Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Malar J. 2021 Nov 25;20(1):446. doi: 10.1186/s12936-021-03983-w.
In the Greater Mekong Subregion, adults are at highest risk for malaria, particularly those who visit forests. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria.
Alongside a clinical trial of anti-malarial chemoprophylaxis in northern Cambodia, qualitative research was conducted, including in-depth interviews and observation, to explore the acceptability of malaria prophylaxis for forest goers, the implementation opportunities, and challenges of this strategy.
Prophylaxis with artemether-lumefantrine for forest goers was found to be acceptable under trial conditions. Three factors played a major role: the community's awareness and perception of the effectiveness of prophylaxis, their trust in the provider, and malaria as a local health concern. The findings highlight how uptake and adherence to prophylaxis are influenced by the perceived balance between benefits and burden of anti-malarials which are modulated by the seasonality of forest visits and its influence on malaria risk.
The implementation of anti-malarial prophylaxis needs to consider how the preventive medication can be incorporated into existing vector-control measures, malaria testing and treatment services. The next step in the roll out of anti-malarial prophylaxis for forest visitors will require support from local health workers.
在大湄公河次区域，成年人感染疟疾的风险最高，特别是那些经常出入森林的人。由于缺乏有效的病媒控制策略，且出入森林的时间有限，因此化学预防可能是保护森林工作者免受疟疾侵害的一种适当策略。
在柬埔寨北部进行抗疟化学预防临床试验的同时，开展了定性研究，包括深入访谈和观察，以探讨森林工作者对疟疾预防的接受程度、该策略的实施机会和挑战。
在试验条件下，发现为森林工作者提供青蒿琥酯-苯芴醇预防疟疾是可接受的。有三个因素起了主要作用：社区对预防措施有效性的认识和看法、对提供者的信任，以及疟疾作为当地的健康关注点。调查结果强调了接受和坚持预防的程度受到抗疟药物益处和负担之间的平衡的影响，这种平衡受森林访问的季节性及其对疟疾风险的影响而发生变化。
实施抗疟预防措施需要考虑如何将预防性药物纳入现有的病媒控制措施、疟疾检测和治疗服务中。下一步将需要当地卫生工作者的支持，以推广针对森林访客的抗疟预防措施。
