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Mapping hypoendemic, seasonal malaria in rural Bandarban, Bangladesh: a prospective surveillance

Wasif A Khan1*, David A Sack2, Sabeena Ahmed1, Chai Shawi Prue1, Mohammad Shafiul Alam1, Rashidul Haque1, Jacob Khyang1, Malathi Ram2, Jasmin Akter1, Myaing Myaing Nyunt2, Douglas Norris2, Gregory Glass2, Timothy Shields2, Md Zahirul Haq1, Alejandro Cravioto1 and David J Sullivan2

Author Affiliations

1 ICDDR, B: International Centre for Diarrhoeal Disease Research, Clinical Sciences Division

2 Johns Hopkins Malaria Research Institute, JHBSPH, Baltimore, MD, USA

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Malaria Journal 2011, 10:124  doi:10.1186/1475-2875-10-124

Published: 14 May 2011



Until recently the Chittagong Hill tracts have been hyperendemic for malaria. A past cross-sectional RDT based survey in 2007 recorded rates of approximately 15%. This study was designed to understand the present epidemiology of malaria in this region, to monitor and facilitate the uptake of malaria intervention activities of the national malaria programme and to serve as an area for developing new and innovative control strategies for malaria.


This research field area was established in two rural unions of Bandarban District of Bangladesh north of Bandarban city, which are known to be endemic for malaria due to Plasmodium falciparum. The project included the following elements: a) a demographic surveillance system including an initial census with updates every four months, b) periodic surveys of knowledge attitude and practice, c) a geographic information system, d) weekly active and continuous passive surveillance for malaria infections using smears, rapid tests and PCR, f) monthly mosquito surveillance, and e) daily weather measures. The programme included both traditional and molecular methods for detecting malaria as well as lab methods for speciating mosquitoes and detecting mosquitoes infected with sporozoites.


The demographic surveillance enumerated and mapped 20,563 people, 75% of which were tribal non-Bengali. The monthly mosquito surveys identified 22 Anopheles species, eight of which were positive by circumsporozoite ELISA. The annual rate of malaria was close to 1% with 85% of cases in the rainy months of May-October. Definitive clustering identified in the low transmission season persisted during the high transmission season.


This demographically and geographically defined area, near to the Myanmar border, which is also hypoendemic for malaria, will be useful for future studies of the epidemiology of malaria and for evaluation of strategies for malaria control including new drugs and vaccines.