Malaria risk factors and care-seeking behaviour within the private sector among high-risk populations in Vietnam: a qualitative study

Abstract

BackgroundVietnam has successfully reduced malaria incidence by more than 90% over the past 10 years, and is now preparing for malaria elimination. However, the remaining malaria burden resides in individuals that are hardest to reach, in highly remote areas, where many malaria cases are treated through the informal private sector and are not reported to public health systems. This qualitative study aimed to contextualize and characterize the role of private providers, care-seeking behaviour of individuals at high risk of malaria, as well as risk factors that should be addressed through malaria elimination programmes in Vietnam.MethodsSemi-structured qualitative interviews were conducted with 11 key informants in Hanoi, 30 providers, 9 potential patients, and 11 individuals at risk of malaria in Binh Phuoc and Kon Tum provinces. Audio recorded interviews were transcribed and uploaded to Atlas TI™, themes were identified, from which programmatic implications and recommendations were synthesized.ResultsQualitative interviews revealed that efforts for malaria elimination in Vietnam should concentrate on reaching highest-risk populations in remote areas as well their care providers, in particular private pharmacies, private clinics, and grocery stores. Among these private providers, diagnosis is currently based on symptoms, leaving unconfirmed cases that are not reported to public health surveillance systems. Among at-risk individuals, knowledge of malaria was limited, and individuals reported not taking full courses of treatment, a practice that threatens selection for drug resistance. Access to insecticide-treated hammock nets, a potentially important preventive measure for settings with outdoor biting Anopheles vectors, was also limited.ConclusionsMalaria elimination efforts in Vietnam can be accelerated by targeting improved treatment, diagnosis, and reporting practices to private pharmacies, private clinics, and grocery stores. Programmes should also seek to increase awareness and understanding of malaria among at-risk populations, in particular the importance of using preventive measures and adhering to complete courses of anti-malarial medicines.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-2060-0) contains supplementary material, which is available to authorized users.

Defining Malaria Risks Among Forest Workers in Aceh, Indonesia: A Formative Assessment

“…Misconceptions around malaria risks, prevention and injections for malaria treatment among individuals in the study suggests a greater need for health education, both at work sites and in villages [21]. Similar to previous ndings [22,23], these results suggest insecticide treated bed nets may have limited impact for forest workers because they are impractical to set up and uncomfortable to sleep under.…”

Defining malaria risks among forest workers in Aceh, Indonesia: A formative assessment

“…Misconceptions around malaria risks, prevention and injections for malaria treatment among individuals in the study suggests a greater need for health education, both at work sites and in villages [23]. Similar to previous ndings [24,25], these results suggest insecticide treated bed nets may have limited impact for forest workers because they are impractical to set up and uncomfortable to sleep under.…”

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

“…Despite risking malaria infection, respondents described that visiting forests was essential for sustenance, usually from swidden farming, hunting or logging. In some settings, malaria was perceived as an insignificant risk because mosquitoes in the forest were not seen as malaria vectors [28] or because only unhealthy individuals could become infected [29]. In one article, the ease with which malaria could be treated also reduced the perceived danger of malaria infection [25].…”

“…In one study, bed nets were only taken to the forest if respondents spent longer than two nights there [27]. Respondents in four studies described how bed nets were left in the village for other household members to use [15, 29, 34, 36] because they did not own extra nets that could be taken to the forest. Insufficient access to bed nets was an issue reported in several sources [15, 27, 29, 34, 36].…”

“…Respondents in four studies described how bed nets were left in the village for other household members to use [15, 29, 34, 36] because they did not own extra nets that could be taken to the forest. Insufficient access to bed nets was an issue reported in several sources [15, 27, 29, 34, 36]. Although free bed net distribution campaigns have taken place across the GMS, forest-goers were sometimes absent during the distribution [27] or did not have a registration card [34] and were not eligible for a free bed net.…”