How using light touch immersion research revealed important insights into the lack of progress in malaria elimination in Eastern Indonesia

• Published in: Malaria Journal
• Main Authors: Dee Jupp, Sherria Ayuandini, Frisca Tobing, Denny Halim, Enny Kenangalem, Maria E. Sumiwi, Hellen D. Prameswari, Minerva Theodora, Hermawan Susanto, Riskha T. P. Dewi, Dedy Supriyanto, Bayu Kurnia, Mrunal Shetye, Ermi Ndoen, Yuka Onishi
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2024
• Subjects: Malaria; Risk perception; Social determinants; Behavior change; Immersion research; Papua; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic; Sumba
• Online Access: https://doi.org/10.1186/s12936-024-04865-7; https://doaj.org/article/02809307c9a641d98a4e3afbfed33ebb

Abstract Background By 2022, the Government of Indonesia had successfully eliminated malaria in 389 out of 514 districts but continues to face a challenge in Eastern Indonesia where 95% of the total 2021 malaria cases were reported from Papua, West Papua and Nusa Tenggara Timur provinces. There is an increased recognition that malaria elimination will require a better understanding of the human behavioural factors hindering malaria prevention and treatment, informed by local context and local practice. Methods This research used a light-touch immersion research approach. Field researchers lived in communities over several days to gather data through informal conversations, group-based discussions using visual tools, participant observation and direct experience. The study was conducted in four high malaria endemic areas in Papua, West Papua, and Sumba Islands in Nusa Tenggara Timur. Results The research highlights how people’s perception of malaria has changed since the introduction of effective treatment which, in turn, has contributed to a casual attitude towards early testing and adherence to malaria treatment. It also confirms that people rarely accept there is a link between mosquitoes and malaria based on their experience but nevertheless take precautions against the annoyance of mosquitoes. There is widespread recognition that babies and small children, elderly and incomers are more likely to be seriously affected by malaria and separately, more troubled by mosquitoes than indigenous adult populations. This is primarily explained by acclimatization and strong immune systems among the latter. Conclusions Using immersion research enabled behaviour research within a naturalistic setting, which in turn enabled experiential-led analysis of findings and revealed previously unrecognized insights into attitudes towards malaria in Eastern Indonesia. The research provides explanations of people’s lack of motivation to consistently use bed nets, seek early diagnosis or complete courses of treatment. The felt concern ...