Abstract
BackgroundA targeted malaria elimination project, including mass drug administrations (MDA) of dihydroartemisinin/piperaquine plus a single low dose primaquine is underway in villages along the Thailand Myanmar border. The intervention has multiple components but the success of the project will depend on the participation of the entire communities. Quantitative surveys were conducted to study reasons for participation or non-participation in the campaign with the aim to identify factors associated with the acceptance and participation in the mass drug administrations.MethodsThe household heads in four study villages in which MDAs had taken place previously were interviewed between January 2014 and July 2015.Results174/378 respondents (46 %) completed three rounds of three drug doses each, 313/378 (83 %) took at least three consecutive doses and 56/378 (15 %) did not participate at all in the MDA. The respondents from the two villages (KNH and TPN) were much more likely to participate in the MDA than respondents from the other two villages (HKT and TOT). The more compliant villages KNH and TPN had both an appearance of cohesive communities with similar demographic and ethnic backgrounds. By contrast the villages with low participation were unique. One village was fragmented following years of armed conflict and many respondents gave little inclination to cooperate with outsiders. The other village with low MDA coverage was characterised by a high percentage of short-term residents with little interest in community interventions. A universal reason for non-participation in the MDA applicable to all villages was an inadequate understanding of the intervention.ConclusionsIt is unlikely that community engagement can unite fragmented communities in participating in an intervention, which benefits the community. Understanding the purpose and the reasons underlying the intervention is an important pre-condition for participation. In the absence of direct benefits and a complete understanding of the indirect benefits trust in the investigators is critical for participation.
Highlights
A targeted malaria elimination project, including mass drug administrations (MDA) of dihydroartemisinin/piperaquine plus a single low dose primaquine is underway in villages along the Thailand Myanmar border
Economic development, deforestation and on-going malaria control activities including the distribution of insecticide-treated bed nets (ITNs) and improved management have reduced malaria prevalence to historically low levels in the Greater Mekong Subregion (GMS)
The interruption of malaria transmission is the remaining best strategy to stop the spread of artemisinin-resistant Plasmodium falciparum, which requires the elimination of all falciparum infections including the submicroscopic parasite reservoir
Summary
A targeted malaria elimination project, including mass drug administrations (MDA) of dihydroartemisinin/piperaquine plus a single low dose primaquine is underway in villages along the Thailand Myanmar border. The recent emergence and spread of artemisinin resistance in Western Cambodia is a threat for the effective treatment of falciparum malaria [1]. The interruption of malaria transmission is the remaining best strategy to stop the spread of artemisinin-resistant Plasmodium falciparum, which requires the elimination of all falciparum infections including the submicroscopic parasite reservoir. Targeted malaria elimination includes mass drug administrations (MDA) for the presumptive treatment of all residents in foci of high sub-microscopic infections in addition to improved case management by village health workers and the distribution of ITNs
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