While there has been a tremendous decline in malaria disease burden in the remote parts of Malaysia, little is known about malaria incidence in its urban localities. This study aimed to analyze trends of malaria cases in urban Kuala Lumpur, Malaysia. All suspected cases presented to a university hospital in Kuala Lumpur from January 2005 to December 2020 were examined by microscopy. Infection status was analyzed using descriptive statistics and curve estimation analysis. Of 3105 blood films examined, 92 (3%) were microscopically confirmed malaria cases. Plasmodium vivax infections accounted for the majority (36.9%) of all malaria cases. Nearly half (47.8%) of cases were found among foreign cases (p < 0.001). The majority of foreign cases were male (86.4%) and came from Southeast Asian countries (65.9%). The curve estimation analysis showed significant decreases in malaria cases due to P. vivax (R2 = 0.598; p < 0.001) and Plasmodium falciparum (R2 = 0.298, p = 0.029), but increases for Plasmodium knowlesi (R2 = 0.325, p = 0.021) during the 16 years. This study showed that malaria incidence in urban Kuala Lumpur is low and has remained stable since 2005. However, P. knowlesi has played a significant role in the increase in overall malaria in the area, highlighting the importance of continued vigilance and improved surveillance.

Malaria remains a public health problem in many parts of the world, including Malaysia. Although Malaysia has been recognized as one of the countries free from indigenous human malaria since 2018, the rising trend of zoonotic malaria, particularly Plasmodium knowlesi cases, poses a threat to public health and is of great concern to the country’s healthcare system. We reviewed previously scattered information on zoonotic malaria infections in both Peninsular Malaysia and Malaysian Borneo to determine the epidemiology and distribution of emerging zoonotic malaria infections. Given the high prevalence of zoonotic malaria in Malaysia, efforts should be made to detect zoonotic malaria in humans, mosquito vectors, and natural hosts to ensure the success of the National Malaria Elimination Strategic Plan.

Background: Malaria remains a major public health challenge in Thailand. In Thailand, the transmission now progressively clusters in hotspots along international borders and among high-risk groups, including forest-goers. Therefore, continuous assessment and understanding of the behavioral and perceptions related to malaria exposure in the high-risk group are necessary to achieve the elimination goal. This study aimed to investigate knowledge, attitudes and practices (KAP) related to malaria in rural communities living close to a forested area in the northeastern part of Thailand.Methods: A community-based cross-sectional survey was conducted in three forest-goer communities (i.e. Ban Khok, Ban Koh and Dong Yang) in Khamcha-i district, Mukdahan Province from July and August 2019. Community members aged 18 years and above were interviewed. Demographic, socio-economic information and KAP data were collected using a structured questionnaire. Data were analyzed using descriptive statistics.Results: Overall, 346 individuals were interviewed. Although the household indoor residual spraying (IRS) coverage was 100%, ownership of mosquito bed net was 24.3% and only reported in Ban Khok. Nevertheless, almost all of the respondents were aware that malaria is transmitted by mosquitoes (97.7%) and bed nets were used to prevent malaria (94.5%). Regarding practice for managing malaria, the most common practice adopted by the respondents was seeking treatment at the nearby clinic (58.1%), followed by self-healing (38.7%) and self-purchase of medication from a local shop (3.2%). Concerning attitude towards malaria transmission, 69.1% and 24.3% of the respondents reported entering nearby forests and spending the night in the forest within the last six months, respectively. Conclusion: This study found that most respondents living in the villages have an acceptable level of knowledge and awareness about malaria. Nevertheless, the positive attitudes and practices concerning malaria prevention measures against malaria require marked improvement. Therefore, new approaches to improving malaria KAP evidently need in this community.

Malaria remains a major public health challenge in Thailand. Continuous assessment and understanding of the behavior and perceptions related to malaria exposure in the high-risk group are necessary to achieve the elimination goal. This study aimed to investigate the parasite prevalence, seroprevalence rate, knowledge, attitudes, and practices (KAP), and malaria risk factors in rural communities living close to a forested area in the northeastern part of Thailand. A community-based cross-sectional survey was conducted in three forest-goer communities (i.e., Ban Khok, Ban Koh, and Dong Yang) located in Khamcha-i district, Mukdahan Province, Thailand, from July to August 2019. Demographic, socioeconomic information and KAP data were collected using a structured questionnaire. Parasite prevalence was determined by microscopy. Seroprevalence was determined via ELISA using two Plasmodium falciparum (PfAMA-1 and PfMSP-119) and two Plasmodium vivax (PvAMA-1 and PvMSP-119) antigens. Age-adjusted antibody responses were analyzed using a reversible catalytic model to calculate seroconversion rate (SCR). Malaria parasite was not detected in any of the 345 participants. The overall malaria seroprevalence was 72.2% for PfAMA-1, 18.8% for PfMSP-119, 32.5% for PvAMA-1, and 4.4% for PvMSP-119. The proportion of seroprevalence for P. falciparum and P. vivax antigens was significantly highest in Ban Koh (35.1%, P &lt; 0.001) and Don Yang (18.8%, P &lt; 0.001), respectively. For all parasite antigens except PvMSP-119, the proportion of seropositive individuals significantly increased with age (P &lt; 0.001). Based on the SCRs, there was a higher level of P. falciparum transmission than P. vivax. Regarding KAP, almost all respondents showed adequate knowledge and awareness about malaria. Nevertheless, significant effort is needed to improve positive attitudes and practices concerning malaria prevention measures. Multivariate regression analyses showed that living in Ban Koh was associated with both P. falciparum (adjusted odds ratio [aOR] 12.87, P &lt; 0.001) and P. vivax (aOR 9.78, P &lt; 0.001) seropositivities. We also found significant associations between age and seropositivity against P. falciparum and P. vivax antigens. The data suggest that seroepidemiological surveillance using AMA-1 and MSP-119 antigens may provide further evidence to reconstruct malaria exposure history. The absence of weak evidence of recent malaria transmission in Mukdahan Province is promising in the context of the disease elimination program.

