Antimalarial chemoprophylaxis for forest goers in southeast Asia: an open-label, individually randomised controlled trial

Tripura, Rupam; Seidlein, Lorenz von; Sovannaroth, Siv; Peto, Thomas J; Callery, James J; Sokha, Meas; Ean, Mom; Heng, Chhouen; Conradis-Jansen, Franca; Madmanee, Wanassanan; Peerawaranun, Pimnara; Waithira, Naomi; Khonputsa, Panarasri; Jongdeepaisal, Monnaphat; Pongsoipetch, Kulchada; Chotthanawathit, Paphapisa; Soviet, Ung; Pell, Christopher; Duanguppama, Jureeporn; Huy, Rekol; Tärning, Joel; Imwong, Mallika; Mukaka, Mavuto; White, Nicholas J.; Dondorp, Arjen M.; Maude, Richard J.

doi:10.1016/s1473-3099(22)00492-3

Cited by 18 publications

(15 citation statements)

References 28 publications

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“…There are a few published articles on TPT activities solely targeting forest-related workers and this area of work should be further pursued. Antimalarial chemoprophylaxis with ACT 42 or PQ 43 also has a potent prophylactic effect to prevent malaria transmission. Targeting high-risk groups such as gold miners in the TPT campaign might help increase overall population coverage.…”

Section: Discussionmentioning

confidence: 99%

Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019–2020

Aung

Soe

et al. 2023

Sci Rep

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Targeted mass primaquine treatment (TPT) might be an effective intervention to facilitate elimination of vivax malaria in Myanmar by 2030. In this study, we explored the factors hindering coverage of a TPT campaign conducted in a malarious township of northern Myanmar. From August 2019 to July 2020, a cross-sectional exploratory design including quantitative and qualitative data was conducted in five villages with high P. vivax prevalence following a TPT campaign. Among a targeted population of 2322; 1973 (85.0%) participated in the baseline mass blood survey (MBS) and only 52.0% of the total targeted population (1208, 91.9% of total eligible population) completed the TPT. G6PD deficiency was found among 13.5% of total MBS participants and those were excluded from TPT. Of 1315 eligible samples, farmers and gold miners, males, and those aged 15 to 45 years had higher percentages of non-participation in TPT. Qualitative findings showed that most of the non-participation groups were outside the villages during TPT because of time-sensitive agricultural and other occupational or education-related purposes. In addition to mitigating of some inclusion criteria (i.e. including young children or offering weekly PQ treatment to G6PD deficient individuals), strengthening community awareness and increasing engagement should be pursued to increase community participation.

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Section: Discussionmentioning

confidence: 99%

Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019–2020

Aung

Soe

et al. 2023

Sci Rep

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“…First, to accelerate Cambodia's malaria elimination goals and following evidence of entomological protective e cacy among local vectors in Mondulkiri province, products within these classes can be delivered to more at-risk individuals using SBCC strategies, collecting implementation outcomes on factors that enable or prevent sustained uptake. These bite prevention products can be given with several other protective measures against malaria including chemoprophylaxis [40,41], to inform the evidence base on eliminating forest malaria. Second, our ndings that the odor of these products in uences user acceptability should be applied to the development of new mosquito bite prevention products or optimization of existing products, using ingredients and formulations that have an acceptable or desirable smell to target populations.…”

Section: Discussionmentioning

confidence: 99%

Applying the COM-B behavior model to inform the delivery of spatial repellents and insecticide-treated clothing among forest exposed populations in Mondulkiri Province, Cambodia

