Targeting high risk forest goers for malaria elimination: a novel approach for investigating forest malaria to inform pr
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RESEARCH ARTICLE
Open Access
Targeting high risk forest goers for malaria elimination: a novel approach for investigating forest malaria to inform program intervention in Vietnam Sara E. Canavati1,2, Gerard C. Kelly1* , Cesia E. Quintero2, Thuan Huu Vo1, Long Khanh Tran1, Thang Duc Ngo3, Duong Thanh Tran3, Kimberly A. Edgel4 and Nicholas J. Martin4
Abstract Background: Individuals that work and sleep in remote forest and farm locations in the Greater Mekong Subregion continue to remain at high risk of both acquiring and transmitting malaria. These difficult-to-access population groups largely fall outside the reach of traditional village-centered interventions, presenting operational challenges for malaria programs. In Vietnam, over 60% of malaria cases are thought to be individuals who sleep in forests or on farms. New malaria elimination strategies are needed in countries where mobile and migrant workers frequently sleep outside of their homes. The aim of this study was to apply targeted surveillance-response based investigative approaches to gather location-specific data on confirmed malaria cases, with an objective to identify associated malaria prevention, treatment and risk behaviors of individuals sleeping in remote forest and farms sites in Vietnam. Methods: A cross-sectional study using novel targeted reactive investigative approaches at remote area sleeping sites was conducted in three mountainous communes in Phu Yen province in 2016. Index cases were defined as individuals routinely sleeping in forests or farms who had tested positive for malaria. Index cases and non-infected neighbors from forest and farm huts within 500 m of the established sleeping locations of index cases were interviewed at their remote-area sleeping sites. Results: A total of 307 participants, 110 index cases and 197 neighbors, were enrolled. Among 93 participants who slept in the forest, index cases were more likely to make > 5 trips to the forest per year (prevalence odds ratio (POR) 7.41, 95% confidence interval (CI) 2.66–20.63), sleep in huts without walls (POR 44.00, 95% CI 13.05–148.33), sleep without mosquito nets (POR 2.95, 95% CI 1.26–6.92), and work after dark (POR 5.48, 95% CI 1.84–16.35). Of the 204 farm-based respondents, a significantly higher proportion of index cases were involved in non-farming activities (logging) (POR 2.74, 95% CI 1.27–5.91). (Continued on next page)
* Correspondence: [email protected] 1 Vysnova Partners, Inc, 8400 Corporate Drive, Suite 130, Landover, MD 20875, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the a
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