https://doi.org/10.4081/mem.2017.503

Il programma di eliminazione della filariasi linfatica in Bangladesh: un modello esportabile? / The lymphatic filariasis elimination programme in Bangladesh: an exportable model?

V. 66 N. 4 (2017)
Ricevuto: ottobre 11, 2017
Accettato: ottobre 11, 2017
Pubblicato: ottobre 11, 2017
filariasi linfatica, Bangladesh, community-based approach, capability approach, equità, Dichiarazione di Alma Ata / lymphatic filariasis, community based approach, equity, Alma Ata Declaration
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Autori

Elena Mancini
elena.mancini@cnr.it
Consiglio Nazionale delle Ricerche, Istituto di Tecnologie Biomediche (UOS di Roma), Italy.
Nel 1971, al termine della sanguinosissima guerra di separazione dal Pakistan, il Bangladesh appariva un paese senza speranza. L'elevatissima crescita demografica -una delle maggiori al mondo- le calamità naturali quali alluvioni e tifoni, la povertà grave e diffusa - con una percentuale di popolazione sotto la soglia di povertà intorno al 30% - la situazione politica interna, con instabilità sociale e latenti conflitti etnici, rendevano il pronostico più che verosimile. A distanza di 40 anni, il BGD è riuscito a smentire in gran parte tale previsione, conseguendo successi nello sviluppo economico, nella salute pubblica e nella trasformazione sociale. Il controllo del tasso di fertilità, la lotta a "big killer" quali la TBC e la diarrea infantile, il miglioramento delle condizioni igieniche e la realizzazione di presidi sanitari territoriali di prima assistenza (community-clinic), efficaci campagne sanitarie, il contrasto di malattie endemiche, sono stati ottenuti grazie all'impiego coordinato delle misure sanitarie dei programmi internazionali. Risultati, questi, conseguiti attraverso una politica sanitaria basata su una proficua collaborazione tra il Ministero della salute nazionale (Ministry of Health and Family Welfare), ONG, organismi sanitari internazionali, istituzioni e fondazioni internazionali. Il BGD ha così conseguito il traguardo della pressochè totale eliminazione delle malattie neglette endemiche nel paese (leishmaniosi viscerale, filariasi linfatica, dengue, lebbra, parassitosi intestinali - infezioni da elminti). L'articolo valuta i fattori che hanno caratterizzato il successo nel programma di eliminazione della filariasi linfatica. Dall'analisi di tali fattori è derivato un possibile modello di governance per la lotta alle malattie neglette in regioni endemiche comparabili sotto il profilo geo-politico.
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In 1971, at the end of the bloodstained separation war with Pakistan, Bangladesh appeared as a country without hope. The intense population growth - one of the highest in the world - natural disasters such as flooding and typhoons, acute and diffuse poverty - with a percentage of population below poverty line of 30% - the internal political scenario, with social instability and underlying ethnical conflicts - made this situation less likely to improve. 40 years later, Bangladesh succeeded in disproving such prevision, with a significant growth in economic development, public healthcare and social conditions. Birth control, countermeasures against "big killers" such as tuberculosis and diarrhea in babies, improvement of hygienic conditions and the implementation of local emergency units (community-clinic), effective sanitary campaigns and prevention of endemic diseases have been accomplished thanks to the coordinated use of sanitary measures in international programmes. Results obtained through a sanitary policy based on fruitful collaborations among the Ministry of Health and Family Welfare, NGOs, international health organizations, international institutions and foundations. This way Bangladesh achieved the result of an almost total elimination of neglected endemic disease in the country (visceral leishmaniasis, lymphatic filariasis, dengue, plague, intestinal parasitosys - helminth infections). The article analyses the factors contributing to the success of the Lymphatic Filariasis Elimination Programme. The study of such factors permitted to identify a governance model for fighting neglected diseases in endemic regions with similar geo-political environments.

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Mancini, E. (2017). Il programma di eliminazione della filariasi linfatica in Bangladesh: un modello esportabile? / The lymphatic filariasis elimination programme in Bangladesh: an exportable model?. Medicina E Morale, 66(4), 495–511. https://doi.org/10.4081/mem.2017.503

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