Temporal trends in severe malaria in Chittagong, Bangladesh

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.

Malaria Hotspots Drive Hypoendemic Transmission in the Chittagong Hill Districts of Bangladesh

“…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]; however, 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]. Most infections are caused by Plasmodium falciparum , although between 5–20% of infections are reported to be caused by P. vivax [11], [14].…”

Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh

“…These hospitals are government tertiary care hospitals with large catchment areas8 covering four of the seven divisions of Bangladesh. Unselected patients of all ages and both genders who came to a hospital and had a blood test for another purpose were screened for the study.…”

Genotypic and phenotypic characterization of G6PD deficiency in Bengali adults with severe and uncomplicated malaria

“…In Bangladesh, approximately 14 million people are at risk for malaria, with over 85% of cases occurring in Chittagong Division (80% in the Chittagong Hill Tracts) [12]. At the outset of this study there was a paucity of literature on the proportion of healthy individuals or malaria patients with G6PD deficiency in Bangladesh.…”