The Practice of Jhum Cultivation and its Relationship to Plasmodium falciparum Infection in the Chittagong Hill Districts of Bangladesh

Sean R. Galagan Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Chai Shwai Prue Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Jacob Khyang Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Wasif Ali Khan Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Sabeena Ahmed Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Malathi Ram Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Mohammad Shafiul Alam Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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M. Zahirul Haq Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Jasmin Akter Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Peter Kim Streatfield Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Gregory Glass Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Douglas E. Norris Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Myaing Myaing Nyunt Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Timothy Shields Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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David J. Sullivan Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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David A. Sack Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Malaria is endemic in the Chittagong Hill Districts of southeastern Bangladesh. Previous epidemiological analyses identified the agricultural practice of jhum cultivation as a potential risk factor for malaria infection. We conducted qualitative interviews with jhum cultivators and surveillance workers to describe jhum cultivation and used demographic and malaria surveillance in two study unions from May of 2010 to August of 2012 to better understand the relationship between jhum cultivation and malaria infection. Qualitative interviews revealed that jhum cultivation is conducted on remote, steep hillsides by ethnic tribal groups. Quantitative analyses found that adult jhum cultivators and individuals who live in the same residence had significantly higher incidence rates of symptomatic Plasmodium falciparum infection compared with non-cultivators. These results confirm that jhum cultivation is an independent risk factor for malaria infection and underscore the need for malaria testing and treatment services to reach remote populations in the Chittagong Hill Districts.

Author Notes

* Address correspondence to David A. Sack, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E5036, Baltimore, MD 21205-5748. E-mail: dsack@jhsph.edu

Financial support: This study was funded by Johns Hopkins Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health Grant 00679. The icddr,b also gratefully acknowledges the following donors, which provide unrestricted support to research efforts: the Australian Agency for International Development (AusAID), the Government of the People's Republic of Bangladesh, the Canadian International Development Agency (CIDA), the Swedish International Development Cooperation Agency (SIDA), and the Department for International Development, United Kingdom (DFID). We thank the Johns Hopkins Center for Global Health and John Snow, Inc., which provided travel funding for a student investigator.

Authors' addresses: Sean R. Galagan, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, E-mail: sgalagan@uw.edu. Chai Shwai Prue, Jacob Khyang, Wasif Ali Khan, Sabeena Ahmed, Mohammad Shafiul Alam, M. Zahirul Haq, Jasmin Akter, and Peter Kim Streatfield, Centre for Population, Urbanization and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: dr_prue@icddrb.org, jacob@icddrb.org, wakhan@icddrb.org, sabeena@icddrb.org, shafiul@icddrb.org, mzhaq@icddrb.org, jakter@icddrb.org, and pkstreatfield@icddrb.org. Malathi Ram, Douglas E. Norris, Myaing Myaing Nyunt, Timothy Shields, David J. Sullivan, and David A. Sack, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: mram@jhsph.edu, dnorris@jhsph.edu, mnyunt@jhsph.edu, tshields@jhsph.edu, dsulliva@jhsph.edu, and dsack@jhsph.edu. Gregory Glass, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Global Biological Threat Reduction Program, Southern Research Institute, Birmingham, AL, E-mail: ggurrigl@jhsph.edu.

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