1.1 Context of the Study
In Myanmar, Malaria remains a major public health problem, which is influenced by climate change and ecological changes, population migration, development of multi-drug resistant Plasmodium- falciparum, development of insecticide resistant vectors and changes in behaviors of malaria vectors (Ministry of Health, 2013).
According to the World Malaria Report produced by World Health Organization (WHO) in 2012, 60% of the total population of Myanmar resides in malaria risk areas. The malaria morbidity rate in Myanmar is 24 per 1,000 population and the mortality rate is 1.2 per 100,000 population. In 2011, there were 1.2 million microscopically confirmed malaria cases of which approximately 68% were caused by P. falciparum (WHO, 2012).
Over the last decade, the malaria situation has shown some improvement as a result of scaling up of preventive and curative interventions including distribution of insecticide-treated mosquito nets (ITNs), particularly long lasting insecticidal nets (LLINs), as well as impregnation of existing mosquito nets with insecticidal tablets and increased access to artemisinin-based combination therapies (ACTs) through health facilities and volunteers in both public and private sectors. Although there is a trend towards decreasing malaria morbidity and mortality in Myanmar, malaria still remains one of the leading causes of morbidity and mortality in this country (Ministry of Health, 2013).
Malaria is also a major health problem in high risk groups especially non-immune internal migrants including laborers in development projects and people who resettled in endemic areas. Due to the outdoor biting behaviour of the major malaria vectors, people working in forests and staying there at night are at a particularly high risk (Ministry of Health, 2013). The risk also occurs in plantations, such as rubber and palm oil plantations, which offer forest-like environment. Rubber is the main agricultural export in Mon State and Thanintharyi Division, along the border between Thailand and Myanmar (Khaing, 2013). There are two main types of rubber workers: (1) Those who stay the whole year in plantations with temporary housings provided by the plantation owners and (2) -those who work only in the rubber tapping season. Most of them are migrants workers from both nearby and remote areas. These workers on rubber plantations are at high risk for malaria and other vector-borne diseases (Bhumiratana et al., 2013a).
In the malaria high risk areas of Myanmar, LLINs and insecticide tablets have been distributed free of charge by the National Malaria Control Program and many international and local organizations. World Vision Myanmar is working on malaria control and other health and development aspects in Thanintharyi region since 2007 with the support of Three Diseases Fund (3DF) and the Global Fund against HIV/AIDS, tuberculosis and malaria (GFATM). The five strategies applied by the Program are: (1)...