Background
The vulnerability of mobile and migrant populations
Development of MMP profiles and intervention packages
Forest malaria | Malaria ecosystem and transmission is closely related to forested areas in Southeast Asia |
Related activities of population | Population movement in relation to malaria, the main focus should be on the interaction/exposure of MMP with the forest |
Local population | Permanent resident in the area for more than 1 year |
Mobile population | Resident in the area for less than 6 months |
Migrant population | Resident in the area for more than 6 months and less than 1 year |
Visitors (from abroad to the country) | Person admitted for short stays for purposes of leisure, recreation, holidays; visits to friends or relatives; business or professional activities. Visitors include excursionists, tourists and business travellers. Tourists, visiting relatives who might spend one or two nights in or near the forest (e.g., family event, ecotourism) |
Seasonal workers | Agricultural activities occurring during planting season (end of dry season) and harvesting season (end of rainy season), usually in foothills/plains/valleys. (e.g., farming/chamkar, rubber, cassava plantations) |
Construction/mine workers | Activities related to infrastructure construction or mining in forested areas, usually in upland forest/hills/valleys. (e.g., dam or road construction, gold or gem mines) |
Forest workers | Activities in heavily forested and remote areas in small mobile groups, usually in upland forest/hills. (e.g., forest products gathering, hunting, logging, fishing) |
Security personnel | Activities related to patrolling in forested border areas |
Delivery mechanisms | Stage of journey | Strategic area | Categories of MMPs | ||
---|---|---|---|---|---|
Forest workers | Construction workers | Seasonal workers | |||
Retail sales (subsidized); voucher system | Lending scheme; retail sale; voucher system | Lending scheme; retail sale; voucher system | |||
Behaviour change communication | Pre-departure en route upon arrival | Prevention | Mass media; taxi driver scheme | Mass media; IPC through MMWs; taxi driver scheme | Mass media; IPC through MMWs; taxi driver scheme |
LLINs | Pre-departure en route upon arrival | Prevention | Forest package; taxi driver scheme | Forest package; taxi driver scheme; LLIN/ITN lending scheme | Forest package; taxi driver scheme; LLIN/ITN lending scheme |
Diagnosis treatment | Upon arrival | EDAT | MMWs; stand-by treatment | MMWs; company health workers; | MMWs |
MMP-surveillance | Upon arrival | Surveillance | Local authorities | Local authorities; company | Local authorities; plantation/farm owner/manager |
MMP-malaria information systems | Upon arrival | Malaria surveillance | mHealth; private/public private mix | mHealth; private/PPM; MMWs | mHealth; private/PPM; MMWs |
Evaluation of interventions
Methods
Interventions assessed
Study team training and composition
Quantitative strand
Sampling
Data analysis
Qualitative strand
Data collection and sampling
FGDs
IDIs
Data analysis
Ethical issues
Results
Demographic characteristics of seasonal worker study participants
Sociodemographic characteristics | Total | |
---|---|---|
N | % | |
Gender | ||
Male | 169 | 55.6 |
Female | 135 | 44.4 |
Age in years (mean, SD) [32, 10.6] | ||
Primary occupation | ||
Agricultural labourer | 149 | 49.0 |
Seller | 1 | 0.3 |
Fisherman | 1 | 0.3 |
Forestry worker | 2 | 0.7 |
Farmer | 148 | 48.7 |
Housewife | 1 | 0.3 |
Other | 1 | 0.7 |
Highest level of education | ||
Never attended school | 60 | 19.7 |
Completed primary (grade 6) | 176 | 57.9 |
Completed secondary (grade 12) | 54 | 17.8 |
More than secondary | 14 | 4.6 |
Marital status | ||
Single, never married | 89 | 29.3 |
Married/living with someone as married | 201 | 66.1 |
Widowed | 7 | 2.3 |
Divorced/separated | 6 | 2.0 |
Married but not living together | 1 | 0.3 |
Normally stay in the farm all year | ||
Yes | 47 | 15.5 |
No | 254 | 84.5 |
Accompanied bya
| ||
Family | 35 | 74.5 |
Friends | 7 | 14.9 |
Alone | 5 | 10.6 |
Seasonal worker characteristics | Total | |
---|---|---|
N | % | |
First time working in Pailin | ||
Yes | 166 | 54.6 |
No | 138 | 45.4 |
Number of times worked in Pailin before (times) | ||
1–2 | 73 | 52.8 |
3–4 | 28 | 20.3 |
>5 | 37 | 22.3 |
Frequency of coming to work in Pailin | ||
Once a year | 38 | 27.5 |
Twice a year | 53 | 38.4 |
Three times a year | 10 | 7.3 |
>3 times a year | 14 | 10.1 |
I never leave | 23 | 16.7 |
Length working in the farm (mean, SD) [18 weeks, 54] (weeks) | ||
<2 | 181 | 59.5 |
3–4 | 41 | 13.5 |
5–6 | 10 | 3.3 |
7–8 | 12 | 4.0 |
>8 | 60 | 19.7 |
Duration planned for this tripa (months) | ||
<2 | 151 | 49.7 |
>2 | 152 | 50.3 |
Ways to find places of manual labour | ||
