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Gallalee S, Zarlinda I, Silaen MG, Cotter C, Cueto C, Elyazar IRF, Jacobson JO, Gosling R, Hsiang MS, Bennett A, Coutrier FN, Smith JL. Forest-goers as a heterogeneous population at high-risk for malaria: a case-control study in Aceh Province, Indonesia. Malar J 2024; 23:37. [PMID: 38291392 PMCID: PMC10826189 DOI: 10.1186/s12936-024-04856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/20/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND A major challenge to malaria elimination is identifying and targeting populations that are harbouring residual infections and contributing to persistent transmission. In many near-elimination settings in Southeast Asia, it is known that forest-goers are at higher risk for malaria infection, but detailed information on their behaviours and exposures is not available. METHODS In Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case-control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection. RESULTS There were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09-92.26; community controls: aOR 16.78, 95% CI 2.19-128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29-17.31 and 13.53, 95% CI 2.10-87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent. CONCLUSIONS Second residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.
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Affiliation(s)
- Sarah Gallalee
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Iska Zarlinda
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Martha G Silaen
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Chris Cotter
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Carmen Cueto
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Iqbal R F Elyazar
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jerry O Jacobson
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle S Hsiang
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Farah N Coutrier
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Jennifer L Smith
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Hoffman-Hall A, Puett R, Silva JA, Chen D, Bredder A, Shevade V, Han ZY, Han KT, Aung PP, Plowe CV, Nyunt MM, Loboda TV. Comparison of deforestation and forest land use factors for malaria elimination in Myanmar. IJID REGIONS 2023; 8:75-83. [PMID: 37533552 PMCID: PMC10393544 DOI: 10.1016/j.ijregi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
Objectives Within the remote region of Ann Township in Myanmar's Rakhine State, malaria prevalence has remained steady at ∼10% of the population from 2016-2019. Previous studies have linked areas of higher malaria prevalence in the region to heavily forested areas, however, little is known about how people live, work, and move through these areas. This work aims to disentangle landscape from land use in regard to malaria exposure. Methods We investigated the roles of forest cover, forest loss, and land use activities with malaria prevalence through the combined use of land use surveys, malaria surveillance, and satellite earth observations. Results Our results confirm previous research that linked areas of high forest cover with high malaria prevalence. However, areas experiencing high levels of deforestation were not associated with malaria prevalence. The land use factors that contribute most significantly to increased malaria risk remained those which put people in direct contact with forests, including conducting forest chores, having an outdoor job, and having a primary occupation in the logging and/or plantation industry. Conclusion Malaria prevention methods in Myanmar should focus on anyone who lives near forests or engages in land use activities that bring them within proximity of forested landscapes, whether through occupation or chores.
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Affiliation(s)
| | - Robin Puett
- University of Maryland, School of Public Health, College Park, USA
| | - Julie A. Silva
- University at Buffalo, Department of Geography, Buffalo, USA
| | - Dong Chen
- University of Maryland, Department of Geographical Sciences, College Park, USA
| | - Allison Bredder
- University of Maryland, Department of Geographical Sciences, College Park, USA
| | - Varada Shevade
- University of Maryland, Department of Geographical Sciences, College Park, USA
| | - Zay Yar Han
- Duke University, Global Health Institute, Durham, USA
| | - Kay Thwe Han
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Poe Poe Aung
- Malaria Consortium, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Tatiana V. Loboda
- University of Maryland, Department of Geographical Sciences, College Park, USA
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Aung PL, Soe MT, Soe TN, Oo TL, Win KM, Cui L, Kyaw MP, Sattabongkot J, Okanurak K, Parker DM. Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019-2020. Sci Rep 2023; 13:5963. [PMID: 37045879 PMCID: PMC10091336 DOI: 10.1038/s41598-023-32371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Targeted mass primaquine treatment (TPT) might be an effective intervention to facilitate elimination of vivax malaria in Myanmar by 2030. In this study, we explored the factors hindering coverage of a TPT campaign conducted in a malarious township of northern Myanmar. From August 2019 to July 2020, a cross-sectional exploratory design including quantitative and qualitative data was conducted in five villages with high P. vivax prevalence following a TPT campaign. Among a targeted population of 2322; 1973 (85.0%) participated in the baseline mass blood survey (MBS) and only 52.0% of the total targeted population (1208, 91.9% of total eligible population) completed the TPT. G6PD deficiency was found among 13.5% of total MBS participants and those were excluded from TPT. Of 1315 eligible samples, farmers and gold miners, males, and those aged 15 to 45 years had higher percentages of non-participation in TPT. Qualitative findings showed that most of the non-participation groups were outside the villages during TPT because of time-sensitive agricultural and other occupational or education-related purposes. In addition to mitigating of some inclusion criteria (i.e. including young children or offering weekly PQ treatment to G6PD deficient individuals), strengthening community awareness and increasing engagement should be pursued to increase community participation.
