Abstract
Malaria control along the Vietnam–Cambodia border presents a challenge for both countries' malaria elimination targets as the region is forested, inhabited by ethnic minority populations, and potentially characterized by early and outdoor malaria transmission. A mixed methods study assessed the vulnerability to malaria among the Jarai population living on both sides of the border in the provinces of Ratanakiri (Cambodia) and Gia Lai (Vietnam). A qualitative study generated preliminary hypotheses that were quantified in two surveys, one targeting youth (N = 498) and the other household leaders (N = 449). Jarai male youth, especially in Cambodia, had lower uptake of preventive measures (57.4%) and more often stayed overnight in the deep forest (35.8%) compared with the female youth and the adult population. Among male youth, a high-risk subgroup was identified that regularly slept at friends' homes or outdoors, who had fewer bed nets (32.5%) that were torn more often (77.8%). The vulnerability of Jarai youth to malaria could be attributed to the transitional character of youth itself, implying less fixed sleeping arrangements in nonpermanent spaces or non-bed sites. Additional tools such as long-lasting hammock nets could be suitable as they are in line with current practices.
Highlights
There is increasing evidence that minority groups and settings are key to malaria elimination as malaria risk is unequally distributed among populations[1,2,3,4,5,6] leading to notable heterogeneity of burden within small areas
In Cambodia, 300 Jarai youth participated in the Youth Survey, with slightly more males (N = 162) than females (N = 138), and a median age of 15 years
Houses located in the Cambodian villages can either be wooden stilted longhouses inhabited by Jarai extended family or a stilted house occupied by only one nuclear family
Summary
There is increasing evidence that minority groups and settings are key to malaria elimination as malaria risk is unequally distributed among populations[1,2,3,4,5,6] leading to notable heterogeneity of burden within small areas. In southeast Asia, despite improved malaria control, a major challenge for malaria elimination is the high mobility of populations in specific settings such as border regions, which are often inhabited by impoverished ethnic minorities largely dependent on the forest for subsistence, as is the case in the Vietnamese and Cambodian highlands.[16,23,24,25,26,27,28,29] For countries with decreased transmission moving toward elimination, these pockets of transmission (or “hotspots”) and their multifactorial determinants have become increasingly important to understand and tackle.[9,10,19,20] Standard approaches such as indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are less likely to be as effective in some of these specific settings because of both human (mobility, housing structures, and low uptake of preventive measures) and mosquito behavior (early and outdoor transmission).[8,18,21,22]
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