Stephan Uttom and Rock Ronald Rozario, Dhaka
Updated: June 12, 2019 05:20 AM GMT
A worker washes chemical containers in the Buriganga River near the Bangladeshi capital Dhaka in this Feb. 2, 2017 file photo. Many world rivers are polluted with antibiotics that exceed environmental safety thresholds by up to 300 times. (Photo by Stephan Uttom/ucanews.com)
A recent article in a British newspaper shocked many people in Bangladesh when it reported that 80 percent of deaths in the intensive care unit (ICU) of the country’s largest hospital might have resulted from superbugs.
Quoting Prof. Sayedur Rahman, chairman of the pharmacology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), the report in The Telegraph on April 22 said 400 out of 900 patients admitted to the ICU in 2018 had died.
About 80 percent of deaths were attributed to a bacterial or fungal infection that was resistant to antibiotics, he said.
Bangladesh, India and Pakistan are seen as drivers of antimicrobial resistance (AMR) because of poor adherence to antibiotic treatment, non-therapeutic use of antibiotics for growth promotion in farm animals, self-medication and illegal over-the-counter access to antibiotics, the report said.
"Superbugs" is a term used to describe strains of bacteria that are resistant to most antibiotics commonly used today, according to the Mayo Clinic, a non-profit medical center in Minnesota in the U.S.
Over time, bacteria adapt to the drugs that are designed to kill them and change to ensure their survival. This makes previously standard treatments for bacterial infections less effective and in some cases ineffective, it states.
Some 70 percent of deaths in ICUs all over Bangladesh can be put down to superbugs, Prof. Ahmed Abu Saleh, chairman of the department of microbiology and immunology at BSMMU, told Bangladeshi newspaper The Daily Star.
The reported proliferation of superbugs has divided doctors, researchers, officials and public opinion in Bangladesh. Some back the findings of the report but others blame endemic water and air pollution due to corruption and lax enforcement of environmental regulations.
However, a recent global study has shed new light on what might be linked to the increase in AMR-related deaths in Bangladesh. On May 27, the University of York in England released a global study that found hundreds of sites in rivers around the world, including in Bangladesh, are polluted with antibiotics that exceed environmental safety thresholds by up to 300 times.
British researchers looked for 14 commonly used antibiotics in rivers in 72 countries across six continents and found antibiotics at 65 percent of the sites monitored, the study said.
Metronidazole, which is used to treat bacterial infections including skin and mouth infections, exceeded safe levels by the biggest margin, with concentrations at one site in Bangladesh 300 times greater than the safe level, it found.
Pesticides, poultry feed and poor surveillance
Indiscriminate use of pesticides in fields, feeding poultry and livestock with fattening hormone-coated fodder and the dumping of chemical waste are the main reasons for the high presence of antibiotics in Bangladeshi rivers, said Dr. Edward Pallab Rozario, secretary of the Catholic Bishops’ Healthcare Commission.
“Pesticides spread in rain and contaminate river water, we eat the meat of livestock that were fattened with hormone drugs, and industrial factories including pharmaceuticals dump waste in the river without treatment. We are putting our lives in danger every day,” Dr. Rozario told ucanews.com.
“A lack of surveillance results in excessive use of antibiotics in hospitals by doctors on patients, while pharmacies sell antibiotics to people without a prescription from registered doctors. These are unacceptable health habits leading to life-threatening situations.”
The recent deaths of two prominent Catholics in Bangladesh — Holy Cross priest Father Benjamin Costa and Dr. Sebastian Halder — were attributed to superbugs in hospitals, he noted.
Dr. Sheikh Zahir Raihan, an associate professor of clinical pharmacy and pharmacology at the University of Dhaka, had similar concerns.
“Nowadays antibiotics and superbugs are hot topics for discussions in a densely populated country where many people don’t have adequate access to health care and many are not even aware about healthy living,” Dr. Raihan told ucanews.com.
The proliferation of superbugs in hospitals and rivers teeming with antibiotics are disasters created by human beings, he said.
“In developed countries, the use of antibiotics is discouraged and restricted, but it is highly disregarded in third world countries like ours. Moreover, contamination of river water is a new but dangerous threat to public health in this riverine country,” Dr. Raihan added.
Proper regulation and enforcement is required to save the nation from an impending health disaster, he warned.
A polluted canal connected to the Buriganga River in the Bangladeshi capital Dhaka is seen in this Feb. 2, 2017 file photo. Chemical and medicinal waste dumping are major causes of water and river pollution in Bangladesh, experts say. (Photo by Stephan Uttom/ucanews.com)
The government has made efforts to curb antibiotic use and river contamination, said Dr. Samir Kanti Sarkar, director of the Directorate General of Health Services (DGHS) under the Ministry of Health.
“Any factory is supposed to have a treatment plant for effluent processing before dumping, but this rule is often flouted. The Department of Environment is tasked to monitor it and punish any factory for violation,” Dr. Sarkar told ucanews.com.
He said the government has learned of the University of York report and a plan is underway to conduct testing of river water in Bangladesh.
“As far as I am concerned, no pharmaceutical company or hospital dumps waste in rivers or canals. Yet, if we find credible evidence against any organization, we will take punitive action,” he added.
On April 25, the High Court ordered the government to take steps to ban the sale of antibiotics without a prescription from registered doctors.
Dr. Sarkar said that once the DGHS obtains the court order, steps will be taken to enforce it nationwide.
Water and river pollution are common in Bangladesh, which has a population of more than 160 million and is crisscrossed by more than 300 rivers and their tributaries that empty into the Bay of Bengal.
Rivers play a vital role in the livelihoods and transport of millions of people. However, many rivers are drying up or are clogged because of pollution and encroachment.
In 2009, a World Bank study found than four major rivers near Bangladeshi capital Dhaka — the Buriganga, Shitalakhya, Turag and Balu — receive 1.5 million cubic meters of wastewater every day from 7,000 industrial units in surrounding areas and another 0.5 million cubic meters from other sources.
“We are trying our level best to stop pollution of rivers. We have a shortage of manpower and a serious lack of public awareness, but we have continued our efforts,” Mohammad Monsur Alam, deputy secretary of the Department of Environment, told ucanews.com.
“The government cannot alone save rivers — it is a responsibility of every citizen.”
This YouTube video shows how many of the world’s rivers are polluted by antibiotics: