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Abstract
BackgroundAdherence to effective malaria medication is extremely important in the context of Cambodia’s elimination targets and drug resistance containment. Although the public sector health facilities are accessible to the local ethnic minorities of Ratanakiri province (Northeast Cambodia), their illness itineraries often lead them to private pharmacies selling “cocktails” and artemether injections, or to local diviners prescribing animal sacrifices to appease the spirits.MethodsThe research design consisted of a mixed methods study, combining qualitative (in-depth interviews and participant observation) and quantitative methods (household and cross-sectional survey).ResultsThree broad options for malaria treatment were identified: i) the public sector; ii) the private sector; iii) traditional treatment based on divination and ceremonial sacrifice. Treatment choice was influenced by the availability of treatment and provider, perceived side effects and efficacy of treatments, perceived etiology of symptoms, and patient-health provider encounters. Moreover, treatment paths proved to be highly flexible, changing mostly in relation to the perceived efficacy of a chosen treatment.ConclusionsDespite good availability of anti-malarial treatment in the public health sector, attendance remained low due to both structural and human behavioral factors. The common use and under-dosage of anti-malaria monotherapy in the private sector (single-dose injections, single-day drug cocktails) represents a threat not only for individual case management, but also for the regional plan of drug resistance containment and malaria elimination.
Highlights
By scaling up malaria interventions and containing artemisinin resistance in the country, the Cambodian Government is currently trying to move towards phased elimination of malaria by 2025 [1]
Effective malaria treatment is the cornerstone of successful malaria control, and artemisinin-based combination therapies (ACTs) are currently the most efficacious therapeutic option available
In Cambodia, ACTs are mainly available through community health centers (HCs) and volunteer Village Malaria Workers (VMWs) after diagnosis by Rapid Diagnostic Tests (RDTs)
Summary
By scaling up malaria interventions and containing artemisinin resistance in the country, the Cambodian Government is currently trying to move towards phased elimination of malaria by 2025 [1]. In a context of malaria pre-elimination, these factors become increasingly important as each untreated or mistreated case could contribute to maintaining transmission [8,9] This is even more relevant where malaria transmission occurs in remote forested areas due to the sylvatic and highly anthropophylic nature of the main vector Anopheles dirus [10,11], as is the case in Southeast Asia. These areas are often inhabited by poor and vulnerable ethnic minorities living off slash and burn agriculture, with substantial population movements within and across international borders. The common use and under-dosage of anti-malaria monotherapy in the private sector (single-dose injections, single-day drug cocktails) represents a threat for individual case management, and for the regional plan of drug resistance containment and malaria elimination
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