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Director's Report Director’s Report For the year 1997, the Centre’s progress is marked by administrative transitions, new initiatives and review of its objectives and agenda as we prepare for the third decade of the Centre’s research and programme implementation in child survival and reproductive health. The scope of activities has expanded to include: conducting research in new areas of infectious diseases; widening the spectrum of our operations research in Bangladesh; strengthening our collaboration with the Government of Bangladesh, regional institutions, and the NGO community; and enhancing our internal capacity through increased interdivisional Prof. Robert M. Suskind collaboration and the identification of new sources of support for the Director Centre. Such expansion will secure the future of the Centre as we prepare for entry into the next millennium. The administrative transition includes my appointment as new Director of the Centre following eight years of leadership under the direction of Dr. Demissie Habte whose tenure concluded in September 1997. In June 1997, the Board of Trustees appointed Mr. Jacques O. Martin, Head of Human Resources Division of Swiss Development Cooperation, as its new Chairman. The Centre continued to feel the impact of the worldwide changes in resources dedicated to development assistance. Changes in the level of support to the Centre from the aid agencies of the various donor governments reflect the shifting strategic plans and priorities of each donor in their provision of foreign assistance, support for international healthcare initiatives and population programmes worldwide. Consequently, the Centre experienced a further decline in donor support in some cases, particularly where donor countries have decided to give priority to sectors of the economy other than the healthcare sector. In other cases, donors have shifted resources into specific project support and severely limited support for the Centre’s core overhead expenditures. Ultimately, the resources that support essential entities within the Centre, such as the Dhaka and Matlab hospitals and the administrative structure of the Centre are insufficient, creating an overall shortfall in the Centre’s budget. Dr. Jon Rhode, member of the Dr. Demissie Habte, the Dr. Maureen Law, Chairperson Board of Trustees outgoing Director of the Centre of the Board of Trustees While the budgetary constraints continue to impact the overall financial condition of the Centre, research initiatives and findings have, nonetheless, continued with significant progress. Several new donors that support our scientific research activities and embrace our achievements have entered our portfolio. Collaboration has strengthened between the Government of Bangladesh and the Centre as well as between the Centre and NGOs in Bangladesh, regionally and internationally. Such activities are well-documented in this report. Achievements in research and service activities in each of the scientific divisions in 1997 are notable. The Clinical Sciences Division developed and tested a protocol to standardize the clinical management of severely malnourished children, which produced dramatic results. Compared to routine management, protocolized clinical management resulted in a 47% reduction in mortality during the acute phase and 55% greater weight gain during the nutritional rehabilitation phase of treatment. In the area of micronutrient research, clinical studies concluded that zinc supplementation reduced diarrhoea and accelerated recovery from persistent diarrhoea. Other important research findings showed that a single large dose of vitamin A significantly enhanced clinical recovery from shigellosis, indicating an adjunctive role of vitamin A in the treatment of children with acute shigellosis. These important outcomes for malnutrition and micronutrient research have application not only in Bangladesh, but globally as well. Laboratory Sciences Division had several important accomplishments through its continued research in characterizing diarrhoeal disease agents and in new research in reproductive health. Through our continued monitoring of V. cholerae O139 Bengal, a new clone was detected. Such monitoring provides important information about the evolution of new clones and their impending spread. A recent survey of rotaviruses that cause infection in Bangladesh identified 2 of the 4 serotypes covered by a recently developed rotavirus vaccine. This suggests a potential role for this vaccine in Bangladesh. Aetiological studies in a Dhaka slum population and in a women’s health clinic demonstrated the importance of the Centre’s continued work in tracking reproductive tract infections and sexually transmitted diseases (RTI/STD) in Bangladesh. 7KH-XQH%270HHWLQJLQ/RQGRQ As we move toward sustainability of global health initiatives, improved preventive measures in child survival and reproductive health are critical. The Public Health Sciences Division increased this knowledge through the development and testing of new prevention measures in the framework of community-based approaches. Notably, in a controlled village-based trial, household nutrition education for the promotion of beta-carotene-rich foods in children was shown to substantially improve dietary intake. The Mirzapur Birth Cohort follow-up study for the epidemiology of diarrhoea and ARI was successfully completed, and the laboratory and statistical analyses are continuing. A study conducted by the Reproductive and Sexual Health Programme found that introduction of high-quality antenatal and delivery care at the union level increased deliveries at the health centre. Mr. Tim Fischer,Hon'ble Deputy Prime Minister of Australia, presenting the AusAID's annual contibution to Director Dr. Demissie Habte. The Australian High Commissioner to Bangladesh H.E, Mr. Charles Stuart (extreme left) is also seen Mr. Peter Goldmark, President of the Rockefeller Foundation, Looking at a mother and her son in the Centre's hospital Identification of patterns in population growth and solutions to health problems has been facilitated through the use of the Demographic Surveillance System (DSS) and the Record Keeping System (RKS) as components of the Matlab Programme. DSS and RKS have provided surveillance data since 1966 and 1977 respectively in part of Matlab thana, a rural area of Bangladesh with a population of 210,000. This data collection system is a unique tool for health and population research in developing countries because of its longevity and accuracy. DSS and RKS have been indispensable in the evaluation of the impact of health interventions carried out in Matlab because they provide the numerators and denominators of demographic and epidemiological parameters, such as birth and death rates, cholera incidence rates and contraceptive use rates. 1997 gave rise to an initiative to set new long-term objectives for Matlab. These objectives included expanding the Safe Motherhood programme in Reproductive Health and testing the validity of the global strategies of the Integrated Management of Childhood Illnesses (IMCI) initiative. The November BOT Meeting in Dhaka Both new and the outgoing Directors of the Centre with Dr. Didier Leboulleux, Medical Director of Rhone-Poulenc Rorer (RPR), Asia region (2nd from left) and Mr. A.K.M. Shamsuddin, Managing Director of RPR, Bangladesh (extreme right) The Health and Population Extension Division entered into a new phase where rural and urban operations research activities in maternal-child health and family planning (MCH-FP) were consolidated into a single operations research portfolio--the Operations Research Project (ORP). The hallmark of the ORP in this phase is the Centre’s partnership with the Ministry of Health and Family Welfare and NGOs under the USAID-funded National Integrated Population and Health Programme (NIPHP). The concept of an essential services package (ESP) developed by HPED and adopted by the Government of Bangladesh provides for delivery of essential healthcare services at every level from the community to the tertiary level of care. These services address child survival and reproductive healthcare needs and are currently being field-tested by ORP. The ESP will be part of the NIPHP contribution to the Health and Population Sector Plan, sponsored by the Government of Bangladesh, the World Bank, and the donor community, which is scheduled to be initiated in June 1998. Part of the audience at the Centre's 6th Annual Scientific Conference (ASCON VI) Prof. A.K. Azad Chowdhury, Vice Chancellor of the University of Dhaka, Presenting the inaugural address in ASCON VI The Centre’s role as a regional and global resource was reflected in the participation by local, regional and global participants in two major conferences during 1997. The "Zinc and Health In South Asia" symposium and workshop brought together investigators, planners, and policy makers in South Asia to critically review the results of recent zinc research and define future questions and programmatic implications. It also provided a forum to share experiences in research on zinc, nutrition and their potential implications on health and diseases in South Asia. The theme of the Sixth Annual Scientific Conference (ASCON VI) was "Reproductive Tract Infections and Sexually Transmitted Infections" and drew participation of colleagues from the Government of Bangladesh, international research community and from the NGO sector. The quality of the participation reflected the high quality of RTI/STI research underway both at the Centre
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