Knowledge, access and utilization of bed-nets among stable and seasonal migrants in an artemisinin resistance containment area of Myanmar

Abstract

BackgroundMyanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies (ACT). Migrant populations are more likely than others to spread ACT resistance. A vital intervention to reduce malaria transmission, resistance spread and eliminate malaria is the use of bed nets. Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar, we compared a) their household characteristics, b) contact with health workers and information material, and c) household knowledge, access and utilization of bed nets.MethodsSecondary data from community-based surveys on 2484 migrant workers (2013 and 2014, Bago Region) were analyzed of which 37% were seasonal migrants. Bed net access and utilization were assessed using a) availability of at least one bed net per household, and b) one bed net per two persons, and c) proportion of household members who slept under abed net during the previous night (Indicator targets = 100%).ResultsOver 70% of all migrants were from unstable work settings with short transitory stays. Average household size was five (range 1–25) and almost half of all households had children under-five years. Roughly 10 % of migrants were night-time workers.Less than 40% of households had contact with health workers and less than 30% had exposure to information education and communication (IEC) materials, the latter being significantly lower among seasonal migrants. About 70% of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets (ITNs/LLINs), but knowledge on insecticide impregnation and retreatment of ITNs was poor (< 10%).Although over 95% of households had access to at least one bed net, the number with one bed net per two persons was grossly inadequate (13% for stable migrants and 9% for seasonal migrants, P = 0.001). About half of all household members slept under a bed net during the previous night.ConclusionsThis study reveals important short-falls in knowledge, access and utilization of bed nets among migrants in Myanmar. Possible ways forward include frequent distribution campaigns to compensate for short transitory stays, matching household distributions to household size, enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms. Better understanding through qualitative research is also merited.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0353-8) contains supplementary material, which is available to authorized users.

Inter-sectoral approaches for the prevention and control of malaria among the mobile and migrant populations: a scoping review

“…Overall, a pooled estimate was 44% (95% CI 35–52%), indicating less than half of the targeted MMPs used ITNs. A subgroup of five studies conducted in Myanmar [ 35 , 37 , 39 , 51 , 54 ] also showed similar results (47%, 95% CI 28–66%) (Fig. 5 ).…”

“…The key characteristics of the included studies are provided in Table 1 . Eleven studies (30.5%) were from Myanmar [ 20 , 25 , 26 , 35 – 37 , 39 , 48 , 51 , 54 , 55 ], four studies (11.1%) from Cambodia [ 22 , 40 , 43 , 52 ], three studies from French Guiana [ 45 , 46 , 48 ] and two studies each from China [ 15 , 50 ], Thailand [ 23 , 27 ], Sri Lanka [ 28 , 32 ] and Uganda [ 24 , 33 ]. The remaining ten single studies were done in Columbia [ 43 ], Congo [ 44 ], Ethiopia [ 41 ], Lao [ 52 ], Malaysia [ 38 ], Namibia [ 34 ], Pakistan [ 31 ], Sierra Leone [ 29 ], Suriname [ 30 ] and South America [ 47 ].…”

Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study

“…Qualitative data also suggested some of the mobile/migrant workers as multi-task holders and their circular and multidirectional movements, reduced their opportunities to contact health staff and malaria volunteers. Short transitory stays among seasonal migrant workers in Bago Region were noted as one of the challenges of the treated-net distribution programme for MMPs [ 16 ]. Similarly, underexposure and low access to malaria interventions was noted among seasonal workers in Pailin Province, Cambodia [ 5 ].…”

“…First, the NMCP purposively selected townships with significant numbers of migrant workers in six endemic regions. A ratio of 1:2 was considered in selecting migrant clusters classified as categories 1 and 2, versus category 3 [ 15 , 16 ]. Then, a random sample of migrant households in specific categories was selected in three rounds of surveys, reaching a total of 9603.…”

“…The National Malaria Control Programme (NMCP) in Myanmar, defined and classified MMPs into three categories by workplace stability: categories 1 (permanent and more stable worksites with high social capital, where sustainable results can be achieved by malaria control); Category 2: semi-permanent work settings with moderate social capital, where sustainable community-based results can be achieved for malaria control; and category 3 (small, often temporary work sites, less stable worksites with low social capital, where sustainable results for malaria control might not easily be achieved) [ 15 , 16 ]. Earlier studies in Myanmar had already pointed out that migrant workers, particularly those in category 3, in remote areas, were hard to reach and contributed towards factors that delayed diagnosis within 24 h of onset of fever, to confirm malaria and receive treatment [ 17 , 18 ].…”