Abstract
BackgroundUntil recently the Chittagong Hill tracts have been hyperendemic for malaria. A past cross-sectional RDT based survey in 2007 recorded rates of approximately 15%. This study was designed to understand the present epidemiology of malaria in this region, to monitor and facilitate the uptake of malaria intervention activities of the national malaria programme and to serve as an area for developing new and innovative control strategies for malaria.MethodsThis research field area was established in two rural unions of Bandarban District of Bangladesh north of Bandarban city, which are known to be endemic for malaria due to Plasmodium falciparum. The project included the following elements: a) a demographic surveillance system including an initial census with updates every four months, b) periodic surveys of knowledge attitude and practice, c) a geographic information system, d) weekly active and continuous passive surveillance for malaria infections using smears, rapid tests and PCR, f) monthly mosquito surveillance, and e) daily weather measures. The programme included both traditional and molecular methods for detecting malaria as well as lab methods for speciating mosquitoes and detecting mosquitoes infected with sporozoites.ResultsThe demographic surveillance enumerated and mapped 20,563 people, 75% of which were tribal non-Bengali. The monthly mosquito surveys identified 22 Anopheles species, eight of which were positive by circumsporozoite ELISA. The annual rate of malaria was close to 1% with 85% of cases in the rainy months of May-October. Definitive clustering identified in the low transmission season persisted during the high transmission season.ConclusionThis demographically and geographically defined area, near to the Myanmar border, which is also hypoendemic for malaria, will be useful for future studies of the epidemiology of malaria and for evaluation of strategies for malaria control including new drugs and vaccines.
Highlights
Until recently the Chittagong Hill tracts have been hyperendemic for malaria
Approaching the community, the ministry, and stakeholders When the two unions were identified as areas which seemed to be ideal for the project, the Upazila Health and Family Planning (UHFP) office in the Bandarban district office was contacted to discuss the purpose of the investigation
PCR will be used to confirm species identification of Anopheline mosquitoes. Looking ahead, this field area will be an important resource for the national programme to evaluate strategies for malaria control, as well as for research on the epidemiology of malaria, the transmission of malaria in a hypoendemic area, studies of genetic and behavioural risk factors, intervention studies to reduce transmission and for vaccine trials of promising new vaccines
Summary
Until recently the Chittagong Hill tracts have been hyperendemic for malaria. A past cross-sectional RDT based survey in 2007 recorded rates of approximately 15%. Reports from district hospitals in these endemic areas demonstrate a reduction in the numbers of cases detected since the programme started in 2008; it is not clear if this reduction is due to the programme activities, to climate related variability in rates from year to year, or differences in the ascertainment of cases. These reports are based on cases treated at health facilities, which may not reflect the true rates of malaria since many patients may not seek treatment or reach a facility. The true rate of malaria in the endemic districts is not well documented
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