country. The Annual Parasitic Incidence (API) is 4.2 (2002). An estimated 1.0 million clinical cases are treated every year while 61,495 laboratory confirmed cases were reported during 2002 from routine surveillance. During 2002, atotal of 598 deaths were reported. Plasmodium falciparum is the predominant infection (61-71%) and An. dirus is the principal vector. Drug resistance to chloroquine and sulphadoxine-pyramethamine is reported from areas of Chittagong Hill Tract Districts.

Components of Malaria Control programme in Bangladesh

Early diagnosis and prompt treatment
For the Early Diagnosis and Prompt Treatment case definitions and treatment guidelines have been adopted in the 'National Guidelines for Clinical Management of Malaria'.

Case definitions
Three new case definitions for endemic areas have been adopted, which are:

• Uncomplicated malaria (UM)
• Treatment failure malaria (TFM)
• Severe malaria (SM)

Uncomplicated Malaria
The case definition for UM is as follows:

• High index of suspicion
• Fever or history of fever within last 48 hours
• Absence of signs of other diseases
• Had antimalarials - inadequate or vomited out
• BSE not mandatory

The treatment guidelines for UM is as follows:

• Oral choloroquine tablet 10 mg base/kg single dose on 1st day, 7.5 mg base/kg single dose on days 2nd and 3rd.
• Oral primaquine (15 mg), 3 tablets single dose on day 3 or 4.

Treatment Failure Malaria
The case definition for TFM is as follows:

• Fever or history of fever
• History of taking Chloroquine and or Fansidar over the last four weeks in adequate dosage duration and without vomiting
• Mandatory Blood Slide Examination.

The treatment guidelines for TFM is as follows:

• Oral quinine sulphate, 10 mg salt/kg/dose 8 hourly for 3 days (9 doses); and
• Oral sulfadoxin/pyremethamine (S/P), 3 tablets in single dose after last dose of quinine (for adult); and
• Oral primaquine, 45 mg single dose along with S/P (adult)

Severe Malaria (SM)

The case definition for SM is as follows:

1. Fever or history of fever within last 48 hours
2. Presence of asexual form of malarial parasite in BSE
3. Presence of any one of the following features of severity
   1. A change of behavior, confusion or drowsiness
   2. Altered consciousness or coma
   3. Convulsion
   4. Hypoglycemia
   5. Acidosis
   6. Difficulty in breathing or pulmonary edema
   7. Oliguria or acute renal failure
   8. Severe anemia (Hematocrit < 20%, Hg <6gm%)
   9. Circulatory collapse or shock
   10. Hyperpyrexia (³42° C)
   11. Hyperparasitemia (>5% RBC parasitised)
   12. Fluid, electrolyte and acid base disturbances
   13. Severe prostration

Treatment guidelines for SM:

• Immediate referral for hospitalization
• Parenteral quinine urgently by IV infusion whenever possible, if not IM injection into anterior thigh may be used when treatment may be delayed by hours for want of infusion facility.
• Dose of quinine is 10 mg base/kg/dose 8 hourly to be given over 4 hours. A loading dose of 20 mg base/kg may be used in absence of contra indications.
• Duration of treatment may be as follows depending on the condition of the patient:
  - Parenteral plus oral quinine for seven days, or
  - Parenteral followed by 3 days oral quinine plus single dose of SP.

General and supportive care as per need of the patient (Ref: Malaria Diagnosis and Treatment Charts: Annex-1-2).

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