The health beliefs, dengue knowledge and control behaviors among internally displaced persons versus local residents in Kachin Special Region II, Myanmar

Cooperative Sentinel Surveillance of Malaria in Laiza and Nearby Areas of Myanmar and Importation Threat Monitoring - China, 2019-2023

Introduction

Laiza and nearby areas (LNA) in Myanmar are identified as the primary malaria hotspots in the bordering regions of Yunnan Province, China.

Methods

Six sentinel surveillance sites were established at the China-Myanmar border in LNA to monitor malaria. Data from 2019 was used as a baseline to analyze malaria incidence and trends in LNA and Myanmar, as well as the importation of malaria cases into China from 2019 to 2023.

Results

Plasmodium vivax was the predominant species, representing 99.95% (14,060/14,066) of confirmed malaria cases in LNA. A total of 8,356 malaria cases were identified in 2023, with an annual parasite incidence (API) of 19.78 per 100 person-years. Compared to 2019, the incidence rate ratio was 21.47 (95% confidence interval: 18.84, 24.48), indicating that the API in 2023 was 21.47 times higher than that in 2019. In Yunnan, out of 1,016 reported cases, 545 imported cases (53.64%) originated from LNA and spread to 18 (13.95%) out of 129 counties. Ten provinces in China, including Yunnan, reported imported malaria cases from LNA in Myanmar.

Conclusions

The increase in population, particularly among internally displaced persons, along with inadequate healthcare services, has led to a notable resurgence of malaria in LNA. This resurgence poses a risk to preventing the re-emergence of malaria transmission in China. There is an urgent need for novel collaborative policies, as well as financial and technical assistance, to enhance malaria control efforts in LNA, Myanmar.

Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border

BACKGROUND

Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border.

METHODS

A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB.

RESULTS

Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07-0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06-4.39, P = 0.0337).

CONCLUSIONS

TSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China.

The public health response to an outbreak of border-spill malaria along China-Myanmar border

INTRODUCTION

Malaria importation can be caused by cross-border movement either of both people and anopheline mosquitoes. However, there still lacks robust evidence of imported malaria caused by Plasmodium spp. infected anopheles along international border areas (border-spill malaria). The objectives of this study were to confirm whether an outbreak of Plasmodium vivax malaria is border-spill malaria and assess the effects of China's public health response along China-Myanmar border.

METHODS

Epidemiological, parasitological and entomological investigations were conducted to investigate the outbreak of border-spill malaria. Meanwhile, comprehensive interventions were carried out to prevent further transmission and reintroduction of malaria.

RESULTS

Rapid diagnostic testing, microscopy and polymerase chain reaction were performed and the infections were confirmed as P. vivax. A total of 22 (9.21%) of 239 workers contracted P. vivax during the outbreak. Multivariate logistic regression analysis identified that the distance of worker shelters in China within 300 meters to the internally displaced person (IDP) camps in Myanmar was a risk factors associated with malaria infection (adjusted odds ratio 7.5920; 95% confidence interval, 2.6079-22.1013; P = 0.0002). After comprehensive interventions, malaria transmission was successfully interpreted and prevented at the project site till the completion of project on 14 January 2020, and recurrence of P. vivax malaria was not detected by the end of 2020.

CONCLUSION

This study provided robust evidence of border-spill malaria along China-Myanmar border. Malaria parasite reservoir and distance travelled by female anopheline mosquitoes are two determinants for border-spill malaria. The public health response to the outbreak indicates that the malaria surveillance and response system works well in preventing reintroduction of malaria. However, prevention of border-spill malaria is still a major challenge in the Yunnan border area, China.

Risk factors associated with malaria infection along China–Myanmar border: a case–control study

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.

