Bhutan's success in malaria control.

Flickr Yohandy

[THIMPHU] Bhutan has, over the last 17 years, dramatically reduced malaria cases, recording just one death in 2011, according to a government report.

The report, published by Bhutan’s Vector-borne Disease Control Programme (VDCP) in the Malaria Journal last month (9 January), said malaria cases declined from 40,000 in 1994 to 194 in 2011, and deaths from 42 to one during the same period.

The report highlighted the country’s success despite several challenges: difficult terrain with landslides blocking roads during the monsoon months, poor road access for 21 per cent of households and an influx of migrant labour from India, where malaria is endemic.

"We target to eliminate malaria by 2016," Thinley Yangzom, chief programme officer of VDCP, told SciDev.Net. 

Bhutan has now almost achieved zero transmission of indigenous cases or infection passing from one person to another within a geographic area. 

Most indigenous cases were attributed to the non-fatal malaria pathogen Plasmodium vivax that accounts for 60 per cent of infections. 

In 2010, there were 436 confirmed indigenous cases, of which 261 were caused by P. vivax, 140 by P. falciparum, that causes fatal cerebral malaria, and 35 cases of mixed infections.

Bhutan’s health officials attributed the decline in malaria incidence to improved access to diagnosis and treatment facilities and increased coverage of high-risk areas with indoor residual spraying and insecticide-treated bed nets.

Of Bhutan’s 20 districts, malaria is endemic in only seven along the border with India, where the climate is favourable for malaria transmission round the year. These districts have a population of 284,512, representing 42 per cent of the country's estimated population of 700,000.

Yangzom anticipates malaria spreading to colder regions such as Thimphu, Gasa, Paro and Bumthang because of global warming. "Climate change will definitely have an impact on malaria incidence in the future."

No study has been done in Bhutan on the likely impact of climate change on malaria, but mosquito larvae survive better in higher temperatures.

Rinzin Namgay, co-author of the report, said as a preventative measure bednets are being distributed in colder regions where malaria cases have not been reported so far.

"We are very much concerned about erratic weather in the country," said Namgay who is deputy chief entomologist at VDCP.

Link to the report in  Malaria Journal: