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Predictors of malaria-association with rubber plantations in Thailand.

Satitvipawee P, Wongkhang W, Pattanasin S, Hoithong P, Bhumiratana A - BMC Public Health (2012)

Bottom Line: For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households.Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others.This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand.

ABSTRACT

Background: The national Global Fund-supported malaria (GFM) program in Thailand, which focuses on the household-level implementation of vector control via insecticide-treated nets (ITNs)/long-lasting insecticidal nets (LLINs) combined with indoor residual spraying (IRS), has been combating malaria risk situations in different provinces with complex epidemiological settings. By using the perception of malaria villagers (MVs), defined as villagers who recognized malaria burden and had local understanding of mosquitoes, malaria, and ITNs/LLINs and practiced preventive measures, this study investigated the predictors for malaria that are associated with rubber plantations in an area of high household-level implementation coverage of IRS (2007-2010) and ITNs/LLINs (2008-2010) in Prachuap Khiri Khan Province.

Methods: A structured questionnaire addressing socio-demographics, household characteristics and health behavioral factors (knowledge, perceptions and practices) regarding the performed interventions was administered to the 313 households (70 malaria-affected and 243 malaria-unaffected) that had respondents aged ≥18 years of both genders. In the univariate and multivariate analyses, only 246 (78.6%) MV respondents (62 malaria-affected and 184 malaria-unaffected) were analyzed to determine the predictors for risk (morbidity).

Results: The majority (70%) of households were covered by IRS. For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households. In a logistic regression analysis using odds ratios (aORs) adjusted on the variables and a 95% confidence interval (CI), malaria affecting MVs was associated with daily worker (i.e., earning daily income by normally practicing laborious activities mostly in agriculture such as rubber tapping and rubber sheet processing at the smallholdings of rubber plantations) (aOR = 2.9, 95% CI: 1.1-7.4), low-moderate level of malaria knowledge (aOR = 2.4, 95% CI: 1.1-5.0) and sleeping under mosquito-nets (nets/ITNs/LLINs intermittently and ITNs/LLINs only) (aOR = 2.0, 95% CI: 1.0-3.7).

Conclusions: The MV predictors for malaria-association with rubber plantations included occupation (daily worker), misconceptions about malaria (mosquito and prevention) and the use of mosquito-nets. Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others. The promotion and use of ITNs/LLINs depends substantially on cultural factors and defensive behaviors relevant to their occupational risk despite the perceived threats of malaria and the perceived benefits of ITNs/LLINs. This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.

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Related in: MedlinePlus

Diagrams of malaria control stratification areas and strategies for a malaria-affected province of Thailand. Malaria transmission area (perennial A1 and periodic A2) regularly occurs with indigenous malaria cases, while in transmission risk area (high-receptive B1 and low-receptive B2) introduced cases with a known infection orgin. With the absence of vectors and incidence for >3 consecutive years of control, the malaria-free zone targeted by the NMCP becomes pre-integrated and integrated into the basic health services in the province. Vector control strategies include IRS (regular and special spraying for A1/A2 as focal for B1/B2) and ITNs)/LLINs. Malaria chemotherapy focuses on both active (ACD) and passive (PCD) case detections, radical treatment (RT), follow-up treatment (FT), case investigation (CI) and foci investigation (FI). The ACD includes mobile malaria clinics (MMC), mass blood surveys (MBS), special case detection (SCD), case investigation surveys (CIS), rapid diagnostic testing (RDT) and ACT through malaria posts, as in the PCD, location and personnel aid the effort, such as the malaria clinic (MC), hospital (H), health center (HC), village health volunteer (VHV) and village malaria volunteer (VMV). For the behavior objective, strategic approaches employ public relations (PR), health education (HE) and community participation (CP). This NMCP management encompasses supervision (S) and monitoring and evaluation (ME) systems, both epidemiological (EP) and entomological (ET). At the household level, such malaria villagers (A) inhabiting transmission risk areas on rubber plantations (B) in Prachuap Khiri Khan Province that were covered by IRS (2007–2010) and ITNs/LLINs (2008–2010) were recruited into the study.
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Figure 1: Diagrams of malaria control stratification areas and strategies for a malaria-affected province of Thailand. Malaria transmission area (perennial A1 and periodic A2) regularly occurs with indigenous malaria cases, while in transmission risk area (high-receptive B1 and low-receptive B2) introduced cases with a known infection orgin. With the absence of vectors and incidence for >3 consecutive years of control, the malaria-free zone targeted by the NMCP becomes pre-integrated and integrated into the basic health services in the province. Vector control strategies include IRS (regular and special spraying for A1/A2 as focal for B1/B2) and ITNs)/LLINs. Malaria chemotherapy focuses on both active (ACD) and passive (PCD) case detections, radical treatment (RT), follow-up treatment (FT), case investigation (CI) and foci investigation (FI). The ACD includes mobile malaria clinics (MMC), mass blood surveys (MBS), special case detection (SCD), case investigation surveys (CIS), rapid diagnostic testing (RDT) and ACT through malaria posts, as in the PCD, location and personnel aid the effort, such as the malaria clinic (MC), hospital (H), health center (HC), village health volunteer (VHV) and village malaria volunteer (VMV). For the behavior objective, strategic approaches employ public relations (PR), health education (HE) and community participation (CP). This NMCP management encompasses supervision (S) and monitoring and evaluation (ME) systems, both epidemiological (EP) and entomological (ET). At the household level, such malaria villagers (A) inhabiting transmission risk areas on rubber plantations (B) in Prachuap Khiri Khan Province that were covered by IRS (2007–2010) and ITNs/LLINs (2008–2010) were recruited into the study.

