Vector-Borne Disease Control Programme, Ministry of Health, Royal Government of Bhutan, Gelephu, Bhutan.
Malar J. 2012 Jan 9;11:9. doi: 10.1186/1475-2875-11-9.
Bhutan has achieved a major reduction in malaria incidence amid multiple challenges. This case study seeks to characterize the Bhutan malaria control programme over the last 10 years.
A review of the malaria epidemiology, control strategies, and elimination strategies employed in Bhutan was carried out through a literature review of peer-reviewed and grey national and international literature with the addition of reviewing the surveillance and vector control records of the Bhutan Vector-Borne Disease Control Programme (VDCP). Data triangulation was used to identify trends in epidemiology and key strategies and interventions through analysis of the VDCP surveillance and programme records and the literature review. Enabling and challenging factors were identified through analysis of socio-economic and health indicators, corroborated through a review of national and international reports and peer-review articles.
Confirmed malaria cases in Bhutan declined by 98.7% from 1994 to 2010. The majority of indigenous cases were due to Plasmodium vivax (59.9%) and adult males are most at-risk of malaria. Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006. Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years. Access to malaria diagnosis in treatment was expanded throughout the country and evidence-based case management, including the introduction of artemisinin-based combination therapy (ACT) for P. falciparum, increasing coverage of high risk areas with Indoor Residual Spraying, insecticide-treated bed nets, and long-lasting insecticidal nets are likely to have contributed to the decline alongside enabling factors such as economic development and increasing access to health services.
Bhutan has made significant strides towards elimination and has adopted a goal of national elimination. A major challenge in the future will be prevention and management of imported malaria infections from neighbouring Indian states. Bhutan plans to implement screening at border points to prevent importation of malaria and to targeted prevention and surveillance efforts towards at-risk Bhutanese and migrant workers in construction sites.
在面临多重挑战的情况下，不丹已成功大幅降低疟疾发病率。本案例研究旨在描述过去 10 年不丹的疟疾控制规划。
通过对同行评议和灰色的国内外文献进行文献回顾，审查不丹的疟疾流行病学、控制策略和消除策略，并补充审查不丹病媒传播疾病控制规划（VDCP）的监测和病媒控制记录。通过分析 VDCP 监测和规划记录以及文献综述，采用数据三角法确定流行病学和主要战略及干预措施的趋势。通过分析社会经济和卫生指标，以及对国内外报告和同行评议文章的审查，确定有利和不利因素。
1994 年至 2010 年，不丹确诊疟疾病例减少了 98.7%。大多数本土病例是由间日疟原虫（59.9%）引起的，成年男性是疟疾的高危人群。输入病例，或外国国民的病例，多年来有所波动，2006 年达到所有确诊病例的 21.8%。不丹病媒传播疾病控制规划实施的策略可能与过去 10 年来病例减少有关。在全国范围内扩大疟疾诊断治疗的获取途径，实施循证病例管理，包括引入针对恶性疟原虫的青蒿素为基础的联合疗法（ACT），扩大高危地区的室内滞留喷洒、经杀虫剂处理的蚊帐和长效驱虫蚊帐的覆盖范围，以及经济发展和增加获得卫生服务的机会等有利因素可能促成了病例的减少。
不丹在消除疟疾方面取得了重大进展，并制定了国家消除疟疾的目标。未来的主要挑战将是预防和管理来自邻国印度的输入性疟疾感染。不丹计划在边境点实施筛查，以防止疟疾输入，并针对建筑工地的高危不丹人和移民工人开展有针对性的预防和监测工作。
