Abstract
Currently, malaria elimination efforts are ongoing in several locations across Southeast Asia, including in Kayin State (also known as Karen State), Myanmar . This paper describes the community engagement efforts for a pilot malaria elimination project, the challenges encountered and lessons learnt. Between May 2013 and June 2015, a study on targeted malaria elimination (TME) that included mass drug administration was conducted in four villages (TPN, TOT, KNH, and HKT) of Kayin State. Community engagement efforts included workshops, meetings and house-to-house visits with community members. Exhibitions related to malaria and fun activities were organized for children. In addition, we provided primary care, small individual incentives and village-level incentives. This paper is based on our analysis of data extracted from meeting minutes, field notes, feedback sessions among staff and with community members as well as our own reflections. Average participation across three rounds of MDA were 84.4%, 57.4%, 88.6% and 59.3% for TPN, TOT, KNH and HKT, respectively. Community engagement was fraught with practical challenges such as seasonal tasks of the villagers. There were challenges in explaining difficult concepts like drug resistance and submicroscopic infection. Another was understanding and navigating the politics of these villages, which are located in politically contested areas. Managing expectations of villagers was difficult as they assumed that the community team must know everything related to health. In the TME project, many different community engagement strategies were employed. We encountered many challenges which included logistical, scientific and political difficulties. An approach that is tailored to the local population is key.
Highlights
Malaria-related morbidity and mortality has declined, the spread of drug resistant parasites in the Greater Mekong Subregion (GMS) poses serious challenges to prevention and control efforts[1]
Multidrug resistant Plasmodium falciparum, the parasite that causes most of the deaths, is established in the GMS2
Mass drug administrations (MDA) of antimalarials are conducted to reduce the prevalence of asymptomatic infections, an important source of infections that are not addressed through passive case detection
Summary
Malaria-related morbidity and mortality has declined, the spread of drug resistant parasites in the Greater Mekong Subregion (GMS) poses serious challenges to prevention and control efforts[1]. To stop the spread of resistant P.falciparum strains, national malaria control programs have to focus on elimination rather than control This includes establishing a malaria post in every village, in addition to other important interventions such as long lasting insecticide treated bednets[3,4,5]. This paper describes the community engagement efforts for a pilot malaria elimination project, the challenges encountered and lessons learnt. Methods: Between May 2013 and June 2015, a study on targeted malaria elimination (TME) that included mass drug administration was conducted in four villages (TPN, TOT, KNH, and HKT) of Kayin State. There were challenges in explaining difficult concepts like drug resistance and submicroscopic infection Another was understanding and navigating the politics of these villages, which are located in politically contested areas. An approach that is tailored to the local population is key
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