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Affiliation(s)
- Pyae Linn Aung
- Myanmar Health Network Organization, Yangon, Myanmar
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Than Naing Soe
- Department of Public Health, Ministry of Health, NayPyiTaw, Myanmar
| | - Thit Lwin Oo
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Kyawt Mon Win
- Department of Public Health, Ministry of Health, NayPyiTaw, Myanmar
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | | | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kamolnetr Okanurak
- Department of Social and Environmental Health, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, Department of Epidemiology, University of California, Irvine, USA.
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Li Y, Stewart K, Han KT, Han ZY, Aung PP, Thein ZW, Htay T, Chen D, Nyunt MM, Plowe CV. Understanding Spatiotemporal Human Mobility Patterns for Malaria Control Using a Multiagent Mobility Simulation Model. Clin Infect Dis 2023; 76:e867-e874. [PMID: 35851600 PMCID: PMC10169429 DOI: 10.1093/cid/ciac568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND More details about human movement patterns are needed to evaluate relationships between daily travel and malaria risk at finer scales. A multiagent mobility simulation model was built to simulate the movements of villagers between home and their workplaces in 2 townships in Myanmar. METHODS An agent-based model (ABM) was built to simulate daily travel to and from work based on responses to a travel survey. Key elements for the ABM were land cover, travel time, travel mode, occupation, malaria prevalence, and a detailed road network. Most visited network segments for different occupations and for malaria-positive cases were extracted and compared. Data from a separate survey were used to validate the simulation. RESULTS Mobility characteristics for different occupation groups showed that while certain patterns were shared among some groups, there were also patterns that were unique to an occupation group. Forest workers were estimated to be the most mobile occupation group, and also had the highest potential malaria exposure associated with their daily travel in Ann Township. In Singu Township, forest workers were not the most mobile group; however, they were estimated to visit regions that had higher prevalence of malaria infection over other occupation groups. CONCLUSIONS Using an ABM to simulate daily travel generated mobility patterns for different occupation groups. These spatial patterns varied by occupation. Our simulation identified occupations at a higher risk of being exposed to malaria and where these exposures were more likely to occur.
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Affiliation(s)
- Yao Li
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, Maryland, USA
| | - Kathleen Stewart
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, Maryland, USA
| | - Kay Thwe Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Zay Yar Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Poe P Aung
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Zaw W Thein
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Thura Htay
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Dong Chen
- Department of Geographical Sciences, University of Maryland, College Park, Maryland, USA
| | - Myaing M Nyunt
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher V Plowe
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Risk factors associated with malaria infection along China–Myanmar border: a case–control study. Malar J 2022; 21:288. [PMID: 36210453 PMCID: PMC9548336 DOI: 10.1186/s12936-022-04312-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) has certificated China malaria free, but imported malaria is a continuous challenge in preventing reintroduction of malaria in the border area of China. Understanding risk factors of malaria along China–Myanmar border is benefit for preventing reintroduction of malaria in China and achieving the WHO’s malaria elimination goal in the Greater Mekong Subregion (GMS). Methods This is a case–control study with one malaria case matched to two controls, in which cases were microscopy-confirmed malaria patients and controls were feverish people with microscopy-excluded malaria. A matched logistic regression analysis (LRA) was used to identify risk factors associated with malaria infection. Results From May 2016 through October 2017, the study recruited 223 malaria cases (152 in China and 71 in Myanmar) and 446 controls (304 in China and 142 in Myanmar). All the 152 cases recruited in China were imported malaria. Independent factors associated with malaria infection were overnight out of home in one month prior to attendance of health facilities (adjusted odd ratio [AOR] 13.37, 95% confidence interval [CI]: 6.32–28.28, P < 0.0001), staying overnight in rural lowland and foothill (AOR 2.73, 95% CI: 1.45–5.14, P = 0.0019), staying overnight at altitude < 500 m (AOR 5.66, 95% CI: 3.01–10.71, P < 0.0001) and streamlets ≤ 100 m (AOR9.98, 95% CI: 4.96–20.09, P < 0.0001) in the border areas of Myanmar; and people lacking of knowledge of malaria transmission (AOR 2.17, 95% CI: 1.42–3.32, P = 0.0004). Conclusions Malaria transmission is highly focalized in lowland and foothill in the border areas of Myanmar. The risk factors associated with malaria infection are overnight staying out of home, at low altitude areas, proximity to streamlets and lack of knowledge of malaria transmission. To prevent reintroduction of malaria transmission in China and achieve the WHO goal of malaria elimination in the GMS, cross-border collaboration is continuously necessary, and health education is sorely needed for people in China to maintain their malaria knowledge and vigilance, and in Myanmar to improve their ability of personal protection. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04312-5.
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