NORTH SOUTH UNIVERSITY

DEPARTMENT OF BBA
ASSIGNMENT 05

SUBMITTED TO
FACULTY NAME: Dr. Nilufar Kamorez Jaha
DEPARTMENT: Public Health
SUBMITTED BY
STUDENT NAME: Md. Abdullah Al Mamun
STUDENT ID: 1631489030
COURSE NAME: PBH101
SECTION: 32

ASSIGNMENT TOPIC
Describe epidemiology of Tuberculosis. Describe epidemiology of Malaria and its
prevention in Bangladesh.

Epidemiology of tuberculosis:
An understanding of the epidemiology of Mycobacterium tuberculosis is critical for effective
control. The global burden of tuberculosis (TB), risk factors for transmission, and the
epidemiology of TB in the United States will be reviewed here. The epidemiology of drug-
resistant TB is discussed separately.
Roughly one-third of the world's population has been infected with M. tuberculosis, and new
infections occur at a rate of one per second. However, not all infections with M. tuberculosis
cause tuberculosis disease and many infections are asymptomatic. In 2007 there were an
estimated 13.7 million chronic active cases, and in 2010 there were 8.8 million new cases, and
1.45 million deaths, mostly in developing countries. 0.35 million of these deaths occur in those
co-infected with HIV.
Tuberculosis is the second most common cause of death from infectious disease (after HIV). The
absolute number of tuberculosis cases has been decreasing since 2005 and new cases since 2002.
China has achieved particularly dramatic progress, with an 80 percent decline in its TB mortality
rate. The distribution of tuberculosis is not uniform across the globe; about 80% of the
population in many Asian and African countries test positive in tuberculin tests, while only 5–
10% of the U.S. population test positive.
In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1200
cases per 100,000 people. As of 2014, India has the largest total incidence, with an estimated 2.2
million new cases. India has more than 0.3 million deaths, and economic losses of $23 billion
(Rs. 143123 crore) every year. Tuberculosis caused the second highest number of deaths in India
with 63265 casualties in 2011, 61887 in 2012 and 57095 in 2013.
In developed countries, tuberculosis is less common and is mainly an urban disease. In the
United Kingdom, the national average was 15 per 100,000 in 2007, and the highest incidence
rates in Western Europe were 30 per 100,000 in Portugal and Spain. These rates compared with
98 per 100,000 in China and 48 per 100,000 in Brazil. In the United States, the overall
tuberculosis case rate was 4 per 100,000 persons in 2007. In Canada, tuberculosis is still endemic
in some rural areas.
The incidence of TB varies with age. In Africa, TB primarily affects adolescents and young
adults.[15] However, in countries where TB has gone from high to low incidence, such as the
United States, TB is mainly a disease of older people, or of the immunocompromised.
Tuberculosis incidence is seasonal, with peaks occurring every spring/summer. The reasons for
this are unclear, but may be related to vitamin D deficiency during the winter. In Europe, deaths
from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in
public health were reducing tuberculosis even before the arrival of antibiotics, although the
disease remained a significant threat to public health, such that when the Medical Research
Council was formed in Britain in 1913 its initial focus was tuberculosis research.

Global epidemiology of tuberculosis:

Despite the availability of effective chemotherapy, tuberculosis (TB) killed 1.3 million people in
2012. Alongside HIV, it remains a top cause of death from an infectious disease. Global targets
for reductions in the epidemiological burden of TB have been set for 2015 and 2050 within the
context of the Millennium Development Goals (MDGs) and by the Stop TB Partnership.
Achieving these targets is the focus of national and international efforts in TB control, and
showing whether or not they are achieved is of major importance to guide future and sustainable
investments. This article provides a short overview of sources of data to estimate TB disease
burden; presents estimates of TB incidence, prevalence, and mortality in 2012 and an assessment
of progress toward the 2015 targets for reductions in these indicators based on trends since 1990
and projections up to 2015; analyzes trends in TB notifications and in the implementation of the
Stop TB Strategy; and considers prospects for elimination of TB after 2015.
Evidence that chemotherapy is among the most cost-effective of all health-care interventions
(Murray et al. 1991; Dye and Floyd 2006), the catastrophic impact of the HIV epidemic on TB in
Africa, and the global concern about the growth of multidrug-resistant TB (MDR-TB) have
emphasized the need to improve TB prevention and control. Global targets for reductions in the
epidemiological burden of TB have been set for 2015 and 2050 within the context of the
Millennium Development Goals (MDGs) and separately by the Stop TB Partnership, a global
coalition of stakeholders established to coordinate international efforts (Box 1). The WHO’s
recommended approach for achieving these targets is the Stop TB Strategy (Raviglione and
Uplekar 2006), which comprises best practices in the diagnosis and treatment of patients with
active TB, approaches to address major epidemiological and system challenges, and the
promotion of research for innovations (Box 2). It was launched in 2006 and underpins the Global
Plan 2011–2015, a comprehensive and budgeted plan to reach the global targets (Raviglione
2006b; 2007; Korenromp et al. 2012).

