TY - JOUR
T1 - Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers
T2 - findings from a qualitative study in Lao PDR
AU - Jongdeepaisal, Monnaphat
AU - Inthasone, Soulixay
AU - Khonputsa, Panarasri
AU - Malaphone, Vilayvone
AU - Pongsoipetch, Kulchada
AU - Pongvongsa, Tiengkham
AU - Mayxay, Mayfong
AU - Chindavongsa, Keobouphaphone
AU - Pell, Christopher
AU - Maude, Richard J.
N1 - 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 whole, or 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. 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 the staff from health centres, district health departments and malaria units, and government offices in Nong and Phine, Savannakhet provincial health department (PHD), Department of Communicable Disease Control (DCDC), and Center of Malariology, Parasitology, and Entomology (CMPE) including Dr Viengxay Vanisavaeth, Dr Thonginh Lienvilaysack, Dr Khamsouane Khamsy, Dr Nalone Sengmanivanh, and Dr Youthanavan who contributed to setting up the study and facilitating the data collection in Lao PDR. In addition, we are grateful to Worarat Khuenpetch, Paphapisa Chotthanawathit, Salwaluk Panapipat, Salintip Chanchaivorawith, and Vimalay Souvong for their support for the ethics application and data management. Publisher Copyright: © 2021, The Author(s).
PY - 2022/1/5
Y1 - 2022/1/5
N2 - Background: Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge in the region; transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited exposure periods, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of anti-malarial chemoprophylaxis for forest goers in Lao PDR. Methods: In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis. Results: In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit sub-optimally using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Lao PDR. Among policymakers, choice and cost of anti-malarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion: Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.
AB - Background: Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge in the region; transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited exposure periods, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of anti-malarial chemoprophylaxis for forest goers in Lao PDR. Methods: In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis. Results: In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit sub-optimally using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Lao PDR. Among policymakers, choice and cost of anti-malarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion: Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.
KW - Forest
KW - Forest goer
KW - Intervention
KW - Lao PDR
KW - Malaria
KW - Prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85122332345&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12936-021-04027-z
DO - https://doi.org/10.1186/s12936-021-04027-z
M3 - Article
C2 - 34983549
SN - 1475-2875
VL - 21
JO - Malaria journal
JF - Malaria journal
M1 - 8
ER -