Malaria in Bangladesh tea estate perspective
Malaria is also prevalent in tea garden areas especially in those surrounded or bordered by forests. In Habiganj district Chaklapunjee Tea Estate and Kapai outgarden of Luskerpore Tea estate are the hyper-endemic areas
Dr Ahmad Munir Hussain
Malaria has always been major public health problem in Bangladesh. In the 50s malaria was widespread in the western and northern parts of the country. During the 60s the malaria eradication programme was very successful to reduce the malaria burden except in some border districts in the northern and eastern parts of the country. Since 1971, the malaria situation got worse steadily. In Bangladesh the official number of malaria cases has gradually increased since the 80s and the total number of reported cases almost doubled in 1992 (0.063 million). This presents only a fraction of total malaria morbidity burden in the country. Almost 8 million people live in the high risk areas.
At present we are facing again an increase in the number of people suffering from malaria in Bangladesh. The worst affected areas of the country are the border areas facing the Garo, Khashia and Jayantia forested hill ranges of India (Meghlaya Tripura) and the endemic forested hilly and foot-heel areas of Chittagong Hill Tracts and greater Sylhet. These areas encompass 17 districts and 54 thanas. Plasmodium falciparum malaria accounts for most of the morbidity and mortality. Recently, however increasing number of cases is reported from the vast plain areas of the country even from Dhaka. Most of the cases in these areas are Plasmodium vivax.
According to the update summary of malaria situation in Bangladesh from 1st January to 18th June, 1994, prepared by the department of health, 34 thanas out of which 3 in Sunamganj, 2 in Netrokona, 8 in Khagrachori,7 in Bandarban,10 in Rangamati and 4 in Chittagong fall in the worst affected areas. The total no. of malaria cases detected in these districts were 97,821. The total number of malaria related deaths in these districts was 360.
Malaria is also prevalent in tea garden areas especially in those surrounded or bordered by forests. In Habiganj district Chaklapunjee Tea Estate and Kapai outgarden of Luskerpore Tea estate are the hyper-endemic areas. Low resistance power of the garden population, increased number of mosquito, almost no practice of mosquito nets in the garden people lead to the increasing no. of malaria in tea estates.
However 3 major factors have made malaria control in Bangladesh very difficult. These are: (1) The increase in parasite resistance to common anti-malarial drugs like Chloroquine. (2) The appearance of Vector resistance to DDT and other insecticide. (3) The worrying emergence of new patterns of transmission especially in the border areas. This last factor points to the possible involvement of new anopheles species of mosquito which was not involved in the past in malaria transmission.
The impact of malaria on the economy of the local community or the household can be assessed as direct costs, such as the cost of treatment and control programmes or indirect costs, such as the value of income lost through disease i.e. death and morbidity. Loss of productivity can be measured as loss of working days or cost of replacement labour.
One study indicated that despite of increased work by healthy members of the family, neighbours and hired workers to compensate for the loss by the sick member, ultimate agricultural productivity is reduced by 30% due to malaria.
Malaria also undermines the effectiveness of investment in education. In highly endemic areas, the learning capacity of an estimated 25% to 60% of school children may be impaired by malaria. In addition, low birth weight baby as well as anaemia of adults and children overwhelmingly burden the family.
Absolute prevention or eradication of malaria is very tough. However this may be achieved to some extent by undertaking following measures: (1) To prevent breeding of mosquito by application of insecticides and larvicides in their breeding places like stagnant water, bushes etc. (2) Jungles and bushes around houses should be cleared for preventing mosquitoes to hide and reproduce. (3) The windows and doors of the household should be netted or screened whenever possible to prevent entry of mosquitoes. (4) Personal protective measures like reduction of exposure to mosquito bites especially during mosquito feeding times (from dusk to dawn) by using mosquito repellents and mosquito nets preferably impregnated with Pyrethroids, ICON, etc. and covering the skin by wearing long clothing, thick socks may be effective. (5) Individuals should avoid nocturnal outdoor activities as much as possible. (6) Pregnant women should not travel to malaria endemic zones especially where chloroquine-resistant Plasmodium falciparum malaria is present. (7) Along with the above measures travelers should receive chemo-prophylaxis with Maloprim and Fansidar/Malacide before, during and after exposure to the Malrious areas of the world. But a single control strategy will not be helpful and individual circumstances require different or combined approach.
Tea planters can contribute to the control of malaria by creating consciousness among the workers during working hours or off time. The workers should be taught to keep the surroundings of their household clean, drain out stagnant water in and around their houses, use repellents, mosquito nets during sleeping hour etc. Housewives of tea planters can also contribute by keeping keen eyes on cleaning of jungles and bushes in and around their bungalows, ensuring no stagnation of water anywhere, proper netting use of bungalow, preventing children from going out after dusk, identifying and sending any case of fever among bungalow servants to the hospital for proper diagnosis and treatment etc.
Very few infectious diseases have the same impact on the social and economic development of mankind as malaria. Three major factors, resistance of the parasite to the common drugs, resistance of the vector to DDT or other Insecticide and newer vectors of transmission have severely impaired the worldwide Malaria Eradication Programme.
So early diagnosis, prompt treatment, vector control and health education are the major elements to control the current malarial picture. Recently Scientists have directed efforts at seeking newer approaches namely vaccines development to control malaria.
The writer is Medical Officer at Ahsanullah University of Science and Technology, Dhaka
