Bhutan-Malaria Situation in SEAR Countries

Malaria Situation in SEAR Countries

Bhutan

Bangladesh

Malaria Situation

Malaria is a serious public health problem in Bhutan. 72% of the country’s population reside in the malaria-risk areas. Of these, 57% reside in seven perennial transmission districts namely Sarpang, Samdrup Jongkhar, Samtse, Chukha, Zhemgang, Dagana and Pemagatshel and 43 % reside in malaria-receptive districts (Tsirang, Wangdiphodrang, Punakha, Trongsa, Tashigang, Mongar, Tashiyangtse and Lhuntse). The southern part of the country bordering eastern part of India, malaria remains a big problem for malaria control. At present, the above mentioned disricts with perennial transmission of malaria constitute around 92% of the total confirmed malaria cases of the country. A very high percentage of malaria cases occur in forests and forest-fringe areas. The main vectors are A. dirus in forested and A. minimus and A. fluviatilis in forest fringe-areas that account for as much as 92.6% of the human biting collections.

During the eradication phase, the malaria situation was under control. This trend continued till 1971. The situation deteriorated there after. The number of cases rose five folds with 3402 cases in 1973 as compared to 1971. It further increased and doubled in 1975 with 7929 cases. After that situation improved and remained static till 1982 with annual cases around 3500 to 5000. However, situation deteriorated from 1983 to 1990 with annual cases were around 10000 to 22000 per annum. It had further deteriorated during 1991 to 1994 and touched the peak with 38 901 cases in 1994. The situation has improved there after regularly. The reported malaria cases came down to 3805 in 2003 and further upto 793 in 2007 and finally, 436 in 2010 respectively (Fig. 1). The P. falciparum proportions

Malaria Situation in Bhutan, 2010 : At a Glance
Total population	: 677,242
Population in malarious areas	: 512,605
Number of Lab confirmed malaria cases	: 436
Pf Proportion	: 40.1%
Number of probable malaria cases	: 0
Number of deaths due to malaria (Reported)	: 2
#of ACT courses Distributed	: 266
No of LLINs Distributed	: 101,645
No. of effective LLINs+ITNs (cumulative) availability	: 131,984
Population protected with ITNs	: 263,968
Population protected with IRS	: 140,503
Vectors: An. dirus, An. minimus, An. Aconitus Malaria is a greater problem in border areas with India No major epidemics reported in 2009. Supported by GFTAM since Rd 7 and Govt. of India and Govt. of India.

reached upto 57% in 2009 and the species is resistant to chloroquine, in some parts of the country, to sulfadoxine-pyrimethamine combination too. The country has adopted ACT as a policy for treatment of Pf cases in 2004 and distributed around 266 courses of ACTs in 2010 (Fig.3). Further, in 2009, for vector control, country has distributed more than 100 000 LLINs which leads the total availability of effective bednets around 131 984 (Fig.2) where as around 140 503 people were protected by IRS. In 1994, DDT was phased out as same had little impact on malaria transmission. Alternatively, since 1995, Deltamethrin is now being applied on a selective basis as an indoor residual spray in forest, forest fringe and project areas. Emphasis is being placed on multi-spectral involvement in malaria vector control. Human migration within the country is also a problem.


Fig. 2 :Cumulative Availability of Effective ITNs & LLINs in Bhutan, 2005-2010	Fig. 3 : Distribution of ACTs and Malaria Deths in Bhutan, 2005-2010

The programme is supported financially by four major agencies namely: the Royal Government of Bhutan, the Government of India, the Global Fund and WHO. Total USD 1.72 million was made available to the programme out of which USD 1.32 (76%) millions was provided by the Global funds (Fig.4). During 2010, programme could able to spent only USD 1.30 million. The highest amount was spent on Training (28%) followed by Infrastructure and equipment (23%) and LLINs (10%) and lowest amount was spent Diagnostics (2.3%) followed by Procurement and Supply Management (2.4%) (Fig. 5)


Fig. 4 : Availability of funds by Source in Bhutan, 2003-2010	Fig. 5: Expenditure Details by Type in Bhutan, 2010

Goals and Targets:

To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country.

Targets	Baseline data in 2005	2010
To reduce the morbidity by 50%of the rate in 2000 by the year	13.9 / 1000	6.95/ 1000
To reduce the mortality by 75%of the rate in 2000 by the year	2.5/ 100000	0.63/ 100000