Mentions: It is hypothesized that if there was a difference in local perceptions of mosquitoes, malaria, ITNs/LLINs and the practice of preventive measures among households, malaria infections and associated factors would vary between different epidemiological settings in Prachuap Khiri Khan. Thus, this analytical cross-sectional study conducted between January and April of 2011 investigated the predictors of the acquisition of malaria infections among malaria-endemic villagers inhabiting transmission risk areas on rubber plantations in the province (Figure 1). Understanding the undesired health behaviors that facilitate exposure to malaria is needed to design preventive measures, and, more specifically, to design individually adapted behavior interventions.


Predictors of malaria-association with rubber plantations in Thailand.

Satitvipawee P, Wongkhang W, Pattanasin S, Hoithong P, Bhumiratana A - BMC Public Health (2012)

Diagrams of malaria control stratification areas and strategies for a malaria-affected province of Thailand. Malaria transmission area (perennial A1 and periodic A2) regularly occurs with indigenous malaria cases, while in transmission risk area (high-receptive B1 and low-receptive B2) introduced cases with a known infection orgin. With the absence of vectors and incidence for >3 consecutive years of control, the malaria-free zone targeted by the NMCP becomes pre-integrated and integrated into the basic health services in the province. Vector control strategies include IRS (regular and special spraying for A1/A2 as focal for B1/B2) and ITNs)/LLINs. Malaria chemotherapy focuses on both active (ACD) and passive (PCD) case detections, radical treatment (RT), follow-up treatment (FT), case investigation (CI) and foci investigation (FI). The ACD includes mobile malaria clinics (MMC), mass blood surveys (MBS), special case detection (SCD), case investigation surveys (CIS), rapid diagnostic testing (RDT) and ACT through malaria posts, as in the PCD, location and personnel aid the effort, such as the malaria clinic (MC), hospital (H), health center (HC), village health volunteer (VHV) and village malaria volunteer (VMV). For the behavior objective, strategic approaches employ public relations (PR), health education (HE) and community participation (CP). This NMCP management encompasses supervision (S) and monitoring and evaluation (ME) systems, both epidemiological (EP) and entomological (ET). At the household level, such malaria villagers (A) inhabiting transmission risk areas on rubber plantations (B) in Prachuap Khiri Khan Province that were covered by IRS (2007–2010) and ITNs/LLINs (2008–2010) were recruited into the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672016&req=5

