Suparat Phuanukoonnon

Despite Thailand’s progress under the 1-3-7 malaria elimination framework, border districts such as Tha Song Yang in Tak Province continue to experience persistent transmission due to high population mobility, geographic constraints, and health system challenges. Understanding how local health systems respond to these pressures is critical for sustaining malaria elimination in complex border settings. This mixed-methods study applied the World Health Organization’s Six Building Blocks framework to examine challenges and responses in malaria elimination in Tha Song Yang District. Qualitative data were collected through in-depth interviews with 24 key informants from district health offices, vector-borne disease units, malaria posts and clinics, hospitals, and local authorities. Quantitative data included household surveys assessing malaria-related knowledge, attitudes, and practices (n = 388), and secondary surveillance data on adherence to the 1-3-7 strategy from 2018 to 2022. Adherence to Day 1 and Day 3 activities improved steadily, reaching 96% and 100%, respectively, while Day 7 adherence declined sharply to 69% in 2022. The household survey showed high levels of malaria knowledge (75.77%) and positive attitudes toward prevention (94.59%), indicating that community awareness was strong despite ongoing transmission. Qualitative findings highlighted a surge of short-term migrants, workforce shortages, reduced domestic funding, and logistical barriers in remote areas as key constraints, while adaptive local responses—including local flexibility, committed leadership, and the use of the Malaria Information System and mobile communication platforms—helped sustain malaria control and surveillance activities. These findings demonstrate that malaria persistence in border areas is driven primarily by systemic and operational challenges rather than gaps in community awareness. Strengthening malaria elimination in similar border settings requires resilient health systems with sustained domestic financing, adaptive surveillance strategies, effective use of digital tools, and governance arrangements that account for population mobility and cross-border complexity.

Human behavioural and occupational factors play a critical role in sustaining malaria transmission. This study aimed to identify factors associated with poor levels of knowledge, attitudes, and practices (KAP) and factors influencing risk behaviours among at-risk populations. A survey of 402 at-risk individuals was conducted in Sisaket Province in late 2022, where substantial progress in malaria elimination has been achieved. Data was collected using a structured questionnaire. Descriptive statistics and logistic regression models were used to identify factors associated with KAP and malaria risk behaviours. Over half of the participants demonstrated good knowledge (51.5%), attitudes (64.7%), and practices (58.2%) regarding malaria transmission, treatment, and prevention. Poor attitudes were significantly more likely among individuals with lower education levels [primary or below: aOR = 2.2, 95% CI 1.2–4.0); senior primary: aOR = 2.5, 95% CI 1.4–4.8] and low socioeconomic status (aOR = 1.8, 95% CI 1.1–3.0). Poor practices were less common among individuals working in agriculture (aOR = 0.2, 95% CI 0.1–0.5). Risk behaviours were significantly more frequent among males (aOR: 2.8, 95% CI 1.2–6.8) and individuals with poor practices (aOR: 3.5, 95% CI 1.6–8.1). Despite overall moderate KAP levels, gaps in attitudes and risk behaviours persist. Targeted strategies, such as social and behaviour change communication, should focus on improving attitudes among individuals with low education levels and reducing risk behaviours among males and those with poor practices by promoting adherence to effective preventive measures.

To achieve the elimination goal by 2026, an effective LLIN distribution system is the essential strategy. This study aims to evaluate the outcome of LLINs distribution system tailored to COVID-19 setting in the Thai-Myanmar border in Tak Province. A retrospective mixed-methods research study was conducted with 16 staffs involved in LLIN distribution and 388 household heads from six sub-districts along the Thai-Myanmar border. The research tools included in-depth interviews and questionnaires. Qualitative analysis employed a thematic analysis approach. Proportions were used to examine ownership, access, and bed net use. The operational system of LLINs distribution included mass distribution campaigns and continuous distribution through routine channels, such as malaria posts (MPs) and malaria clinics (MCs). Although lockdown measures stopped the mass campaign during the COVID-19 pandemic (2020–2021), the operational system used to distribute LLINs in this study setting had resilience. According to this system's post-pandemic outcome, 95.9% of households had at least one bed net, and 87.9% of household members used any type of bed net. The in-depth interviews showed that a small proportion of individuals would like a different type of bed net and could not acquire them. During the pandemic, most community members still had sufficient bed nets to cover their sleeping spaces. Staying at home during lockdowns likely provided an opportunity for better adherence to bed net use among those who previously would have been traveling. Factors contributing to the success of LLIN distribution in this setting included good cooperation between government and partnerships, effective management, and a useful electronic database for decision-making. The coverage of bed nets is high in this area, and as long as there is not a disruption that is longer than the lifespan of the bed nets, high coverage has been maintained. This high coverage indicated the effectiveness of the operational system of LLIN distribution in this study setting. These findings could be useful in the policy improvement of the LLIN distribution system, which could ultimately contribute to the successful elimination of malaria.

