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CASE STUDIES of MALARIA PATIENTS Thanatcha THE STUDY OF FACTORS CONTRIBUTING TO MALARIA OCCURRENCE IN SRI TOY SUB-DISTRICT: CASE STUDIES OF MALARIA PATIENTS Thanatcha Thaithanasarn1*, Siriporn Chuathao1, Phuriphat Teeralux2, Taksin Tinmeung3 and Amornrat Anuwatnonthakate1,4 1 Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand 2 Mae Suai Public Health Office, Chiang Rai, Thailand 3 Sri Toy Health Promoting Hospital, Chiang Rai, Thailand 4Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand *e-mail : [email protected] ___________________________________________________________________________ Abstract Background: Malaria is major public health problem in tropical and subtropical areas of the world. In Thailand, malaria remains high prevalence in the forest areas along the mountainous border. This qualitative study aimed to examine how the factors contributing to an occurrence of malaria in Sri Toy sub-district, Mea Suai district, Chiang Rai province. Methods: A qualitative method including in-depth interviews and focus group discussion technique was conducted. Ten participants were recruited from propulsive sampling. Data were obtained from non-participant observation and medical record. Semi-structure questions guideline adopted from Office of Disease Prevention and Control 7, UbonRatchathani were used for collecting data.. The data was verify by the triangulation method and interpretation by the content analysis. Results: The malaria patients were Thai male and Muser, 83.4% were aged 15-44 years old, and all were agriculturist. They had basic knowledge about malaria and experience with malaria influence on their malaria preventive behavior. Moreover, most of them had self- medication before seek medical treatment. The majority of patient living in three villages including Ayiko, Mai Mae Yang Min, and Phaya Kong Dee. In three villages which ongoing of malaria transmission located near the forest and small stream which were ideal for malaria vectors and malaria transmission. The structure of dwelling in the villages has been influenced from culture and economic reason. Conclusion: The factors contributing to malaria occurrence in Sri Toy sub-district are villages located near forest and small stream, uncontrolled migration of students from border area of Thai-Myanmar. ___________________________________________________________________________ Keywords : malaria, factors Rational and Background Malaria is a life-threatening disease and remains a major public health problem in many tropical and subtropical areas of the world. Malaria caused by parasites belonging to the genus Plasmodium. The four human Plasmodium species transmitted from person to person are Plasmodium falciparum, P. vivax, P. ovaleand P. malariae, of which P. falciparum and P. vivax are the most prevalent and P. falciparum the most dangerous. In addition, human infections with the simian malaria parasite P. knowlesi are being reported from the forested 56 regions South-East Asia [1-3]. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors" which bite mainly between dusk and dawn [4-5]. There is available treatment for malaria and artemisinin-based combination therapy (ACT) is the best available treatment for malaria, particularly for P. falciparum malaria. Early diagnosis and treatment of malaria can prevents deaths and reduces disease because it also contributes to reducing malaria transmission. In 2014, global financing for malaria control increased from an estimated US$ 960 million in 2005 to US$ 2.5 billion because of vector control is the main way to prevent and reduce malaria transmission. Two forms of vector control are insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRF). If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community [1][3]. However, appropriate infrastructure and community participation were required to reduce the burden of malaria [6]. Despite being preventable and treatable, malaria continues to have a devastating impact on people’s health and livelihoods around the world. Young children under the age of 5 years old, pregnant women, refugees, non-immune travelers from malaria-free areas are particularly vulnerable to the disease when they become infected. According to the latest available data, about 3.2 billion people were at risk of the disease in 97 countries, territories and areas in 2015, and an estimated 214 million cases of malaria occurred worldwide (range: 149 million–303 million) leading to 438,000 malaria deaths (range: 263,000–635,000) Most cases and deaths in 2015 are estimated to have occurred in the WHO African Region, followed by the WHO South-East Asia Region [7][1][3]. In 2011, 2.1 million confirmed malaria cases and 1819 malaria deaths were reported in the WHO South-East Asia Region reported in the Region [8]. Malaria is still one of the important infectious disease in Thailand, despite decades of successful control programs and dramatic reductions in morbidity and mortality. In 2015, 15,446 malaria cases were reported. One third of cases were foreign national (24.65%) and more than half were Thais (75.35%). The number of patients are lower than the same period of recent year about 50.37% [9-10]. However, malaria remains high prevalence in local clusters, and the forest areas along the mountainous border are the places most affected due to logging, agriculture, road construction and other economic activities along Thailand’s border areas attract people especially hilltribes and migrant workers [11-14]. In Chiang Rai province, 164 malaria cases were reported in surveillance system in 2015. There have many hilltribes and migrant workers, moreover, many areas in Chiang Rai were classified intomalarial transmission area. Sritoy sub-district, Mae Suai district was one of malaria endemic area and classify as the periodic transmission area (A2) [15]. Despite the malaria control program including insecticide-treated nets (ITNs) and indoor residual spraying (IRS) was attempt to reduce and control malaria transmission in this area, malaria cases were reported continuous every years. In 2015, all of malaria cases in Sri Toy sub-district were hilltribes and the morbidity rate was 1.1 per 1,000 population [16]. Nevertheless, the morbidity rate remain higher than the expectation of national malaria control and elimination strategy of Thailand (2011-2016) which Annual Parasite Incidence (API) per 1000 mid‐year population among Thai andnon Thai M1 migrants should reduce to 0.2 per 1000 population by the year 2016 [17]. In spite of many research has studies about the associated factors of malaria, however, no study had been conducting to describes the underlying factors of malaria occurrence in Sri Toy sub- district. In order to understand the underlying reasons for occurrence of malaria in Sri Toy sub- district, the aim of this study were to examine how the factors contributing to an occurrence of malaria in Sri Toy sub-district. We used a qualitative study for describes the underlying 57 factors for occurrence of malaria. The benefit of this study could help to design the appropriate malaria control program in Sri Toy sub-district. Materials and methods Study design and population Aqualitative method including in-depth interviews and focus group discussion technique was conducted in Sri Toy sub-district, Mae Suai district, Chiang Rai, Thailand.Purposive sampling was used to select the subjects and 10 participants were recruited. Inclusion criteria were malaria patients age 15 and above which reported in surveillance system in Sri Toy sub-district during 1 January to 31 December 2015, representative of malaria patient in household present with more than three cases in the past 5 years during 2011 to 2015, recurrent malaria patient age 15 and above in the past 5 years during 2011 to 2015 and related people who responsibility with malaria in Sri Toy sub- district including health worker and malaria village health volunteers. Data collection Data wereobtained from In-depth interviews eight persons, focus group discussion 3 persons, non-participant observation and medical record. Interview was conducted only after the inform consent was obtained from participants. The instruments used in this study were tape recorder, field note and semi-structure questions guideline. Semi-structure questions guidelinewas adopted from Office of Disease Prevention and Control Region 7, UbonRatchathani, Ministry of Public Health. The guideline compose of open-end questions for 3 specific groups in the study.The first is the semi-structured questions guideline for malaria patients contained questions aboutgeneral information of patients (age, gender, marital status, educational level, religious, history of malaria treatment), socioeconomic, culture, knowledge attitude and behavior related to malaria.The second is the semi-structured questions guideline for health worker contained questions aboutactivities related to malaria, malaria control and prevention program, and factors related to malaria occurrence.The third is the semi-structured questions guideline for malaria village volunteer contained questions about knowledge toward malaria, responsibility, and factors related to malaria occurrence. Data analysis Methodological triangulation was used to cross verification of data. Content analysis was used to analyses and categorize
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