Association between post-traumatic stress symptoms and functional health among internally displaced people in Myanmar

WHAT IS KNOWN ON THE SUBJECT?: Internally displaced persons (IDPs) in Myanmar have been exposed to conflict and violence for a long time and experience physical, psychological and social problems. Post-traumatic stress symptoms (PTSS) are more prevalent among IDPs than among general populations and refugees, and limited research is available on this topic among IDPs in Myanmar. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: More than one-third of the IDPs in our sample from Myanmar camps had a high PTSS score. More than two-thirds experienced traumatic events and left home after age 18. The overall functional health of IDPs was poor, and the presence or absence of PTSS led to differences in the factors associated with functional health in each group. Resilience and PTSS were associated with the functional health of IDPs in Myanmar. Further, functional health was positively correlated with levels of resilience among those relatively low in PTSS. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to assess IDPs' health status and PTSS by first performing health screening at camps in Myanmar. Subsequently, tailored interventions can be provided according to individual health conditions and PTSS severity. IDPs in Myanmar need psychological first aid to cope with the ongoing conflict and violence, and further mental health nurse training is necessary to implement this aid and tailored interventions for PTSS.

ABSTRACT

INTRODUCTION: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post-traumatic stress symptoms (PTSS) are prevalent in this population.

AIM

To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS.

METHOD

This cross-sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t-tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses.

RESULTS

Over one-third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS.

DISCUSSION

Tailored resilience-building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS.

IMPLICATIONS FOR PRACTICE

Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly.

Malaria from hyperendemicity to elimination along international borders in Yunnan, China during 2003‒2020: a case study

BACKGROUND

Border malaria is one of the most intractable problems hindering malaria elimination worldwide. Movement of both the human population and anopheline mosquitoes infected with Plasmodium spp. can cause cross-border malaria transmission. The Yunnan border area was still hyperendemic for malaria in the early part of this century. The objective of this case study was to analyze the strategies, interventions and impacts of malaria control and elimination in the Yunnan border area.

MAIN TEXT

A total of 10,349 malaria cases and 17.1 per 10,000 person-years of annual parasite incidence (API) were reported in the border area in 2003. Based on natural village-based stratification, integrated interventions, including mass drug administration for radical cures and preventive treatment, clinically presumptive treatment of all febrile patients for malaria and indoor residual spraying or dipping bed nets with insecticides were successfully carried out from 2003 to 2013. The overall API was reduced to 0.6 per 10,000 person-years by 2013, while effective cross-border collaboration interventions dramatically reduced the malaria burden in the neighbouring border areas of Myanmar. From 2014 forward, the comprehensive strategy, including universal coverage of surveillance to detect malaria cases, a rapid response to possible malaria cases and effective border collaboration with neighbouring areas, successfully eliminated malaria and prevented reintroduction of malaria transmission in the Yunnan border area.

CONCLUSIONS

In Yunnan malaria burden has successfully reduced by dynamically accurate stratification and comprehensive interventions; and then the region achieved elimination and prevented reintroduction of malaria transmission through intensive surveillance, rapid response and border collaboration. Other border areas should perform their own intervention trials to develop their own effective strategy.

Public and health professional epidemic risk perceptions in countries that are highly vulnerable to epidemics: a systematic review

Background

Risk communication interventions during epidemics aim to modify risk perceptions to achieve rapid shifts in population health behaviours. Exposure to frequent and often concurrent epidemics may influence how the public and health professionals perceive and respond to epidemic risks. This review aimed to systematically examine the evidence on risk perceptions of epidemic-prone diseases in countries highly vulnerable to epidemics.

Methods

We conducted a systematic review using PRISMA standards. We included peer-reviewed studies describing or measuring risk perceptions of epidemic-prone diseases among the general adult population or health professionals in 62 countries considered highly vulnerable to epidemics. We searched seven bibliographic databases and applied a four-stage screening and selection process, followed by quality appraisal. We conducted a narrative meta-synthesis and descriptive summary of the evidence, guided by the Social Amplification of Risk Framework.

Results

Fifty-six studies were eligible for the final review. They were conducted in eighteen countries and addressed thirteen epidemic-prone diseases. Forty-five studies were quantitative, six qualitative and five used mixed methods. Forty-one studies described epidemic risk perceptions in the general public and nineteen among health professionals. Perceived severity of epidemic-prone diseases appeared high across public and health professional populations. However, perceived likelihood of acquiring disease varied from low to moderate to high among the general public, and appeared consistently high amongst health professionals. Other occupational groups with high exposure to specific diseases, such as bushmeat handlers, reported even lower perceived likelihood than the general population. Among health professionals, the safety and effectiveness of the work environment and of the broader health system response influenced perceptions. Among the general population, disease severity, familiarity and controllability of diseases were influential factors. However, the evidence on how epidemic risk perceptions are formed or modified in these populations is limited.

