The use of respondent-driven sampling to assess malaria knowledge, treatment-seeking behaviours and preventive practices among mobile and migrant populations in a setting of artemisinin resistance in Western Cambodia

Abstract

BackgroundMulti-drug-resistant Plasmodium falciparum threatens malaria elimination efforts in Cambodia and the Greater Mekong Subregion (GMS). Malaria burden in the GMS is higher among certain high-risk demographic groups in Cambodia, especially among migrant and mobile populations (MMPs). This respondent driven sampling (RDS) study was conducted in order to determine malaria knowledge, treatment-seeking behaviours and preventive practices among two MMP groups in Western Cambodia.MethodsAn RDS survey of MMPs was implemented in four purposively-selected communes along the Thai–Cambodia border; two in Veal Veang District and two in Pailin Province, chosen due to their sizeable MMP groups, their convenience of access, and their proximity to Thailand, which allowed for comparison with RDS studies in Thailand.ResultsThere were 764 participants in Pailin Province and 737 in Veal Veang District. Health messages received in Veal Veang were most likely to come from billboards (76.5%) and family and friends (57.7%), while in Pailin they were most likely to come from sources like radio (57.1%) and television (31.3%). Knowledge of malaria transmission by mosquito and prevention by bed net was above 94% in both locations, but some misinformation regarding means of transmission and prevention methods existed, predominantly in Veal Veang. Ownership of treated bed nets was lower in Pailin than in Veal Veang (25.3% vs 53.2%), while reported use the night before the survey was higher in Pailin than in Veal Veang (57.1% vs 31.6%). Use of private sector health and pharmaceutical services was common, but 81.1% of patients treated for malaria in Pailin and 86.6% in Veal Veang had received a diagnostic test. Only 29.6% of patients treated in Pailin and 19.6% of those treated in Veal Veng reported receiving the indicated first-line treatment.DiscussionBarriers in access to malaria prevention and case management were common among MMPs, with marked variation by site. Resolving both nation-wide and MMP-specific challenges will require targeted interventions that take into account this heterogeneity.

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

“…were solely provided by the emergency relief organisations and the UN Lee, 2008 [ 25 ] Myanmar Feasibility of delivering effective disease control interventions in an area of active conflict through the trained volunteers Kirkbya, 2012 [ 32 ] Sri Lanka Malaria is taught during grade 6 of the school curriculum, i.e. at the beginning of secondary school education Nyunt, 2014 [ 35 ] Myanmar Free distribution was found as one of the major factors causing utilization of ITNs in migrant workers Canavati, 2016 [ 43 ] Cambodia Targeted community was satisfied with the mobile malaria workers’ services Lessons learned (challenges) Wai, 2014 [ 36 ] Myanmar Need to improve mechanisms of communication among multiple partners Wai, 2014 [ 36 ] Myanmar Need collaborative work between health department and administrators to inform and motivate the regular use of LLINs Abeyasinghe, 2012 [ 28 ] Sri Lanka The assurance of long-term, sustainable funding Ly, 2017 [ 53 ]; Wai, 2014 [ 36 ]; Wangroongsarb, 2011 [ 27 ]; Peeters, 2015 [ 40 ] Cambodia; Myanmar; Thailand Limited the effectiveness of health education message/IEC due to limited literary or language barrier in multilingual ethnic groups Ly, 2017 [ 53 ] Cambodia ~ 10% of participants treated for malaria did not have a confirmed diagnosis Ly, 2017 [ 53 ]; Obol, 2013 [ 33 ]; Charchuk, 2016 [ 44 ] Cambodia; Uganda; …”

“…A subset of eight studies from six countries was identified, that provided details on the proportion of MMPs with the correct knowledge about malaria as a mosquito borne disease [ 27 , 31 , 32 , 37 , 39 , 41 , 43 , 53 ]. Overall, a pooled estimate was 70% (95% CI 57–83%), indicating a high proportion of the targeted MMPs had correct knowledge about malaria transmission (Fig.…”

“…4 ). There was a substantial variation within study heterogeneity, and the estimates varied from a low level 48% (95% CI 44–52%) in Ethiopia [ 41 ] to sufficient level of knowledge in Cambodia (93%, 95% CI 92–95%) [ 53 ]. Gaps were obvious even within the same country.…”

“…Interestingly, the paradoxical phenomenon of a high proportion of MMPs with knowledge about malaria transmission, but with a low proportion of net utilization was found in a study from Cambodia [ 53 ], and vice versa in a study from Ethiopia [ 41 ]. This implied that there was a gap between knowledge acquisition and the actual practice among these MMPs.…”

Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis

“…The mobility and geographical location of migrants can have significant implications for their access to health services (8,12,25,106). For example, forest workers in Cambodia were found to be at increased risk of receiving late and substandard treatment for malaria due to poor geographical access to health facilities (85,107). High levels of mobility can reduce access to health care for people requiring ongoing treatment, such as those with TB (108).…”