Rubber plantations and drug resistant malaria: a cross-sectional survey in Cambodia

The ongoing spread of artemisinin resistant Plasmodium falciparum malaria is a major threat to global health. In response, countries in the Greater Mekong Sub-region, including Cambodia, have declared ambitious goals to eliminate malaria. Major challenges include the lack of information on the at-ri...

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Bibliographic Details
Published in:	Malaria journal Vol. 18; no. 1; pp. 379 - 14
Main Authors:	Thomson, Rebecca, Sochea, Phok, Sarath, Mak, MacDonald, Amanda, Pratt, Abigail, Poyer, Steve, Allen, Henrietta, Kunthy, Sok, Chamroeun, Sok, Daro, Kim, Samean, Sourn, Panharith, Nou, Ra, Sok, Sovottha, Chan, Mundy, Gary, Yeung, Shunmay
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 27-11-2019 BioMed Central BMC
Subjects:	Adolescent Adult Agriculture Antimalarials - pharmacology Artemisinin Artemisinin resistance Artemisinins - pharmacology Asia Cambodia Cambodia - epidemiology Case management Cross-Sectional Studies Diagnostic tests Disease eradication DNA Drug Resistance Drug therapy Female Forest Forestry Forests Gender Gene mutation Genetic analysis Genetic research Global health Health aspects Health care access Health risks Hevea Human diseases Humans Infections Insecticides Malaria Malaria, Falciparum - epidemiology Malaria, Vivax - epidemiology Male Medical diagnosis Middle Aged Mutation Nucleotide sequence Occupational Diseases - epidemiology Occupational Diseases - parasitology PCR Plantation workers Plantations Plasmodium falciparum Plasmodium falciparum - drug effects Plasmodium vivax - drug effects Polls & surveys Population Prevalence Pyrimethamine Questionnaires Risk Factors Risk groups Rubber Rubber industry Security personnel Surveying Surveys Temporary employees Vector-borne diseases Vectors Workers World health Young Adult Cambodia Thailand Artemisinin resistance Forest Cambodia Malaria Asia Plantations
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Summary:	The ongoing spread of artemisinin resistant Plasmodium falciparum malaria is a major threat to global health. In response, countries in the Greater Mekong Sub-region, including Cambodia, have declared ambitious goals to eliminate malaria. Major challenges include the lack of information on the at-risk population-individuals who live or work in or near the forest where the malaria vectors are found, including plantation workers. This study aimed to address this knowledge gap through a cross-sectional survey conducted in rubber plantations in Cambodia in 2014. The survey was conducted in two rounds in four provinces and included a malaria prevalence survey, analysis for the K13 genetic mutation, and a comprehensive behavioural questionnaire. Forty plantations were included in each round, and 4201 interviews were conducted. An additional 701 blood samples were collected from family members of plantation workers. Overall malaria prevalence was relatively low with adjusted PCR prevalence rate of 0.6% for P. falciparum and 0.3% for Plasmodium vivax, and was very heterogenous between plantations. There was little difference in risk between permanent residents and temporary workers, and between the two rounds. The main risk factors for P. falciparum infection were smaller plantations, age under 30 years, lack of self-reported use of a treated net and recent travel, especially to the Northeastern provinces. Proximity of plantations to the forest was also a risk factor for malaria in round one, while male gender was also a risk factor for malaria by either species. With Cambodia's P. falciparum elimination target on the horizon, identifying every single malaria case will become increasingly important. Plantations workers are relatively accessible compared to some other at-risk groups and will likely remain a high priority. Ongoing surveillance and adaptive strategies will be critical if malaria elimination is to be achieved in this setting.
ISSN:	1475-2875 1475-2875
DOI:	10.1186/s12936-019-3000-y