Acceptability and feasibility of malaria prophylaxis for forest goers: findings from a qualitative study in Cambodia

Abstract

Background In the Greater Mekong Subregion, adults are at highest risk for malaria, particularly those who visit forests. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria. Methods Alongside a clinical trial of anti-malarial chemoprophylaxis in northern Cambodia, qualitative research was conducted, including in-depth interviews and observation, to explore the acceptability of malaria prophylaxis for forest goers, the implementation opportunities, and challenges of this strategy. Results Prophylaxis with artemether–lumefantrine for forest goers was found to be acceptable under trial conditions. Three factors played a major role: the community’s awareness and perception of the effectiveness of prophylaxis, their trust in the provider, and malaria as a local health concern. The findings highlight how uptake and adherence to prophylaxis are influenced by the perceived balance between benefits and burden of anti-malarials which are modulated by the seasonality of forest visits and its influence on malaria risk. Conclusions The implementation of anti-malarial prophylaxis needs to consider how the preventive medication can be incorporated into existing vector-control measures, malaria testing and treatment services. The next step in the roll out of anti-malarial prophylaxis for forest visitors will require support from local health workers.

Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia

“…Furthermore, among those who did seek care, only 39% did so within the recommended 24 h. Findings from the qualitative interviews clarified that forest-goers often evaluated the severity of their illness based on past experiences and preferred to self-treat and see if the fever resolved before seeking formal care. These findings are consistent with other research which shows that forest-goers undergo a complex decision-making process, weighing the perceived severity of their illness against time spent accessing care and the opportunity cost involved [28,29].…”

Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Thailand

“…Similar studies conducted in Cambodia [ 67 ] and Lao PDR [ 68 ] highlighted how forest activities were the main livelihoods and source of income—from foraging to farming—for forest goers in all three countries. Most forest goers had past experience with malaria and were aware of their malaria risk in the forest but the use of mosquito-bite protection was more limited among Cambodian and Lao respondents.…”

Antimalarial chemoprophylaxis for forest goers in southeast Asia: an open-label, individually randomised controlled trial

“…Seasonal malaria chemoprevention is popular with the target population and has been found to be highly cost-effective. 19 More than 10 million children living in the Sahel now receive seasonal malaria chemoprevention annually. Due to the fundamental differences in malaria epidemiology between the Sahel and Greater Mekong subregion, adult forest goers and not children are at highest risk in the Greater Mekong subregion.…”