Malaria, Once a Scourge in Bhutan, is Nearing Elimination

Bhutan, a Himalayan nation with a population of fewer than a million people, is well on its way to eliminating the scourge of malaria.

Investigators from the National Malaria Surveillance System of Bhutan report a dramatic drop in malaria cases, from nearly 40,000 in 1994 to only 45 in 2013. Many of the new infections are clustered in regions along the border with India.

The surveillance system itself was evaluated from 2006 to 2012 to meet the objectives of the Bhutan Vector-borne Disease Control Program and to set priorities for moving toward malaria elimination. Yale School of Public Health researchers, in collaboration with the Bhutanese Ministry of Health, did the evaluation. The results were published recently in the journal Frontiers in Public Health.

During the evaluation period, malaria cases dropped from an average slide positivity rate of 3.4 percent in 2006 to 0.2 percent in 2012. However, the evaluators concluded that achieving malaria elimination would require more steps, including better case detection, rapid investigation and improved health-worker training and accountability. Many of these measures have already been undertaken or are planned as part of the next phase of Bhutan’s National Strategic Plan.

“With the partnership of the Bhutanese team, we hope that this evaluation provides actionable items that will assist the nation in achieving its goal of being certified as malaria-free by 2020,” said Assistant Professor Sunil Parikh, M.D., M.P.H., the study’s lead author and a malaria specialist.

Malaria is caused by a parasite transmitted to humans through a mosquito bite. The disease causes fever, chills and flu-like illness and, in some cases, death. In 2015 an estimated 214 million cases of malaria occurred worldwide and 438,000 people died, mostly children in the Africa, according to the Centers for Disease Control and Prevention. About 1,500 cases of malaria are diagnosed annually in the United States.

The Bhutanese public health workers who did the malaria survey were trained by the Royal Institute of Health Sciences of Bhutan (now the Faculty of Nursing and Public Health at the Khesar Gyalpo University of Medical Sciences) which recently started a bachelors of public health program to train health workers. To help with teaching and research capacity building, the university has partnered with the Yale School of Public Health to facilitate faculty and student exchanges. The program supports the collaboration of students and faculty from Yale to work jointly with Bhutanese students and faculty on public health-related research in Bhutan. The initiative is led by YSPH Associate Professor Kaveh Khoshnood, Ph.D., M.P.H. This fall, Tshering Dukpa from the Faculty of Nursing and Public Health of Bhutan is at the Yale School of Public Health as a visiting scholar.

The partnership has also included summer research projects by Yale M.P.H. students who conducted malaria-related research under Parikh’s mentorship. The partnership’s next phase of is to further build health research capacity in Bhutan. In 2014, Khoshnood participated in the first ever National Health Research Mapping and Priority Setting Workshop in Thimphu, Bhutan.

“We are excited about the growing partnership with our Bhutanese colleagues and hopeful that it will lead to measurable improvements in the health of Bhutanese people,” Khoshnood said. “I would highly recommend M.P.H. students interested in global health to consider Bhutan as a destination for their summer internship.”

The malaria evaluation study was possible with funding from the Bhutan Foundation, the Yale School of Public Health, the Geballe Bhutan Research Support Fund and the Yale South Asian Studies Council.

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