Abstract
BackgroundMalaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people. The highest rates of malaria in Bangladesh occur in the Chittagong Hill Districts, and Plasmodium falciparum (predominately chloroquine resistant) is the most prevalent species.MethodsThe objective of this research was to describe the epidemiology of symptomatic P. falciparum malaria in an area of Bangladesh following the introduction of a national malaria control program. We carried out surveillance for symptomatic malaria due to P. falciparum in two demographically defined unions of the Chittagong Hill Districts in Bangladesh, bordering western Myanmar, between October 2009 and May 2012. The association between sociodemographics and temporal and climate factors with symptomatic P. falciparum infection over two years of surveillance data was assessed. Risk factors for infection were determined using a multivariate regression model.Results472 cases of symptomatic P. falciparum malaria cases were identified among 23,372 residents during the study period. Greater than 85% of cases occurred during the rainy season from May to October, and cases were highly clustered geographically within these two unions with more than 80% of infections occurring in areas that contain approximately one-third of the total population. Risk factors statistically associated with infection in a multivariate logistic regression model were living in the areas of high incidence, young age, and having an occupation including jhum cultivation and/or daily labor. Use of long lasting insecticide-treated bed nets was high (89.3%), but its use was not associated with decreased incidence of infection.ConclusionHere we show that P. falciparum malaria continues to be hypoendemic in the Chittagong Hill Districts of Bangladesh, is highly seasonal, and is much more common in certain geographically limited hot spots and among certain occupations.
Highlights
Malaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people
Understanding the patterns of transmission and risk factors for malaria infection in these hypoendemic areas is essential for developing effective malaria control strategies, especially as programs aim toward elimination
This paper investigates the epidemiology of symptomatic P. falciparum malaria infection over two years of prospective malaria surveillance in Kuhalong and Rajbila unions
Summary
Malaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people. The highest rates of malaria in Bangladesh occur in the Chittagong Hill Districts, and Plasmodium falciparum (predominately chloroquine resistant) is the most prevalent species. Understanding the patterns of transmission and risk factors for malaria infection in these hypoendemic areas is essential for developing effective malaria control strategies, especially as programs aim toward elimination. Over the previous decade the national malaria control program in Bangladesh has reported more than 50,000 cases per year and between 100 to 500 deaths per year [9]; it is likely that the burden of malaria is underestimated. Malaria in Bangladesh occurs seasonally with the majority of malaria infections in the rainy season from May to October [11,12], and transmission is variable across endemic districts with the highest incidence in the Chittagong Hill Districts (CHD) of Southeast Bangladesh [12,13]. P. ovale and P. malariae infections have been reported, but are extremely rare [15,16]
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