Abstract
BackgroundMalaria incidence has been steadily declining in Cambodia, where the government is aiming to eliminate malaria by 2025. Successful malaria elimination requires active engagement and participation of communities to recognize malaria symptoms and the development of prompt treatment-seeking behavior for early diagnosis and appropriate treatment. This study examined malaria knowledge, preventive actions, and treatment-seeking behavior among different groups of ethnic minorities and Khmer in Ratanakiri Province, Cambodia.MethodsFace-to-face interviews were conducted in December 2015, targeting 388 mothers with children under 2 years old, who belonged to ten ethnic minority groups or the Khmer group living in 62 rural villages in Ratanakiri. In addition to describing mothers’ knowledge and actions for malaria prevention, logistic regression analysis was performed to identify determinants of fever during the most recent pregnancy and among children under two.ResultsOverall 388 mothers were identified for enrollment into the study of which 377 (97.2%) were included in analyses. The majority of mothers slept under bed nets at home (95.8%) and wore long-sleeved clothes (83.8%) for malaria prevention. However, knowledge of malaria was limited: 44.6% were aware of malaria symptoms, 40.6% knew the malaria transmission route precisely, and 29.2% knew of mosquito breeding places. Staying overnight at a farm hut was significantly associated with having fever during the most recent pregnancy (adjusted odds ratio [AOR] 2.008, 95% confidence interval [CI]: 1.215–3.321) and a child having fever (AOR 3.681, 95% CI 1.943–6.972). Mothers’ partaking in a variety of malaria preventive actions was protective against fever in children (AOR 0.292, 95% CI: 0.136–0.650). Among those who had fever during pregnancy, 39.4% did not seek treatment.ConclusionAlthough the majority of mothers took malaria preventive actions, knowledge of malaria epidemiology and vector ecology and treatment-seeking behavior for fever were limited. Staying overnight at farm huts, regardless of the differences in socio-demographic and socio-cultural characteristics, was strongly associated with fever episodes during pregnancy and childhood. This study indicates the necessity of spreading accurate malaria knowledge, raising awareness of health risks related to agricultural practices, and promoting treatment-seeking behavior among ethnic minorities to strengthen their engagement in malaria elimination.
Highlights
Malaria incidence has been steadily declining in Cambodia, where the government is aiming to eliminate malaria by 2025
This study indicates the necessity of spreading accurate malaria knowledge, raising awareness of health risks related to agricultural practices, and promoting treatment-seeking behavior among ethnic minorities to strengthen their engagement in malaria elimination
We conducted a post hoc power analysis, and the sample size was determined to achieve a power of greater than 80% using the effect size we observed. To our knowledge, this was the first study to examine malaria knowledge, preventive actions, and treatment-seeking behavior of mothers who belonged to ten ethnic minority groups and the Khmer ethnic group, both of whom reside in remote, agricultural villages in Ratanakiri Province, Cambodia
Summary
Malaria incidence has been steadily declining in Cambodia, where the government is aiming to eliminate malaria by 2025. In Cambodia, a marked decrease in Plasmodium falciparum (P. falciparum) has been observed since 2009; this coincides with the scale-up of the distribution of insecticide treated bed nets and the strengthening of Village Malaria Workers (VMWs) who provide early diagnosis and treatment of malaria for their villagers. Malaria transmission in Cambodia has been low recently, 21 of the 25 provinces are still endemic, and more than half of the population (approximately 8.6 million people) is still at risk of malaria. Four provinces in northeastern Cambodia (Rattanakiri, Mondulkiri, Steung Treng, and Kratie Provinces) have only 3% of the national population, they were reported to have had 43% and 25% of falciparum and vivax malaria cases in the country in 2013, respectively [2]
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