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Wednesday, April 29, 2015, Baishakh 16, 1422 BS, Rajab 9, 1436 Hijr


Preventing the bite to check malaria
Saleem Samad, returning from Netrokona
Published : Wednesday, 29 April, 2015,  Time : 12:00 AM,  View Count : 86
Fifty years ago, a reader wrote a letter to the Editor of an English daily that while travelling by train he could not sleep, as he had to listen to 'singing mosquitoes' in his compartment.
I was not concerned about the sleepless passenger, but was wondering whether I could collect few 'singing mosquitoes'. Riding a bicycle, the following day, I went to the magnificent Kamalapur railway station to find the 'singer', after sometime I realised the fact after talking to an apparently 'friendly' coolie sporting a red shirt and wearing a turban of a 'gamcha' when he laughed at me at the station platform. Talking to me in confidence he said the 'singing mosquitoes' are horror insects, which inject malaria parasite in human blood veins to kill, but slowly.
Shocked to hear the railway coolie, I headed home and stopped for a while at a local pharmacy in the old Dhaka city, where a paramedic described the number of malaria patients he administer a popular antidote Quinine to save the victims from dying.
In a hilly village in Susang Durgapur, home of indigenous Garo community, Lia Ritchel, a 36-year-old health worker, is contended with her work, especially when patients, women and children, are treated and recovered from the fatal bite.
Lia, a bare-footed health worker for Peace and Rights Development Society (PRDS) based in Netrokona, walks in five villages in Susang Durgapur literally for days, months and years to protect the villagers from the deadly bite of Anopheles mosquito species.
Nowadays she does not get more than one patient a month, Lia said with a smile of confidence that the malaria attacks have significantly reduced in recent years.
In the foothills of Meghalaya hills, she was returning from Bhanipur village inhabited by Garo community at the fringe of the Bangladesh-India border.
Treatments exist but new drugs would help to move closer to elimination. These include drugs for fighting increasing resistance to current treatments and a complete cure that would enable patients to be cleared from all malaria parasites, and stop transmission to other humans.
Netrokona is on the frontiers and the most epidemic prone region along the border districts of Kurigram, Sherpur, Mymensingh, Sunamganj, Sylhet, Habiganj and Maulvibazar, while the three districts of Chittagong Hill Tracts, Cox Bazar and Chittagong are highly endemic region.
Malaria is one of the major public health issues in Bangladesh. Out of the total 64 districts, 13 districts are in the high endemic areas of malaria transmissions. In these 13 endemic districts there are 70 endemic upazilas covering 620 unions with the total population of 10.9 million. Over 98 per cent of the total cases in the country are reported from these areas.
Bangladesh has significantly brought down the number of patients and people at risk. The government managed Malaria and Parasitic Disease Control Unit reports that the number of deaths due to the vector-borne disease dropped to 47 in 2009, from 154 in 2008. The Unit's data indicate that the malaria death toll has dramatically declined since 2002, when the deaths stood at 588. According to the Unit, the number of persons infected with malaria decreased to 63,873 in 2009, from 84,690 in 2008.
According to World Health Organisation (WHO), 33.6 per cent of the country's population --- 50.6 million people --- are at risk of malaria, primarily in 13 districts along the north-eastern and south-eastern borders.
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. In the early 1970s, malaria re-emerged in the country, and the programme changed its focus to malaria control and eradication took a back seat.
According to the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Bangladesh stands number one in South Asia as malaria endemic country.
Malaria is an infectious disease transmitted through infected mosquitoes. Symptoms include fever, headache and vomiting, and usually appear 10-15 days after the mosquito bite. If ignored treatment, malaria can become life-threatening.
Malaria is a major public health problem in some parts of Bangladesh, particularly in 13 districts in the north-east and south-east areas, bordering India and Myanmar. Among them are the Chittagong Hill Tracts (CHT) districts which highly endemic and Cox's Bazar which is moderately endemic.
The National Malaria Control Programme (NMCP) established an effective partnership with a consortium of 21 NGOs led by BRAC. This partnership has leveraged the programme and increased the access to malaria treatment, prevention and awareness raising activities within communities, including the hard-to-reach areas.
In partnership with the NMCP, BRAC successfully secured an international grant to strengthen and expand national malaria control programme to all endemic districts working directly and through other NGOs.
The objective of NMCP is to reduce the overall burden of malaria (morbidity and mortality) by 60 per cent from baseline year 2008 in 10.9 million populations in 13 high endemic districts of Bangladesh by 2015.
The programme success in distributing two nets per household of Long Lasting Insecticidal bed Nets (LLIN) free, to achieve 100 per cent coverage in the three malaria endemic districts and to ensure 80 per cent coverage with insecticide treated mosquito nets.
Various sensitisation and advocacy meetings are conducted among different stakeholders of the community to make them aware of malaria symptoms and to engage them in the effort to identify patients, increase utilisation of LLIN and to create early care seeking behaviour. The stakeholders include local figures, religious leaders, headmen, karbaris, teachers, village doctors, pharmacists, private practitioners and hotel owners/ managers.
One key to making faster progress is to pull resources together and to work in partnership - enabling NGOs, governments, academia and the private sector to contribute their best assets toward the elimination of malaria.
In order to make further progress toward malaria elimination, more resources are needed to strengthen national health systems. This is absolutely critical for drug delivery or healthcare services to function. The government should be in the lead of these efforts.

Saleem Samad is Special Currespondent, The Daily Observer











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