Oral Presentation First Malaria World Congress 2018

Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study (#118)

Aung Ye Naung Win 1 2 , Thae Maung Maung 1 , Khin Thet Wai 1 , Tin Oo 1 , Aung Thi 3 , Rungrawee Tipmontree 4 , Ngamphol Soonthornworasiri 2 , Mondha Kengganpanich 5 , Jaranit Kaewkungwal 2
  1. Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
  2. Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  3. Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
  4. Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
  5. Department of Health Education and Behavior Sciences, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Migration flows and emerging resistance to artemisinin-based combination therapies in Greater Mekong Sub-region (GMS) create programmatic challenges to meeting 2030 malaria elimination target in Myanmar. National Malaria Control Program (NMCP) targeted migrant workers based mainly on stability of worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess migration patterns, malaria treatment-seeking preferences, challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting.

A mixed-methods explanatory sequential study retrospectively analyzed secondary data acquired through migrant mapping surveys (2013-2015) in six endemic regions (n=9,603). A multivariate logistic regression model was used to ascertain contributing factors. A qualitative strand (2016-2017) was added by conducting five focus-group discussions (n=50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region.

Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR=1.4 and 2.3 respectively for categories 2 and 1); longer duration of stay (adjusted OR=3.5); adjusted OR < 2 for received malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for informal healthcare sector due to convenience, trust, good relations, and put migrant workers at risk of substandard care. Moreover, the availability of cheap antimalarial in unregistered small groceries encouraged self-medication. Infrequent or no contact with rural health centers and voluntary health workers worsened the situation.

Mitigating key drivers that favor poor utilization of public-sector services among highly mobile migrant workers in less stable work-settings should be given priority in a malaria-elimination setting. These issues are challenging for NMCP in Myanmar and might be generalized to other countries in the GMS to achieve malaria-elimination goals.