Social Determinants of Malaria among Gold Miners in Shwekyin Township, Myanmar

Abstract

Background: Myanmar is one of the countries with evidence of artemisinin resistance and the greatest burden of malaria in the Greater Mekong Subregion. At present, migrant/mobile populations are considered to play a major role in the potential spread of artemisinin-resistant malaria within countries and across borders. In this regard, we conducted a cross-sectional community-based survey in Shwekyin Township, Bago Division, of Myanmar from March to April of 2013 to investigate social determinants of malaria among gold miners. Methodology: We conducted a total of nine Key Informant Interviews and five Focus Group Discussions in two gold mines and two villages with different accessibilities to health facilities. We asked key informants about local health services, people’s perception of malaria, and treatment-seeking behaviors. We performed Focus Group Discussions on knowledge, attitudes, and treatment-seeking behaviors of migrants regarding malaria. Results: Most villagers and gold miners had a fair understanding of causes, transmission, and symptoms of malaria though somewhat mixed and confused. The villagers had better knowledge and practices of prevention than the gold miners. Though villagers close to rural health centre used to undergo treatment within 48 hours of fever, those living with malaria social workers and gold miners were still experiencing self-treatment. Drug retailers played a major role in their first and initial response to malaria. Artesunate and artemether were the most familiar anti-malarials among all respondents. All the respondents accepted the use of rapid diagnostic tests well but they understood negative test results poorly and sometimes this led to self-treatment using artemisinin-based monotherapies. Conclusion: Limited knowledge and practice of malaria prevention might be social determinants of malaria among gold miners. Self-treatment using artemisinin-based monotherapies was still common, even after negative rapid diagnostic test results in the vicinity of a health facility.