The Practice of Jhum Cultivation and its Relationship to Plasmodium falciparum Infection in the Chittagong Hill Districts of Bangladesh

Abstract

Abstract. Malaria is endemic in the Chittagong Hill Districts of southeastern Bangladesh. Previous epidemiological analyses identified the agricultural practice of jhum cultivation as a potential risk factor for malaria infection. We conducted qualitative interviews with jhum cultivators and surveillance workers to describe jhum cultivation and used demographic and malaria surveillance in two study unions from May of 2010 to August of 2012 to better understand the relationship between jhum cultivation and malaria infection. Qualitative interviews revealed that jhum cultivation is conducted on remote, steep hillsides by ethnic tribal groups. Quantitative analyses found that adult jhum cultivators and individuals who live in the same residence had significantly higher incidence rates of symptomatic Plasmodium falciparum infection compared with non-cultivators. These results confirm that jhum cultivation is an independent risk factor for malaria infection and underscore the need for malaria testing and treatment services to reach remote populations in the Chittagong Hill Districts. BACKGROUND

Mapping the travel patterns of people with malaria in Bangladesh

“…Males of working age (25-49 years) comprised the largest group of forest visitors, and reasons for travelling to the forest included cutting wood, jhum cultivation, plantation, bamboo collection and miscellaneous daily labourer activities. Jhum workers can be found in both the northern and southern part of Chittagong Hill Tracts, and are a particularly important group to target, as they have been found to be asymptomatic carriers of malaria, with the risk of contracting malaria increasing in other household members who do not engage in jhum cultivation [25,33]. Similar findings in the GMS implicate men of working age to be at higher risk of contracting malaria through occupational activities such as working in the forest.…”

“…Other studies have looked at domestic travel and malaria in Bangladesh in subgroups in limited areas including one which asked about prior history of travel at the district level of patients with severe malaria who had been treated in the tertiary referral hospital in Chittagong [24]. Galagan [33] reported internal migration of jhum (shifting cultivation) workers within two unions in Bandarban district from a surveillance study in that area.…”

Geospatial Technology: A Tool to Aid in the Elimination of Malaria in Bangladesh

“…Through June 2014, there were 17 published studies that have used geospatial technologies (GIS, GPS and/or RS) to understand and predict malaria risks [1,2,8,[13][14][15][16][17][18][19][20][21], develop malaria risk maps, [21,22] and provide findings for targeted interventions strategies in Bangladesh. To supply feedback to the NMCP, national malaria risk maps were produced [2,23].…”

“…In another study, in the Bandarban District, a cohort framework of over 4000 households was established and mapped for a longitudinal study [21]. Four studies prepared risk maps in the same district focusing on pregnant women and jhum cultivators-subsistent farmers that use slash and burn methods of farming [18,24]. There were six malaria risk mapping studies conducted in Rajasthali, a sub-district of Rangamati district, which in 2007 had the highest (36%) malaria prevalence rates in the country [23].…”

“…Based on the findings of these studies, the following are recommendations for the NMCP to implement to further the malaria elimination program in Bangladesh: identify high-risk malaria zones to determine spatial distribution; combine surveillance with GIS and weather pattern database to determine geographic and climate risks [21]; conduct further studies to understand malaria transmission among impacted populations during high transmission season; develop strategies to interrupt transmission in low transmission settings [18]; use mass screening in stable hot-spot areas to identify asymptomatic reservoirs and provide treatment to reduce the malaria burden [16]; promote malaria test and treatment services particularly among vulnerable populations, such as children under five years and jhum cultivators [18]; monitor asymptomatic malaria particularly among pregnant women living in low-intensity malaria transmission areas [24]; target interventions at fine spatial scales for malaria control programs; improve equity of access to interventions [15]; improve collaboration between researchers using geostatistical techniques and malaria control managers; target high malaria transmission areas [8] to provide more GPS, GIS, and RS strategies to characterize spatial heterogeneity with malaria risk at a fine scale and identify high risk areas that have not been studied [19]; and lastly focus on interventions to be targeted and timed according to risk profiles of endemic areas [38].…”