88% of malaria cases in Bandarban, Rangamati; DGHS aims for zero by 2030

Infographics: TBS

As Bangladesh accelerates its efforts to eliminate malaria by 2030, new data from the Directorate General of Health Services (DGHS) reveals that just two southeastern hill districts – Bandarban and Rangamati – account for an overwhelming 88% of the country's malaria cases.

In 2024, Bangladesh recorded 13,099 malaria cases nationwide. Of these, 11,501 were reported from Bandarban and Rangamati alone. Within Bandarban, the upazilas of Lama, Alikadam, and Thanchi contributed 63% of the district's total cases, while in Rangamati, 86% of cases came from Jurachhari, Belaichhari, Baghachhari, and Barkal.

Malaria is a life-threatening disease transmitted through the bites of infected female Anopheles mosquitoes. The World Health Organisation (WHO) reports that Bangladesh is home to 36 Anopheles species, of which four are considered the primary vectors of malaria.

Despite the alarming concentration of cases in the hill districts, malaria cases and fatalities have seen a marked decline in the last decade. 

According to DGHS, in 2014, the country reported 57,480 cases and 45 deaths. By comparison, in 2024, cases fell to 13,099, with just six deaths recorded. 

However, malaria remains endemic in 13 out of 64 districts: Sherpur, Mymensingh, Netrokona, Kurigram, Sylhet, Habiganj, Sunamganj, Moulvibazar, Khagrachhari, Rangamati, Chattogram, Bandarban, and Cox's Bazar.

"Malaria persists in 13 districts, though there is no transmission now in four districts of the Mymensingh zone," said Shyamol Kumer Das, deputy programme manager for Malaria and Aedes-transmitted Diseases at DGHS. "Transmission is low in the Sylhet zone, but the most malaria-prone regions remain Bandarban and Rangamati."

Challenges in hill districts

Shyamol Kumer pointed out that the geographic and demographic characteristics of the Chattogram Hill Tracts present significant challenges to malaria control efforts. 

"The landscape – comprising dense forests and remote hill settlements – makes it extremely difficult to reach at-risk populations," he explained. 

"People engaged in jhum cultivation or forest-based work often live nomadically and travel far from home for extended periods, making disease surveillance and treatment challenging."

He also identified the border regions of these districts as hotspots for transmission, given their proximity to countries with higher malaria prevalence. "Language barriers and communication gaps further complicate intervention efforts," he added.

Expanded interventions 

In response to the concentrated outbreak, the government is scaling up its malaria control strategy. Alongside routine measures – such as distributing insecticide-treated mosquito nets, indoor residual spraying, rapid diagnostic testing, and free oral treatment – the DGHS is deploying Targeted Drug Administration (TDA) in high-risk zones.

TDA, a WHO-recommended method, involves giving an entire community a full course of antimalarial medication regardless of individual infection status, especially in areas with limited access to testing.

"In four villages of Bandarban, the results of TDA were promising, with no new cases reported," said Shyamol Kumer. "Based on this success, we expanded the initiative to 31 villages in Rangamati, and starting in May, we will roll it out in another 31 villages in Bandarban. We're optimistic this will help bring case numbers down."

The government is also exploring long-term solutions through vaccine trials. The WHO has recommended two effective malaria vaccines for children in Africa, and Bangladesh is now conducting clinical trials to assess their impact locally.

"The authorities are running trials in 100 villages in Lama and Alikadam, dividing the residents into 25 groups," said Prof MA Faiz, former director general of DGHS and a leading malaria specialist. 

"Each group is receiving a different combination of services and interventions to measure vaccine effectiveness. The research is being conducted in partnership with Oxford University, and we expect results by next year."

World Malaria Day will be observed today with the theme "Malaria Ends With Us: Reinvest, Reimagine, Reignite."