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

BackgroundClandestine gold miners remain key hosts for malaria in French Guiana (FG) who 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. MethodThe primary outcome was the overall KAP score over time and among participants and not participantsin 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.ResultsPerception 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 (respectively +0.16 and +0.47 points, 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]).ConclusionWe observed a decrease in perception and knowledge about malaria but an improvement of attitudes and practices as the incidence of malaria decreased. 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 programs could help to improve the KAP, even in areas where malaria is nearly eliminated, through optimal training and health empowerment. TRIAL REGISTRATIONClinicalTrials.gov registration number : NCT03695770

Modeling the impact of Malakit intervention: one more step towards malaria elimination in the Guiana Shield?

“…This can explain the lower impact of Malakit estimated on Pv transmission, as reported when ACT was implemented in other settings (19). Malakit could also have had an effect on malaria transmission through the increased use of long lasting insecticidal nets (LLINs), by improving access and awareness of this preventive measure among participants (20). However, there is little evidence about the effectiveness of LLINs for malaria prevention in this context given one fifth of gold miners report working at night and the diurnal biting behavior of An.…”