Friends | 39 | 12.8 |
Farm owner | 126 | 41.5 |
Used to come here before | 23 | 7.5 |
Neighbour | 109 | 35.9 |
Family member | 73 | 24.0 |
Evaluation of interventions
Education through mass media
Media habits | Overall | |
---|---|---|
N | % | |
How often listen to the radio | ||
Once a week | 12 | 6.6 |
2–4 times a week | 26 | 14.4 |
5–6 times a week | 4 | 2.2 |
Daily | 40 | 22.1 |
Never | 99 | 54.7 |
Last week, heard a message about malaria on the radio | ||
Yes | 28 | 36.4 |
No | 49 | 63.6 |
How often watch television | ||
Once a week | 13 | 9.4 |
2–4 times a week | 25 | 18.1 |
5–6 times a week | 1 | 0.7 |
Daily | 35 | 25.4 |
Never (during last month) | 64 | 46.4 |
Last week, heard a message about malaria on television | ||
Yes | 14 | 51.9 |
No | 13 | 48.2 |
Listener and viewer clubs
Communication | Overall | |
---|---|---|
N | % | |
Messages or information related to malaria prevention heard | ||
Malaria is caused by mosquito bites | 258 | 84.9 |
Wear long sleeved clothes from dusk to dawn to prevent mosquito bites | 121 | 39.8 |
Sleep under a mosquito net every night | 175 | 57.6 |
Sleep under an insecticide-treated net | 140 | 46.1 |
Buy the bundled net at the market and dip it with Super-Malatab | 11 | 3.6 |
Super-Malatab is free, safe and easy to use | 2 | 0.7 |
Malaria is dangerous | 5 | 1.6 |
Malaria can kill | 1 | 0.3 |
Messages related to malaria diagnosis and treatment heard | ||
Seek treatment for malaria from a MMW | 202 | 66.5 |
Visit your MMW for free malaria diagnosis and treatment | 39 | 12.8 |
Get a blood test before taking anti-malarial drugs | 79 | 26.0 |
If you have fever, always seek a blood test for malaria at nearest health facility | 59 | 14.4 |
Complete anti-malarial treatment | 10 | 3.3 |
Do not buy cocktail; your malaria will not be cured | 2 | 0.7 |
Messages related to using and caring for mosquito nets heard | ||
Sleeping under an ITN is especially important for pregnant women | 2 | 0.7 |
Sleeping under an ITN is especially important for children under 5 years old | 3 | 1.0 |
Carry and sleep under a mosquito net when travelling | 92 | 30.3 |
Carry and sleep under a mosquito net when visiting the forest | 28 | 9.2 |
The less you wash your treated net the longer it will retain its effectiveness | 30 | 9.9 |
Repair any holes in the net | 52 | 17.1 |
Do not use too much soap when washing your net | 27 | 8.9 |
Dry mosquito net indoors | 124 | 40.8 |
Prepare floor before tying | 143 | 47.0 |
Source of messages | ||
MMW | 68 | 22.4 |
Health facility staff | 60 | 19.7 |
Private health provider/pharmacy | 4 | 1.3 |
Teachers/religious leaders/monks | 6 | 2.0 |
Family member/friend/neighbour | 195 | 64.1 |
Television | 81 | 26.6 |
Radio | 88 | 29.0 |
Mobile video unit | 5 | 1.6 |
Poster/leaflet/brochures/billboards | 28 | 9.2 |
NGO staff | 29 | 9.5 |
Have attended an event in the community with a screen/speaker on health messages | ||
Yes | 36 | 11.8 |
No | 268 | 88.2 |
Mobile Malaria Worker services
MMWs | Overall | |
---|---|---|
N | % | |
Know the MMW | ||
Yes | 88 | 29.0 |
No | 216 | 71.1 |
MMW visited the migrants while in the farma
| ||
Yes | 76 | 86.4 |
No | 12 | 13.6 |
Received malaria education from MMWa
| ||
Yes | 81 | 92.0 |
No | 7 | 8.0 |
Know that free malaria testing/treatment is available from MMWs | ||
Yes | 84 | 95.4 |
No | 4 | 4.5 |
Previously contacted MMW when having fever | ||
Yes | 48 | 54.5 |
No | 40 | 45.5 |
Ways migrants have contacted MMW | ||
Went to the MMW | 59 | 67.1 |
MMW visited the migrant worker | 16 | 18.2 |
Migrant worker never contacted MMW | 13 | 14.8 |
Interpersonal communication | Overall | |
---|---|---|
N | % | |
Ever discussed any topics concerning malaria | ||
Yes | 218 | 71.7 |
No | 86 | 28.3 |
Person with whom discussed malaria | ||
Family member | 118 | 82.6 |
Villager | 46 | 21.1 |
Friend | 93 | 42.7 |
MMW | 34 | 15.6 |
Topics discussed | ||
How to prevent malaria | 163 | 74.8 |
How malaria is transmitted | 102 | 46.8 |
How to treat malaria | 53 | 24.3 |
Malaria drug resistance | 4 | 1.8 |
Malaria testing | 36 | 16.5 |
Where to seek advice | 16 | 7.3 |
Who to seek advice from | 4 | 1.8 |
Variable | Treatment sought at | |||
---|---|---|---|---|
MMW N (%) | Public health provider N (%) | Private health provider N (%) | Other N (%) | |
First action if a migrant thinks he/she has malaria | 64 (21.1) | 247 (81.3) | 95 (31.3) | 102 (33.6)a
|
Potential place visited for malaria test | 64 (21.1) | 263 (86.5) | 89 (29.3) | – |
Action taken if malaria test positive | 54 (17.8) | 271 (89.1) | 113 (37.2) | 14 (4.6)b
|
Action to be taken if febrile patient with negative malaria test | N/A | 265 (87.17) | 110 (36.18) | 58 (19.1)c
|
M: Don’t you know that in the fields there are volunteers who help treat malaria?
