Abstract
BackgroundMigration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting.MethodsA mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013–2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016–2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings.ResultsAmong others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap anti-malarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centres and voluntary health workers worsened the situation.ConclusionsMitigating key drivers that favour poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for the NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals. Further innovative out-reach programmes designed and implemented specific to the nature of mobile/migrant workers is crucial.
Highlights
Migration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar
Adopting the integration principles and practices in mixed-methods designs [25, 29], quantitative and qualitative findings were reported in two different sections that involved the use of the contiguous adjoining approach
Migrant households in Bago Region were significantly less likely to report having contact with health workers for malaria-related reasons than those in other regions (1655/3662, 45% vs. 3748/5936, 63%), they were more likely to receive any form of malaria-related IEC than those in other regions (1230/3662, 34% vs. 1749/5936, 30%; P ≤ 0.001)
Summary
Migration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programmes of Cambodia, Lao PDR, Vietnam, and Myanmar have tailored approaches for mobile and migrant populations (MMPs), due to their higher risk of malaria infection. These programmes promote malaria elimination strategies that worked towards shrinking parasite reservoirs and interrupting transmission taking into account of equity issues [2, 3]. MMPs create epidemiological and operational challenges to meet malaria elimination targets in remote areas Their movements contribute to the spread of the drug-resistance problem from endemic areas to malaria-free regions in the GMS [8,9,10]. Studies from Vietnam, Cambodia, and Lao PDR have supported evidence of migration flows and the emergence of drugresistant falciparum malaria [11,12,13,14]
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