Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

Featured project: Why are forests foci of malaria transmission in western Cambodia, and what can be done to protect forest workers?

Nou Sanann and Tom Peto are 2017 GHBN Bursary Fellows.


Nou Sanann: I manage a research station in Pailin, western Cambodia which conducts field-based and hospital-based research into infectious diseases. Recently we have conducted a trial of mass drug administration to eliminate malaria in remote villages. I organize the team and conduct social research alongside the clinical studies to find out more about local understanding of malaria, patterns of behaviour, and opportunities to eliminate malaria. I have previously worked for different health non-governmental organizations in Cambodia and led provincial-level activities to support village malaria workers. I coordinate our research group’s work with local and national authorities so we can assist their aims.

Tom Peto: I am an epidemiologist studying malaria in Southeast Asia for the Mahidol-Oxford Tropical Medicine Research Unit. My research focuses chiefly on malaria elimination and evaluating new strategies to interrupt malaria transmission. I also conduct clinical trials testing new treatments for malaria to replace those that are losing efficacy due to the spread of drug-resistance. I am from the UK and studied infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. Before coming to Asia I worked in Africa for 7 years and did a PhD on the effectiveness of infant hepatitis B vaccination.

Project Title: Why are forests foci of malaria transmission in western Cambodia, and what can be done to protect forest workers and prevent forest-acquired malaria undermining malaria elimination in neighbouring villages?

Travel to forests has been repeatedly reported as risk factor for clinical and subclinical malaria infections in Cambodia and forest malaria is becoming a barrier to the interruption of malaria transmission in western Cambodia. Activities and behaviour that result in forest-acquired malaria are poorly understood. Forest workers are a vulnerable and hard-to-reach population due to the unstable and sometime illegal nature of their work and targeted approaches are needed to include them in malaria elimination strategies.

Understanding what goes on in forests will assist the design of acceptable and effective interventions targeted at forest visitors. Interventions need to consider several factors. This will be a qualitative, descriptive study with mixed methods. A Cambodian social scientist will work with local health authorities and a clinical research team to identify from treatment records 20 recent falciparum malaria patients who work in forests from three areas in in Pailin province and three in neighbouring Battambang province. A description of behaviour in forests related to malaria infection and treatment will be produced through a mixed methods approach including: digital diaries, semi-structured interviews, focus group discussions, and the review of local malaria treatment records. 

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