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

Abstract

BackgroundMigration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting.MethodsA mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013–2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016–2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings.ResultsAmong others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap anti-malarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centres and voluntary health workers worsened the situation.ConclusionsMitigating key drivers that favour poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for the NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals. Further innovative out-reach programmes designed and implemented specific to the nature of mobile/migrant workers is crucial.Electronic supplementary materialThe online version of this article (10.1186/s12936-017-2113-4) contains supplementary material, which is available to authorized users.

Quality of Malaria Treatment Provided under ‘Better Health Together’ Project in Ethnic Communities of Myanmar: How Are We Performing?

“…This finding is similar to the previous study based on the nationwide malaria data of NMCP [15]. The reasons from the patient side for delayed presentation have been studied elsewhere among migrant populations [13,18]. These are inappropriate health care seeking, self-medication, not giving importance to fever, transportation difficulty (if allotted volunteer lived in another village), uninformed about the volunteer or his/her activities and lack of symptomatic treatment from a volunteer [13].…”

Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study

“…Challenges perceived for malaria elimination were distinct in conflict-affected areas as well as in areas of high population mobility and this might affect foci classification such as active foci, residual non-active foci and clear foci. Moreover, the provision of health education to community members could not be carried out adequately in these areas, as found in other studies in Myanmar and elsewhere [9,10,18]. The findings indicate a window of opportunity to strengthen the coordinated efforts between the NMCP and partner organizations for future training, refresher training and continuing technical support and to further promote community engagement in malaria elimination.…”

“…The annual parasite index (API) of the five regions except Mon State was less than 1 in 2016. In addition, there were conflict-affected townships in Bago region in which mobile migrant workers were also common as shown in published studies [9].…”

“…However, the problem of artemisinin resistance has emerged as one of the impediments to elimination [4][5][6][7]. Moreover, conflict-affected settings and areas with high population mobility have enhanced the programmatic challenges of moving towards elimination [8][9][10].…”

Challenges in early phase of implementing the 1-3-7 surveillance and response approach in malaria elimination setting: A field study from Myanmar

“…1) [18]. In 2016, the annual parasite index (API) within five of these regions was less than 1 and slightly over 1 in Mon State [19]. The "1-3-7" strategy of Myanmar NMCP that comprehends malaria surveillance activities towards targeted elimination was presented in Table 1 and Fig.…”