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

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.

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.

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 Plasmodium falciparum remains the dominant species responsible for the majority of the clinical burden, emerging challenges include: (1) biological threats like non-kelch13 artemisinin-partial resistance in Plasmodium falciparum and complexities of Plasmodium vivax 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.

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 P. vivax 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.