title: Malaria burden and control in Bangladesh and prospects for elimination: an epidemiological and economic assessment.
abstract: BACKGROUND
  Malaria is endemic in 13 of 64 districts in Bangladesh. About 14 million people are at risk. Some evidence suggests that the prevalence of malaria in Bangladesh has decreased since the the Global Fund to Fight AIDS, Tuberculosis and Malaria started to support the National Malaria Control Program (NMCP) in 2007. We did an epidemiological and economic assessment of malaria control in Bangladesh.
  
  
  METHODS
  We obtained annually reported, district-level aggregated malaria case data and information about disbursed funds from the NMCP. We used a Poisson regression model to examine the associations between total malaria, severe malaria, malaria-attributable mortality, and insecticide-treated net coverage. We identified and mapped malaria hotspots using the Getis-Ord Gi* statistic. We estimated the cost-effectiveness of the NMCP by estimating the cost per confirmed case, cost per treated case, and cost per person of insecticide-treated net coverage.
  
  
  RESULTS
  During the study period (from Jan 1, 2008, to Dec 31, 2012) there were 285,731 confirmed malaria cases. Malaria decreased from 6.2 cases per 1000 population in 2008, to 2.1 cases per 1000 population in 2012. Prevalence of all malaria decreased by 65% (95% CI 65-66), severe malaria decreased by 79% (78-80), and malaria-associated mortality decreased by 91% (83-95). By 2012, there was one insecticide-treated net for every 2.6 individuals (SD 0.20). Districts with more than 0.5 insecticide-treated nets per person had a decrease in prevalence of 21% (95% CI 19-23) for all malaria, 25% (17-32) for severe malaria, and 76% (35-91) for malaria-associated mortality among all age groups. Malaria hotspots remained in the highly endemic districts in the Chittagong Hill Tracts. The cost per diagnosed case was US$0.39 (SD 0.02) and per treated case was $0.51 (0.27); $0.05 (0.04) was invested per person per year for health education and $0.68 (0.30) was spent per person per year for insecticide-treated net coverage.
  
  
  CONCLUSIONS
  Malaria elimination is an achievable prospect in Bangladesh and failure to push for elimination nearly ensures a resurgence of disease. Consistent financing is needed to avoid resurgence and maintain elimination goals.
  
  
  BACKGROUND
  None.
authors.affiliation: W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: ubydul.kth@gmail.com.
authors.forename: Ubydul
authors.initials: U
authors.lastname: Haque
authors.affiliation: Department of Mathematical Sciences and Technology, Norwegian University of Life Sciences, Ås, Norway.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Overgaard
authors.affiliation: University of Queensland, Infectious Disease Epidemiology Unit, School of Population Health, Herston, QLD, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
authors.affiliation: W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Norris
authors.affiliation: Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
authors.forename: Nazrul
authors.initials: N
authors.lastname: Islam
authors.affiliation: Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
authors.forename: Jahirul
authors.initials: J
authors.lastname: Karim
authors.affiliation: Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
authors.forename: Shyamal
authors.initials: S
authors.lastname: Roy
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Waziul
authors.initials: W
authors.lastname: Haque
authors.affiliation: BRAC Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh.
authors.forename: Moktadir
authors.initials: M
authors.lastname: Kabir
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Southern Research Institute, Frederick, MD, USA.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Glass
mesh_terms: D000293:Adolescent; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D060740:Disease Eradication; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D016012:Poisson Distribution