Description
Background: Located in the Amazon, the region of Loreto reported 22,723 new cases of malaria in 2022 (15.7% P. falciparum), which accounted for 84.0% of the total burden of the disease in Peru. In Loreto, populations involved in informal wood extraction have been identified at higher risk of malaria, like other mobile and hard-to-reach populations in the Amazon region, such as gold miners. In French Guiana, a new intervention named Malakit relying on the distribution of kits for self-diagnosis and self-treatment was implemented successfully between 2018 and 2020 and contributed significantly to improving malaria control in informal gold mining areas.
Methods: This mixed-methods study aimed at determining the relevance of the Malakit intervention to the context of isolated communities involved in wood extraction in Loreto. Between February and November 2022, a monthly quantitative survey was carried out in three communities from the district of Mazan as part of an existing cohort study to document their mobility patterns, their involvement in wood extraction and their history of malaria. Focus groups were held within each community to explore their perceptions about malaria and priority health concerns.
Results: A total of 692 inhabitants participated to the survey; 52.9% were men with a median age of 20 years (IQR 10 – 45). Fifty participants (7.2%) reported having stayed at least once in an area of wood extraction over the past three years, with a median travel time of three days (IQR 1-6), a median length of stay of 56 days (IQR 28-70) and seasonal peak of activity between January and March. Of them, 32 were aged 15 or more; a majority (68.8%, 22/32) perceived malaria transmission as high in areas of wood extraction, yet only three reported experiencing symptoms of malaria while staying there. Focus group participants showed a good knowledge of malaria but did not perceive it as a primary concern in comparison to other health issues such as fever, anemia, or diarrhea, particularly in children.
Discussion: Understanding the population and the context of implementation is a crucial step when transferring a complex intervention such as Malakit. This work characterized the mobility profile of people involved in wood extraction in the region of Loreto. The quantitative survey was ancillary to a cohort study which conducted monthly active case detection: this could explain the smaller incidence of malaria observed in the surveyed communities and the contrasted perception of malaria by focus group participants. We did not objectify a link between malaria and wood extraction. Given the marked seasonality of wood extraction, and the limited time spent in remote areas, other interventions than Malakit could be considered instead. Strengthening access to healthcare within communities would not only help address malaria but also other health concerns.
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