Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment

Area of Science:

• Medical Entomology
• Infectious Diseases
• Public Health Surveillance

Background:

• Malaria elimination efforts in Aceh are challenged by risks associated with forest work.
• Geographically-based reactive case detection (RACD) identified forest work as a risk factor, with notable Plasmodium knowlesi infections.
• Understanding malaria transmission dynamics among forest workers is crucial for targeted surveillance.

Purpose of the Study:

• To understand malaria risks associated with forest work in Aceh.
• To identify effective strategies for malaria surveillance among forest workers.
• To adapt reactive case detection (RACD) for this high-risk population.

Main Methods:

• Qualitative formative assessment using focus groups and in-depth interviews with forest workers and key informants.
• Exploration of forest activities, worker mobility, primate interactions, and healthcare-seeking behaviors.
• Assessment of willingness to participate in malaria surveys at forest work sites and via peer-referral.

Main Results:

• Forest activities like mining, logging, and agriculture involve prolonged stays in remote areas with limited mosquito prevention.
• Workers often self-medicate or seek traditional/pharmacy care for fevers, bypassing formal health facilities.
• Employers and workers expressed willingness for malaria testing and survey participation through peer-referral and at work sites.

Conclusions:

• Forest workers in Aceh are a diverse group at significant risk of malaria, including Plasmodium knowlesi.
• Current passive surveillance and household screening likely underestimate malaria burden in this population.
• Adapting active surveillance methods, such as work-site screening and peer-referral, is a promising strategy to detect hidden infections.