Impact of Malakit intervention on perceptions, knowledge, attitudes, and practices related to malaria among workers in clandestine gold mines in French Guiana: results of multicentric cross-sectional surveys over time

Abstract

Background Clandestine gold miners remain key hosts for malaria in French Guiana (FG) and contribute to imported malaria cases in Suriname and Brazil. The Malakit intervention, implemented in FG borders with Suriname and Brazil, provided gold miners with training on malaria and kits for self-diagnosis and self-treatment. Having shown a likely impact on malaria transmission, Suriname has now implemented it in routine care for cross-border moving populations. However, a decrease in malaria transmission is frequently associated with a decrease in risk perception, knowledge, and good practices regarding malaria. This study aims to describe the evolution of the perceptions, knowledge, attitudes, and practices (KAP) related to malaria among clandestine gold miners between 2015 and 2019, and to estimate the impact of Malakit on the FG/Suriname border. Methods The primary outcome was the overall KAP score over time and among participants and not participants in the Malakit intervention. A propensity score matching analysis and an inverse probability of treatment weighing analysis were used to estimate the Average Treatment effect on the Treated and the Average Treatment Effect of Malakit, respectively. Results Perception and knowledge scores were significantly lower in 2019 compared to 2015 (− 0.27 and − 0.23 points, respectively, p < 0.001) while attitude and practice scores were higher (+ 0.16 and + 0.47 points, respectively, p < 0.001). The overall KAP score was significantly higher among participants in Malakit with both propensity score matching (+ 0.72 points, 95%IC [0.29; 1.15]) and inverse probability of treatment weighting analysis (+ 0.70 points, 95%IC [0.34; 1.05]). Conclusion A decrease in perception and knowledge about malaria but an improvement of attitudes and practices as the incidence of malaria decreased are observed. The Malakit intervention seems to have a significant positive impact on the overall KAP related to malaria. The integration of this strategy into malaria control programmes could help to improve the KAP, even in areas where malaria is nearly eliminated, through optimal training and health empowerment. Trial registration ClinicalTrials.gov registration number: NCT03695770.

Malaria in areas under mining activity in the Amazon: A review

“…The project distributes kits to the rest areas, specific neighborhoods in border towns, and small informal settlements along border rivers that miners use to rest, buy supplies, or sell gold. Participation in interventions has been associated with significant improvements in self-care practices and a reduction in the frequency and incidence of malaria in French Guiana and Brazil 46 , 47 .…”

“…The Malakit project is an international initiative for malaria control in illegal mining in French Guiana, which includes training people associated with mining to self-diagnose and self-treat the disease, report cases, and distributing bed nets 46 , 92 . The training of miners does not include reporting cases because this population lives in isolated conditions in the Amazon rainforest, with a lack of electricity supply and Internet connections.…”

Core principles of Malakit intervention for transferability in other contexts

“…The 2-year research project (2018–2020) used an effectiveness evaluation by quasi-experimental design. The intervention was associated with an improvement in number of important outcomes: there was a significant increase of reliance on rapid malaria diagnosis before taking certified artemisinin-based combination therapy (ACT) (from 54.2% to 68.1%; OR = 1.8 (95% CI [1.1–3.0]); the intervention was followed by a significant decrease of malaria prevalence (on the border with Suriname) and of malaria cases exported from French Guiana to Suriname and Brazil, with an acceleration of the decline in malaria incidence in the region by 42.9% between 2018 and 2020 [ 6 – 8 ]. No safety or ethical concerns (such as significant resale on the black market) were reported.…”

“…Malar J. 2022 Dec 28;21:397 Evolution of knowledge, attitudes and practices among malaria before-after the Malakit of the targeted population project: positive impact on attitudes [ 8 ] Comparison of of KAP between people participanting or not in Malakit using propension score: improvement of perception, knowledge and practice 8 Douine M, Lambert Y, Galindo MS, Mutricy L, Sanna A, Peterka C, et al Self-diagnosis and self-treatment of malaria in hard-to-reach and mobile populations of the Amazon: results of Malakit, an international multicentric intervention research project. Lancet Reg Health Am.…”

Determination of different social groups’ level of knowledge about malaria in a multicultural Amazonian cross-border context

“…In this context, assessing knowledge about malaria, related attitudes, and associated practices in at-risk populations living in endemic foci is essential to identify groups of individuals requiring educational actions, and to ensure that the educational tools implemented are culturally appropriate. No data are available regarding knowledge, attitudes, and practices (KAP) of local population living outside the gold mining camps [ 9 ] except practices regarding the use of plants as traditional remedies [ 10 ]. In the Amazonian context, some studies have investigated these aspects [ 11 – 15 ] however, results are generally specific of an area and population.…”