TY - JOUR
T1 - Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers
T2 - findings from a qualitative study in Thailand
AU - Jongdeepaisal, Monnaphat
AU - Khonputsa, Panarasri
AU - Prasert, Orathai
AU - Maneenet, Suphitsara
AU - Pongsoipetch, Kulchada
AU - Jatapai, Anchalee
AU - Rotejanaprasert, Chawarat
AU - Sudathip, Prayuth
AU - Maude, Richard J.
AU - Pell, Christopher
N1 - Funding Information: The authors would like to thank the respondents and the communities who participated in the study and took time to share their experiences and opinions with members of the research team. We would also like to thank a team of staff from Raks Thai Foundation, Buntharik hospital, Malaria Clinics and Provincial Health Departments in Ubon Ratchathani and Si Sa Ket, Faculty of Tropical Medicine, Mahidol University, and Division of Vector-Borne Disease staff, including Darin Areechokchai and Suravadee Kitchakarn, who contributed to setting up the study and facilitating the data collection in Thailand. We wish to acknowledge the help provided by Apichart Santaweesuk, Namfon Buasiri, Nucharin Sriboon, and Panya Jiramahasan for their advice on the interview guides and study sites. In addition, we are grateful to Worarat Khuenpetch, Paphapisa Chotthanawathit, Salwaluk Panapipat, and Salintip Chanchaivorawith for their support on the ethics application and data management. Funding Information: This study was funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, Grant Number: 20864-003-44. This research was funded in part, by the Wellcome Trust [220211]. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Across the Greater Mekong Subregion, malaria remains a dangerous infectious disease, particularly for people who visit forested areas where residual transmission continues. Because vector control measures offer incomplete protection to forest goers, chemoprophylaxis has been suggested as a potential supplementary measure for malaria prevention and control. To implement prophylaxis effectively, additional information is needed to understand forest goers’ activities and their willingness to use malaria prevention measures, including prophylaxis, and how it could be delivered in communities. Drawing on in-depth interviews with forest goers and stakeholders, this article examines the potential acceptability and implementation challenges of malaria prophylaxis for forest goers in northeast Thailand. Methods: In-depth interviews were conducted with forest goers (n = 11) and stakeholders (n = 16) including healthcare workers, community leaders, and policymakers. Interviews were audio-recorded, transcribed and coded using NVivo, employing an inductive and deductive approach, for thematic analysis. Results: Forest goers were well aware of their (elevated) malaria risk and reported seeking care for malaria from local health care providers. Forest goers and community members have a close relationship with the forest but are not a homogenous group: their place and time-at-risk varied according to their activities and length of stay in the forest. Among stakeholders, the choice and cost of anti-malarial prophylactic regimen—its efficacy, length and complexity, number of tablets, potential side effects, and long-term impact on users—were key considerations for its feasibility. They also expressed concern about adherence to the preventive therapy and potential difficulty treating malaria patients with the same regimen. Prophylaxis was considered a low priority in areas with perceived accessible health system and approaching malaria elimination. Conclusions: In the context of multi-drug resistance, there are several considerations for implementing malaria prophylaxis: the need to target forest goers who are at-risk with a clear period of exposure, to ensure continued use of vector control measures and adherence to prophylactic anti-malarials, and to adopt an evidence-based approach to determine an appropriate regimen. Beyond addressing current intervention challenges and managing malaria incidence in low-transmission setting, it is crucial to keep malaria services available and accessible at the village level especially in areas home to highly mobile populations.
AB - Background: Across the Greater Mekong Subregion, malaria remains a dangerous infectious disease, particularly for people who visit forested areas where residual transmission continues. Because vector control measures offer incomplete protection to forest goers, chemoprophylaxis has been suggested as a potential supplementary measure for malaria prevention and control. To implement prophylaxis effectively, additional information is needed to understand forest goers’ activities and their willingness to use malaria prevention measures, including prophylaxis, and how it could be delivered in communities. Drawing on in-depth interviews with forest goers and stakeholders, this article examines the potential acceptability and implementation challenges of malaria prophylaxis for forest goers in northeast Thailand. Methods: In-depth interviews were conducted with forest goers (n = 11) and stakeholders (n = 16) including healthcare workers, community leaders, and policymakers. Interviews were audio-recorded, transcribed and coded using NVivo, employing an inductive and deductive approach, for thematic analysis. Results: Forest goers were well aware of their (elevated) malaria risk and reported seeking care for malaria from local health care providers. Forest goers and community members have a close relationship with the forest but are not a homogenous group: their place and time-at-risk varied according to their activities and length of stay in the forest. Among stakeholders, the choice and cost of anti-malarial prophylactic regimen—its efficacy, length and complexity, number of tablets, potential side effects, and long-term impact on users—were key considerations for its feasibility. They also expressed concern about adherence to the preventive therapy and potential difficulty treating malaria patients with the same regimen. Prophylaxis was considered a low priority in areas with perceived accessible health system and approaching malaria elimination. Conclusions: In the context of multi-drug resistance, there are several considerations for implementing malaria prophylaxis: the need to target forest goers who are at-risk with a clear period of exposure, to ensure continued use of vector control measures and adherence to prophylactic anti-malarials, and to adopt an evidence-based approach to determine an appropriate regimen. Beyond addressing current intervention challenges and managing malaria incidence in low-transmission setting, it is crucial to keep malaria services available and accessible at the village level especially in areas home to highly mobile populations.
KW - Forest goer
KW - Malaria, forest
KW - Malaria, intervention
KW - Malaria, prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85124582660&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12936-022-04070-4
DO - https://doi.org/10.1186/s12936-022-04070-4
M3 - Article
C2 - 35164759
SN - 1475-2875
VL - 21
JO - Malaria journal
JF - Malaria journal
IS - 1
M1 - 47
ER -