Epidemiology of malaria in Rohingya refugee camps in Bangladesh within 2017–2020

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Overall, 30,460 people were tested for malaria, of which 1940 were in KRC and 28,520 in NMC. Testing results are summarized in Table 1 and TPR by month in Fig. 2. Of these, 49 (0.16%) had a positive test and there were no deaths from malaria. Plasmodium falciparum mono infection was found in 53% (TPR 0.09%), 37% Plasmodium vivax (TPR 0.06%), and mixed P. falciparum / P. vivax in 10% (TPR 0.02%). The API was 0.19 per 1000 population.

Table 1 Summary of annual malaria testing results from 2017 to 2020

TRP was higher by RDT (0.25%) compared to microscopy (0.04%, p < 0.001).

There was no consistent seasonal pattern of TPR in 2017–2018, 2018–2019, or 2019–2020 in either camp or combined (Figs. 3, 4 and 5). Overall, TPR was 0.13% in pre-monsoon, 0.23% in monsoon, and 0.09% in post-monsoon seasons (p = 0.03). Overall annual malaria TPR was highest in 2017–2018 at 0.33% (p < 0.001). From 2017 to 2020, overall TPR was higher in KRC than in NMC, p = 0.01.

Malaria TPR was higher in KRC than in NMC during 2017–2018 (1.92% vs. 0.16%, p < 0.001) but not in the other years (0.13% vs. 0.10%, p = 0.79, in 2018–2019; 0.18% vs. 0.12%, p = 0.71, in 2019–2020; Fig. 6).

TPR was highest among people aged 15–60 years (OR (95% CI) = 6 (2–19), p = 0.01), and males (OR (95% CI) = 3 (2–6), p < 0.001).

TPR among people who had travelled to the forest in the previous two months (13.60%) was much higher than in those who had not (0.11%, OR (95% CI) = 120 (60–238), p < 0.001). TPR among the 1858 people who slept under bed nets was 0%, all cases occurring in people who did not use bed nets, (p = 0.01, Fig. 7). All malaria positive cases were treated (with chloroquine plus primaquine for P. vivax and artemether-lumefantrine for P. falciparum). No cases presented again with malaria, thus all were presumed cured.