Malaria Control Program
Malaria is a significant health problem in Bangladesh, ranking third among major infectious diseases causing death. Prevalence of malaria is highly endemic in 13 out of 64 districts in Bangladesh: Khagrachari, Rangamati, Bandarban, Cox's Bazar, Chittagong, Sylhet, Sunamganj, Moulovibazar, Habiganj, Mymensingh, Netrokona, Sherpur and Kurigram. About 98% of total malaria cases are reported from these districts. The number of malaria endemic sub-districts (upazilas) is 70. The total population at risk is 10.9 million.
In 2007, a total of 59,857 laboratory confirmed cases were reported of which 228 resulted in death. Routine surveillance data shows that the proportion of male and female cases of malaria in Bangladesh is 55% and 45% respectively. The income generating group (>15 years) presents the greatest number of malaria cases. Children and pregnant women also belong to this high risk category. The poor and marginalized populations are also prone to infection and are at an increased risk of fatality. In Bangladesh more than 75% of the total cases are P.falciparum malaria (Malaria Baseline Socioeconomic and Prevalence Survey 2007; M&PDC, BRAC, ICDDR,B).
In 2007, the government of Bangladesh initiated a 5-year project to reduce the burden of malaria infection with financial assistance from The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). In April 2008, SAJIDA joined a consortium of 20 NGOs led by BRAC, to begin implementing this project in 10 unions of Dharampasha Upazila in Sunamganj district.
To reduce the occurrence of malaria by 50% in Dharmapasha upazila of Sunamganj district by 2012.
SAJIDA's main approach to malaria control is to inform and educate people at the community level by promoting the use of insecticidal nets, and highlighting the importance of early diagnosis and prompt treatment. Long lasting insecticide treated nets (LLIN) are distributed to poor households and those households with pregnant women and children under five. The households having ordinary bed nets are treated with insecticides (K-O tab). Diagnostic and treatment services are delivered mainly through community-based health workers. Information, Education & Communication (IEC) materials are used regularly during health education sessions and individual communications. During health education sessions, information on prevention, symptoms, and facilities available for diagnosis and treatment of malaria are discussed. SAJIDA also conducts orientations with different stakeholders of the community to make them aware of malarial symptoms, to encourage the use of LLIN/ITNs, to enhance referrals of symptomatic cases for diagnosis by Rapid Diagnostic Tests (RDT) or Blood Slide Examinations (BSE), to ensure treatment and to reduce stigma.
Community-Based Behaviour Change Communication
SAJIDA conducts advocacy workshops at the upazila level with various stakeholders including government officials, Upazila Nirbahi Officers, teachers, religious leaders, opinion leaders, village doctors, pharmacists and other NGO workers to orient and involve them in the malaria control program. Presided by the Upazila Health and Family Planning Officer (UH&FPO) this meeting generates discussion on malaria and provides feedback and suggestions to achieve the program's goal. To date, 280 people attended such workshops.
At the union level, orientation sessions were also organized to disseminate malaria information and generate project support. These were attended by religious leaders, village doctors, local opinion leaders, union members and local government representatives. To date, 627 participants have attended 20 orientation sessions.
Messages regarding malaria were also disseminated through loudspeaker announcements. To create general awareness about malaria, popular theatre and folk songs were developed and performed at the community level by a locally trained theatre group to illustrate the signs and symptoms of malaria, its severity, preventive measure, consequences, stigma, etc. These activities have shown marked involvement and responses from community members. To date, 12 popular theatres and 12 folk songs have been arranged.
Early Diagnosis and Treatment
The female community health workers play a pivotal role in malaria interventions at the community level, promoting community participation and bridging the gap between the community and formal health care services. The community health workers undergo a 7-day malaria training program with monthly refresher training thereafter. Each worker is responsible for overseeing an average of 2,000 households at approximately 20 household visits per day. This number may vary depending upon the geographical pattern and distribution of the households.
During household visits the community health workers raise awareness about malaria, educate people on the use of LLIN/ITNs and identify potential malaria patients. They diagnose possible malaria cases using RDT. Those who test positive are administered treatment, while those who test negative are referred to the SAJIDA laboratory for confirmation of diagnosis by blood slides. Health workers in each union of the upazila are provided with RDT kits and training to enable them to identify persons needing treatment. All positive cases are followed up to ensure the proper intake of medication. If the patient is a pregnant women, a child under 5 years of age, or shows signs of severe malaria, health workers refer such patients to the nearest health facility without delay.
SAJIDA has set up a laboratory in Maddhyanagar union, and temporary sub-centres in three other unions due to the high incidence of malaria in such areas. A laboratory technician works three days each week in the laboratory and one day in each of the sub-centres examining blood samples and prescribing medications.for patients who test positive for malaria.
Distribution and Treatment of bed nets
In 2008, SAJIDA carried out a complete household survey of the upazila, collecting information on household members, household socio-economic status and presence/conditions of bed nets in the household. Based on the findings, poor households and those with pregnant women and children under five were targeted for the distribution of LLIN.
Capacity development of Project Staff
In the last 12 months, project staff at various levels received training on malaria control activities from BRAC in collaboration with the Malaria and Parasite Disease Control (M&PDC) unit of DG Health. The lab technician received two weeks training on microscope malaria diagnosis. To build further capacity, the lab technician was sent to Chittagong Hill Tracts for one week to gain more experience. The upazila manager received a week-long training from BRAC on advocacy, social mobilization and communication.
In order to ensure the transparency of the program, during the first week of every month slides were sent to the Upazila Health Complex (UHC) for cross checking and feedback. All the positive slides and 10% of the negative slides were cross checked.
Following are SAJIDA's suggestions for the forthcoming years to continue the current momentum and to reach and sustain the MDGs set for 2015: