The Malaria Control and Mapping for MMPs Programme, implemented by the Cambodian Health Partnership Consortium (HPA, CRS, and PfD), targets mobile and migrant populations (MMPs) not currently supported by existing health systems or ongoing malaria programme activities along the Cambodia-Loas Border. The programme provides capacity building to PHD/OD/HC through provincial teams which also undertake community mobilization/BCC activities, KAP MMP Outreach, and VMW support activities.
Mobile and migrant populations, particularly those involved in forest related activities are “both at high risk of being infected with malaria and at risk of receiving late and sub-standard treatment due to poor access to health services” (Guyant, et al., 2015).
Malaria in Cambodia and the rest of Southeast Asia has been referred to as ‘forest malaria’ due the main vectors of malaria being forest vectors such as Anopheles dirus and Anopheles minimus. Bates et al. define vulnerability as encompassing “the factors that lead to variation in the impact of disease between different communities and individuals” (Bates, et al., 2004). MMPs are vulnerable to malaria particularly because many often come from non-forested areas where they are not exposed to malaria, compared to the local population who may have developed a relative immunity to malaria through past contraction. Furthermore MMPs, are less likely to have been exposed to educational messaging than the local population who have been exposed to health messaging due to their proximity to malaria transmission areas. Knowing where to seek treatment may pose an additional challenge to an MMP who contracts malaria as they may be unfamiliar with the local context.
Guyant et all put forward a framework to categorize MMPs in Cambodia with the aim to “develop more targeted behavior change and outreach interventions” (Guyant, et al., 2015). This framework categorized MMPs based on their risk scores on vulnerability (immunity score, economic score, and knowledge score), access (demand and supply), exposure (work in relation to forest, housing type, ownership and use of preventative measures) indices with a higher total score indicating higher risk (ibid).
This analysis found that the highest risk groups in order were mobile forest workers, migrant forest workers, mobile construction workers, mobile security personnel and local forest workers. Overall the study found that MMPs engaged in forest related activities were more at risk (ibid). In this regard, this study has a particular emphasis on better understanding MMPs who are more exposed to the forest.
Scope of Work
To better understand the user context, CHPC conducted a household survey on 8566 MMP households and household members in target regions. The purpose of the review was to summarize the main results from the household survey conducted across the three implementation regions. This review also focused on describing MMPs in the projects target regions, summarizing the knowledge, attitudes and practices of MMPs towards malaria and health-seeking behavior, and identifying key recommendations for future IEC/BCC toolkit development.
Village Malaria Workers. Findings suggest that VMWs influence both malaria knowledge and mosquito net usage. A linear regression found that having a VMW in the village is a strong predictor of malaria knowledge, as measured through the overall percentage correct on knowledge items. Furthermore, Chi-square tests determine that there is a statistically significant association between having a VMW in the village and having used a mosquito net recently. The project should continue to actively support VMWs in capacity building and outreach activities as they are effective implementation modalities.
Access to Village Malaria Workers and barriers to seeking treatment from VMWs. Not all respondents have access to VMWs in their village. 47.5% of participants have a Village Malaria Worker in their village and 60.1% report having used VMW services. In Mondul Kiri, for example, only 37% of respondents’ report using the services provided by a VMW. Furthermore, the most common barrier to respondents seeking treatment from VMWs was that they lacked medical supplies (6.1%) or were too far away (2.4%). The programme should address this in its on-going advocacy activities with local partners.
Malaria Knowledge. Whilst on average all regions exhibited strong knowledge of malaria (Mean 89.9% on knowledge items), only 36% of participants could correctly list three more symptoms of Malaria. IEC/BCC activities should focus on improving the ability of MMPs to identify symptoms to ensure timely access to treatment.