Abstract
BackgroundThe transition from malaria control to elimination requires understanding and targeting interventions among high-risk populations. In Vietnam, forest-goers are often difficult to test, treat and follow-up for malaria because they are highly mobile. If undiagnosed, forest-goers can maintain parasite reservoirs and contribute to ongoing malaria transmission.MethodsA case–control study was conducted to identify malaria risk factors associated with forest-goers in three communes in Phu Yen Province, Vietnam. Cases (n = 81) were residents from the study area diagnosed with malaria and known to frequent forest areas. Controls (n = 94) were randomly selected forest-going residents from within the study area with no identified malaria infection. Participants were interviewed face-to-face using a standard questionnaire to identify malaria risk factors. Logistic regression was used to calculate odds ratios (ORs) and 95% CI for risk factors after adjusting for socio-demographic characteristics.ResultsAmong the cases, malaria infection varied by species: 66.7% were positive for Plasmodium falciparum, 29.6% for Plasmodium vivax, and 3.7% were diagnosed as mixed infection. Cases were less likely than controls to use treated nets (aOR = 0.31; 95% CI 0.12–0.80), work after dark (aOR = 2.93; 95% CI 1.35, 6.34), bath in a stream after dark (aOR = 2.44; 95% CI 1.02–5.88), and collect water after dark (aOR = 1.99; 95% CI 1.02–3.90).ConclusionsAs Vietnam moves toward malaria elimination, these findings can inform behaviour change communication and malaria prevention strategies, incorporating the risk of after-dark and water-related activities, in this priority and difficult-to-access population group.
Highlights
The transition from malaria control to elimination requires understanding and targeting interventions among high-risk populations
Countries pursuing an elimination agenda must address increased heterogeneity in the distribution of remaining pockets of malaria infection [3, 4]. Heterogeneity exists both in a geographic context, relating to the spatial distribution of transmission, and in a demographic context, where specific population groups may be at a higher risk of malaria infection or serve as a significant asymptomatic parasite reservoir
Malaria infection varied by species: 66.7% were positive for Plasmodium falciparum, 29.6% for Plasmodium vivax, and 3.7% were diagnosed as mixed infection
Summary
The transition from malaria control to elimination requires understanding and targeting interventions among high-risk populations. In the Greater Mekong Subregion (GMS), epidemiological complexities such as the presence of mobile and migrant populations including forest-goers who mostly reside in remote locations, and the spread of anti-malarial drug resistance pose key challenges for malaria programmes [8, 9] To address these concerns, Vietnam’s elimination programme includes improving access to early diagnosis and prompt effective treatment, ensuring uniform intervention coverage for at-risk populations, and strengthening the malaria epidemiological surveillance system and capacity to implement robust malaria epidemic response [1]. Even in Vietnam, forestgoers maybe not reached or covered by health services, due in part to their remote location and mobile lifestyles These characteristics are challenges to effectively test and treat these populations for malaria, as well as track and implement routine malaria prevention measures [10]. Due to these factors surveillance systems are not optimized to target these hard to reach groups in Vietnam and the magnitude of this problem is not yet fully elucidated
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