Abstract
BackgroundPopulation movements along the Thailand-Cambodia border, particularly among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance. Data on treatment-seeking behaviours, knowledge and perceptions about malaria, and use of preventive measures is lacking as characteristics of this population prevent them from being represented in routine surveillance and the lack of a sampling frame makes reliable surveys challenging.MethodsA survey of migrant populations from Cambodia and Myanmar was implemented in five selected rural locations in Thailand along the Thai-Cambodian border using respondent driven sampling (RDS) to determine demographic characteristics of the population, migratory patterns, knowledge about malaria, and health-care -seeking behaviours.ResultsThe majority of migrants from Myanmar are long-term residents (98%) with no plans to move back to Myanmar, understand spoken Thai (77%) and can therefore benefit from health messages in Thai, have Thai health insurance (99%) and accessed public health services in Thailand (63%) for their last illness. In comparison, the majority of Cambodian migrants are short-term (72%). Of the short-term Cambodian migrants, 92% work in agriculture, 18% speak Thai, 3.4% have Thai health insurance, and the majority returned to Cambodia for treatment (45%), self-treated (11%), or did not seek treatment for their last illness (27%).ConclusionMost highly mobile migrants along the Thai-Cambodia border are not accessing health messages or health treatment in Thailand, increasing their risk of malaria and facilitating the spread of potentially resistant Plasmodium falciparum as they return to Cambodia to seek treatment. Reaching out to highly mobile migrants with health messaging they can understand and malaria diagnosis and treatment services they can access is imperative in the effort to contain the spread of artemisinin-resistant P. falciparum.
Highlights
Population movements along the Thailand-Cambodia border, among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance
The goal of the containment strategy is to reduce selection pressure and eliminate resistant P. falciparum strains in the 17 provinces of the Cambodia-Thailand border
In a retrospective study in Thailand [8], it was found that the Thailand-Myanmar and Thailand-Cambodia border areas, locations with high numbers of migrant workers, had the highest incidence rates for malaria including P. falciparum, Plasmodium vivax, and mixed species infections
Summary
Population movements along the Thailand-Cambodia border, among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance. Studies in the GMS over the last five years show an increased proportion of patients with delayed parasite clearance time when artemisinin the containment strategy is to reduce selection pressure and eliminate resistant P. falciparum strains in the 17 provinces of the Cambodia-Thailand border. There has been movement of migrant labour from Myanmar to the provinces on the Thai-Cambodian border, often from areas of high transmission. In a retrospective study in Thailand [8], it was found that the Thailand-Myanmar and Thailand-Cambodia border areas, locations with high numbers of migrant workers, had the highest incidence rates for malaria including P. falciparum, Plasmodium vivax, and mixed species infections
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