Thalassemia in Bangladesh: progress, challenges, and a strategic blueprint for prevention

Thalassemia, a preventable hereditary disorder causing defective hemoglobin production, presents a growing public health concern in Bangladesh, a country situated within the Global Thalassemia Belt. This review systematically synthesizes all available data on the prevalence, clinical characteristics, management challenges, and socio-economic implications of thalassemia in Bangladesh, offering a blueprint for a prevention strategy tailored to its unique socio-economic and cultural context. The review highlights a high carrier prevalence of 10.9-13.3%, translating to approximately 17-22 million carriers, with significant regional and ethnic variations, including a disproportionately high E-trait prevalence. Most transfusion-dependent thalassemia cases in Bangladesh are Hb E-Beta Thalassemia. With proper care, many patients can avoid regular transfusions. However, clinical management remains inadequate due to insufficient healthcare infrastructure, poor access to safe blood transfusions, limited iron chelation therapy, and a lack of multidisciplinary care. These gaps are compounded by socio-economic barriers, with most patients bearing 74% of treatment costs out-of-pocket, leaving many deprived of adequate care. Building on successful international prevention models from countries such as Cyprus, Iran, and Italy, the paper proposes a high school-centric intervention strategy for Bangladesh. This includes awareness campaigns, carrier screening, and genetic counseling targeted at adolescents, coupled with the integration of thalassemia education into school curricula. Additionally, it calls for the establishment of district-level treatment centers, a national patient registry, and policies to subsidize treatment costs. Despite the cultural and logistical challenges, the review underscores the urgent need to prioritize awareness, early diagnosis, and prevention over treatment. It emphasizes that thalassemia is theoretically 100% preventable through premarital screening and prenatal diagnosis if implemented with religious and cultural sensitivity. By providing a roadmap for a comprehensive thalassemia prevention and management strategy, this review aims to guide policymakers and stakeholders while improving the quality of life for existing patients.