Bangladesh South-East Region

I. Epidemiological prole Population (UN Population Division) 2017 % Parasites and vectors High transmission (>1 case per 1000 population) 2.1M 1 plasmodium P.falciparum: 89 (%) , P.vivax: 11 (%) Low transmission (0-1 case per 1000 population) 15.6M 9 species: Malaria free (0 cases) 147M 89 Major anopheles An. dirus, An. minimus, An. philippinensis, An. sundaicus, An. albimanus, An. Total 164.7M species: annularis

Reported cases and deaths Estimates Reported conrmed cases (health facility): 4893 Estimated cases: 32.9K [30.1K, 36.2K] Conrmed cases at community level: 24 114 Conrmed cases from private sector: 221 Reported deaths: 13 Estimated deaths: 76 [3, 127]

II. Intervention policies and strategies Yes/ Year Intervention Policies/Strategies Medicine Year adopted No adopted Antimalaria treatment policy ITN ITNs/LLINs distributed free of charge Yes 2008 First-line treatment of unconrmed malaria - - ITNs/LLINs distributed to all age groups Yes 2008 First-line treatment of P. falciparum AL 2004 IRS IRS is recommended Yes 2008 For treatment failure of P. falciparum QN+D; QN+T 2004 DDT is used for IRS No 1993 Treatment of severe malaria AS+AL; QN 2016 Larval control Use of Larval Control No Treatment of P. vivax CQ+PQ(14d) 2004 IPT IPT used to prevent malaria during pregnancy NA - Dosage of primaquine for radical treatment of P. vivax 0.25 mg/Kg (14 days) Diagnosis Patients of all ages should receive diagnostic test Yes 2008 Type of RDT used P.f + P.v specic (Combo) Malaria diagnosis is free of charge in the public sector Yes 2008 Therapeutic efcacy tests (clinical and parasitological failure, %) Treatment ACT is free for all ages in public sector Yes 2007 Medicine Year Min Median Max Follow-up No. of studies Species has AL 2010-2018 0 0 14.3 28 days 15 P. falciparum never The sale of oral artemisinin-based monotherapies (oAMTs) - CQ+PQ 2014-2015 0 0 0 28 days 1 P. vivax been allowed Resistance status by insecticide class (2010-2017) and use of class for malaria vector control (2017) Single dose of primaquine (0.25 mg base/kg) is used as Yes 2009 Insecticide class Years (%) sites1 Vectors2 Used3 gametocidal medicine for P. falciparum Carbamates - - - No Primaquine is used for radical treatment of P. vivax Yes 2004 Organochlorines - - - No G6PD test is a requirement before treatment with primaquine No - Organophosphates 2017-2017 0% (3) - No Directly observed treatment with primaquine is undertaken No - Pyrethroids 2012-2017 75% (12) An. philippinensis, An. vagus Yes System for monitoring of adverse reaction to antimalarials exists Yes 2008 1Percent of sites for which resistance conrmed and total number of sites that reported data (n) Surveillance ACD for case investigation (reactive) Yes 2008 2Principal vectors that exhibited resistance ACD at community level of febrile cases (pro-active) Yes 2008 3Class used for malaria vector control in 2017 Mass screening is undertaken No - Uncomplicated P. falciparum cases routinely admitted No - Uncomplicated P. vivax cases routinely admitted No - Case and foci investigation undertaken 2015 Case reporting from private sector is mandatory No -

III. Charts Sources of nancing Government expenditure by intervention in 2017

20M

15M

10M Contribution($USm) 5M

0M

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Insecticides & spray materials ITNs Diagnostic testing Others WHO/UNICEF USAID/PMI Worldbank (USD) Antimalarial medicines Monitoring and evaluation Global Fund (USD) Government contribution Human resources & technical assistance Management and other costs

IV. Coverage Coverage of ITN and IRS Cases tested and treated in public sector

100 100

75 75

50 (%) 50 Population 25

25

0

0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Suspected cases tested Antimalarials distributed vs reported cases ACTs distributed vs reported P. f. cases At high risk protected with ITNs At high risk protected with IRS Primaquine distributed vs reported P. v. cases % of the population who slept under an ITN the previous night (survey) % <5 fever cases who had a finger/ heel stick (survey) % of households with at least 1 ITN (survey ACTs as % of all antimalarials received by <5 (survey)

Source: DHS (est.) 2011, DHS 2014 V. Impact Cases treated Test positivity

100% 100

75% 75

50 50% (%) Tests(%)

25 25%

0 0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Slide positivity rate RDT positivity rate % fever cases <5 seeking treatment at public HF (survey) % of children under 5 with a positive microscopy slide on the day of the survey Reporting completeness % of children under 5 with a positive rdt on the day of the survey

Source: DHS 2007, 2011, 2014

V. Impact Conrmed malaria cases per 1000 and ABER Malaria admissions and deaths

10 5 8k 800

8 4 6k 600 Deaths

6 3 ABER (%) 4k 400 Admissions 4 2 Cases per 1000 Cases

2k 200

2 1

0k 0 0 0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Admissions (all species) Admissions (P. vivax)) Deaths (all species) ABER Cases(all species) Cases (P. vivax) Deaths (P. vivax))

World Malaria Report 2018