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Malaria in Bhutan
2005: More efforts needed to contain malaria

Although control measures have helped in bringing down malaria related illnesses and deaths in the southern belt, the disease is still a threat, according to the latest reports from the Vector-borne Disease Control Programme (VDCP) in Gelephu, Sarpang.

Reported malaria cases
Malaria cases
1994 1998 1999 2001 2004
38,901 3,403 6,380 2,670 5,982
A total of 2,670 cases of malaria with five deaths were reported in 2004 against 5,982 reported cases and 14 deaths in 2001.

"There has been a considerable improvement but challenges still exist," said the VDCP programme manager, Dr. Karma Lhazeen. For the first time, Samtse dzongkhag reported the highest number of malaria cases contributing 38 percent of the total in 2004. "This is the first time in the history of malaria in Bhutan," said Dr. Karma Lhazeen.

Decrease of malaria cases

Dr. Lhazeen said that in 1994, when there were 38,901 reported malaria cases in the country, the highest ever recorded, Samtse contributed only about seven percent. "This is a startling increase in few years," she said, adding that there were some factors that may be the probable causes.

The resettlement of people from less malaria prone areas to the endemic areas and increase in the movement of these people into the high malaria transmission localities were cited as some major causes contributing to the increase in malaria cases. "Besides, routine surveillance and supervisory activities in this dzongkhag are hampered because of inadequate fund," said Dr. Lhazeen.

Meanwhile, the two most malaria plagued sub-tropical dzongkhags of Sarpang and Samdrup Jongkhar have shown considerable improvement. In Sarpang, the cases have been reduced from 51 percent in 2001 to 34 percent last year. Samdrup Jongkhar also showed a decrease from 46 percent in 1998 to only 14 percent in 2004.

Intensified awareness campaigns and strengthened surveillance activities were cited as the reasons for the improvement. "Since the early years these dzongkhags have been given priority as they are the most prone areas to malaria infection," said Dr. Lhazeen.

Meanwhile, the latest figures show that the beginning of 2005 saw 67 cases of malaria which, according to Dr. Lhazeen, is better than last year's number of 94 for the same period.

Of the various initiatives, Insecticide Treated Bed Nets (ITBN) were "impregnated" with the insecticide twice a year. In areas with high Plasmodium falciparum malaria, Focal Indoor Residual Spray (IRS) was done once a year in high transmission areas and forest and other adjoining areas just before the maximum transmission season.

New strategies
New strategies have also been recently introduced to curb the problem. The long lasting insecticide nets (LLINs) which are pre-treated bed nets that need not be treated with insecticides like ordinary bed-nets have been lately introduced along with a new drug called co-artem for treatment of uncomplicated falciparum malaria. "This drug is very effective and will prevent spread of drug resistant malaria," said Dr. Lhazeen.
Malaria caused by mosquito bites
Malaria, most often, is caused by the bite of a female Anopheles species mosquito that is infected with one of the four different species of the protozoan genus Plasmodium, the parasitic protozoa that cause malaria. Plasmodium vivax and Plasmodium falciparum were the two most common infections found in Bhutan.

Malaria can also be transmitted via a blood transfusion or congenitally between mother and fetus, although these forms of infection were rare, the health officials said.

The health officials warn that Plasmodium falciparum is the most widespread and dangerous and if left untreated it can lead to fatal cerebral malaria.

Symptoms of malaria
Fever, cough, shaking chills, headache and pain in the joints are some early symptoms of malaria. The patient usually remains "asymptomatic" for a week or more after the infecting mosquito bite, said the health officials.
"Malaria is a complex but a curable and preventable disease," said Dr. Lhazeen.

"Lives can be saved if the disease is detected early. The longer a person delays in seeking medical care, more the chances of developing complications which may lead to death."

Health officials also advise the people to keep the surrounding areas clean and dry by clearing drains frequently, clearing bushes around the dwellings before spraying operations so that mosquito-resting places are destroyed.

Health centers
About 177 health centers scattered across the country reported on malaria cases, with 46 of these established in the endemic areas. Sibsoo hospital reported 438 numbers of malaria cases, followed by Lhamoizinkha in Sarpang and Samtse hospital at 289 and 223 cases respectively.

About 177 health centers scattered across the country reported on malaria cases, with 46 of these established in the endemic areas. Sibsoo hospital reported 438 numbers of malaria cases, followed by Lhamoizinkha in Sarpang and Samtse hospital at 289 and 223 cases respectively.

Despite the efforts the challenge still remains, said Dr. Lhazeen. "We are targeting to 50 percent reduction in malaria with no deaths in 2005," she said. "For this, we need strong support and commitment of the dzongkhag administrations, community participation through consistent net use and committed field workers to carry out routine surveillance were important."

Meanwhile, dengue fever, Japanese encephalitis and filariasis were other diseases that were posing risk to people in areas with a hot and humid climate as vectors of these diseases were found abundant in all endemic areas and even in non-malarious dzongkhags in Bhutan.

This article was contributed by Kinley Wangmo, KUENSEL, Bhutan's National Newspaper
External links
World Health Organization (WHO) World Meteorological Organization (WMO)
Information about Malaria
Malaria Vaccine Initiative
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