Conclusions

The evidence affords some insights into patterns of epidemic risk perception and influencing factors, but inadequately explores what underlies perceptions and their variability, particularly among diseases, populations and over time. Approaches to defining and measuring epidemic risk perceptions are relatively underdeveloped.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00927-z.

Community Knowledge and Attitudes about the Transmission of Dengue Haemorrhagic Fever and Its Relationship to Prevention Behaviour in Palembang, South Sumatra, Indonesia

BACKGROUND: PSN 3 M Plus is a long-running program in Indonesia for the prevention and control of dengue hemorrhagic fever (DHF). AIM: This study aimed to determine the knowledge, behavior, attitudes, and beliefs of the community toward PSN 3 M Plus in preventing and controlling the spread of DHF. METHODS: A cluster random sampling method was used to recruit 200 respondents in endemic areas and 100 respondents in sporadic locations of Indonesia from August 2020 to February 2021. The respondents were interviewed directly by interviewers and the relationships between demographics and characteristics with the practice of PSN 3M Plus prevention behavior on the incidence of DHF were analyzed. RESULTS: Most respondents had good knowledge regarding the cause of DHF. Although respondents recognized and understood the dangers of and how to control DHF, most did not follow PSN 3 M Plus and believed that fogging was the most effective control measure. There was a significant relationship between the characteristics of the respondents in terms of education, occupation, and attitude on vector control practice. CONCLUSION: Although community environmental modifications can be a cost-effective approach to reduce the incidence of DHF, there is a need to raise public awareness regarding preventive vector control measures as good knowledge does not guarantee good compliance with PSN 3M Plus recommendations.

The health perceptions, dengue knowledge and control willingness among Dai ethnic minority in Yunnan Province, China

Background

Outbreaks of dengue fever are often found among Dai ethnical communities along China-Myanmar border. The objective of this study was: 1) to investigate residents’ health perceptions, knowledge and control willingness to participate in dengue control and 2) to identify factors associated with control willingness among the Dai ethnic community.

Methods

This is a mixed method study of a cross-sectional design, in which qualitative in-depth interviews and quantitative household questionnaire surveys are included.

Results

Questionnaire was administered to 261 household heads, and in-depth interview was conducted with 18 key informants. Of them, many participants (70%, 182/259) and 12 key informants (66.7%) from the two rural communities believed that the Lord Buddha would protect the good people. Majority of the participants (81.4%, 206/253) knew that fever was one of dengue fever symptoms and most of them (82.2%, 213/259) indicated that mosquitoes could transmit dengue fever. However, only one third of the participants (30.1%, 78/259) indicated the perceived susceptibility of dengue fever, and only a half of them (50.2%, 130/259) indicated the perceived severity of dengue fever. Multivariate logistic analysis (MLA) indicated that the participants with family wealth index (FWI) 4–5 (OR: 22.9728; 95%CI: 2.4257–217.5688, p = 0.0063) were more likely to turn containers upside down (TCUD) compared to those with FWI 1–3; and the participants in the urban community (OR: 0.0239; 95%CI: 0.0019–0.3032, p = 0.004) were less likely to TCUD compared to those in the two rural communities. Around one third of the participants (36.8%, 96/239) reported that they were willing to seek treatment first for dengue fever from public health facilities. The MLA identified that the participants with the perceived severity of dengue fever (OR: 5.0564; 95%CI: 2.0672–12.3683, p = 0.0004), and with beliefs of sound hygiene helpful to people’s health (OR: 11.5671; 95%CI: 2.0505–65.2502, p = 0.0055) were more likely to seek treatment first for dengue fever from the public health facilities.

