Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study

Malaria Journal

Research

Rungrawee Tipmontree¹  Mondha Kengganpanich²  Tin Oo³  Khin Thet Wai³  Jaranit Kaewkungwal⁴  Ngamphol Soonthornworasiri⁴  Aung Ye Naung Win⁵  Thae Maung Maung⁶  Aung Thi⁷ 

[1] Bureau of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand;Department of Health Education and Behavior Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand;Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar;Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Epidemiology Research Division, Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar;Medical Statistics Division, Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar;National Malaria Control Programme, Department of Public Health, NayPyiTaw, Myanmar;

关键词: Malaria elimination;    Migrant workers;    Mixed-methods design;    Voluntary health workers;    Rural health centers;    Public sector;    Myanmar;    GMS;   

DOI  :  10.1186/s12936-017-2113-4

 received in 2017-07-13, accepted in 2017-11-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMigration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting.MethodsA mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013–2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016–2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings.ResultsAmong others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap anti-malarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centres and voluntary health workers worsened the situation.ConclusionsMitigating key drivers that favour poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for the NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals. Further innovative out-reach programmes designed and implemented specific to the nature of mobile/migrant workers is crucial.

【 授权许可】

CC BY   
© The Author(s) 2017