Chen

Doum²,

Mannion

et al. 2023

Preprint

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Background: Southeast Asia is making tremendous progress towards their 2030 malaria elimination goal but needs new interventions to stop forest malaria. This study trials two new vector control tools, a volatile pyrethroid spatial repellent (VSPR) and insecticide-treated clothing (ITC), amongst forest-exposed populations in Mondulkiri Province Cambodia to inform their potential use for eliminating forest malaria. Methods: 21 forest-exposed individuals were given a questionnaire on their perceptions of malaria and preventive practices used, after which they trialed two products sequentially. Mixed methods were used to understand their experience, attitudes, and preferences regarding the products trialed. Quantitative data was summarized and qualitative insights were analyzed using thematic analysis, applying the Capability, Opportunity, Motivation Behavior Change (COM-B) model and Behavior Change Wheel Framework to identify intervention functions to support tailored product rollout amongst these populations. Results: Study participants reported a need for protection from mosquito bites in outdoor and forest-exposed settings and perceived both products trialed to be effective for this purpose. The VPSR product was preferred when travel was not required, whereas ITC was preferred for ease of use when going to the forest, especially in rainy conditions. COM-B analysis identified that key enablers for use of both products included their perceived efficacy and ease of use, which required no skill or preparation. For barriers to use, the odor of ITC was sometimes perceived as being toxic, as well as its inability to protect uncovered skin from mosquito bites, while the perceived usefulness of the VPSR product trialed was limited by its water sensitivity in rainy forest settings. Intervention components to encourage appropriate and sustained use of these products include education about how to use these products and what to expect, persuasion to use them from community leaders and targeted ads, and enablement to guarantee access. Conclusion: The rollout of VPSRs and ITC amongst forest-exposed populations can be useful for eliminating malaria in Southeast Asia. Study findings can be applied to increase product uptake in Cambodia, while research efforts can aim to develop products that are rainproof, easy to use in forest settings, and have favorable odor profiles to target users.

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“…The vector control product classes suggested here are safe for humans and have demonstrated an ability to reduce mosquito bites [15,[23][24][25][26]. Another option is to provide chemoprophylaxis, a method shown to be effective for forest-going populations in Cambodia [27] that could be delivered with vector control interventions to further improve impact [27,28].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of malaria and preventive practices used among Orang Rimba forest dwellers in Sumatra Indonesia

Chen,

Syafruddin,

Asih

et al. 2023

Preprint

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Background Southeast Asia aims to eliminate malaria by 2030, requiring that risk factors for malaria among hard-to-reach populations be understood and addressed. This is the first study of malaria risks on the Orang Rimba, a culturally unique nomadic ethnic group residing in the lowland rain forests of Sumatra, Indonesia that usually functions outside of the health system. This study characterizes perceptions of malaria and preventive practices used, to inform the selection of interventions that can support malaria elimination efforts for this specific and sensitive population.Methods A small cross-sectional survey was conducted among the Orang Rimba people in the Sarolangun District of Jambi, Indonesia between March and May of 2021. The survey identified participant demographics, their knowledge of malaria, prevention practices in use, and pregnancy-related health behaviors among females. For cultural reasons, questions for women were asked through men.Results We enrolled 39 participants, 87% of which were male. Most participants (77%) had no formal schooling, and all worked in agriculture and/or hunting. Their understanding of malaria was limited, with approximately half understanding that malaria transmission takes place through the bite of an infected mosquito, and 62% citing fever as a symptom of malaria. The vast majority of participants (90%) used mosquito coils and/or insecticide-treated bednets (ITNs) (87%) the night before the survey. Women did not perceive malaria to be a greater health risk in pregnancy, and received limited prenatal care (29%) and ITNs (46%) during their pregnancies.Conclusions Orang Rimba forest dwellers in Sumatra are vulnerable, socioeconomically disadvantaged, and separated from the healthcare system. If Indonesia and the Greater Mekong Subregion are to meet their goal to eliminate malaria by 2030, deliberate and continuous efforts targeted at reducing outdoor transmission among the Orang Rimba communities will be essential. Education on malaria and the provision of prenatal care would likely benefit this community.

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Antimalarial chemoprophylaxis for forest goers in southeast Asia: an open-label, individually randomised controlled trial

Cited by 18 publications

References 28 publications

Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019–2020

Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019–2020

Applying the COM-B behavior model to inform the delivery of spatial repellents and insecticide-treated clothing among forest exposed populations in Mondulkiri Province, Cambodia

Perceptions of malaria and preventive practices used among Orang Rimba forest dwellers in Sumatra Indonesia

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