Conclusion

The study finds that most of Dai people have sound knowledge. However, health educational interventions should target to promote the perceived susceptibility and the perceived severity of dengue fever among Dai people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11864-9.

Intensive surveillance, rapid response and border collaboration for malaria elimination: China Yunnan's ''3 + 1''strategy

Background

Eliminating malaria and preventing re-establishment of malaria transmission in border areas requires universal coverage of malaria surveillance and a rapid response to any threats (i.e. malaria cues) of re-establishing transmission.

Main text

Strategy 1: Intensive interventions within 2.5 km-wide perimeter along the border to prevent border-spill malaria. The area within 2.5 km along the international border is the travel radius of anopheline mosquitoes. Comprehensive interventions should include: (1) proactive and passive case detection, (2) intensive vector surveillance, (3) evidence-based vector control, and (4) evidence-based preventative treatment with anti-malarial drugs. Strategy 2: Community-based malaria detection and screening of migrants and travellers in frontier townships. Un-permitted travellers cross borders frequently and present in frontier townships. Maintenance of intensified malaria surveillance should include: (1) passive malaria detection in the township hospitals, (2) seek assistance from villager leaders and health workers to monitor cross border travellers, and refer febrile patients to the township hospitals and (3) the county’s Centre for Disease Control and Prevention maintain regular proactive case detection. Strategy 3: Universal coverage of malaria surveillance to detect malaria cues. Passive detection should be consolidated into the normal health service. Health services personnel should remain vigilant to ensure universal coverage of malaria detection and react promptly to any malaria cues. Strategy + 1: Strong collaborative support with neighbouring countries. Based on the agreement between the two countries, integrated control strategies should be carried out to reduce malaria burden for both countries. There should be a clear focus on the border areas between neighbouring countries.

Conclusion

The 3 + 1 strategy is an experience summary of border malaria control and elimination, and then contributed to malaria elimination in Yunnan’s border areas, China. Nevertheless, Yunnan still has remaining challenges of re-establishment of malaria transmission in the border areas, and the 3 + 1 strategy should still be carried out.

Development and validation of a structured survey questionnaire on knowledge, attitude, preventive practice, and treatment-seeking behaviour regarding dengue among the resident population of Sabah, Malaysia: an exploratory factor analysis

BACKGROUND

Several studies have reported a significant association of knowledge, attitude and preventive practice (KAP) regarding dengue infection among community's resident in endemic areas. In this study we aimed to assess and develop a reliable and valid KAP survey on the subject of dengue that is suitable for the resident population of Sabah, Malaysia.

METHODS

A community-based cross-sectional study was conducted from October 2019 to February 2020 involving 468 respondents. Information on the socio-demographic characteristics of the participants (six items), their KAP (44, 15 and 18 items on knowledge, attitude and practice, respectively) and treatment-seeking behaviour (five items) towards dengue was collected using a structured questionnaire. Data analysis was performed using SPSS and R software in the R Studio environment. The knowledge section was analysed by two-parameter logistic item response theory (2-PL IRT) using ltm package. The construct validity and reliability of items for sections on attitude, practice and treatment-seeking behaviour were analysed using psy package.

RESULTS

For the knowledge section, only 70.5% (31/44) of items were within or close to the parameter acceptable range of -3 to + 3 of difficulty. In terms of discrimination, 65.9% (29/44) of items were within or close to the acceptable range of 0.35 to 2.5, and 24 items (54.5%) failed to fit the 2-PL IRT model (P < 0.05) after assessing by goodness-of-fit analysis. Only eight items were reliable and retained in the attitude section with a Kaiser-Meyer-Olkin (KMO) test value of > 0.7, while based on the communalities, 11 items in the attitude section were excluded due to very low h2, factor loading values and low correlation with the total (< 0.5). The practice section was found suitable for factor analysis because the KMO value was > 0.7. The communalities of the practice section showed that seven items had low h2 values (< 0.3), which were therefore excluded from further analysis, and only 11 items were retained.

CONCLUSIONS

The KAP items retained in the final version of the survey were reliable and valid to be use as a questionnaire reference when conducting future similar studies among the population of Sabah.

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.