Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia

• Published in: Malaria Journal
• Main Authors: Sochea Phok, Kemi Tesfazghi, Andy Tompsett, Boukheng Thavrine, Po Ly, Saad El-Din Hassan, Avery Avrakotos, Jim Malster, Erica Felker-Kantor
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Forest-goers; Malaria; Long-lasting insecticide-treated nets; Care-seeking; Cambodia; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-022-04390-5; https://doaj.org/article/6953fa4f687943d98927211285d07d76

Abstract Background Cambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers’ knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever. Methods A mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis. Results All study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99–2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00–2.88). Social support ...