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A saying goes in Africa: “If you think you are too small to make a difference, you have not spent a night with a mosquito”. The five millimetre species has overwhelmed humankind for over 500,000 years, making it one of the world’s deadliest antiquated disease-carriers. Bangladesh, however, has made remarkable progress over the past 50 years in battling malaria, one of the most deadly diseases the mosquito carries.
Malaria is a worldwide endemic illness that has affected approximately 229 million people in 87 countries in 2019, killing an estimated 409,000 people.
Bangladesh contributed to less than one percent of the total reported cases in Southeast Asia in 2019 compared to ten percent in 2008.
Nineteen million people in 13 malaria-endemic districts share boundaries with the eastern states of India and Myanmar, and endure the brunt of the disease. Contributing to about 93% of malaria cases in the country, the Chattogram Hill Tracts stands as the highest risk zone in the country.
Elimination through alliance
BRAC’s initiatives to end malaria in Bangladesh began in 1998 in the Chattogram Hill Tracts. A grant was received from the Global Fund to Fight TB, AIDS and Malaria, and the BRAC Malaria Elimination Programme was expanded, in partnership with National Malaria Elimination Programme (NMEP) in 2007. The Programme led a consortium of non-governmental organisations as the principal recipient of the grant, and strengthened its malaria-fighting activities in 13 malaria-endemic districts of Bangladesh.
Better coverage and access to the provision of malaria services in the community was ensured by the collaboration, through strengthening of surveillance, management and reporting systems. This improved both the quality and the speed of programme outputs.
Currently, BRAC is implementing the programme in all sub-districts of the Chattogram Hill Tracts and Chattogram district, two sub-districts of Cox’s Bazar district (Ukhia and Moheshkhali). BRAC also lends support to the government in the eight districts of Sylhet and Mymensingh.
What has been the secret to Bangladesh’s progress towards ending malaria?
A total of 7,942,167 Rapid Diagnostic Tests (RDT) and microscopies were conducted by BRAC NGO Consortium during the period of May 2007 to December 2020. This formed 75% of the total Rapid Diagnostic Tests and microscopy tests done in the country. x
During the same period, 374,808 cases were diagnosed and treated by the Consortium, which were 67% of the total number of confirmed malaria cases which received treatment. Between 2008-2020, the programme has distributed 12,732,804 long lasting insecticidal nets (LLINs).
Bangladesh saw a fall in the incidence of malaria cases by 93% – from 84,690 cases in 2008 to 6,130 in 2020. In 2008, the number of severe malaria cases was 3,042 which fell to 92 in 2020, showing a decrease of 97%. There has been a 94% reduction in the total malaria deaths – from 154 in 2008, to nine in 2020.
The annual parasite incidence (API) is the number of new, confirmed cases of malaria, registered in a given year. It is expressed per 1,000 individuals under surveillance. In 2020, the collective API for the 13 districts was 0.33, with only two districts having an individual API greater than one. In 2008, all 13 districts had an API of more than 1.
This accomplishment prompted the National Malaria Control Programme to move to the elimination phase. The success over the years was a testament of the scaled-up initiatives. These included disease prevention and management interventions, real-time case notification, surveillance, mobile health camps, screening for new malaria cases through mass blood examination, insecticidal nets distribution, focus on high-risk groups, and analysis of cases from the elimination areas (regions where the burden of malaria cases are low).
Challenges in these efforts included the unexpected surge of the forcibly displaced Myanmar nationals in 2017, limited vector presence data, frequent migration of people, language barriers, political rife between different communities, and traditional practices which made it hard to sustain the current elimination phase.
What barriers to a post-malaria world are we now facing?
The effects of the COVID-19 pandemic on the fight against malaria could be tragic. Resurgence of malaria is a possibility. Movement is limited as a result of strengthening safety precautions, so malaria prevention activities may be curtailed.
BRAC is remaining adaptive and agile, continuing to raise awareness against the pandemic, while preserving services to fight against malaria. BRAC looks forward to a post-malaria world through ingenuity, sustained commitment, advocacy with national and international donors and civil society, and adequate financing.
As Bangladesh celebrates 50 years of independence, we also embrace World Malaria Day to recommit to eliminating malaria and revitalise the successes in the fight against malaria. With collaboration, Bangladesh can succeed in reaching the zero malaria target, and strengthen our efforts towards a world free of malaria by 2030.
Dr Kazi Mariam Naher is an Epidemiologist in BRAC Malaria Elimination Programme.