Abstract
Background: In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar. Methods: Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme. Results: Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations. Conclusions: Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.
Highlights
Artemisinin-based combination therapies are globally the first line of treatment against Plasmodium falciparum malaria
Nine dimensions Interviews were conducted with a total of 17 community engagement (CE) team members (n=17), with 10 participant observations and interviews conducted with villagers (n=10)
How did the villagers view their worlds and the world at large? Did villagers have time to participate in the TME programme? Did villagers desire to participate? In answering these basic questions, the following nine dimensions emerged as a crucial conceptual tool for navigating CE: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle; vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations
Summary
Artemisinin-based combination therapies are globally the first line of treatment against Plasmodium falciparum malaria. Resistance to antimalarial drugs has developed in Southeast Asia, with artemisinin resistance first reported in western Cambodia (Dondorp et al, 2009) and spreading to other areas of mainland Southeast Asia (Ashley et al, 2014). This is of great concern because resistance—as has happened with other antimalarial drugs—could spread to Africa at great cost to public health and malaria control efforts (von Seidlein & Dondorp, 2015). Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar.
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