Closing the door on one of the world’s oldest diseases

In 2017, an estimated 219 million malaria cases and 435,000 malaria deaths was reported worldwide. South-east Asia alone accounted for 1.24 million cases and 299 deaths.

The age old disease is still endemic across 13 border districts of Bangladesh, which share boundaries with the eastern states of India and Myanmar. The disease has posed threat to about 18 million people, with the Chittagong Hill Tracts standing as the highest risk zone.

The area accounts for about 90% of malaria cases in the country. In 2018, 7% of the reported 10,523 malaria cases were of children under five and 0.41% were pregnant women. Lengrung Mro was one of them.

Jhum cultivator Lengrung Mro, a 20-year-old woman, resides in a remote village of Bandarban. Her route to work is a hectic journey which includes a boat ride and climbing a mountain. Lengrung had accepted the routine struggles that came with her job, even when she was pregnant, until she developed a high fever in her third trimester. Thinking it as a minor issue, Lengrung shrugged it off. When her fever did not let up, a BRAC health worker advised her to take a malaria test. The test came back positive, and she was given anti-malarials immediately, along with necessary advice.

Today Lengrung and her baby are healthy, both of whom have survived the deadly disease. One advice was able to save two lives. The community health workers have laid their contributions to hundreds of such success stories – some heard, most unheard.

Paving the path towards elimination

Incidence rate of malaria in Bangladesh saw a fall from 84,690 in 2008 to 10,523 in 2018 – a reduction of 87.6%. This feat urged the National Malaria Elimination Programme to  leap into the elimination phase from the control phase. This outcome is a display of combined efforts of the programme and the NGO consortium led by BRAC, aided by The Global Fund.

A feasible elimination is a testament of the scaled up initiatives, including interventions, surveillance, malaria test kits and anti-malarial drugs, insecticidal nets distribution, focus on high-risk groups, and analysis of cases from the elimination areas.

The hurdles on the way

With reduced susceptibility, the sudden influx of the forcibly displaced Rohingya refugees has threatened the progress of the programme, making it hard to sustain the current elimination phase. Challenges are compounded by frequent migration, language barriers, and political rife between different communities. Keeping in mind such hindrances, achieving elimination will require innovation and creativity, thereby optimising the existing interventions and strategies.

Adding voice to the ongoing battle

Our success is remarkably fragile, and efforts must be made to sustain it. Bangladesh contributed to less than 1% (0.2%) of the total reported cases in South East Asia in 2016. On World Malaria Day, as the global progress on the efforts to control malaria is recognised, Bangladesh’s accomplishments have motivated its national strategy to gear towards a malaria-free Bangladesh by 2030.

Dr Kazi Mariam Naher is an Epidemiologist in the BRAC Malaria Elimination Programme.