Community engagement and the social context of targeted malaria treatment: a qualitative study in Kayin (Karen) State, Myanmar

Abstract

BackgroundThe spread of artemisinin-resistance in Plasmodium falciparum is a threat to current global malaria control initiatives. Targeted malaria treatment (TMT), which combines mass anti-malarial administration with conventional malaria prevention and control measures, has been proposed as a strategy to tackle this problem. The effectiveness of TMT depends on high levels of population coverage and is influenced by accompanying community engagement activities and the local social context. The article explores how these factors influenced attitudes and behaviours towards TMT in Kayin (Karen) State, Myanmar.MethodsSemi-structured interviews were conducted with villagers from study villages (N = 31) and TMT project staff (N = 14) between March and July 2015.ResultsCommunity engagement consisted of a range of activities to communicate the local malaria situation (including anti-malarial drug resistance and asymptomatic malaria), the aims of the TMT project, and its potential benefits. Community engagement was seen by staff as integral to the TMT project as a whole and not a sub-set of activities. Attitudes towards TMT (including towards community engagement) showed that developing trusting relationships helped foster participation. After initial wariness, staff received hospitality and acceptance among villagers. Offering healthcare alongside TMT proved mutually beneficial for the study and villagers. A handful of more socially-mobile and wealthy community members were reluctant to participate. The challenges of community engagement included time constraints and the isolation of the community with its limited infrastructure and a history of conflict.ConclusionsCommunity engagement had to be responsive to the local community even though staff faced time constraints. Understanding the social context of engagement helped TMT to foster respectful and trusting relationships. The complex relationship between the local context and community engagement complicated evaluation of the community strategy. Nonetheless, the project did record high levels of population coverage.

Community engagement for malaria elimination in contested areas of the Karen/Kayin State, Myanmar: A case study on the Malaria Elimination Task Force

“…While the importance of CE for malaria elimination approaches is widely acknowledged, literature on the role and nature of CE in such contexts is scarce (Adhikari et al, 2016;Sahan et al, 2017). However, quite a number of studies on CE for malaria elimination in Southeast Asia and also Myanmar have been published in 2016 and 2017.…”

“…In their qualitative study on CE in the same pilot villages, Tangseefa et al 1 (unpublished report) developed eight dimensions of people's lifeworlds that were important for CE in the context of the elimination program: (1) The space people lived in, (2) the history of the village, (3) what kinds of work people did, (4) whether they subscribed to a capital logic, (5) their knowledge about the world, (6) what leadership figures were associated with the village, (7) villagers' relations with health institution(s) and (8) whether there were any rumours going around in the village. In their study on CE for targeted malaria treatment (TMT) in other parts of the Karen/Kayin State, Sahan et al (2017) write that "Community engagement was seen by staff as integral to the TMT project as a whole and not a sub-set of Activities". Furthermore, they emphasise the importance of building trusting relationships and the benefit of offering healthcare alongside TMT.…”

Mass drug administrations with dihydroartemisinin-piperaquine and single low dose primaquine to eliminate Plasmodium falciparum have only a transient impact on Plasmodium vivax: Findings from randomised controlled trials

“…Data were collected through community-wide surveys at baseline, and then every three months. Surveys were preceded by a community census to re-enumerate the study population and to provide intensive community engagement in order to improve high coverage [10][11][12][13][14]. Information collected included demographics, bednet use, duration of stay in the forest, and adverse events.…”

Rapid Ethnographic Assessment for Potential Anti-Malarial Mass Drug Administration in an Outbreak Area of Santo Domingo, Dominican Republic

“…Although desirability bias cannot be excluded, inspection of eld notes indicated strong themes of solidarity. Given this nding, one way to ensure high participation in MDA would be to implement MDA as a part of a larger effort to improve community health [23,24,28,29]. Campaign sensitization could use salient idioms and phrases used by participants in this study to build on the idea of participation in MDA as a way to care for and take pride in one's community (see Table 3 above).…”

“…One potential way forward to build trust in affected communities is to conduct MDA in conjunction with other services, such as free medical screening for hypertension and diabetes and donations of children's school materials, chlorine tablets for home water storage, and iron tablets and prenatal vitamins. Such ancillary activities have been shown to improve participation in MDA in other contexts [23,24,29] and would help to align MDA with community health concerns. "Beyond health concerns, [people] see solutions to basic problems, like electricity, potable water, and lack of work as important", wrote one assistant in an analysis essay; another assistant wrote simply that, "They seek to obtain a better way of life."…”