Limits...
Malaria control in Bhutan: case study of a country embarking on elimination.

Yangzom T, Gueye CS, Namgay R, Galappaththy GN, Thimasarn K, Gosling R, Murugasampillay S, Dev V - Malar. J. (2012)

Bottom Line: Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006.Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years.Bhutan has made significant strides towards elimination and has adopted a goal of national elimination.

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Affiliation: Vector-Borne Disease Control Programme, Ministry of Health, Royal Government of Bhutan, Gelephu, Bhutan.

ABSTRACT

Background: Bhutan has achieved a major reduction in malaria incidence amid multiple challenges. This case study seeks to characterize the Bhutan malaria control programme over the last 10 years.

Methods: A review of the malaria epidemiology, control strategies, and elimination strategies employed in Bhutan was carried out through a literature review of peer-reviewed and grey national and international literature with the addition of reviewing the surveillance and vector control records of the Bhutan Vector-Borne Disease Control Programme (VDCP). Data triangulation was used to identify trends in epidemiology and key strategies and interventions through analysis of the VDCP surveillance and programme records and the literature review. Enabling and challenging factors were identified through analysis of socio-economic and health indicators, corroborated through a review of national and international reports and peer-review articles.

Findings: Confirmed malaria cases in Bhutan declined by 98.7% from 1994 to 2010. The majority of indigenous cases were due to Plasmodium vivax (59.9%) and adult males are most at-risk of malaria. Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006. Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years. Access to malaria diagnosis in treatment was expanded throughout the country and evidence-based case management, including the introduction of artemisinin-based combination therapy (ACT) for P. falciparum, increasing coverage of high risk areas with Indoor Residual Spraying, insecticide-treated bed nets, and long-lasting insecticidal nets are likely to have contributed to the decline alongside enabling factors such as economic development and increasing access to health services.

Conclusion: Bhutan has made significant strides towards elimination and has adopted a goal of national elimination. A major challenge in the future will be prevention and management of imported malaria infections from neighbouring Indian states. Bhutan plans to implement screening at border points to prevent importation of malaria and to targeted prevention and surveillance efforts towards at-risk Bhutanese and migrant workers in construction sites.

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Confirmed cases in Sarpang District, indigenous and imported cases, 2000-2010, with total annual rainfall in Sarpang District [25].
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Figure 4: Confirmed cases in Sarpang District, indigenous and imported cases, 2000-2010, with total annual rainfall in Sarpang District [25].

Mentions: Sarpang District, which borders Assam State of India, recorded the majority of imported cases (every year from 2000 to 2010) and the highest number of indigenous cases in 7 out of 10 years (2000-03, 2005, 2008-10). Over the last decade, this district has contributed an average of 87.5% of imported cases and an average of 47.1% of indigenous cases in Bhutan. The border is highly porous, exemplified by the many residents of neighboring Assam receiving treatment in the district's health clinics. In 2009 there was a reported outbreak of malaria in Assam with a 26.8% increase in reported cases [23]. This trend was mirrored in Sarpang, where a three-fold increase was reported that same year (Figure 4). Eighty percent of infections that year were due to P. falciparum. Rainfall trends from 2000 to 2010 from Bhur Station in Sarpang District indicate that there was no clear trend in rainfall in this district over this period (Figure 4) [25].


Malaria control in Bhutan: case study of a country embarking on elimination.

Yangzom T, Gueye CS, Namgay R, Galappaththy GN, Thimasarn K, Gosling R, Murugasampillay S, Dev V - Malar. J. (2012)

Confirmed cases in Sarpang District, indigenous and imported cases, 2000-2010, with total annual rainfall in Sarpang District [25].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3278342&req=5

Figure 4: Confirmed cases in Sarpang District, indigenous and imported cases, 2000-2010, with total annual rainfall in Sarpang District [25].
Mentions: Sarpang District, which borders Assam State of India, recorded the majority of imported cases (every year from 2000 to 2010) and the highest number of indigenous cases in 7 out of 10 years (2000-03, 2005, 2008-10). Over the last decade, this district has contributed an average of 87.5% of imported cases and an average of 47.1% of indigenous cases in Bhutan. The border is highly porous, exemplified by the many residents of neighboring Assam receiving treatment in the district's health clinics. In 2009 there was a reported outbreak of malaria in Assam with a 26.8% increase in reported cases [23]. This trend was mirrored in Sarpang, where a three-fold increase was reported that same year (Figure 4). Eighty percent of infections that year were due to P. falciparum. Rainfall trends from 2000 to 2010 from Bhur Station in Sarpang District indicate that there was no clear trend in rainfall in this district over this period (Figure 4) [25].

Bottom Line: Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006.Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years.Bhutan has made significant strides towards elimination and has adopted a goal of national elimination.

View Article: PubMed Central - HTML - PubMed

Affiliation: Vector-Borne Disease Control Programme, Ministry of Health, Royal Government of Bhutan, Gelephu, Bhutan.

ABSTRACT

Background: Bhutan has achieved a major reduction in malaria incidence amid multiple challenges. This case study seeks to characterize the Bhutan malaria control programme over the last 10 years.

Methods: A review of the malaria epidemiology, control strategies, and elimination strategies employed in Bhutan was carried out through a literature review of peer-reviewed and grey national and international literature with the addition of reviewing the surveillance and vector control records of the Bhutan Vector-Borne Disease Control Programme (VDCP). Data triangulation was used to identify trends in epidemiology and key strategies and interventions through analysis of the VDCP surveillance and programme records and the literature review. Enabling and challenging factors were identified through analysis of socio-economic and health indicators, corroborated through a review of national and international reports and peer-review articles.

Findings: Confirmed malaria cases in Bhutan declined by 98.7% from 1994 to 2010. The majority of indigenous cases were due to Plasmodium vivax (59.9%) and adult males are most at-risk of malaria. Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006. Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years. Access to malaria diagnosis in treatment was expanded throughout the country and evidence-based case management, including the introduction of artemisinin-based combination therapy (ACT) for P. falciparum, increasing coverage of high risk areas with Indoor Residual Spraying, insecticide-treated bed nets, and long-lasting insecticidal nets are likely to have contributed to the decline alongside enabling factors such as economic development and increasing access to health services.

Conclusion: Bhutan has made significant strides towards elimination and has adopted a goal of national elimination. A major challenge in the future will be prevention and management of imported malaria infections from neighbouring Indian states. Bhutan plans to implement screening at border points to prevent importation of malaria and to targeted prevention and surveillance efforts towards at-risk Bhutanese and migrant workers in construction sites.

Show MeSH
Related in: MedlinePlus