The main prevention and control strategy, then, was active surveillance, case management, and vector control by Indoor Residual Spraying (IRS) with DDT. Later was renamed as National Malaria Control Programme (NMCP). Since 2003 the programme has been functioning under
the name of Vector-borne Disease Control Programme(VDCP) and also looks after other mosquito borne diseases. The prevalent vector
borne diseases in Bhutan are malaria, dengue. Visceral leishmaniasis (Kala azar)and Japanese encephalitis. Malaria cases have been reported since 1965. The first dengue outbreak in Bhutan was reported in July 2004. In July 2007 about 12 (kala azar) cases have been documented from the Eastern dzongkhags of Tashigang, Tashiyangtse and Mongar. A few sporadic cases of Japanese encephalitis have been treated in the referral hospitals in the last few years. Malaria Prevention and control strategies:
Since 1965 till 1994 Malaria control strategy was focused on Indoor residual Spraying (IRS) with DDT. A major programme decision was taken at that point and the chemical for Indoor Residual Spray (IRS) was changed from DDT to deltamethrine and since then
IRS remained the main vector control strategy in Bhutan till 1997. As significant reduction in malaria was achieved in 1998 IRS was completely phased out and replaced by Insecticide Treated Bed Nets (ITBN) in phased manner till 2003. In 2004 focal IRS was also done for one round as the coverage with Insecticide treated nets was very low. The programme as well as the communities faced several challenges and difficulties as the bed nets had to be re impregnated twice a year at 6 monthly intervals as a result of which significant malaria control could not be achieved in spite of all efforts. In 2006 with support from Global Fund the malaria prevention and control strategies have been scaled up and newer tools (new drug Artemether-Lumefantrine and Long Lasting Insecticide-treated Nets) highly recommended for prevention and control globally were introduced. Scaled up interventions in Bhutan resulted in significant decline in malaria cases in Bhutan
10th FYP Goal and Objectives:
The 10th five year goal is to reduce malaria morbidity and mortality by 75% by 2013 from the 2005 baseline and thus contribute to MDG Goal 6;Target 8 “ have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”
Objectives
1. To intensify vector control and other preventive measures against malaria
2. To provide early diagnosis and prompt treatment of malaria
3. To strengthen surveillance system
4. To strengthen technical and managerial capacities for efficient and effective control of malaria leading towards malaria elimination
5. To sustain political and inter-sectoral support geared towards malaria elimination
Country malaria status
1994 was the year when the highest number of malaria cases was reported in the country with 39,852 confirmed cases. The malaria trend is now declining in all the dzongkhags. The Annual Parasite Index has reduced from 104/1000 population in 1994 to 2/1000 in 2007. The Slide Positivity Rate (SPR) has reduced from 20% in 1994 to 2% in 2007. Plasmodium falciparum
malaria is 48% of the cases in 2007.The annual Blood examination rate (ABER) is 11% in 2007. Number of deaths has declined from 48 in 1994 to 1 in 2011. In the last five years the case fatality rate has been maintained below 1%.
