Population Services International, Phnom Penh, Cambodia.
Population Services International, Washington, DC, USA.
Malar J. 2022 Dec 2;21(1):362. doi: 10.1186/s12936-022-04390-5.
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.
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.
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 from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32-18.12).
Study findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking.
柬埔寨在实现 2025 年消除疟疾目标方面取得了重大进展。病例持续减少，主要集中在森林地区。由于靠近森林、睡眠条件差、频繁流动以及远离医疗服务，森林工作者面临最大的疟疾风险。持续使用长效驱虫蚊帐或吊床蚊帐（LLIN/LLIHN）、及时诊断和治疗病例是减轻疾病负担的核心。本研究旨在了解森林工作者在预防和寻求疟疾护理方面的知识、态度和做法，并确定 LLIN/LLIHN 使用和发热后 24 小时内及时就医的关键行为决定因素。
本研究采用横断面调查和定性深入访谈相结合的混合方法设计，在柬埔寨的两个省份实施。使用应答驱动抽样法招募调查参与者（N=654）。采用目的性抽样法选择访谈参与者（N=28）。使用单变量和双变量分析以及多变量加权逻辑回归分析对调查结果进行分析。对访谈内容进行编码和主题内容分析。
所有研究参与者都听说过疟疾，98%的人知道疟疾是由蚊子传播的。LLIN/LLIHN 的拥有率很高（94%）。尽管 99%的参与者认为 LLIN/LLIHN 使用是预防疟疾的重要措施，但只有 76%的参与者在最近一次前往森林时使用了 LLIN/LLIHN。在最近一次发热性疾病期间，仅 39%的报告就医的调查参与者在建议的 24 小时内就医。在所有研究参与者中，43%的人在最近一次发热时没有寻求任何医疗服务。在控制回归模型中，社区社会规范感知与 LLIN/LLIHN 使用（OR：2.7，96%CI 1.99-2.64）和发热后 24 小时内就医（OR：1.7，95%CI 1.00-2.88）显著相关。来自其他森林工作者的社会支持也与 LLIN/LLIHN 使用显著相关（OR：4.9，95%CI 1.32-18.12）。
研究结果与其他关于 LLIN/LLIHN 使用和就医行为的研究一致。虽然研究人群中 LLIN/LLIHN 的拥有率很高，但使用率却不高。更令人担忧的是就医时间延迟。鉴于已确定的与 LLIN/LLIHN 使用和及时就医相关的积极关联，社会行为改变活动应将社会规范和社会支持作为行为改变的机制。
