Reimagining zoonotic malaria control in communities exposed to Plasmodium knowlesi infection

Abstract

Plasmodium knowlesi malaria infection in humans has been reported throughout southeast Asia. The communities at risk are those living in areas where Macaque monkeys and Anopheles mosquito are present. Zoonotic malaria control is challenging due to the presence of the reservoir host and the possibility of human-vector-human transmission. Current control measures, including insecticide-treated nets (ITNs) and indoor residual spraying (IRS), are insufficient to address this threat due to gaps in protection associated with outdoor and early evening vector biting and social and economic activities, such as agricultural and forest work. Understanding the challenges faced by affected communities in preventing mosquito bites is important for reducing disease transmission. This opinion paper discusses opportunities to improve P. knowlesi malaria control through understanding the challenges faced by communities at risk and increasing community engagement and ownership of control measures. The paper highlights this issue by describing how the concept of reimagining malaria can be adapted to zoonotic malaria control measures including identifying current gaps in vector control, understanding interactions between environmental, economic, and human behavioral factors, and increasing community participation in and ownership of control measures.

Exploring the key anthropological drivers of and barriers to zoonotic malaria preventative behaviour in a community exposed to Plasmodium knowlesi infection in Malaysia: protocol for a qualitative study with a participatory research design

“…1 Individuals who may come into contact with macaques and Anopheles mosquitoes are at risk of P. knowlesi malaria. [2][3][4][5][6][7][8][9][10] Ecological changes due to deforestation and other anthropogenic activities increase the risk of zoonotic malaria. 8 Zoonotic spillovers expose communities living in rural and semirural areas to P. knowlesi malaria infection due to the destruction of the natural hosts' habitat.…”

“… 10 The potential impact of this zoonotic spillover into vulnerable communities requires interim strategies and multisectoral approaches for its prevention and control. 7 11 …”

“…While majority of cases were uncomplicated, fatalities were reported in patients as young as 31 years old 6. Furthermore, the detection of asymptomatic cases of P. knowlesi malaria in human populations, including in children and within families, suggests potential target populations for interventions 3 7…”

“…Malaria generally affects poor communities with low levels of education and limited access to health services 1. Individuals who may come into contact with macaques and Anopheles mosquitoes are at risk of P. knowles i malaria 2–10. Ecological changes due to deforestation and other anthropogenic activities increase the risk of zoonotic malaria 8.…”

“…Vectors may also breed in sites like bamboo stumps, tins and other artificial containers 10. The potential impact of this zoonotic spillover into vulnerable communities requires interim strategies and multisectoral approaches for its prevention and control 7 11…”