title: High mobility, low access thwarts interventions among seasonal workers in the Greater Mekong Sub-region: lessons from the malaria containment project.
abstract: During the process of malaria elimination in the Greater Mekong Sub-region, mobile and migrant populations (MMPs) have been identified as the most at-risk demographic. An important sub-group of MMPs are seasonal workers, and this paper presents an evaluation of the reach and effectiveness of interventions tailored towards this group and was carried out as part of the Containment Project from 2009-11.
  
  
  
  A mixed-methods study was conducted in Pailin Province in Western Cambodia. Three-hundred-and-four seasonal workers were surveyed using a structured questionnaire. Qualitative data were gathered through a total of eight focus group discussions and 14 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis.
  
  
  
  High mobility and low access of the target population to the interventions, as well as lack of social and anthropological research that led to implementation oversights, resulted in under-exposure of seasonal workers to interventions. Consequently, their reach and impact were severely limited. Some services, particularly Mobile Malaria Workers, had the ability to significantly impact key factors, such as risky behaviours among those they did reach. Others, like Listening and Viewing Clubs and mass media campaigns, showed little impact.
  
  
  
  There is potential in two of the interventions assessed, but high mobility and inadequate exposure of seasonal workers to these interventions must be considered in the development and planning of future interventions to avoid investing in low-impact activities and ensure that all interventions perform according to their maximum potential. This will be critical in order for Cambodia to achieve its aim of malaria elimination. The lessons learned from this study can be extrapolated to other areas of health care in Cambodia and other countries in order to reduce the gap between healthcare provided to MMPs, especially seasonal workers, and to the general population.
authors: Centre for Biomedical Research, Burnet Institute, Melbourne, Australia. sara.canavati@burnet.edu.au.|Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. sara.canavati@burnet.edu.au.
authors: Sara E
authors: SE
authors: Canavati
authors: Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
authors: Cesia E
authors: CE
authors: Quintero
authors: The National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia.
authors: Harriet L S
authors: HL
authors: Lawford
authors: Provincial Health Department, Pailin City, Pailin Province, Cambodia.|National Institute of Public Health, #2, St. 289, Toul Kork District, Phnom Penh, Cambodia.
authors: Sovann
authors: S
authors: Yok
authors: The National Centre For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia.|National Institute of Public Health, #2, St. 289, Toul Kork District, Phnom Penh, Cambodia.
authors: Dysoley
authors: D
authors: Lek
authors: Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.|Department of Medicine, University of Melbourne, Melbourne, Australia.|Department of Microbiology, Monash University, Melbourne, Australia.
authors: Jack S
authors: JS
authors: Richards
authors: College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia.
authors: Maxine Anne
authors: MA
authors: Whittaker
mesh_terms: D000328:Adult; D002160:Cambodia / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods*; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D014171:Transients and Migrants; D055815:Young Adult
keywords: Artemisinin resistance; Cambodia; Community malaria worker; Health system strengthening; Malaria elimination; Mobile malaria worker; Sustainable development goals