BackgroundMalaria is endemic in 13 districts of Bangladesh. A baseline malaria prevalence survey across the endemic districts of Bangladesh was conducted in 2007, when the prevalence was reported around 39.7 per 1000 population. After two rounds of Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)-funded intervention by the National Malaria Control Programme (NMCP) and a BRAC-led NGO consortium, a follow-up survey was conducted across the malaria-endemic districts of Bangladesh to measure the change in prevalence rate and in people’s knowledge of malaria.MethodsThe survey was carried out from August to November 2013 in 70 upazilas (sub-districts) of 13 malaria-endemic districts of Bangladesh, following the same multi-stage cluster sampling design and the same number of households enrolled during the baseline prevalence survey in 2007, to collect 9750 randomly selected blood samples. For on-the-spot diagnosis of malaria, a rapid diagnostic test was used. The household head or eldest person available was interviewed using a pre-coded structured questionnaire to collect data on the knowledge and awareness of malaria in the household.ResultsBased on a weighted calculation, the overall malaria prevalence was found to be 1.41 per 1000 population. The proportion of Plasmodium falciparum mono-infection was 77.78% while both Plasmodium vivax mono-infection and mixed infection of the two species were found to be 11.11%. Bandarban had the highest prevalence (6.67 per 1000 population). Knowledge of malaria signs, symptoms and mode of transmission were higher in the follow-up survey (97.26%) than the baseline survey. Use of bed nets for prevention of malaria was found to be high (90.15%) at respondent level. People’s knowledge of selected parameters increased significantly during the follow-up survey compared to the baseline survey conducted in 2007.ConclusionsA reduced prevalence rate of malaria and increased level of knowledge were observed in the present malaria prevalence survey in Bangladesh.
BackgroundMalaria is still a major public health concern in Bangladesh in spite of mass distribution of long-lasting insecticide-treated nets (LLINs) as a key preventive strategy. There might be a considerable gap between coverage and actual use of nets by the population in endemic areas. This study intended to assess the gap between coverage, access to and use of LLINs among the households in malaria-endemic settings in Bangladesh.MethodsThis cross-sectional study collected data from 2640 households of 13 endemic districts of Bangladesh through three-stage cluster random sampling. The gap between coverage, access and use of LLINs were calculated using the procedure established by the Roll Back Malaria Monitoring and Evaluation Reference Group. To support the quantitative findings, qualitative data were also collected through in-depth interview, focus group discussion and key informant interview and analysed accordingly.ResultsOf 2640 total households, 77.4% (n = 2044) possessed at least two LLINs, 56.8% (n = 1499) had insufficient access, and 18.8% (n = 495) had excess LLINs. Members of 77.9% (n = 2056) households had used LLINs the previous night and 6.0% (n = 68) did not use LLINs despite having sufficient access. LLIN use was lower in non-hill track areas, in Bengali community, in richer households and households with more than four members. Moreover, qualitative findings revealed that the major reasons behind not using LLINs were insufficient access, sleeping outside the home, migration, perceived low efficacy of LLINs, or fear of physical side effects.ConclusionClosing the access gap by providing enough nets through solid investment and well-designed behavioural change interventions are crucial for achieving and sustaining universal coverage.
Introduction. Netrokona is one of the first phase malaria elimination targeted 8 districts of Bangladesh by 2021. The district constitutes only 7% of the population but contributes half of the malaria cases in that area. Most of the cases of that district are imported from Meghalaya State of India. The study was conducted to understand the epidemiology of these imported malaria cases for further strategy development to prevent both imported and introduced cases. Methodology. The study was retrospectively conducted on the malaria cases confirmed by microscopy and/or RDT by the government and/or NGO service providers between 2013 and 2018. The information of the cases was collected from the verbal “investigation” report of individual malaria confirmed cases. The respondents of the “investigation” were either the patients or their family members. Out of the 713 cases during the study period, descriptive analysis of 626 cases (based on the completeness of “investigation form”) of the district was done using MS Excel version 2016. Results. Proportion of imported malaria in Netrokona district increased from 60% in 2013 to 95% in 2018 which persists throughout the year with a little seasonal fluctuation. The overall contribution of these imported cases is 93% by cross-border workers by population type and 84%, 66%, and 95% by male, labour, and tribal population considering the factors of sex, occupation, and ethnicity, respectively. Population aged between 15 and 49 years contributed 82% of these imported cases. All of these cases occurred in the internationally bordering belt with Meghalaya State of India. Species-wise distribution revealed lower P. falciparum (63%) and higher mixed (28%) infection in imported cases compared to the 71% Pf and 20% mixed infection among the indigenous infections whereas P. vivax is similar in both cases. Conclusion. Imported malaria is an emerging issue that has a potential risk of increased local transmission which might be a challenge to malaria elimination in that area. Appropriate interventions targeting the cross-border workers are essential to prevent the introduced cases and subsequently avoid reestablishment when elimination of the disease is achieved.
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