Figure 1: Diagrams of malaria control stratification areas and strategies for a malaria-affected province of Thailand. Malaria transmission area (perennial A1 and periodic A2) regularly occurs with indigenous malaria cases, while in transmission risk area (high-receptive B1 and low-receptive B2) introduced cases with a known infection orgin. With the absence of vectors and incidence for >3 consecutive years of control, the malaria-free zone targeted by the NMCP becomes pre-integrated and integrated into the basic health services in the province. Vector control strategies include IRS (regular and special spraying for A1/A2 as focal for B1/B2) and ITNs)/LLINs. Malaria chemotherapy focuses on both active (ACD) and passive (PCD) case detections, radical treatment (RT), follow-up treatment (FT), case investigation (CI) and foci investigation (FI). The ACD includes mobile malaria clinics (MMC), mass blood surveys (MBS), special case detection (SCD), case investigation surveys (CIS), rapid diagnostic testing (RDT) and ACT through malaria posts, as in the PCD, location and personnel aid the effort, such as the malaria clinic (MC), hospital (H), health center (HC), village health volunteer (VHV) and village malaria volunteer (VMV). For the behavior objective, strategic approaches employ public relations (PR), health education (HE) and community participation (CP). This NMCP management encompasses supervision (S) and monitoring and evaluation (ME) systems, both epidemiological (EP) and entomological (ET). At the household level, such malaria villagers (A) inhabiting transmission risk areas on rubber plantations (B) in Prachuap Khiri Khan Province that were covered by IRS (2007–2010) and ITNs/LLINs (2008–2010) were recruited into the study.
Mentions: It is hypothesized that if there was a difference in local perceptions of mosquitoes, malaria, ITNs/LLINs and the practice of preventive measures among households, malaria infections and associated factors would vary between different epidemiological settings in Prachuap Khiri Khan. Thus, this analytical cross-sectional study conducted between January and April of 2011 investigated the predictors of the acquisition of malaria infections among malaria-endemic villagers inhabiting transmission risk areas on rubber plantations in the province (Figure 1). Understanding the undesired health behaviors that facilitate exposure to malaria is needed to design preventive measures, and, more specifically, to design individually adapted behavior interventions.

Bottom Line: For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households.Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others.This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand.

ABSTRACT

Background: The national Global Fund-supported malaria (GFM) program in Thailand, which focuses on the household-level implementation of vector control via insecticide-treated nets (ITNs)/long-lasting insecticidal nets (LLINs) combined with indoor residual spraying (IRS), has been combating malaria risk situations in different provinces with complex epidemiological settings. By using the perception of malaria villagers (MVs), defined as villagers who recognized malaria burden and had local understanding of mosquitoes, malaria, and ITNs/LLINs and practiced preventive measures, this study investigated the predictors for malaria that are associated with rubber plantations in an area of high household-level implementation coverage of IRS (2007-2010) and ITNs/LLINs (2008-2010) in Prachuap Khiri Khan Province.

Methods: A structured questionnaire addressing socio-demographics, household characteristics and health behavioral factors (knowledge, perceptions and practices) regarding the performed interventions was administered to the 313 households (70 malaria-affected and 243 malaria-unaffected) that had respondents aged ≥18 years of both genders. In the univariate and multivariate analyses, only 246 (78.6%) MV respondents (62 malaria-affected and 184 malaria-unaffected) were analyzed to determine the predictors for risk (morbidity).

Results: The majority (70%) of households were covered by IRS. For a combination of ITNs/LLINs, there were 74% of malaria-affected households covered and 46% of malaria-unaffected households. In a logistic regression analysis using odds ratios (aORs) adjusted on the variables and a 95% confidence interval (CI), malaria affecting MVs was associated with daily worker (i.e., earning daily income by normally practicing laborious activities mostly in agriculture such as rubber tapping and rubber sheet processing at the smallholdings of rubber plantations) (aOR = 2.9, 95% CI: 1.1-7.4), low-moderate level of malaria knowledge (aOR = 2.4, 95% CI: 1.1-5.0) and sleeping under mosquito-nets (nets/ITNs/LLINs intermittently and ITNs/LLINs only) (aOR = 2.0, 95% CI: 1.0-3.7).

Conclusions: The MV predictors for malaria-association with rubber plantations included occupation (daily worker), misconceptions about malaria (mosquito and prevention) and the use of mosquito-nets. Human practices such as revisiting rubber plantations while exposed to multiple bites at multiple locations are more likely to apply to daily workers than to rubber farmers/tappers and others. The promotion and use of ITNs/LLINs depends substantially on cultural factors and defensive behaviors relevant to their occupational risk despite the perceived threats of malaria and the perceived benefits of ITNs/LLINs. This information supports the conclusion that GFM program implementation in Thailand or elsewhere for malaria-associated with rubber plantations would benefit from the potential use of ITNs/LLINs and changes in personal protection behaviors.

Show MeSH
Related in: MedlinePlus