Predictors of antimalarial self-medication in illegal gold miners in French Guiana: a pathway towards artemisinin resistance

Abstract

The risk factors for the selection of resistance are well known and this study showed that they are present in FG with persons who self-medicated with poor adherence. Interventions should be implemented among this specific population to avoid the emergence of artemisinin resistance.

Malaria in Gold Miners in the Guianas and the Amazon: Current Knowledge and Challenges

“…Gold miners work and live outdoors, often in camps without walls, and are thus exposed to mosquito bites for long periods of time, by day and at night [8,29]. The use of mosquito net is scarce for several reasons: nets can be unavailable or miners may find them uncomfortable or useless [30].…”

“…Access to health facilities is difficult and leads gold miners to use antimalarial treatment as self-medication. In French Guiana in 2015, despite possible access to regular care, selfmedication was used by 52 to 59% of gold miners during their last malaria episode [30,12]. Treatment was directly bought on mining sites (80.7%) or given by friends or family (6.1%).…”

“…Treatment was directly bought on mining sites (80.7%) or given by friends or family (6.1%). The treatment course was with artemisinin-based combination therapies (ACT), but incomplete in 40% [30,12]. Selfmedication is also very frequent in Suriname [44] and in Guyana [37], where the quality of antimalarials (in public, private, and informal sectors) is substandard [45,46].…”

“…In Suriname, despite a warning signal in 2011 in a study showing 31% of positive parasitemia at day 3 after artemether-lumefantrine treatment, no pfk13 mutations have been observed [52,53]. In French Guiana, in 2015, none of the 32 samples collected from gold miners revealed mutations in the pfk13 gene although one of the samples shows a slightly above-threshold survival rate with the ring-stage assay method [30,48].…”

“…Knowledge, attitude, and practices (KAP) studies performed on the Guiana Shield showed that malaria symptoms and transmission modes are well known by gold miners. But even with good knowledge, only 16 to 36% of them declared having slept under a mosquito net the last night on the mining camp [30,44]. In Guyana, the KAP study showed that behaviors were more influenced by knowledge than by risk perception, contrary to that found in Suriname [44].…”