P4: I don’t know because I’m just a new arrival.
M: How many days have you been here?
P4: 6 days.
M: So, all of you, do you know that in the fields there are volunteers who help cure malaria fever?
P1: Don’t know.
P3: If we were living here for one or two years, surely we would know.
M: So, do you know, brother?
P6: No, I don’t. […]
M: So none of you here know that there are volunteers in the fields, do you?
P5: No! (FGD 04 Seasonal workers)
…If the health centres did not have medicine, I wrote letters to malaria centre…so that patients could get medicine from the centre. If the centre had no medicine, I sent them to a private clinic. (IDI 05, MMW, male).
The difficulty is that we cannot educate them as we educate villagers living with us. They don’t know much about methods of preventing malaria and about symptoms of malaria. Due to their lack of knowledge, migrants try to bear with the disease and think that it is a cold, and after a few days it becomes severe malaria. (IDI 02, MMW, male).
There is no hospital around the farm. We have to go far away to Pailin city. Those who have worked here for a very long time know where to go for treatment because they have access to the village malaria worker, but for us, we don’t know where to go because we keep moving from one farm to another. Whenever we get sick, we go to state-run hospital in Pailin City or buy medicine at pharmacy. (FGD 08, Seasonal workers).
Reported satisfaction of MMW services | Overall | |
---|---|---|
N | % | |
MMW able to provide advice | 82 | 93.2 |
Easy to get in touch with the MMW | 82 | 93.2 |
Easy to communicate with the MMW | 84 | 95.5 |
MMW understands malaria | 79 | 90.1 |
MMW provides support (testing and treatment) | 82 | 93.2 |
Satisfied by MMW services | 84 | 95.5 |
Would refer an ill friend to MMW | 84 | 95.5 |
Volunteers don’t look down on us. When we go to see them, even though they are working, or stay far from us, they will come fast. There isn’t any problem. (FGD 08, Seasonal workers).
For me, I think it is very good that malaria volunteers come and teach about malaria prevention. As a farm owner, I can be aware of how I can help prevent my workers from being attacked by such a disease, and I can see many benefits. First, the workers working here are not sick, so they can speed up their work for me. Second, it is the workers’ benefit that they do not need to spend their money on medicines, and they can save some money to go back home. Next year they will work with me again since they can keep a good deal of money, won’t they? (IDI 01, Farm owner).
Migrant workers know that it is so beneficial when they come and get the medicine from me. If they are too ill to come, I can approach them. If they do not come to get the medicine from me, they have to spend up to 30,000 Riels (7.5 US$) for the motor taxi. (IDI 06, MMW, female).
LLIN/ITN lending scheme
Taxi driver scheme
Discussion
Mass media and LVCs
MMW services
LLIN/ITN lending scheme
Taxi driver scheme
Study limitations
The need for future social and anthropological research
Variables | Forest workers | Construction workers | Security personnel | Seasonal workers | Visitors | |
---|---|---|---|---|---|---|
Profile | FW | CW | SP | SW | T | |
Main activities | Hunting, fishing, logging, non-timber forest products | Dam or road construction, mining | Patrolling | Farming, plantation, chamkar
| ||
Population type | Local, Mobile, Migrant | Mobile, Migrant | Mobile, Migrant | Local, Mobile, Migrant | Mobile | |
Forest/malaria exposure | Location from forest | In forest | In forest/forest fringe | In forest | Forest fringe | Forest fringe |
Duration of stay in forest | 1–4 weeks | 1–6 months | Weeks to months? | 1–4 weeks | 1 week | |
Forest exposure | High | Medium to high | High | Low to medium | Low | |
Housing type | Tents, none | Huts, barracks, tents | Huts, barracks, tents | Tents, huts | Wooden or concrete house | |
Working conditions/access/outreach | Work area | Forest, hills | Forest, hills | Border forest | Foot hills, plains, valleys | |
Work location | Mobile | Fixed | Semi-mobile | Fixed | ||
Link/affiliation | None or village for local population | Company | Government | Farm owner/company | None | |
Main point of contact | None or village for local population | Company | Military base | Farm owner/company | Guest houses/hotels |