Thalassemias in South Asia: clinical lessons learnt from Bangladesh

Abstract

Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries.

Lack of knowledge and misperceptions about thalassaemia among college students in Bangladesh: a cross-sectional baseline study

“…We found that the level of thalassaemia awareness was surprisingly low, and only one-third of the respondents (33%, n = 1578) had heard of thalassaemia. Being situated in the world's thalassaemia belt with an estimated carrier of about 6-12%, this result is quite unexpected [4] as compared to other thalassaemia-prevalent countries such as Malaysia (~87%), Italy (85%), Greece (95%), Bahrain (65%), Turkey (58%) and Saudi Arabia (48%) [12,[22][23][24][25][26]. This indicates that a major public health concern has been overlooked in Bangladesh.…”

“…As a consequence of globalisation, thalassaemia has become a global public health concern. An estimated 1-5% of the world population are carriers of thalassaemia [3] including an estimated 45-70 million people in South Asian countries [4]. Nearly half a million babies are born with serious hemoglobin disorders annually [5], with over 90% of these births in developing countries [3].…”

“…Nearly half a million babies are born with serious hemoglobin disorders annually [5], with over 90% of these births in developing countries [3]. In most developing countries the number of thalassemic children is expected to rise in the coming years with the decline in child mortality owing to better management of infectious diseases and malnutrition [4]. In Bangladesh, 6-12% of the population (about 10-19 million people) are carriers of a gene causing thalassaemia [4].…”

“…Standard management of thalassaemia is with regular blood transfusion and iron chelation therapy. In non-subsidised healthcare systems, the cost of standard treatment is high and greatly exceeds the average family income [4]. Moreover, the psychological impact of living with a long-term condition and associated social stigmatization is also a heavy burden for patients and their families in this part of the world [7,8].…”

“…Bangladesh is a low-income country with a population of over 160 million of whom around 72% live in rural areas. Although situated in the world's thalassaemia belt, the epidemiology and natural history of thalassaemia in Bangladesh are poorly documented [4]. Unlike, other South Asian countries (India, Pakistan, Sri Lanka and Maldives), there are no organized national programs in Bangladesh for raising awareness, screening carriers or managing patients with thalassaemia [13][14][15][16][17].…”