Malaria prevention in eastern Myanmar
Background: Insecticide-treated bed-nets (ITNs) and mass drug administration (MDA) are key malaria elimination tools but their varied uptake has not been extensively explored among ethnic minority and displaced populations in Southeast Asia. Objectives: (1) To describe prevalence of ITN possession, access, and use; (2) assess the association between biological sex of household members and ITN use and whether any such associations were dependent on age or household ITN supply; and (3) provide an overview of factors affecting uptake of ITNs and MDA in Southeast Asia. Methods: Manuscript 1. Data from ethnic minority and internally displaced communities in eastern Myanmar was used to describe prevalence of ITN possession, access, and use. The association between a household member’s biological sex and their ITN use was assessed using multilevel log binomial regression. Age and sufficient household ITN supply were tested as potential effect modifiers. Manuscript 2. A scoping review of academic and grey literature was conducted to provide an overview of factors influencing ITN use and individual participation in MDA programs in South East Asian countries. Results: Manuscript 1. 89.9% (95% CI: 89.6, 90.2) of people lived in households with at least one ITN. Approximately half belonged to households with sufficient ITN supply and used an ITN. Pregnant women and children under five had the highest proportion of ITN use regardless of sufficient household ITN status. Female adults aged 15 to 49 years old (RR: 1.1, 95% CI: 1.05, 1.08) and females aged 50 years and above (RR: 1.04, 95% CI: 1.01, 1.06) were more likely to use ITNs. This relationship did not differ by sufficient household ITN status. Manuscript 2. Determinants of ITN and MDA coverage were quite consistent across interventions and countries and related to access, knowledge of malaria, intervention knowledge, perceptions of interventions, social dynamics, affordability and incentives, and individual sociodemographic characteristics. “Social dynamics” was a unique determinant of MDA individual participation. Conclusion: Certain subgroups were more likely to use ITNs, although overall ITN access and use remains low. Further research and interventions are needed to address gaps in ITN access and use, and MDA participation across Southeast Asia.