Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones

Abstract

BackgroundPopulation movements along the Thailand-Cambodia border, particularly among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance. Data on treatment-seeking behaviours, knowledge and perceptions about malaria, and use of preventive measures is lacking as characteristics of this population prevent them from being represented in routine surveillance and the lack of a sampling frame makes reliable surveys challenging.MethodsA survey of migrant populations from Cambodia and Myanmar was implemented in five selected rural locations in Thailand along the Thai-Cambodian border using respondent driven sampling (RDS) to determine demographic characteristics of the population, migratory patterns, knowledge about malaria, and health-care -seeking behaviours.ResultsThe majority of migrants from Myanmar are long-term residents (98%) with no plans to move back to Myanmar, understand spoken Thai (77%) and can therefore benefit from health messages in Thai, have Thai health insurance (99%) and accessed public health services in Thailand (63%) for their last illness. In comparison, the majority of Cambodian migrants are short-term (72%). Of the short-term Cambodian migrants, 92% work in agriculture, 18% speak Thai, 3.4% have Thai health insurance, and the majority returned to Cambodia for treatment (45%), self-treated (11%), or did not seek treatment for their last illness (27%).ConclusionMost highly mobile migrants along the Thai-Cambodia border are not accessing health messages or health treatment in Thailand, increasing their risk of malaria and facilitating the spread of potentially resistant Plasmodium falciparum as they return to Cambodia to seek treatment. Reaching out to highly mobile migrants with health messaging they can understand and malaria diagnosis and treatment services they can access is imperative in the effort to contain the spread of artemisinin-resistant P. falciparum.

Spatial distribution, work patterns, and perception towards malaria interventions among temporary mobile/migrant workers in artemisinin resistance containment zone

“…This observation is consistent with the previous finding during the MARC survey [1]. As observed in other studies [16], self-medication practices were common, andthe private sector was typically preferred over the public sector. The majority of the migrant workers reported to rely on cocktail mixtures of drugs or artemisinin monotherapy, rather than prescribed ACT, freely available in the unregulated private sectors.…”

“…Although the majority of the migrant populations understood Myanmar language, limited education level may impede their understanding of the message [11]. As shown in other studies conducted in similar circumstances [8,14-16], these physical, social and language barriers in the study population likely increase the potential risk in malaria transmission and spread of artemisinin resistance. Effective communication in this diverse high-risk group is critical and may be better reached by the use of simple language, inclusion of common ethnic languages in addition to Myanmar, and/or well-trained motivated interpreters.…”

The Practice of Jhum Cultivation and its Relationship to Plasmodium falciparum Infection in the Chittagong Hill Districts of Bangladesh

“…Furthermore, studies in Myanmar and on the Thai-Cambodian border found that malaria treatment was often delayed in remote areas. 25,26 Because jhum cultivators often work in large groups at various phases of cultivation, lack of prompt malaria treatment may facilitate local malaria outbreaks that can later be spread when jhum cultivators return to their villages.…”

Using Respondent Driven Sampling to Identify Malaria Risks and Occupational Networks among Migrant Workers in Ranong, Thailand

“…In October 2009, an RDS study on migrant workers was carried out in Thailand along the Thai-Cambodia border and later a similar study was implemented in Cambodia to better understand internal migration patterns in two provinces on the border in the context of artemisinin resistance [10,11]. While there have been some studies along the northern stretch of the Thailand-Myanmar border [12–14], relatively little is known about migration along the southern portion of the border, which is believed to be a significant port of entry for many migrants from Myanmar.…”