title: Mapping hypoendemic, seasonal malaria in rural Bandarban, Bangladesh: a prospective surveillance.
abstract: BACKGROUND
  Until recently the Chittagong Hill tracts have been hyperendemic for malaria. A past cross-sectional RDT based survey in 2007 recorded rates of approximately 15%. This study was designed to understand the present epidemiology of malaria in this region, to monitor and facilitate the uptake of malaria intervention activities of the national malaria programme and to serve as an area for developing new and innovative control strategies for malaria.
  
  
  METHODS
  This research field area was established in two rural unions of Bandarban District of Bangladesh north of Bandarban city, which are known to be endemic for malaria due to Plasmodium falciparum. The project included the following elements: a) a demographic surveillance system including an initial census with updates every four months, b) periodic surveys of knowledge attitude and practice, c) a geographic information system, d) weekly active and continuous passive surveillance for malaria infections using smears, rapid tests and PCR, f) monthly mosquito surveillance, and e) daily weather measures. The programme included both traditional and molecular methods for detecting malaria as well as lab methods for speciating mosquitoes and detecting mosquitoes infected with sporozoites.
  
  
  RESULTS
  The demographic surveillance enumerated and mapped 20,563 people, 75% of which were tribal non-Bengali. The monthly mosquito surveys identified 22 Anopheles species, eight of which were positive by circumsporozoite ELISA. The annual rate of malaria was close to 1% with 85% of cases in the rainy months of May-October. Definitive clustering identified in the low transmission season persisted during the high transmission season.
  
  
  CONCLUSIONS
  This demographically and geographically defined area, near to the Myanmar border, which is also hypoendemic for malaria, will be useful for future studies of the epidemiology of malaria and for evaluation of strategies for malaria control including new drugs and vaccines.
authors.affiliation: ICDDR, B: International Centre for Diarrhoeal Disease Research, Clinical Sciences Division. wakhan@icddrb.org
authors.forename: Wasif A
authors.initials: WA
authors.lastname: Khan
authors.forename: David A
authors.initials: DA
authors.lastname: Sack
authors.forename: Sabeena
authors.initials: S
authors.lastname: Ahmed
authors.forename: Chai Shawi
authors.initials: CS
authors.lastname: Prue
authors.forename: Mohammad Shafiul
authors.initials: MS
authors.lastname: Alam
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.forename: Jacob
authors.initials: J
authors.lastname: Khyang
authors.forename: Malathi
authors.initials: M
authors.lastname: Ram
authors.forename: Jasmin
authors.initials: J
authors.lastname: Akter
authors.forename: Myaing Myaing
authors.initials: MM
authors.lastname: Nyunt
authors.forename: Douglas
authors.initials: D
authors.lastname: Norris
authors.forename: Gregory
authors.initials: G
authors.lastname: Glass
authors.forename: Timothy
authors.initials: T
authors.lastname: Shields
authors.forename: Md Zahirul
authors.initials: MZ
authors.lastname: Haq
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cravioto
authors.forename: David J
authors.initials: DJ
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000852:Anopheles / Q000254:growth & development / Q000469:parasitology; D000953:Antigens, Protozoan / Q000032:analysis; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005843:Geography; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011247:Pregnancy; D012424:Rural Population; D012621:Seasons; D055815:Young Adult
chemical_list: D000953:Antigens, Protozoan