Lhakpa Quendren
Gelephu—Following the investigation into a malaria case in Phibsoo, Sarpang, Bhutan is set to mark its third consecutive year with zero indigenous cases, bringing the country closer to malaria elimination.
If the ongoing investigation confirms this case as non-indigenous, Bhutan will qualify for World Health Organization (WHO) malaria-free certification by 2025. This timeline follows the country’s missed elimination target in 2018, as detailed in the National Strategic Plan 2015-2020.
Given that the Phibsoo area has been free of malaria cases for the last nine years, health officials suspect this case may be imported, although the investigation is still ongoing.
The chief entomologist of the Vector-borne Disease Control Programme, Rinzin Namgay, said that the investigation report will be submitted to the expert team of the Malaria Elimination Taskforce for review.
The WHO certification requires credible evidence that indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least three consecutive years, along with the ability to prevent its re-establishment.
With numerous measures underway, health officials are optimistic about achieving malaria-free certification from WHO. “We will need to write to WHO SEARO in November, after which their expert team will come to assess the situation, and the WHO will then verify and issue the certificate,” Rinzin Namgay said.
Efforts have included distributing mosquito nets in 2022 and applying Indoor Residual Spraying (IRS) biannually to control the mosquito population. Community acceptance groups were established in gewogs to provide training and raise awareness.
Cross-border cooperation has also been initiated with neighbouring Indian states, including Assam and West Bengal, with support from the WHO and the health ministry.
“When residents from Saralpara in Assam test positive for malaria at Sarpang Hospital, we inform our counterparts in Chirang District, who then conduct screenings in affected communities,” explained Rinzin Namgay.
To prevent and control malaria transmission, a two-day training for community group members across 10 gewogs in Sarpang is underway. The Vector-borne Disease Control Programme and the Sarpang dzongkhag health sector reinstated this training after two years of inactivity.
The training covers malaria-related diseases, modes of transmission, and the importance of clean water and environmental sanitation in preventing malaria, as well as controlling rabies.
Sarpang Dzongkhag Public Health Officer Ugyen Dorji said that about five members from each chiwog are attending the training at their respective gewog centers. The Global Fund is supporting the programme.
Bhutan has made significant progress in reducing malaria incidence from 39,000 cases in the 1990s to fewer than five cases in 2022. There have been no deaths since 2019, following one death each reported in 2017 and 2018.
Having achieved pre-elimination status in 2013, Bhutan faced challenges in maintaining it due to border cases. The malaria elimination target was further complicated by 22 indigenous cases reported in 2020 along the southern border, alongside the impacts of the Covid-19 pandemic.
“We have not reported a single indigenous case in the last two years, but we continue to struggle with a few imported cases,” said Ugyen Dorji. “We face challenges in tracing travel history because infected individuals often do not disclose their travel information.”
Currently, 42 countries and territories, including two member states of the South-East Asia Region—Maldives and Sri Lanka—have been declared malaria-free, achieving this status in 2015 and 2016, respectively.