Progress and challenges to control malaria in a remote area of Chittagong hill tracts, Bangladesh.
BACKGROUND
Malaria is endemic in 13 eastern districts where the overall infection prevalence is 3.97%. In 2006, Bangladesh received US$ 36.9 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to support the national malaria control programme of Bangladesh.


OBJECTIVE
The objective of this study was to i) clarify factors associated with treatment seeking behaviours of malaria ii) distribution of LLIN, and iii) re-treatment of ITN in remote area of a CHT district of Bangladesh two years after implementation of national control programme.


METHODS
All households of Rajasthali sub-district of Rangamati district (households about 5,322, population about 24,097), all BRAC health workers (n = 15), health facilities and drug vendors' locations were mapped. Distances from households to health facilities, BRAC health workers and drug vendors were calculated. Logistic regression analysis was performed to assess the associations between the choice of the treatment and the distance to various treatment sources, education, occupation and ethnicity. SaTScan was used to detect clustering of treatment-seeking approaches.


RESULTS
LLIN distribution and the re-treatment of ITN exceeded target goals. The most common treatment facility for malaria-associated fever was malaria control programme led by BRAC and government (66.6%) followed by the drug vendor (48.8%).


CONCLUSIONS
Closeness to health facilities run by the malaria control programme and drug vendors were significantly associated with the choice of treatment. A high proportion of people preferred drug vendors without having a proper diagnosis. Drug vendors are highly patronized and thus there is a need to improve their services for public health good. Otherwise it may cause incomplete treatment, misuse of anti-malarial drugs that will contribute to the risk of drug resistance and jeopardize the present malaria control efforts in Bangladesh.
Haque
Ubydul
U
International Center for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka 1212, Bangladesh. ubydul@icddrb.org
Hashizume
Masahiro
M
Sunahara
Toshihiko
T
Hossain
Shahed
S
Ahmed
Syed Masud
SM
Haque
Rashidul
R
Yamamoto
Taro
T
Glass
Gregory E
GE
D000962:Antimalarials / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D016000:Cluster Analysis; D005191:Family Characteristics; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D010342:Patient Acceptance of Health Care; D015995:Prevalence
D000962:Antimalarials; D007306:Insecticides