Challenges in universal coverage and utilization of insecticide-treated bed nets in migrant plantation workers in Myanmar

Abstract

BackgroundHigh coverage of the bed nets can reduce mortality and morbidity of mosquito-borne diseases including malaria. Although the migrant workers are at high risk of malaria, there are many hidden challenges in universal coverage and utilization of the insecticide-treated nets (ITNs) in this populations.MethodsCross sectional study was conducted in 170 migrant workers in palm oil plantation sites in Tanintharyi Region and 175 in rubber plantation sites in Mon State. A multistage stratified cluster sampling was applied to select the participants. During household visit, face-to-face interviews using structured pre-coded, pre tested questionnaires and direct observation on installation of the bed nets was conducted. Two focus group discussions in each site were done by sample stratified purposive sampling method mainly focused on effective utilization of bed nets.ResultsAmong them, 332 (96.2%) had a bed net and 284 (82.3%) had an ITN, while 204 (59.1%) had unused extranets. Among the ITNs users, 28.9% reported problems including insecticide smell (56.9%), dizziness (20.2%), headache (12.8%) and itchiness (9.2%). More than 75% received ITNs from health authorities and NGOs free-of-charge. More than 70% wanted to buy a net but they were unaffordable for 64% of them. On observation, only five families could show no bed net, but 80% showed 1–3 ITNs. Consistent utilization in all seasons was noted in 189 (53.1%), that was higher in palm oil plantation than rubber plantation workers (p = 0.0001) due to the nature of the work at night. Perceived malaria risk was also significantly higher ITNs consistent users than non-users (p = 0.0004) and better willingness to buy an ITN by themselves (p = 0.0005). They said that effectiveness of the ITNs was reduced after 6 months and 2–3 times washing. They wished to receive more durable smooth nets with small holes in lace. Misuses of the ITNs such as use the nets for animals and fishing, were also noted.ConclusionThere should be efforts to improve effective utilization of ITNs by continuous mass free distribution, durability monitoring, surveillance of insecticide resistance of the vector and behaviour change interventions in migrant plantation workers.

Perceptions and prevention practices on malaria among the indigenous Orang Asli community in Kelantan, Peninsular Malaysia

“…Despite the very high respondents utilizing LLIN every night in this study, about half reported understanding the bene t of bed net as a prevention tool against malaria. It is not clear what could be driving the low understanding among the community, however, lack of knowledge, perceptions of risk and inadequate social behaviour change communication programme may contributing to the observed pattern (19,20). This study also noted that a small number of respondents stated that they did not use bednets because of low mosquito population density and low disease incidence.…”

Global Epidemiology of Plasmodium vivax

“…Many migrants work in high-risk environments such as natural forest, palm oil or rubber plantations, and fish farms 89. In areas where major epidemiological shifts toward elimination have occurred, these migrant workers, predominantly adult males, sustain transmission 71.…”

Utilization of insecticide-treated bed nets and care-seeking for fever and its associated socio-demographic and geographical factors among under-five children in different regions: evidence from the Myanmar Demographic and Health Survey, 2015–2016

“…Myanmar aims at achieving and maintaining 100% access and utilization of ITNs at the household level. Previous studies from Myanmar have assessed ownership and utilization of ITNs in the general population [12], in specific regions/settings [13,14] and key migrant occupations such as plantation workers [15,16]. However, information on ITN usage among underfive children and the associated factors is scarce.…”