Abstract
BackgroundEpidemiological data on malaria in Bangladesh are sparse, particularly on severe and fatal malaria. This hampers the allocation of healthcare provision in this resource-poor setting. Over 85% of the estimated 150,000-250,000 annual malaria cases in Bangladesh occur in Chittagong Division with 80% in the Chittagong Hill Tracts (CHT). Chittagong Medical College Hospital (CMCH) is the major tertiary referral hospital for severe malaria in Chittagong Division.MethodsMalaria screening data from 22,785 inpatients in CMCH from 1999–2011 were analysed to investigate the patterns of referral, temporal trends and geographical distribution of severe malaria in Chittagong Division, Bangladesh.ResultsFrom 1999 till 2011, 2,394 malaria cases were admitted, of which 96% harboured Plasmodium falciparum and 4% Plasmodium vivax. Infection was commonest in males (67%) between 15 and 34 years of age. Seasonality of malaria incidence was marked with a single peak in P. falciparum transmission from June to August coinciding with peak rainfall, whereas P. vivax showed an additional peak in February-March possibly representing relapse infections. Since 2007 there has been a substantial decrease in the absolute number of admitted malaria cases. Case fatality in severe malaria was 18% from 2008–2011, remaining steady during this period.A travel history obtained in 226 malaria patients revealed only 33% had been to the CHT in the preceding three weeks. Of all admitted malaria patients, only 9% lived in the CHT, and none in the more remote malaria endemic regions near the Indian border.ConclusionsThe overall decline in admitted malaria cases to CMCH suggests recent control measures are successful. However, there are no reliable data on the incidence of severe malaria in the CHT, the most endemic area of Bangladesh, and most of these patients do not reach tertiary health facilities. Improvement of early treatment and simple supportive care for severe malaria in remote areas and implementation of a referral system for cases requiring additional supportive care could be important contributors to further reducing malaria-attributable disease and death in Bangladesh.
Highlights
Epidemiological data on malaria in Bangladesh are sparse, on severe and fatal malaria
The present analysis strongly suggests that only a small proportion of severe cases reach tertiary care (0.2-1.6%), since a mean of 177 malaria patients per year were admitted to Chittagong Medical College Hospital (CMCH), the only tertiary care facility in the area, whereas the estimated total numbers of severe cases nationally is around 11,000-80,000 per year of which 80% reside in the Chittagong Hill Tracts (CHT)
Of the patients admitted to CMCH, 96% had P. falciparum and 4% of patients had P. vivax, whereas mortality was only associated with P. falciparum
Summary
Epidemiological data on malaria in Bangladesh are sparse, on severe and fatal malaria. This hampers the allocation of healthcare provision in this resource-poor setting. Over 85% of the estimated 150,000-250,000 annual malaria cases in Bangladesh occur in Chittagong Division with 80% in the Chittagong Hill Tracts (CHT). Over a million suspected cases of malaria are reported annually to the World Health Organization (WHO) in Bangladesh, the number of confirmed cases is only 60,000, and estimates of the true incidence vary widely [1,2,3]. Cases from most medical college hospitals, specialized hospitals, NGO hospitals and private clinics and hospitals are not included and the true number is estimated to be three times higher [1,4]. The true incidence of malaria is probably in the range of 150,000-250,000 cases per year [1,3,4]
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