Malaria is endemic in 13 eastern and north-eastern border belt districts of the country with variable transmission potentials (high, moderate and low). A total of 13.25 million people are at risk of malaria inhabited in those districts. In 2013 the prevalence rate of malaria was found to be 0.7% in these districts. About 80% of the total cases are reported from the three Chittagong Hill Tract (CHT) districts (Rangamati, Khagrachari and Banderban) including Chittagong and the coastal district Cox’s Bazar. The CHT districts have perennial transmission throughout the year due to the geo-physical location in the hilly, forested and the foot-hills, climate, and other favourable conditions for the vector species An. baimi (dirus), An. minimus and An. philippinensis. The map of Bangladesh blow shows the malaria endemic areas (high, moderate, low, pre-elimination districts, and malaria free) based on available epidemiological data.
Total population of the three CHT districts is 1.6 million. The indigenous population constitutes about 50% of the total population in these districts. The tribal hamlets are in clusters in the remote hills and foothills and some are hard-to-reach due to lack of communication. Most of the houses are thatched built with indigenous material e.g. bamboo, wood etc. and these houses seldom have any protection against the vector mosquitoes and thus peoples are vulnerable to malaria infection. The aggregation of laborers for development work sometimes further aggravates the malaria situation in these areas. Settlers coming from the plain areas of the country in the CHT districts are non-immune and more prone to get malaria infection. Traditional ‘Jhum cultivators’, forest goers, refugees, travellers from non-endemic areas, and mobile population are the most-at-risk groups due to lack of adequate protection for mosquito bites and adoption of personal protection measures. There are also higher risk of malaria transmission in the border areas, due to cross-border movement/migration across international boundaries with eastern states of India and part of Myanmar.
Four districts (Mymensingh, Netrakona, Sherpur and Kurigram) with eight endemic upazilas have low transmission of malaria and have shown <5% malaria positivity rates (RDT and Microscopy) over last three years. These districts currently may be considered for adopting pre-elimination strategies. The NMCP should have phased targets of elimination for these districts and gradually expanding to the other moderate endemic areas in near future. There is significant progress in malaria control in Bangladesh during the period from 2008 to 2013 showing a progressive decline in total cases and deaths. The graph below shows the epidemiological trend of case incidence and deaths 2007-2013.
The NMCP had the GFATM support since 2007 and there was an increase in number of cases due to scaling up of interventions; introduction of RDR for diagnosis, and ACT for treatment of P. falciparum cases. Thereafter, a steady decline is noted from 84,690 cases in 2008 to 26,891 cases in 2013, having a 68.2% reduction in case incidence. The total deaths came down to 15 in 2013 as against 154 in 2008 showing 90.2 % reduction.
Population at Risk
The total population at risk of malaria in the 13 endemic districts is approximately 13.25 million. (Ref: NMCP Routine Surveillance data). About 80% of the cases of malaria in Bangladesh are reported from the three CHT districts with a total population of about 1.6 million. The indigenous population constitutes about 50% of the total population in CHT districts. The tribal hamlets are in clusters in the remote hills and foothills. Most of the houses are thatched built with indigenous material e.g. bamboo, wood etc. and these houses seldom have any protection against the vector mosquitoes. The peoples are vulnerable to malaria infection. The aggregation of laborers for development work sometimes further aggravates the malaria situation in these areas. Settlers coming from the plain areas of the country in the hill district are non-immune and more prone to get malaria infection.
Seasonal workers such as ‘Jhum cultivators’, forest goers etc. are at high risk group due to staying overnight in open spaces in the forest and hill. There are higher than average levels of malaria in border areas which may be due to migration to and from endemic areas of neighboring India and Myanmar.
Malaria affects all age groups and both males and females; however, adult males are commonly affected mainly due to occupations and behavior that put them at risk of being bitten by malaria vectors. Pregnant women and children <5yrs are biologically at higher risk and they tend to develop more severe malaria due to low level of immunity. Thus, in high transmission areas, these groups should be given priority for interventions. High risk populations, thus includes: i) Young children, particularly under <5 yr children, ii) Pregnant women, iii) Travelers from non-endemic areas, iv) People from non-endemic areas residing for a long time and returning home,
v) ‘Jhum cultivators’ and forest goers, Tea estates; vi) Refugees and mobile population, and vi) People with HIV/AIDS and TB (for co-infections, if any).
Malaria MDG Goals and Targets
Bangladesh is also on track to achieving the malaria MDGs Goals, and Targets. The Table below shows the status of MDG goals and targets related to malaria in 2012-13 as compared to baseline 2008.
Source: NSP 2015-2020, NMCP