Epidemiological Situation of Malaria Control and Elimination in Bangladesh
Sazid Ibna ZamanMohammad Jahirul KarimMd. Mushfiqur RahmanAbu Nayeem Md Sohel
Anjan SahaLisa J White
Richard J MoudeMORU & NMCP
Background
Methods
Results
Discussion
Conclusion
Use of DDT during Malaria Eradication Program (MEP)—two rounds/year for three years followed by focal sprayingMEP Stopped in 1974Formation of National Malaria Control Program in 1977NMCP Partnership with a BRAC led 21 member NGO Consortium in 2007
Historical Malaria Cases84690 cases in 200826891 cases in 2013
Contributor to decrease•Widespread use of ACT(Artemisinin Combination
Therapy)•Use of Long-lasting Insecticide treated bednets•Vector control measure
57480 cases in 2014Increase continuing into 2015
Contributor to Increase• Unclear• Investigation needed
Historical Malaria Incidence Data
NMCP Activities
A change in climate and timing of the monsoon, Relaxation of malaria control activities due to decreasing disease burden, A similar increase in cases in adjacent Tripura State in India and Stockouts of ACTs.
Analyzed
Analyzed
Plasmodium falciparum was found in 94% of cases in 2013 & 96% in 2014 (Bangladesh Perspective) 92% of cases in 2013 & 97% in 2014 (Four Districts Perspective)
Malaria Cases & Spatial Distribution of Plasmodium Falciparum
Increasing Rate (more than double from 2013 to 2014) Eastern parts of Rangamati (7976 to 17166) Eastern parts of Bandarban (9459 to 24418)
Cox’s Bazar
Bandarban
KhagrachhariRangamati
Importation of malaria from India and Myanmar are possible contributors to the increase that warrant further investigation.
Proportionate spatial distribution of Bednet by Upazila from 2011 to 2013 and Plasmodium Falciparum Annual Incidence Rate by union in 2014 in Chittagong division
Spatial Distribution of Bednets
The increase in cases was not clearly related to a change in climate, timing of the monsoon although there was a mid-season drop in rainfall, or LLIN distribution. There have been reports of low LLIN efficacy needing further investigation.
Spatial Distribution of Monthly ACT Course Stock and Plasmodium Falciparum Incidence in Chittagong Division in 2014Yearly ACT Course Stock and Plasmodium Falciparum cases form 2008-2014
ACT Course Stock Plasmodium Falciparum
Possible factors contributing to the increase include:
Insufficient stocks of ACT treatmentReported low efficacy of old LLINImportation from India / Myanmar. Increase in malaria in Tripura State, India bordering Chittagong DivisionMid-season interruption in rainfallRelaxation of efforts by health workers (govt & NGO)
Less likely: Antimalarial resistance: TES of ACT in 3 sentinel sites by NMCP in 2013-14 found 100% efficacy of ACT. Further TES is ongoing.Insecticide resistance: susceptibility testing by NMCP in 2014: An. vagus showed reduced (80% to 97%) susceptibility to deltamethrine. Other species 100% susceptible..
A range of analyses and prospective studies are planned or underway to investigate these further. These include
Bed net surveys, Population movement studies, Parasite genetics and Mathematical modelling of interventions to eliminate malaria including mass drug administration.
Beyond MDG (2000-2015)
Sustainable Development Goal
Sustainable Development Goal (SDG) [2016-2030], 17 GOALS
Other Sector Health Sector, GOAL-3
Sustainable Development Goal
Goal for Phase wise elimination of Malaria from Bangladesh
The sudden, large increase in malaria in Bangladesh in 2014 was likely multifactorial. Illustrates the complexity and challenges of achieving malaria elimination within a short timeline. Detailed study of events of this type can provide invaluable insights for malaria elimination programs. More evidence on vector and LLIN , EDPT are neededMalaria Strategy of Bangladesh needs re-visit .Retrospective analyses, prospective field studies and mathematical modelling are being employed in Bangladesh to inform program activities and help plan future elimination efforts.
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