Diagnostic Practices and Treatment for P. vivax in the InterEthnic Therapeutic Encounter of South-Central Vietnam: A Mixed-Methods Study

Abstract

Malaria elimination in the Greater Mekong Sub-Region is challenged by a rising proportion of malaria attributable to P. vivax. Primaquine (PQ) is effective in eliminating the parasite’s dormant liver stages and can prevent relapsing infections, but it induces severe haemolysis in patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, highlighting the importance of testing enzyme activity prior to treatment. A mixed-method study was conducted in south-central Vietnam to explore the factors that affect acceptability of G6PD testing, treatment-seeking behaviors, and adherence to current regimens. The majority of respondents (75.7%) were unaware of the different parasite species and rather differentiated malaria by perceived severity. People sought a diagnosis if suspected of malaria fever but not if they perceived their fevers as mild. Most respondents agreed to take prescribed medication to treat asymptomatic infection (94.1%) and to continue medication even if they felt better (91.5%). Health professionals did not have G6PD diagnostic tools nor the means to prescribe PQ safely. Adherence to treatment was linked to trust in public providers, who were perceived to make therapeutic decisions in the interest of the patient. Greater focus on providing acceptable ways of assessing G6PD deficiency will be needed to ensure the timely elimination of malaria in Vietnam.

Use of antimicrobials and other medical products in an ethnic minority context of South-Central Vietnam: A qualitative study of vulnerability

“…Our study highlights the precarious socio-economic situation of some Raglai communities, which is partially linked to their position in society as "ethnic minority" people [78,79], leading to marginalization and sometimes even self-discrimination. This position as an "ethnic minority" affects the inter-ethnic encounter in health-seeking itineraries of ethnic minority groups in Vietnam as has been shown in other studies [80][81][82][83][84][85]. Chambers describes how the body is the most crucial asset of the poorest (referring to the body's role in manual labour, which is often the main subsistence strategy of the poorest), yet it is more vulnerable compared to the less poor and therefore physical disabilities comprise higher personal costs [86].…”

Molecular Characterization and Genotype-Phenotype Correlation of G6PD Mutations in Five Ethnicities of Northern Vietnam

“…Although the rate of G6PD in the Lue ethnic group was 13.51%, the different local languages show the variation in Ta-Kadai (9.69%), Sino-Tibetan (4.51%), Austroasiatic (7.58%), and Hmong-Mien groups (1.77%) [ 29 ]. An extreme distribution of G6PD deficiency in the Great Mekong Subregion (GMS) countries can be understood because these countries were seriously affected by the malaria pandemic [ 30 ]. It could be a possible evolutionary factor to increase the prevalence of G6PD deficiency in the population.…”

Magnitude and patterns of severe Plasmodium vivax monoinfection in Vietnam: a 4-year single-center retrospective study

“…Indeed, it has been well documented that in comparable developing countries, "efforts to control COVID-19 would impact efforts to control other existing health problems that are endemic, such as malaria" (23). To the best of our knowledge, there are a few papers related to malaria in Vietnam published between 2020 and 2022 (18,19,(24)(25)(26)(27). However, none of these studies specifically documented the evolution of malaria in southern Vietnam.…”