Limits...
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.

Show MeSH

Related in: MedlinePlus

Diagram displaying the successive processes of the selection of 313 households/respondents and 246 malaria villagers. Malaria-affected households and malaria villagers are described in the text.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672016&req=5

Figure 3: Diagram displaying the successive processes of the selection of 313 households/respondents and 246 malaria villagers. Malaria-affected households and malaria villagers are described in the text.

Mentions: The data on malaria-affected households retrieved from the electronic reporting system of notifiable diseases revealed 130 malaria cases reported during the period between 2006 and 2010 (Figure 2). This information was used in sampling the households as follows. Of the 435 previously surveyed households (Figure 3), a statistically required sample size of 339 assigned to a stratified two-stage random sampling was calculated at a 95% confidence level. Hypothetically, this was based on the proportion of 20% malaria-affected households reported during this period and the estimate with a 10% of margin of error. However, the 26 malaria-affected households that had reported cases had been reported before 2007 were not available for selection due to either their relocation or absence. Finally, a total of 313 randomly selected households had knowledgeable respondents aged ≥18 years of both genders. These respondents (72% coverage) from the 7 hamlets were from 70 malaria-affected households and 243 malaria-unaffected households. A malaria-affected household was defined as any household that had at least one member who experienced malaria for the first time in his/her lifetime from 2007 to 2010, regardless of the type of infections (single or mixed), infection episode (once or multiple), relapsing of P. vivax malaria and malaria foci (inside or outside the village). In this regard, the at-risk households with any member involved in work at either rubber plantations or natural rubber productions who occasionally became infected with malaria might have been psycho-sociologically affected by the household member’s ailment. This was because the disease resulted in a deviation from a normal lifestyle and caused loss of work days. It directly reduced family income, indirectly increasing patient costs. Moreover, the family members felt anxiety about whether the malaria-infected member would spread the disease to others. Of the 70 malaria-affected households that were followed up with 75% (98/130) of recorded malaria cases (Table 1), only 44% of the follow-up cases (21 male and 22 female) were recruited into the study as the respondents; 25% were not followed due to relocation, absence or death (Figure 3).


Predictors of malaria-association with rubber plantations in Thailand.

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

Diagram displaying the successive processes of the selection of 313 households/respondents and 246 malaria villagers. Malaria-affected households and malaria villagers are described in the text.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Diagram displaying the successive processes of the selection of 313 households/respondents and 246 malaria villagers. Malaria-affected households and malaria villagers are described in the text.
Mentions: The data on malaria-affected households retrieved from the electronic reporting system of notifiable diseases revealed 130 malaria cases reported during the period between 2006 and 2010 (Figure 2). This information was used in sampling the households as follows. Of the 435 previously surveyed households (Figure 3), a statistically required sample size of 339 assigned to a stratified two-stage random sampling was calculated at a 95% confidence level. Hypothetically, this was based on the proportion of 20% malaria-affected households reported during this period and the estimate with a 10% of margin of error. However, the 26 malaria-affected households that had reported cases had been reported before 2007 were not available for selection due to either their relocation or absence. Finally, a total of 313 randomly selected households had knowledgeable respondents aged ≥18 years of both genders. These respondents (72% coverage) from the 7 hamlets were from 70 malaria-affected households and 243 malaria-unaffected households. A malaria-affected household was defined as any household that had at least one member who experienced malaria for the first time in his/her lifetime from 2007 to 2010, regardless of the type of infections (single or mixed), infection episode (once or multiple), relapsing of P. vivax malaria and malaria foci (inside or outside the village). In this regard, the at-risk households with any member involved in work at either rubber plantations or natural rubber productions who occasionally became infected with malaria might have been psycho-sociologically affected by the household member’s ailment. This was because the disease resulted in a deviation from a normal lifestyle and caused loss of work days. It directly reduced family income, indirectly increasing patient costs. Moreover, the family members felt anxiety about whether the malaria-infected member would spread the disease to others. Of the 70 malaria-affected households that were followed up with 75% (98/130) of recorded malaria cases (Table 1), only 44% of the follow-up cases (21 male and 22 female) were recruited into the study as the respondents; 25% were not followed due to relocation, absence or death (Figure 3).

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