Epidemiology of Malaria:
Epidemiologists have recently paid greater attention than in the past to the epidemiology of
clinical malaria as opposed to the epidemiology of malarial infection. This change of emphasis
has been stimulated in part by the need for better clinical definitions of malaria in the evaluation
of control measures such as insecticide-treated materials and malaria vaccines. Methods of
determining mortality from malaria and of defining severe and uncomplicated malaria have been
devised. The limited data available indicate that malaria-attributable mortality and the incidence
of severe malaria do not increase with an increase in the entomological inoculation rate above a
threshold value, an observation that has important implications for the likely long-term effects of
attempts to contain malaria through vector control. Study of the epidemiology of severe malaria
in Africa has shown different epidemiological patterns for the two most frequent forms of this
condition: cerebral malaria and severe malarial anaemia. Severe malarial anaemia is seen most
frequently in areas of very high malaria transmission and most frequently in young children. In
contrast, cerebral malaria predominates in areas of moderate transmission, especially where this
is seasonal, and it is seen most frequently in older children. Study of patients with uncomplicated
malaria has established the relationship between fever and parasite density and has demonstrated
ways of defining fever thresholds. Algorithms have been developed to help in the diagnosis of
malaria in the absence of parasitological confirmation but this approach has proved difficult
because of the overlap in symptoms and signs between malaria and other acute febrile illnesses
such as pneumonia.

Epidemiology of Malaria prevention in Bangladesh:

Malaria is a parasitic infectiontransmitted by the female Anopheles mosquito, infecting humans
and insects alternatively. Caused by four Plasmodium species (P vivax, P falciparum, P ovale
and P malariae), malaria is a public health problem in 90 countries around the world, affecting
300 million people and responsible directly for about one million deaths annually. Africa
accounts for 90% of the mortality burden for malaria and South-east Asia accounts for 9% of the
burden. Bangladesh is considered as one of the malaria endemic countries in South Asia.
General symptoms of malaria include headache, nausea, fever, vomiting and flu-like symptoms,
however these can vary depending on the species causing the infection. Bangladesh has 34
Anopheles mosquito species. An entomological investigation conducted by ICDDR,B scientists
identified seven species to be positive with highest infection rate: Anopheles Karwari, An.
maculatus, An. barbriostris , An. nigerrimus, An. vagus , An. subpictus and An. philippinensis.
World Health Organization (WHO) considers malaria to be a major public health concern in
Bangladesh. Malaria was nearly eradicated from the country by 1970s but never disappeared in
the eastern regions which are associated with tea gardens and forests. It re-emerged as one of the
major public health concern in the 1990s and remains so. Malaria transmission is mostly
seasonal and concentrated in the border regions of Bangladesh. Out of 64 districts 13 districts
bordering east and northeast parts of Bangladesh facing Indian states of Assam, Tripura and
Meghalaya and part of Myanmar belong to the high risk malaria zone.
ICDDR,B was requested to conduct a cross sectional survey in 2007-2008 with the largest NGO
in Bangladesh, BRAC and the Government of Bangladesh, to identify the prevalence of malaria.
GFATM funded BRAC to implement a malaria control programme in the 13 malaria-endemic
districts to reduce burden of malaria in Bangladesh, including both preventative and curative
measures.
A three-year surveillance study begins for the first time in Bangladesh in 2009 to map malaria
epidemiology, to record benchmark information on the prevalence of infection, knowledge and
awareness, health-seeking behaviour, use of bed nets and socioeconomic differentials in the
community, before launching the malaria control interventions. This project is a collaboration
with Johns Hopkins Malaria Research Institution.
The new knowledge generated from these projects will be used to fill gaps in our understanding
of the social aspects of malaria in Bangladesh, and will help various organizations to develop
intervention components strategically appropriate for the malaria-prone areas.
Prevention:
Background: Malaria is endemic in 13 of 64 districts in Bangladesh. About 14 million people
are at risk. Some evidence
suggests that the prevalence of malaria in Bangladesh has decreased since the the Global Fund to
Fight AIDS,
Tuberculosis and Malaria started to support the National Malaria Control Program (NMCP) in
2007. We did an
epidemiological and economic assessment of malaria control in Bangladesh.
Methods: We obtained annually reported, district-level aggregated malaria case data and
information about disbursed
funds from the NMCP. We used a Poisson regression model to examine the associations between
total malaria,
severe malaria, malaria-attributable mortality, and insecticide-treated net coverage. We identifi
ed and mapped malaria
hotspots using the Getis-Ord Gi* statistic. We estimated the cost-eff ectiveness of the NMCP by
estimating the cost per
confi rmed case, cost per treated case, and cost per person of insecticide-treated net coverage.
Findings: During the study period (from Jan 1, 2008, to Dec 31, 2012) there were 285 731 confi
rmed malaria cases.
Malaria decreased from 6·2 cases per 1000 population in 2008, to 2·1 cases per 1000 population
in 2012. Prevalence
of all malaria decreased by 65% (95% CI 65–66), severe malaria decreased by 79% (78–80), and
malaria-associated
mortality decreased by 91% (83–95). By 2012, there was one insecticide-treated net for every
2·6 individuals
(SD 0·20). Districts with more than 0·5 insecticide-treated nets per person had a decrease in
prevalence of 21%
(95% CI 19–23) for all malaria, 25% (17–32) for severe malaria, and 76% (35–91) for malaria-
associated mortality
among all age groups. Malaria hotspots remained in the highly endemic districts in the
Chittagong Hill Tracts. The
cost per diagnosed case was US$0·39 (SD 0·02) and per treated case was $0·51 (0·27); $0·05
(0·04) was invested
per person per year for health education and $0·68 (0·30) was spent per person per year for
insecticide-treated net
coverage.

Interpretation: Malaria elimination is an achievable prospect in Bangladesh and failure to push

for elimination nearly
ensures a resurgence of disease. Consistent fi nancing is needed to avoid resurgence and maintain
elimination.

THE END