Abstract
BackgroundIn the island of Hainan, the great majority of malaria cases occur in mountain worker populations. Using the behavioral change communication (BCC) strategy, an interventional study was conducted to promote mountain worker malaria prevention at a test site. This study found the methods and measures that are suitable for malaria prevention among mountain worker populations.MethodsDuring the Plasmodium falciparum elimination stage in Hainan, a representative sampling method was used to establish testing and control sites in areas of Hainan that were both affected by malaria and had a relatively high density of mountain workers. Two different methods were used: a BCC strategy and a conventional strategy as a control. Before and after the intervention, house visits, core group discussions, and structural surveys were utilized to collect qualitative and quantitative data regarding mountain worker populations (including knowledge, attitudes, and practices [KAPs]; infection status; and serological data), and these data from the testing and control areas were compared to evaluate the effectiveness of BCC strategies in the prevention of malaria.ResultsIn the BCC malaria prevention strategy testing areas, the accuracy rates of malaria-related KAP were significantly improved among mountain worker populations. The accuracy rates in the 3 aspects of malaria-related KAP increased from 37.73%, 37.00%, and 43.04% to 89.01%, 91.53%, and 92.25%, respectively. The changes in all 3 aspects of KAP were statistically significant (p < 0.01). In the control sites, the changes in the indices were not as marked as in the testing areas, and the change was not statistically significant (p > 0.05). Furthermore, in the testing areas, both the percentage testing positive in the serum malaria indirect fluorescent antibody test (IFAT) and the number of people inflicted decreased more significantly than in the control sites (p < 0.01).ConclusionThe use of the BCC strategy significantly improved the ability of mountain workers in Hainan to avoid malarial infection. Educational and promotional materials and measures were developed and selected in the process, and hands-on experience was gained that will help achieve the goal of total malaria elimination in Hainan.
Highlights
In the island of Hainan, the great majority of malaria cases occur in mountain worker populations
Hainan Island has 50 years of malaria control records without any systematic research regarding behavioral change communication (BCC) strategies, and there is a similar absence of literature regarding this strategy in other parts of China [3,9,10]
Malaria serum samples and control grouping The inclusion criteria were as follows: (1) individuals who had lived in the selected mountain areas for ≥ three years or who had worked in the mountains for ≥ three years, including local and migrant workers; and (2) individuals with titers ≥ 1:20 in number when tested with indirect fluorescent antibody test (IFAT) based on malaria serological survey methods [33]
Summary
Sampling of mountain worker populations Among the towns and cities in Hainan that were malaria-endemic and had higher concentrations of mountain workers, representative sampling methods were used to arrange the cities, towns, and farms based on their malaria incidence rates in 2007–2008. Malaria serum samples and control (positive and negative) grouping The inclusion criteria were as follows: (1) individuals who had lived in the selected mountain areas for ≥ three years or who had worked in the mountains for ≥ three years, including local and migrant workers; and (2) individuals with titers ≥ 1:20 in number when tested with IFAT based on malaria serological survey methods [33].
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