Accelerating Malaria Elimination in Conflict-Affected Areas of Southern Thailand : An Operational Model from Yala Province

Abstract

This mixed-methods study aimed to 1) evaluate the results of malaria elimination activities implemented during 2017 - 2024 in Yala Province, 2) draw lessons learned from program implementation and utilize them to improve future programming. The study was conducted in three steps. These were 1) extracting and analyzing output and impact data from the malaria information system managed by the Division of Vector Borne Diseases (DVBD), 2) utilizing DVBD’s questionnaires and conducting a quantitative survey among 558 participants in five districts where activities have been implemented, to obtain outcome level results on malaria knowledge and preventive behaviors, and 3) conducting semi-structured interviews with public health officials and   focus group discussion with relevant community partners on the inputs and processes. The outputs, outcomes and impact data were measured against the indicators and targets set by the Department of Disease Control. Data were analyzed using descriptive statistics and content analysis. 

1. Significant progress toward malaria elimination has been made, most of the important indicators exceeded those of national targets. Patients receiving treatment according to National Treatment Guidelines were at 100%; at-risk population sleeping under insecticide treated net the night before the survey was at 86.70%; and the Annual Parasite Incidence (API) per thousand population decreased from 6.74 in 2017 to 0.12 in 2024. However, Yala has not been able to stop local malaria transmission for 3 years.

2. Lessons learned indicated that public health agencies implemented a case-data feedback strategy, returning malaria case information by village to enhance community awareness and ownership. This fostered collaboration between health authorities and local communities, expanding preventive, diagnostic, and treatment services. Youth Muslim Association communicators worked with community and Islamic religious leaders to convey malaria knowledge in linguistically and culturally appropriate ways, thereby improving health behaviors and participation.

Recommendations are that to improve program performance, relevant health agencies need to establish a two-way open communication channel for timely reporting malaria cases, so to achieve malaria elimination. Responsible public health agencies need to develop future programs planning with local resources.