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Spatio-temporal patterns of malaria infection in Bhutan: a country embarking on malaria elimination.

Wangdi K, Kaewkungwal J, Singhasivanon P, Silawan T, Lawpoolsri S, White NJ - Malar. J. (2011)

Bottom Line: Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend.Clusters extended to the non-transmission areas in the eastern Bhutan.The decrease in the trend can be attributed to the success of the control and preventive measures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. dockinley@gmail.com

ABSTRACT

Background: At the verge of elimination of malaria in Bhutan, this study was carried out to analyse the trend of malaria in the endemic districts of Bhutan and to identify malaria clusters at the sub-districts. The findings would aid in implementing the control activities. Poisson regression was performed to study the trend of malaria incidences at district level from 1994 to 2008. Spatial Empirical Bayesian smoothing was deployed to identify clusters of malaria at the sub-district level from 2004 to 2008.

Results: Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend. Spatial cluster-outlier analysis showed that malaria clusters were mostly concentrated in the central and eastern Bhutan in three districts of Dagana, Samdrup Jongkhar and Sarpang. The disease clusters were reported throughout the year. Clusters extended to the non-transmission areas in the eastern Bhutan.

Conclusions: There is significant decrease in the trend of malaria with the elimination at the sight. The decrease in the trend can be attributed to the success of the control and preventive measures. In order to realize the target of elimination of malaria, the control measure needs to be prioritized in these high-risk clusters of malaria.

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Related in: MedlinePlus

Malaria trends of the endemic districts of Bhutan with control and treatment measures. (Note: SP: sulphadoxine-pyrimethamine; QT: quinine; PQ: primaquine; AS:Artesunate; A-L: artemether and lumefantrine).
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Figure 4: Malaria trends of the endemic districts of Bhutan with control and treatment measures. (Note: SP: sulphadoxine-pyrimethamine; QT: quinine; PQ: primaquine; AS:Artesunate; A-L: artemether and lumefantrine).

Mentions: The decrease in the trend of overall districts and most of the districts could be due to a number of factors. One round of IRS with deltamethrin (synthetic pyrethoid) was the main prevention and control measures from 1994 to 1997. The chemicals used for IRS till 1994 was DDT. The introduction of ITN with IRS from 1998 led to significant decrease in the malaria cases. The bed nets were treated every six months and one round of IRS was carried out. In 2006, VDCP introduced LLINs, and distributed over 100,000 LLINs with the grants from GFATM to the seven endemic districts of Bhutan. Similarly, the treatment of P. falciparum changed from sulphadoxine and pyrimethamine in 1997 to artesunate and doxycycline between 1997 and 2006. Finally, in 2006 the combination therapy of artemether and lumefantrine (CoartemĀ®) was introduced. However, P. vivax is still treated with three days regimen of chloroquine and fourteen days primaquine, with quinine as the secondary drug for the treatment of complicated malaria till now (Figure 4). A study in Thailand by Zhou reported sharp drop in falciparum cases when the drug for the treatment of P. falciparum was introduced [19]. However, this was not true in case of Bhutan since both types of infection, P. falciparum and P. vivax infection, decreased proportionately (Figure 5). Therefore, it was concluded that the decrease in the trend could be attributed to the successful implementation of the control measures.


Spatio-temporal patterns of malaria infection in Bhutan: a country embarking on malaria elimination.

Wangdi K, Kaewkungwal J, Singhasivanon P, Silawan T, Lawpoolsri S, White NJ - Malar. J. (2011)

Malaria trends of the endemic districts of Bhutan with control and treatment measures. (Note: SP: sulphadoxine-pyrimethamine; QT: quinine; PQ: primaquine; AS:Artesunate; A-L: artemether and lumefantrine).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3094227&req=5

Figure 4: Malaria trends of the endemic districts of Bhutan with control and treatment measures. (Note: SP: sulphadoxine-pyrimethamine; QT: quinine; PQ: primaquine; AS:Artesunate; A-L: artemether and lumefantrine).
Mentions: The decrease in the trend of overall districts and most of the districts could be due to a number of factors. One round of IRS with deltamethrin (synthetic pyrethoid) was the main prevention and control measures from 1994 to 1997. The chemicals used for IRS till 1994 was DDT. The introduction of ITN with IRS from 1998 led to significant decrease in the malaria cases. The bed nets were treated every six months and one round of IRS was carried out. In 2006, VDCP introduced LLINs, and distributed over 100,000 LLINs with the grants from GFATM to the seven endemic districts of Bhutan. Similarly, the treatment of P. falciparum changed from sulphadoxine and pyrimethamine in 1997 to artesunate and doxycycline between 1997 and 2006. Finally, in 2006 the combination therapy of artemether and lumefantrine (CoartemĀ®) was introduced. However, P. vivax is still treated with three days regimen of chloroquine and fourteen days primaquine, with quinine as the secondary drug for the treatment of complicated malaria till now (Figure 4). A study in Thailand by Zhou reported sharp drop in falciparum cases when the drug for the treatment of P. falciparum was introduced [19]. However, this was not true in case of Bhutan since both types of infection, P. falciparum and P. vivax infection, decreased proportionately (Figure 5). Therefore, it was concluded that the decrease in the trend could be attributed to the successful implementation of the control measures.

Bottom Line: Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend.Clusters extended to the non-transmission areas in the eastern Bhutan.The decrease in the trend can be attributed to the success of the control and preventive measures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. dockinley@gmail.com

ABSTRACT

Background: At the verge of elimination of malaria in Bhutan, this study was carried out to analyse the trend of malaria in the endemic districts of Bhutan and to identify malaria clusters at the sub-districts. The findings would aid in implementing the control activities. Poisson regression was performed to study the trend of malaria incidences at district level from 1994 to 2008. Spatial Empirical Bayesian smoothing was deployed to identify clusters of malaria at the sub-district level from 2004 to 2008.

Results: Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend. Spatial cluster-outlier analysis showed that malaria clusters were mostly concentrated in the central and eastern Bhutan in three districts of Dagana, Samdrup Jongkhar and Sarpang. The disease clusters were reported throughout the year. Clusters extended to the non-transmission areas in the eastern Bhutan.

Conclusions: There is significant decrease in the trend of malaria with the elimination at the sight. The decrease in the trend can be attributed to the success of the control and preventive measures. In order to realize the target of elimination of malaria, the control measure needs to be prioritized in these high-risk clusters of malaria.

Show MeSH
Related in: MedlinePlus