Precarity at the Margins of Malaria Control in the Chittagong Hill Tracts in Bangladesh: A Mixed-Methods Study

Abstract

Bangladesh has achieved significant progress towards malaria elimination, although health service delivery for malaria remains challenging in remote forested areas such as the Chittagong Hill Tracts (CHT). The aim of this study was to investigate perceptions of malaria and its treatment among the local population to inform contextualized strategies for rolling out radical cure for P. vivax in Bangladesh. The study comprised two sequential strands whereby the preliminary results of a qualitative strand informed the development of a structured survey questionnaire used in the quantitative strand. Results show that ethnic minority populations in the CHT live in precarious socio-economic conditions which increase their exposure to infectious diseases, and that febrile patients often self-treat, including home remedies and pharmaceuticals, before attending a healthcare facility. Perceived low quality of care and lack of communication between Bengali health providers and ethnic minority patients also affects access to public healthcare. Malaria is viewed as a condition that affects vulnerable people weakened by agricultural work and taking away blood is perceived to increase such vulnerability. Healthcare providers that initiate and sustain a dialogue about these issues with ethnic minority patients may foster the trust that is needed for local malaria elimination efforts.

Implementing radical cure diagnostics for malaria: user perspectives on G6PD testing in Bangladesh

“…To assess the feasibility of implementing the biosensor in Bangladesh from the perspective of various users, a qualitative research study was undertaken to investigate user perspectives and practices of G6PD diagnostics [ 27 , 28 ]. However, considerations around specific treatment courses and P. vivax case management as a whole were beyond the scope of the study, but have been the focus of another recent study [ 29 ]. This paper reports the different considerations and practices at clinic, health worker and policy levels that influence the introduction ofG6PD diagnostics for new radical cure therapeutics.…”

Bangladesh should engage the private sector for malaria elimination by 2030

“…The Bangladeshi context was initiated through a combination of published literature in Bangladesh, insights from informal conversations with malaria elimination experts from NMEP and BRAC, and focus group discussions with private healthcare Providers. [3][4][5][6][7]20 RESULTS.…”

“…These districts also feature a high proportion of remote communities of isolated, Indigenous (non-Bengali) peoples, presenting cultural practices that compound geographical barriers to prevent access for malaria elimination programs. 4,5 In contrast, two low-endemic districts, Cox’s Bazar and Chittagong, are more accessible to present control efforts. These regions plan to eliminate the endogenous transmission within the districts by 2025, but will continue to face the prospect of imported malaria due to high levels of human travel from the neighboring high-transmission CHT districts until the 2030 elimination date.…”

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“…However, patients must pay for services and drugs provided at private clinics, pharmacies, and, to some extent, public hospitals; it is unlikely that many participants would prefer this option over free treatment delivered at home as part of the DSS. A subset of 100 participants from each case and control arm were included in a separate study of the perceptions of malaria [47]. A total of 6 participants from the control arm recalled having had malaria previously, whereas only 1 case could not recall any previous episodes of malaria.…”