Thailand’s goal to eliminate malaria by 2030 faces significant challenges, in part due to inadequate vector control measures. Innovative strategies, such as mass drug administration (MDA) of ivermectin, have shown promise in improving vector control efforts. This study aims to assess the factors influencing the acceptance of ivermectin MDA among residents in southern Thailand. In 2022, a cross-sectional study was conducted in three districts of Surat Thani Province, southern Thailand, where an ivermectin MDA program was planned. Quantitative data were collected through structured surveys administered to randomly selected household heads using a standardized questionnaire. Descriptive statistics and multiple logistic regression models were employed to identify factors associated with the reported acceptance of ivermectin MDA. A total of 391 participants were surveyed, with the majority (96.4%) expressing acceptance of the planned ivermectin MDA. Forest-related workers (aOR: 4.2, 95% CI: 1.1–16.1) and those who believed malaria could be eliminated from their villages (aOR: 9.1, 95% CI: 2.8–29.9) were more likely to exhibit higher levels of acceptance. However, according to programmatic records, only 59.0% of the 3,137 eligible individuals completed all three rounds of ivermectin MDA. Key barriers to participation included absence from the village for unspecified reasons and reluctance to take the drug, particularly in later rounds. There was a noticeable gap between reported acceptance and actual participation in the ivermectin MDA. Targeted efforts to engage forest-related workers are crucial to maintain high participation rates. Strengthening community engagement by emphasizing the risks and benefits of ivermectin, outlining safety measures, and raising awareness about malaria prevention and control are crucial for improving MDA uptake.

Corrigendum: Handwashing among caregivers of young children in a protracted and complex refugee and immigration context: a mixed methods study on the Thai–Myanmar border

Introduction: Protracted refugee situations create complex contexts that present significant health risks for young children. Effective hand hygiene practices by caregivers can reduce respiratory infections and diarrhoeal disease, the two largest contributors to mortality among children between 1 month and 5 years of age. This study documented handwashing patterns and access to water, sanitation and hygiene (WASH) infrastructure among caregivers of young children living along the Thai–Myanmar border, one of the world’s most protracted and complex refugee and immigration contexts. It also examined the association between handwashing and socio-demographic variables and captured participants’ explanations for when and how hands are washed. The study broadened the scope of previous research by also including the large number of caregivers living outside formal camps.Methods: Caregivers of children attending 11 preschools in Tak province, Thailand participated in a mixed-methods cross-sectional study. Quantitative questionnaire data (n = 384) were supplemented by a thematic analysis of data from in-depth interviews (n = 9).Results: Fewer than half the caregivers reported routinely washing their hands before preparing meals or after using the latrine/toilet. Fewer than one-in-five routinely used soap in these situations. Interviewees explained that handwashing was only necessary when a substance could be felt or seen, in which case wiping with a cloth or a rinsing with water were sufficient to clean hands. However, their explanations also suggested some potential avenues for culturally appropriate and feasible interventions to improve hand hygiene.Conclusion: The results confirmed previous research on the multi-dimensional barriers to good hand hygiene in protracted refugee situations and other low-resource settings. Additional investment to overcome shortages in the infrastructure necessary to support good hand hygiene and creative means of drawing on and developing human capital will be necessary to realize the potential hand hygiene holds for reducing ill-health and mortality among young children living in these contexts.

Background: Mass drug administration (MDA) with primaquine (PQ) is being considered for accelerating Plasmodium vivax elimination in remaining active foci. This study aimed to determine the acceptability of MDA with PQ in malaria endemic villages in a malarious setting in the South of Thailand undergoing MDA with PQ. Methods: A cross-sectional mixed-methods approach was conducted in seven malaria endemic villages where MDA with PQ was implemented. The data were collected from community villagers and health workers using structured questionnaires, in-depth interviews, and focus group discussions. Descriptive statistics and logistic regression models were used for quantitative data analysis. Thematic analysis was applied for qualitative data. Results: Among a total of 469 participants from the MDA villages, 293 participants were eligible for MDA with PQ and 79.86% (234) completed 14-days of PQ. The logistic regressions indicated that males (adjusted odds ratio: 2.52 [95% confidence interval: 1.33–4.81]) and those who are farmers (2.57 [1.12–5.90]) were most likely to participate in the MDA. Among 293 participants in the post-MDA study, 74.06% had originally agreed to participate in the MDA with PQ while 25.94% had originally reported not wanting to participate in the MDA. Of those who originally reported being willing to participate in the MDA, 71.23% followed through with participation in the first or second round. Conversely, 93.24% of those who originally reported not being willing to participate in the MDA did in fact participate in the MDA. Factors contributing to higher odds of agreeing to participate and following through with participation included being male (1.98 [1.06–3.69]) and correctly responding that malaria is preventable (2.32 [1.01–5.35]) with some differences by village. Five key themes emerged from the qualitative analyses: concern about side effects from taking PQ; disbelief that malaria could be eliminated in this setting; low overall concern about malaria infections; misunderstandings about malaria; and a general need to tailor public health efforts for this unique context. Conclusion: While the reported likelihood of participating in MDA was high in this setting, actual follow-through was relatively moderate, partially because of eligibility (roughly 71% of those in the follow-up survey who originally agreed to participate actually followed through with participation). One of the largest concerns among study participants was PQ-related side effects—and these concerns likely heavily influenced participant adherence to the MDA. The results of this study can be used to tailor future MDAs, or other public health interventions, in this and potentially other similar settings.