Exploring the key anthropological drivers of and barriers to zoonotic malaria preventative behaviour in a community exposed to Plasmodium knowlesi infection in Malaysia: protocol for a qualitative study with a participatory research design

Abstract

IntroductionPlasmodium knowlesi malaria is a zoonotic mosquito-borne disease with complex epidemiology. According to the WHO, the prevention and control of vector-borne diseases require community participation to increase coherence between malaria interventions and sustainable public health programmes. We describe a participatory research (PR) design for a study aimed at exploring the key anthropological drivers of and barriers to zoonotic malaria preventive behaviour among communities exposed to P. knowlesi infection in Malaysia. Participatory approaches can facilitate policymakers in designing future zoonotic malaria control programmes by investigating community perspectives and concerns about zoonotic malaria in a local context.Methods and analysisThe PR will be conducted over a period of 12 months, from March 2022 to March 2023, among adults (>18 years old) who are permanent residents in a rural village exposed to P. knowlesi malaria in Sabah, Malaysia. We will select patients who were diagnosed with P. knowlesi infection from January to December 2021 for focus group discussions (FGDs), as they can provide perspectives on the disease from the point of view of those previously diagnosed with infection. In-depth interviews (IDIs) with people of importance in the community, such as village heads, will also be conducted. Both FGDs and IDIs will be conducted from March 2022 until June 2022. Concurrently, a photovoice with adults over 18 years old who reside in the community will be conducted. The target sample sizes for FGDs, IDIs and photovoice are 6–8, 12 and 10–15 participants, respectively. We will use a study framework as a theoretical lens to guide the exploration of the beliefs, social contexts, barriers and drivers surrounding zoonotic malaria preventive behaviour.Ethics and disseminationThis study has been approved by the Medical Research and Ethics Committee Ministry of Health Malaysia (NMRR ID-21-01980-JEH) and the Research and Innovation Secretariat, Faculty of Medicine, Universiti Kebangsaan Malaysia (FF-2021-462). All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at conferences and on other platforms.

The economic burden of zoonoticPlasmodium knowlesimalaria on households in Sabah, Malaysia compared to malaria from human-onlyPlasmodiumspecies

“…Despite the provision of free health-facility-related costs of malaria care by the Ministry of Economy, Malaysia [38], patients in Sabah faced substantial personal financial barriers when accessing care with a mean cost of $138 for each malaria episode. Malaysia has successfully controlled human-only malaria in recent years, with only small numbers of imported cases of P. vivax and P. falciparum now reported [1].…”

“…The total cost for working-age males was higher than the remainder of the participants, with a mean of US$144.01 (SD=105 19). versus US$110.22 (SD=92 38). respectively (p=0.007; Supplementary Table4).…”

A systematic review of asymptomatic Plasmodium knowlesi infection: an emerging challenge involving an emerging infectious disease

“…Amid concern that current preventive measures might be sub-optimal, community participation coupled with multisectoral strategies can provide more effective malaria control [ 18 ]. Deforestation and habitat destruction are causing an increase in the risk of zoonotic malaria transmission occurring [ 35 , 36 ]. For example, a higher intensity of asymptomatic cases in Sumatra [ 28 ], as compared to Aceh, Indonesia [ 27 ] was suggested to be due to the deforestation that has occurred in the last few years.…”

Generating Trust in Participatory Research on Plasmodium knowlesi Malaria: A Study with Rural Community Gatekeepers during the COVID-19 Pandemic

“…Instead, the researchers spent time in the village from 8 am to 5 pm daily for one to two weeks a month. The study protocol has been described previously [ 14 ].…”

“…Using this model, Storey et al identified factors of bed net use for malaria prevention in three African countries, such as malaria-related knowledge, awareness towards the disease and descriptive norm about its usage [ 24 ]. In this study, the model was improved by additional themes which were generated from an expert consensus using a modified Delphi study, specifically, (1) experiences of being a malaria patient, (2) feasibility of interventions, and (3) affordability of interventions [ 14 ] ( Figure 2 ).…”