Perceptions of asymptomatic malaria infection and their implications for malaria control and elimination in Laos

Background: In the Greater Mekong Sub-region (GMS), malaria elimination efforts are targeting the asymptomatic parasite reservoirs. Understanding community perceptions about asymptomatic malaria infections and interventions that target this reservoir is critical to the design of community engagement. This article examines knowledge, attitudes, perceptions and practices related to asymptomatic malaria infections and mass drug administration (MDA) in malaria-endemic villages in southern Savannakhet Province, Laos. Methods: A questionnaire consisting of questions on socio-demographic characteristics, knowledge, attitudes, perceptions and practices on malaria and MDA was administered to each household head or representative (n = 281) in four villages. These topics were also further discussed in 12 single-gender focus group discussions (FGDs). The FGDs were conducted in all four villages and consisted of eight to 10 participants. Results: A minority (14.2%; 40/281) of respondents agreed that a seemingly healthy person could have malaria parasite in his or her blood. Half (52%; 146/281) disagreed and one third (33.8%, 95/281) were unsure. Respondents who responded that “MDA aims to cure everyone” [AOR = 4.6; CI: 1.6–13.1], “MDA is to make our community malaria free” [AOR = 3.3; CI: 1.3–8.1] and “I will take part in future MDA” [AOR = 9.9; CI: 1.2–78.8] were more likely to accept the idea of asymptomatic malaria. During FGDs, respondents recalled signs and symptoms of malaria (fever, chills and headache), and described malaria as a major health problem. Symptomatic and asymptomatic malaria infections were associated with their work in the forest and living conditions. Measures described to eliminate malaria included using mosquito nets, wearing long-sleeved clothes and taking medicine when symptomatic. Most respondents were unaware of MDA as a tool to eliminate malaria. Conclusions: Awareness of asymptomatic malaria infections, and MDA as a tool to eliminate malaria, was low. With the need to target asymptomatic malaria carriers for elimination efforts in the GMS, as well as informing target groups about asymptomatic infection, accompanying community engagement must build trust in interventions through the active collaboration of government stakeholders, key local persons and community members. This entails training and devolving responsibilities to the community members to implement and sustain the control and elimination efforts.