Health and Population Extension Division. Professor Patrick Vaughan’s contributions to the reorganization of the Public Health Sciences Division and strengthening of the Matlab Research and Service Centre, its community-based clinics and demographic surveillance system are noteworthy and much appreciated as significant accomplishments for the Centre. In July 1998, I agreed to serve as the Centre’s Interim Director at the request of and appointment by the Board of Trustees. In November 1998, the Board of Trustees selected Professor David Sack of the Johns Hopkins School of Hygiene and Public Health to assume the post of Director of ICDDR,B, effective October 1999. As a former director of the Laboratory Sciences Division, Dr. Sack has had a longstanding relationship with the Centre. We look forward to working with him in his future role as Centre Director. The Prime Minister of Bangladesh Sheikh Hasina visited the Dhaka hospital on 28 September during the height of the diarrhoeal disease epidemic caused by the unprecedented flood of 1998. During her visit, the Prime Minister observed the treatment of severely malnourished children in the Nutrition Rehabilitation Unit and patients in the Short Stay Ward, the General Ward, and the makeshift unit of the hospital. The makeshift unit had to expand to serve the patient load that tripled in its daily average during the flood epidemic. Once again, the Prime Minister praised the Centre, expressed her satisfaction over the diarrhoea management system, and pledged continued support to the Centre. Donor support to the Centre was multifaceted. Although unrestricted (core) contributions continued to decline, project support expanded with major funding provided for new initiatives in emerging and re-emerging infectious diseases, safe motherhood and reproductive health, vaccine studies, and nutrition, including micronutrient interventions. The shift of selected core activities to restricted (project) funds, coupled with significant savings in 1998, resulted in a decrease of approximately US$589,000 in our net expenditure, excluding capital costs, for the year that led to a deficit of US$ 818,000. The reduction in our deficit of almost one million US dollar stands in contrast to the previous projection that our deficit would be nearly US$ 1,611,000 in 1998. Initiatives to right-size the Centre’s workforce, particularly through streamlining its administrative structure, have resulted in a potential annual reduction in salary outlay of approximately US$ 471,000 in future years. This concerted effort by the Centre has enabled a reduction in our deficit from US$ 1.8 million in 1997 to an actual of US$ 818,000 by the end of 1998. The long-term financial impact of our efforts to right-size, as the first major step in the Centre’s reorganization, will not be fully realised till the year 2001. Additional support during the flood-related epidemic from our traditional donors covered the cost of treatment of the expanded patient population, helped us rehabilitate the ICDDR,B facilities in the hospitals and communities affected by the flood damage, and provided new equipment to enable us to better control infection in our hospital and clinical facilities. The contribution from four international energy companies marked the first major private-sector contribution that not only provided relief during an epidemic but also provided support to strengthen the hospital’s infrastructure to ensure its ability to successfully manage future epidemics. The External Relations and Institutional Development Office played a key role in coordinating the donor responses to the flood-related epidemic. Upon completion of a human resources review in May, the staff size was reduced by 94 personnel through separation and retirement packages. The Board of Trustees endorsed the conceptual framework for the Centre’s reorganization. Acknowledging that the process will be continued over the next year, the senior management team is carefully approaching reorganization with a view to structuring the Centre in a way that will preserve existing strengths of the institution. At the same time, emphasis will be given to a cross-divisional thematic approach for research and other programmes. This is expected to make more efficient use of the multidisciplinary skills of the Centre and be also more consistent with the way in which donors provide funding. The Clinical Sciences Division (CSD) continued to strengthen its programmes in research, service, and training in 1998. The Clinical Research and Service Centre—the Dhaka hospital of ICDDR,B—treated a record highest number of 157,441 patients, reflecting in large part the flood- related epidemic of diarrhoeal diseases. This implies a 37% increase in patient visits compared to 1997. Hospital surveillance data revealed enterotoxigenic Escherichia coli to be more significantly associated than V. cholerae with summer peak of diarrhoeal diseases while childhood shigellosis and cholera were found to be associated with malnutrition in contrast to rotavirus which was associated with better-nourished children. Case management remains an important area of CSD’s research. Zinc supplementation to under- nourished children with persistent diarrhoea resulted in reduced duration of diarrhoea, better nutritional status, and fewer deaths. The roles of zinc, vitamin A, and iron in the management of severe malnutrition, diarrhoeal diseases, acute respiratory tract infections (ARI), Helicobacter pylori infection, and anaemia in children and women, and in the immune response in humans are also being assessed in a number of hospital- and community-based studies. Efforts continued toward development of better oral rehydration solutions to meet special requirements of specific population groups, such as neonates, young infants, and severely malnourished children. Under the emerging Mr. Alexander Downer, Hon’ble Foreign Minister of Australia, presenting AusAID’s annual contribution and to Director Prof. Robert M. Suskind re-emerging disease research initiative, CSD expanded its research activity in ALRI including identification of aetiology, antimicrobial resistance among major bacterial pathogens, and designing better therapeutic interventions. As part of its child survival activities through the Dhaka hospital, CSD maintained its programme for treatment of severely malnourished children, immunization against EPI diseases, and health education. Promotion of home management of diarrhoeal diseases; prevention of malnutrition through the use of locally-available, culturally-acceptable inexpensive foods; promotion of immunizations, exclusive breast-feeding during the first five months of life; and family planning remain the primary objectives of the child survival programme. To continue support for these child survival activities, CSD entered into discussions with JSI Urban Family Health Partnership in Bangladesh as a collaborator in providing services, improving hospital-based educational programmes, developing a referral network to UFHP’s urban clinics for follow-up and identifying means of self-sustainability of hospital services. The collaboration is expected to begin in mid- 1999. The Laboratory Sciences Division (LSD) undertook and developed a new strategic plan for the Division in 1998. Research into the causes and reservoirs of Vibrio cholerae O1 and V. cholerae O139 and the possible mechanisms for the emergence of new epidemic strains of V. cholerae continued. In the field of vaccine evaluation,