How can interventions that target forest-goers be tailored to accelerate malaria elimination in the Greater Mekong Subregion? A systematic review of the qualitative literature

Abstract

BackgroundDespite decreases in incidence and related mortality, malaria remains a major public health challenge in the Greater Mekong Sub-region (GMS). The emergence of artemisinin resistance threatens these gains and has prompted efforts to accelerate elimination in the region. In the GMS, transmission now clusters in hotspots along international borders and among high-risk populations, including forest-goers. To eliminate malaria in the region, interventions must target such hard-to-reach populations. This review provides a comprehensive overview of the qualitative research on behaviours and perceptions that influence uptake of and adherence to malaria interventions among forest-goers in the GMS.MethodsA systematic search strategy was used to identify relevant sources, including database (OVID SP, PubMed, ISI Web of Knowledge) and bibliographic searches. Relevant findings from qualitative research methods were extracted and thematic analysis undertaken.ResultsOf 268 sources retrieved in searches twenty-two were reviewed. Most reported studies were conducted in Cambodia (n = 10), and were published after 2014 (n = 16). Four major themes emerged that are particularly relevant to the design of intervention packages targeted at forest-goers: (1) understanding of malaria and perceived risk; (2) preventive measures used when visiting the forest; (3) behaviours that put forest-goers at risk of infection; and, (4) malaria-related treatment seeking. There were notable differences across the reviewed articles that suggest the need for a locally tailored approach.ConclusionA more detailed characterization of forest activities is needed but research on this topic raises methodological challenges. Current vector control measures have limitations, with use of insecticidal-treated nets, hammocks and repellents influenced by the type of forest activities and the characteristics of these measures. In contrast, anti-malarial drugs, for example, as chemoprophylaxis, hold promise but require further evaluation.Electronic supplementary materialThe online version of this article (10.1186/s12936-019-2666-5) contains supplementary material, which is available to authorized users.

Semi Field Evaluation of Freestanding Transfluthrin Passive Emanators and the BG Sentinel Trap as a “Push-Pull control Strategy” Against Aedes aegypti Mosquitoes

“…As the device provides protection at the household level, it is likely to provide a more cost-effective approach to bite prevention outside of sleeping hours and to be more acceptable among community members for protection of the whole family [45]. Topical repellents are logistical prohibitive to use [46] and more suitable for targeted distribution among high risk populations such as forest goers in pre-elimination areas [47].…”

Targeting high risk forest goers for malaria elimination: A novel approach for investigating forest malaria to inform program intervention in Vietnam

“…Ten participants slept in both forests and on farms and were excluded from forest and farm subgroup analysis. Index cases reported employment in harvesting aloe (27) or timber (5), farming cassava (24) or rice (19), trapping (2), plantation labor (16), construction (10), and other unspeci ed activities (7). Thirty-one (28%) index cases reported work activities at night, de ned as between 6 pm and 5 am.…”

“…Together with multi-drug resistant malaria, the GMS faces additional region-speci c challenges to malaria elimination including complex vector biology and forest malaria, and increasing prevalence of Plasmodium vivax (Pv) malaria, and large populations of vulnerable, mobile and remote individuals (3)(4)(5)(6). In order to address these challenges, there is a need for further operational research on forest-goers and the characterization of forest activities to effectively target this high-priority population group with appropriate interventions (7). Malaria elimination programs in the GMS require innovative approaches to capture relevant data, support effective decision-making and implement targeted context-speci c actions in these remote yet critically important environments.…”

Tools to accelerate falciparum malaria elimination in Cambodia: a meeting report

“…Furthermore, the population at highest risk in SSA are young children sleeping in a home, usually in a brick or a wattle and daub house with their parents or guardians. The population at highest risk in Cambodia and most of the GMS are forest workers who sleep in mostly improvised shelters in forested areas where they work, eat, and socialize outdoors-activities that do not lend themselves to conventional vector control approaches [11,12]. Militaries, another high-risk population working in the forest, face the similar challenges, being left unprotected during peak biting hours.…”