Introduction: Malaria is prevalent in north-eastern and south-eastern parts of Bangladesh bordering with India and Myanmar. A total of 17.52 million population of 13 districts are at risk of malaria. Most of the malaria cases and deaths are concentrated in the three Chittagong Hill Tract (CHT) districts. These districts located in hilly and remote areas suffer from geographical disadvantages with difficult communication. Delay in diagnosis and referrals which ultimately result in severe malaria and death.
Objective: To make malaria diagnostic and treatment services available in hard to reach pockets areas, improve early health care seeking behavior and timely referral, thereby reducing severity and the risk of transmission of malaria.
Method: Special health workers (SHW) were deployed in hard-to-reach pockets of CHT in addition to regular workforce in 2014 when there was an upsurge doubling the number of malaria cases from previous year. They were hired from the locality at lower cost in remote places devoid of usual transport routes with long travel time. After a quick orientation, conducted screening by RDT, treated positive patients with ACT drugs and arranged awareness activities especially on insecticidal bed-net use.
Result: SHW’s contribution in total malaria case detection in CHT areas were increased gradually to 12%, 26% and 32% in the year 2015, 2016 and 2017. Malaria cases were decreased by 24% in 2017 compared to 2015. Whereas, at the same period severe malaria cases came down by 36%. In 2015, about 2.1% malaria cases were turned to severity while in 2017 it came down to 1.8%.
Conclusion: Increased health workforce in hard-to-reach areas has increased the accessibility to malaria services. This intervention has ultimately reduced the severity and risk of death from malaria which needs to be sustained to ensure maximum coverage and reach the programme goal towards malaria free Bangladesh.