Rohingya population displacement: Concern for spread of drug-resistant malaria?

The Chittagong Hill Tracts (CHT) region in south-eastern Bangladesh is neighbouring to the Greater Mekong region, currently flagged for the spread of resistance to the widely used antimalarial drug ‘artemisinin.’

Artemisinin-resistance means that at present the most widely used drug may not work against the disease spread by mosquitoes.

Map: Inamul Shahriar / W A Khan / icddr,b

First detected in 2009 in Cambodia, artemisinin-resistance has been found in Laos, Thailand and subsequently in Bangladesh’s close neighbour Myanmar, demonstrating a trend of moving westward similar to that of  chloroquine as seen in the 1970s.

Recently the great influx of Forcibly Displaced Myanmar Nationals (FDMNs) in Bangladesh has increased population movements around the CHT area.

“It increases the risk of malaria not only among the Rohingya population but also among the local community as we approach the rainy season, since malaria parasite carrying vectors (mosquitoes) are prevalent in Cox’s Bazar as part of the CHT,” says Dr Wasif Ali Khan, scientist working on malaria research with icddr,b’s infectious diseases division.

“Thus it is important that sooner than later the community health workers are taught on malaria rapid diagnostic tests (RDT) usage and treatment before any potential malaria outbreak in those makeshift tents,” suggests Dr Khan, who is also a member of an Asia Pacific Malaria Elimination Network (APMEN) working group.

There is still no evidence of artemisinin-resistance in the CHT, according to a new evidence from icddr,b study published in the Malaria Journal, co-authored by Dr Khan.

However, Bangladesh needs monitoring for artemisinin susceptibility to ensure early detection and containment of anti-malarial resistance if found, says Dr Mohammad Shafiul Alam, icddr,b associate scientist and first author of the study.

Co-authored by the two icddr,b scientists, a recent publication in the New England Journal of Medicine (NEJM) on the first global mapping of artemisinin resistance (KARMA study led by Institut Pasteur) has shown that artemisinin-resistance is currently confined to Southeast Asia.

icddr,b’s malaria surveillance field site in the CHT district of Bandarban on the Bangladesh-Myanmar border has been a great resource, contributing to nearly a decade of malaria research towards navigating safe and effective cure and publication of over 50 articles in peer-reviewed journals.

The Chittagong Hill Tracts (CHT) is in southeastern Bangladesh. Photo: Wasif A Khan / icddr,b

According to the Malaria National Strategic Plan 2015-2020, around 13 million people in Bangladesh’s malaria-endemic districts are at risk of this infectious disease. On the brighter side, icddr,b studies have found that malaria prevalence in all endemic districts including the CHT has declined from 40 to less than 2 people per 1000 population and people have become more aware about preventing the disease
Success in reducing malaria in Bangladesh: Will it continue?

Since 2010 Bangladesh has successfully reduced malaria cases by 50 percent while its national-level target aims to eliminate the infectious disease by the year 2027, mentions a new Malaria Elimination Initiative (MEI) report jointly authored by University of California, San Francisco (UCSF), Dr Khan from icddr,b and collaborators in Asia and South Africa.

However, currently Bangladesh allocates only 0.12% of its total domestic health spending for malaria eradication while donor assistance for malaria declined by almost 60% between 2013 and 2015, notes the study report titled "An Investment Case for Eliminating Malaria in Bangladesh," supported by Asian Development Bank and the Bill and Melinda Gates Foundation.

Using bed nets is one of the best ways to prevent Malaria. Photo: GMB Akash / icddr,b

With this World Malaria Day theme ‘Ready to Beat Malaria’, the World Health Organization (WHO) underscores the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria. Bangladesh is among the countries committed to malaria-free Asia Pacific by 2030 – an initiative expedited by the APMEN Secretariat in close partnership with the Asia Pacific Leaders Malaria Alliance (APLMA).

The recent UCSF report urges Bangladesh for more domestic financing to keep up the progress as it estimates sevenfold gains in return of one dollar investment, achievable through savings in healthcare costs, low-wages and productivity due to malaria-related illnesses.

Muhamamd Zahir Hassan Nabil