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While there has been a tremendous decline in malaria disease burden in the remote parts of the Malaysia, little is known about malaria incidence in its urban localities. This study aimed to analyse trends of malaria cases in urban Kuala Lumpur, Malaysia. All suspected cases presented to a university hospital in Kuala Lumpur from January 2005 to December 2020 were examined by microscopy. Infection status was analysed using descriptive statistics and curve estimation analysis. Of 3105 blood films examined, 92 (3%) were microscopically confirmed malaria cases. Plasmodium vivax infections accounted for the majority (36.9%) of all malaria cases. Nearly half (47.8%) of cases were found among foreign cases (P&amp;lt;0.001). The majority of foreign cases were males (86.4%) and came from Southeast Asian countries (65.9%). Curve estimation analysis showed significant decreases of malaria cases due to P. vivax (R2 = 0.598; P&amp;lt;0.001) and Plasmodium falciparum (R2 = 0.0259, P = 0.029), but increase for Plasmodium knowlesi (R2 = 0.325, P = 0.021) during the 16 years. This study revealed that malaria incidence in urban Kuala Lumpur is low and has remained stable since 2005. However, P. knowlesi played a significant role in the increase of overall malaria in the area, highlighting the importance of continued vigilance and improved surveillance.

Anaemia continues to be a major public health challenge in developing countries. An important and often unreported group at risk for anaemia is indigenous communities. This study aimed to assess the prevalence of anaemia and to identify its determinants in the indigenous Temiar Orang Asli community in Peninsular Malaysia. A community-based cross-sectional study was conducted in 2019. Six hundred and forty participants aged one and older were enrolled and personal characteristic data were collected. Anaemia status was determined using haemoglobin level (Hb) according to the World Health Organization (WHO) Hb cut-off. The overall anaemia prevalence was 44.7% (286/640) and the prevalence rates of mild, moderate and severe anaemia were 42.7%, 50.7% and 6.6%, respectively. Anaemia-specific prevalence varied significantly by age groups (P<0.001) and was highest in the 6–17 group for mild anaemia (39.3%, 95% CI: 30.6–48.6), followed by ≤5 group for both moderate anaemia (43.4%; 95%CI: 35.2–51.9) and severe anaemia (42.1%; 95%CI: 20.3–66.5). In the multivariate logistic regression, anaemia was associated in age groups of ≤5 (adjusted odds ratio [aOR] 5.6 [95%CI: 3.3–9.4], P<0.001) and 6–17 (aOR 2.1 [95%CI: 1.4–3.2], P<0.001) as well in those living in Lambok (aOR 2.7 [95%CI: 1.3–5.5], P = 0.006). This study has highlighted the high prevalence of anaemia among indigenous Orang Asli in Peninsular Malaysia and revealed that younger children were positively associated with childhood anaemia. Effective interventions and special attention for this indigenous population need to be implemented to reduce the risk of anaemia.

Malaria remains a public health problem in many parts of the world. In Malaysia, the significant progress towards the national elimination programme and effective disease notification on malaria has resulted in zero indigenous human malaria cases since 2018. However, the country still needs to determine the extent of malaria exposure and transmission patterns, particularly in high-risk populations. In this study, a serological method was used to measure transmission levels of Plasmodium falciparum and Plasmodium vivax among indigenous Orang Asli communities in Kelantan, Peninsular Malaysia. A community-based cross-sectional survey was conducted in three Orang Asli communities (i.e., Pos Bihai, Pos Gob, and Pos Kuala Betis) in Kelantan from June to July 2019. Antibody responses to malaria were assessed by enzyme-linked immunosorbent assay (ELISA) using two P. falciparum (PfAMA-1 and PfMSP-119) and two P. vivax (PvAMA-1 and PvMSP-119) antigens. Age-adjusted antibody responses were analysed using a reversible catalytic model to calculate seroconversion rates (SCRs). Multiple logistic regression was used to investigate factors associated with malaria exposure. The overall malaria seroprevalence was 38.8% for PfAMA-1, 36.4% for PfMSP-119, 2.2% for PvAMA-1, and 9.3% for PvMSP-119. Between study areas, the proportion of seropositivity for any P. falciparum and P. vivax antigens was significantly highest in Pos Kuala Betis with 34.7% (p &lt; 0.001) and 13.6% (p &lt; 0.001), respectively. For all parasite antigens except for PvAMA-1, the proportion of seropositive individuals significantly increased with age (all p &lt; 0.001). Based on the SCR, there was a higher level of P. falciparum transmission than P. vivax in the study area. Multivariate regression analyses showed that living in Pos Kuala Betis was associated with both P. falciparum (adjusted odds ratio [aOR] 5.6, p &lt; 0.001) and P. vivax (aOR 2.1, p &lt; 0.001) seropositivities. Significant associations were also found between age and seropositivity to P. falciparum and P. vivax antigens. Analysis of community-based serological data helps describe the level of transmission, heterogeneity, and factors associated with malaria exposure among indigenous communities in Peninsular Malaysia. This approach could be an important adjunct tool for malaria monitoring and surveillance in low malaria transmission settings in the country.