Malaria is a parasitic infectiontransmitted by the female Anopheles mosquito, infecting humans and insects alternatively. Caused by four Plasmodium species (P vivax, P falciparum, P ovale and P malariae), malaria is a public health problem in 90 countries around the world, affecting 300 million people and responsible directly for about one million deaths annually. Africa accounts for 90% of the mortality burden for malaria and South-east Asia accounts for 9% of the burden. Bangladesh is considered as one of the malaria endemic countries in South Asia.
General symptoms of malaria include headache, nausea, fever, vomiting and flu-like symptoms, however these can vary depending on the species causing the infection. Bangladesh has 34 Anopheles mosquito species. An entomological investigation conducted by ICDDR,B scientists identified seven species to be positive with highest infection rate: Anopheles Karwari, An. maculatus, An. barbriostris , An. nigerrimus, An. vagus , An. subpictus and An. philippinensis.
World Health Organization (WHO) considers malaria to be a major public health concern in Bangladesh. Malaria was nearly eradicated from the country by 1970s but never disappeared in the eastern regions which are associated with tea gardens and forests. It re-emerged as one of the major public health concern in the 1990s and remains so. Malaria transmission is mostly seasonal and concentrated in the border regions of Bangladesh. Out of 64 districts 13 districts bordering east and northeast parts of Bangladesh facing Indian states of Assam, Tripura and Meghalaya and part of Myanmar belong to the high risk malaria zone.
ICDDR,B was requested to conduct a cross sectional survey in 2007-2008 with the largest NGO in Bangladesh, BRAC and the Government of Bangladesh, to identify the prevalence of malaria. GFATM funded BRAC to implement a malaria control programme in the 13 malaria-endemic districts to reduce burden of malaria in Bangladesh, including both preventative and curative measures.

ICDDR,B found that the overall malaria prevalence in these 13 districts was 3.1% and it was significantly higher in children. The prevalence of Falciparum malaria in children up to 4years was as high as 8.5% and between 5 and14 years, 6.6%. In Khagrachari district however, the average prevalence was over 15%. Understanding this spatial distribution of malaria, identifying geographic risk factors and the population at risk are important steps toward effective malaria control and targeted interventions in high risk areas can significantly control malaria. A lack of proper data to date has prevented targeted interventions taking place in any of these endemic districts yet.
A three-year surveillance study begins for the first time in Bangladesh in 2009 to map malaria epidemiology, to record benchmark information on the prevalence of infection, knowledge and awareness, health-seeking behaviour, use of bed nets and socioeconomic differentials in the community, before launching the malaria control interventions. This project is a collaboration with Johns Hopkins Malaria Research Institution.
Artemisinin is used to treat multi-drug resistant strains of falciparum malaria, but recent data indicated the first cases in Asia of resistance to the treatment along the Cambodian-Thai border and according to WHO it could spread in south and southeast Asia. To address this WHO funded ICDDR,B to determine the sensitivity and efficacy of artesunate monotherapy for the treatment of uncomplicated falciparum malaria in Bangladesh – a project ongoing since 2008.
The new knowledge generated from these projects will be used to fill gaps in our understanding of the social aspects of malaria in Bangladesh, and will help various organizations to develop intervention components strategically appropriate for the malaria-prone areas.
For more information on malaria research at ICDDR,B contact Dr Wasif Ali Khan (wakhan@icddrb.org).