Abstract
BackgroundThe spread of artemisinin-resistance in Plasmodium falciparum is a threat to current global malaria control initiatives. Targeted malaria treatment (TMT), which combines mass anti-malarial administration with conventional malaria prevention and control measures, has been proposed as a strategy to tackle this problem. The effectiveness of TMT depends on high levels of population coverage and is influenced by accompanying community engagement activities and the local social context. The article explores how these factors influenced attitudes and behaviours towards TMT in Kayin (Karen) State, Myanmar.MethodsSemi-structured interviews were conducted with villagers from study villages (N = 31) and TMT project staff (N = 14) between March and July 2015.ResultsCommunity engagement consisted of a range of activities to communicate the local malaria situation (including anti-malarial drug resistance and asymptomatic malaria), the aims of the TMT project, and its potential benefits. Community engagement was seen by staff as integral to the TMT project as a whole and not a sub-set of activities. Attitudes towards TMT (including towards community engagement) showed that developing trusting relationships helped foster participation. After initial wariness, staff received hospitality and acceptance among villagers. Offering healthcare alongside TMT proved mutually beneficial for the study and villagers. A handful of more socially-mobile and wealthy community members were reluctant to participate. The challenges of community engagement included time constraints and the isolation of the community with its limited infrastructure and a history of conflict.ConclusionsCommunity engagement had to be responsive to the local community even though staff faced time constraints. Understanding the social context of engagement helped TMT to foster respectful and trusting relationships. The complex relationship between the local context and community engagement complicated evaluation of the community strategy. Nonetheless, the project did record high levels of population coverage.
Highlights
The spread of artemisinin-resistance in Plasmodium falciparum is a threat to current global malaria control initiatives
Background the greatest malaria burden lies in sub-Saharan Africa, the spotlight has recently returned to South East Asia, where artemisinin resistant Plasmodium falciparum is increasingly prevalent [1,2,3,4]
The spread of multidrug resistant P. falciparum is one of the greatest threats to malaria control [5], and, for the World Health Organization (WHO), elimination of P. falciparum is an urgent priority in the greater Mekong subregion (GMS) [6]
Summary
The spread of artemisinin-resistance in Plasmodium falciparum is a threat to current global malaria control initiatives. One initiative is targeted malaria treatment (TMT), sometimes referred to as Targeted Malaria Elimination, an integrated approach that combines mass drug administrations (MDAs) with conventional anti-malarial control activities, such as strengthening a network of village health workers (VHWs) to provide appropriate case management, and distribute long-lasting insecticide-treated bed nets. In spite of the mixed results of previous MDA efforts, this approach is viewed as a potential tool to reduce the spread of artemisinin resistance in P. falciparum [7,8,9]. This entails administering a curative anti-malarial dose to all individuals within a village irrespective of malaria infection without reliance on diagnostic tests. Stemming drug resistance in Myanmar, which has the highest prevalence of malaria in the GMS and is known as the “gateway for drug resistance” to malaria, offers important strategic gains [4, 10]
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