MALARIA: Progress and challenges to control malaria in a remote area of Chittagong hill tracts, Bangladesh

Background
Malaria is endemic in 13 eastern districts where the overall infection prevalence is 3.97%. In 2006, Bangladesh received US$ 36.9 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to support the national malaria control programme of Bangladesh. Objectives The objective of this study was to i) clarify factors associated with treatment-seeking behaviours two years after implementation of national malaria control programme, ii) investigate the distribution of LLIN and iii) re-treatment of ITN in remote areas of a CHT district of Bangladesh.
Methods
All households of Rajasthali sub-district of Rangamati district (households about 5,322, population about 24,097), all BRAC health workers (n = 15), health facilities and drug vendors' locations were mapped. Distances from households to health facilities, BRAC health workers and drug vendors were calculated. Logistic regression analysis was performed to assess the associations between the choice of the treatment and the distance to various treatment sources, education, occupation and ethnicity. SaTScan was used to detect clustering of treatment-seeking approaches.
Findings
LLIN distribution and the re-treatment of ITN exceeded target goals. The most common treatment facility for malaria-associated fever was malaria control programme led by BRAC and government (66.6%) followed by the drug vendor (48.8%).
Conclusion
Closeness to health facilities runs by the malaria control programme and drug vendors were significantly associated with the choice of treatment. A high proportion of people preferred drug vendors without having a proper diagnosis. Drug vendors are highly patronized and thus there may be an opportunity to improve and integrate their services in public health programmes. Otherwise this may cause incomplete treatment, misuse of anti-malarial drugs, contribute to the risk of drug resistance and jeopardize the present malaria control efforts in Bangladesh.
Malaria Journal 2010, 9:156 (10 June 2010)