Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

Malaria, drug resistance and mobile and migrants population in Cambodia: from research to strategy

The movement of populations in malaria-endemic areas poses a major threat to the spread of artemisinin resistance along the Cambodia–Thailand border. Mobile and migrant populations (MMP) are usually poorly connected to routine public health interventions and surveillance systems and therefore represent a vulnerable group with regards to the malaria control and elimination. Targeting this population has therefore been identified as a strategic priority, however the information needed to do so, has been lacking. A number of activities were therefore undertaken to fill this gap and to contribute to the strategy making process. These activities, have been taking place concurrently and are iterative, in order to maximize the relevance of the research to strategy.
A review of existing literature on previous work on mobile and border populations was conducted in September 2012.
In collaboration with MoH, WHO and Malaria Consortium, two stakeholder workshops were organised to collect information on all previous migrant related research and discuss potential interventions. A working group composed of government and non-government bodies working with migrants was set up to develop the MMP strategy.
A cornerstone of the strategy was the development of a population movement “framework” which aimed to define different MMP profiles. The Framework was developed describing (i) forest exposure index as a proxy to malaria risk (ii) an access/outreach index as a proxy for accessibility and outreach to/for MMP, based on the working location of the MMP (iii) a malaria vulnerability index was developed based on the above scores. Based on these considerations, six MMP profiles were defined: seasonal workers/farmers; construction/mine workers; forest workers; security personnel and visitors. A description of these groups will be presented as well as the proposed strategy-interventions packages for each risk group and the specific epidemiological context.
A special focus is given at maximising coverage, accessibility and acceptability of the interventions for each of the MMP groups. Operational research and intervention piloting and evaluation are also needed to identify optimal approaches for reaching these vulnerable populations.
The MMP strategy was developed to support reaching the goals of the National Malaria Elimination Strategy 2025 through adapting and better targeting interventions to these hard-to reach populations. This strategy describes the process of characterising and defining the MMPs in Cambodia, identifying the different activities and risks as well as the types of intervention strategies needed to appropriately target this high malaria risk group in Cambodia.

 Philippe Guyant (1), Sara Canavati (2) (3) (4), Char, Meng Chuor (3), Chea Nguon (3), Arantxa Roca (2), Shunmay Yeung(1) (1) London School of Hygiene and Tropical Medicine (2) Malaria Consortium, Cambodia (3) Faculty of Tropical Medicine, Mahidol University (4) National Malaria Control Program in Cambodia

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Comment by Dina Rippon on October 14, 2013 at 10:18

Thank you for such a brilliant summary of your recent work, Sara. The strategy you and your team have put together seems very well thought out, and essential for targeting such hard to reach populations. I would be really interested to hear how this strategy plays out, and how access improves for these MMP groups. Please keep us updated!

Comment by Sara-Canavati on October 14, 2013 at 15:23

Thanks Dina

Will keep you updated, indeed. It has been a move from research to strategy and policy. We felt it was the time. Indeed, it was team effort to gather all grey literatura on MMP research in Cambodia! Actually Dr Chea Nguon will be presenting this week in BKK on the same strategy. All the best, sara

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