Low perception of malaria risk among the Ra-glai ethnic minority in south-central Vietnam: implications for forest malaria control
Low perception of malaria risk among the Ra-glai ethnic minority in south-central Vietnam: implications for forest malaria control
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DOI：
10.1186/1475-2875-9-23
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发表时间：
2010-01-20
期刊：
影响因子：
3
通讯作者：
Erhart, Annette
中科院分区：
文献类型：
--
作者：
Grietens, Koen Peeters;Xa Nguyen Xuan;Erhart, Annette
背景：尽管越南在过去十年中在降低疟疾死亡率和发病率方面取得了成功，但疟疾仍然存在于中南部省份的森林和山区，50%以上的临床病例和90%的重症病例和疟疾死亡发生在那里。方法：2005年7月至2006年9月，一项多方法研究，对疟疾横断面调查和重点人种学的定性数据进行三角测量，结果：尽管拉格里人的疟疾负担相对较高，而且他们普遍意识到蚊子可以传播一种非特异性的发热(84.2%)，但在疟疾风险最高的农民林地，国家疟疾控制计划免费分发的蚊帐的使用率仍然很低。然而，为了满足劳动密集型疟疾传播和雨季期间的工作要求，Ra-tari农民将居住在公路沿线政府支持的村庄与位于森林中的砍伐和焚烧田地的第二个家或庇护所结合在一起。村中蚊帐使用率为84.6%，林地中蚊帐使用率仅为52.9%，两地均有20.6%的被调查者露宿。如此低的使用量可能是因为人们对疟疾风险的认识较低，减少了对睡眠保护的感知需求。原因有以下几点：(1)只有15.6%的人承认在森林中感染疟疾的风险比在村子里高；(2)蚊虫叮咬的感知时间与大劣按蚊和微小按蚊的真实叮咬时间只有部分重合；(3)当地确认为疟疾的疾病对林农的日常生活几乎没有影响，因为即使在卫生中心被诊断为疟疾(20.9%)后，他们也不知道自己患上了哪种特殊的发烧。结论：疟疾逐渐限制在大湄公河次区域的少数群体和环境中，这意味着疟疾控制的进一步成功将与对这些特定社会文化背景的研究相联系。调查结果突出表明，需要制定针对具体情况的疟疾控制政策；这不仅是为了减轻当地的疟疾负担，而且也是为了最大限度地减少疟疾传播到实际上已停止传播的其他地区的风险。
Background: Despite Vietnam's success in reducing malaria mortality and morbidity over the last decade, malaria persists in the forested and mountainous areas of the central and southern provinces, where more than 50% of the clinical cases and 90% of severe cases and malaria deaths occur.Methods: Between July 2005 and September 2006, a multi-method study, triangulating a malariometric cross-sectional survey and qualitative data from focused ethnography, was carried out among the Ra-glai ethnic minority in the hilly forested areas of south-central Vietnam.Results: Despite the relatively high malaria burden among the Ra-glai and their general awareness that mosquitoes can transmit an unspecific kind of fever (84.2%), the use of bed nets, distributed free of charge by the national malaria control programme, remains low at the farmers' forest fields where the malaria risk is the highest. However, to meet work requirements during the labour intensive malaria transmission and rainy season, Ra-glai farmers combine living in government supported villages along the road with a second home or shelter at their slash and burn fields located in the forest. Bed net use was 84.6% in the villages but only 52.9% at the forest fields; 20.6% of the respondents slept unprotected in both places. Such low use may be explained by the low perception of the risk for malaria, decreasing the perceived need to sleep protected. Several reasons may account for this: (1) only 15.6% acknowledged the higher risk of contracting malaria in the forest than in the village; (2) perceived mosquito biting times only partially coincided with Anopheles dirus ss and Anopheles minimus A true biting times; (3) the disease locally identified as 'malaria' was hardly perceived as having an impact on forest farmers' daily lives as they were unaware of the specific kind of fevers from which they had suffered even after being diagnosed with malaria at the health centre (20.9%).Conclusions: The progressive confinement of malaria to minority groups and settings in the Greater Mekong sub-region implies that further success in malaria control will be linked to research into these specific socio-cultural contexts. Findings highlight the need for context sensitive malaria control policies; not only to reduce the local malaria burden but also to minimize the risk of malaria spreading to other areas where transmission has virtually ceased.