Research

Low perception of malaria risk among the Ra-glai ethnic minority in south-central Vietnam: implications for forest malaria control

Koen Peeters Grietens^1,2 , Xa Nguyen Xuan³ , Wim Van Bortel¹ , Thang Ngo Duc³ , Joan Muela Ribera² , Truong Ba Nhat⁴ , Ky Pham Van⁴ , Hung Le Xuan³ , Umberto D'Alessandro¹ and Annette Erhart¹

¹  Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium

²  Partners for Applied Social Sciences | PASS International, 3980 Tessenderlo, Belgium

³  National Institute for Malariology, Parasitology and Entomology, Luong The Vinh Street 245, Hanoi, Vietnam

⁴  Provincial Malaria Station. Ngo Gia Tu street 156 - Phan Rang City. Ninh Thuan Province, Vietnam

author email corresponding author email

Malaria Journal 2010, 9:23doi:10.1186/1475-2875-9-23

Published:	20 January 2010

Abstract

Background

Despite Vietnam's success in reducing malaria mortality and morbidity over the last decade, malaria persists in the forested and mountainous areas of the central and southern provinces, where more than 50% of the clinical cases and 90% of severe cases and malaria deaths occur.

Methods

Between July 2005 and September 2006, a multi-method study, triangulating a malariometric cross-sectional survey and qualitative data from focused ethnography, was carried out among the Ra-glai ethnic minority in the hilly forested areas of south-central Vietnam.

Results

Despite the relatively high malaria burden among the Ra-glai and their general awareness that mosquitoes can transmit an unspecific kind of fever (84.2%), the use of bed nets, distributed free of charge by the national malaria control programme, remains low at the farmers' forest fields where the malaria risk is the highest. However, to meet work requirements during the labour intensive malaria transmission and rainy season, Ra-glai farmers combine living in government supported villages along the road with a second home or shelter at their slash and burn fields located in the forest. Bed net use was 84.6% in the villages but only 52.9% at the forest fields; 20.6% of the respondents slept unprotected in both places. Such low use may be explained by the low perception of the risk for malaria, decreasing the perceived need to sleep protected. Several reasons may account for this: (1) only 15.6% acknowledged the higher risk of contracting malaria in the forest than in the village; (2) perceived mosquito biting times only partially coincided with Anopheles dirus ss and Anopheles minimus A true biting times; (3) the disease locally identified as 'malaria' was hardly perceived as having an impact on forest farmers' daily lives as they were unaware of the specific kind of fevers from which they had suffered even after being diagnosed with malaria at the health centre (20.9%).

Conclusions

The progressive confinement of malaria to minority groups and settings in the Greater Mekong sub-region implies that further success in malaria control will be linked to research into these specific socio-cultural contexts. Findings highlight the need for context sensitive malaria control policies; not only to reduce the local malaria burden but also to minimize the risk of malaria spreading to other areas where transmission has virtually ceased.