AUTHOR=Nguyen Thuan Thi , Gryseels Charlotte , Tran Duong Thanh , Smekens Tom , Gerrets René , Nguyen Xa Xuan , Peeters Grietens Koen 

TITLE=Understanding Malaria Persistence: A Mixed-Methods Study on the Effectiveness of Malaria Elimination Strategies in South-Central Vietnam

JOURNAL=Frontiers in Public Health

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.742378

DOI=10.3389/fpubh.2021.742378

ISSN=2296-2565

ABSTRACT=Despite the scale-up of vector control, diagnosis and treatment, active surveillance and health information campaigns, malaria persists in the forested areas of South-Central Vietnam, home to ethnic minority populations. A mixed-methods study using an exploratory sequential design was conducted in ten Ra-glai villages in Bac Ai district of Ninh Thuan province to examine which social factors limited the effectiveness of the national malaria elimination strategy in the local setting. Territorial arrangements and mobility between the old and new villages were found to directly limit the effectiveness of indoor residual spraying, insectidical treated nets and hammock nets. Households (n=410) were resettled in “new villages” by the government, where they received brick houses (87.1%) and sufficient bednets (97.3%). However, 97.6% of households went back to their “old villages” to continue slash-and-burn agriculture. In the old village, 48.5% of households lived in open-structured plot huts (48.5%) and only 5.7% of them had sufficient bednet coverage. Household representatives believed malaria could be cured with medicines (57.8%), but also perceived non-malarial medicines, rituals, and vitamin supplements to be effective against malaria. Household members (n=1,957) used public health services for their most recent illness (62.9%), but also reported to buy low-cost medicines in the private sector to treat fevers and discomfort as these were perceived to be the most cost-effective treatment option for slash-and-burn farmers. The study calls for the application of a complex system approach to malaria persistence that intervention strategies are adaptive and reflexive to the socio-ecological diversity and local contexts shaping malaria persistence.