Malaria in Bangladesh, 2000-2025: Navigating the Headwinds From Control to Elimination.

Abstract

<h4>Background and aims</h4>Bangladesh has dramatically reduced its malaria burden since 2000, confining the disease to specific geographic zones. However, the national 2030 elimination goal is now threatened by a complex interplay of biological, ecological, and social factors. This narrative review synthesizes the country's malaria landscape from 2000 to 2025, analyzes the headwinds to elimination, and proposes a strategic framework that integrates genomic surveillance to address the nuanced challenges of residual transmission for the "last-mile" effort.<h4>Methods</h4>A narrative review of scientific literature (January 2000-June 2025) was conducted using PubMed and Medline. The search strategy utilized relevant Medical Subject Headings (MeSH) to identify English-language, peer-reviewed articles on Bangladeshi malaria epidemiology, diagnostics, treatment, vector biology, and health systems, focusing on health outcomes and prevention strategies.<h4>Results</h4>The review confirms a > 90% reduction in malaria cases (2008-2020) driven by targeted vector control, RDTs, and ACTs, concentrating the remaining burden in the Chittagong Hill Tracts (CHT). While <i>Plasmodium falciparum</i> remains the dominant species responsible for the majority of the clinical burden, emerging challenges include: (1) biological threats like non-<i>kelch13</i> artemisinin-partial resistance in <i>Plasmodium falciparum</i> and complexities of <i>Plasmodium vivax</i> radical cure amid G6PD deficiency; (2) ecological factors such as outdoor-biting vectors that evade bed nets; and (3) social dynamics, including high cross-border mobility and a large asymptomatic infection reservoir.<h4>Conclusion</h4>The 2030 elimination target is attainable but requires a strategic pivot from broad control to a granular, intelligence-driven approach. Success depends on implementing solutions for outdoor-biting vectors, mainstreaming routine G6PD screening for safe <i>P. vivax</i> cure, and deploying robust genomic epidemiological surveillance to detect parasite resistance and human mobility. Addressing the specific needs of forest-going and ethnic minority communities bearing the remaining risk is essential for stopping the final transmission.