As India targets malaria elimination by 2030, a study from Northeastern Meghalaya indicates a positive trend: tribal communities increasingly seek treatment at government hospitals instead of traditional healers. This shift, partly due to the belief that timely and effective malaria treatment is available in the public health system, reflects significant progress in the country's malaria control efforts, according to the study published in the journal Malaria.
"By recognising these evolving attitudes, policymakers and healthcare providers can better tailor their interventions and communication strategies to more effectively address ongoing needs and concerns as India faces the 'last mile' in malaria elimination," the researchers noted.Malaria in India is predominantly concentrated in the eastern and central parts of the country, particularly in forested and hilly states with tribal populations and limited health services. These states include Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, and Maharashtra, as well as the northeastern states of Tripura, Meghalaya, and Mizoram. Transmission in these areas is often challenging and persistent due to social and ecological factors, including conflict-affected regions and low community awareness about malaria prevention and control.
However, the study highlighted that patients still incur out-of-pocket expenses for travel, medications, or services unavailable at the PHC (primary health centre) level, leading some to seek private healthcare providers.
The lack of awareness and knowledge about preventive measures, such as insecticide-treated bed nets, indoor residual spraying, and timely healthcare-seeking, can hinder efforts to reduce malaria transmission.
To address these issues, the study focused on West Khasi Hills (WKH), West Jaiñtia Hills (WJH), and South Garo Hills (SGH) in Meghalaya, which had the highest Annual Parasite Index (API) between 2016 and 2019. Data were collected from August 2019 to November 2021 from residents of 23 villages served by four PHCs across these districts. Researchers examined community preferences for treatment and the use of healthcare services, such as visiting public or private health facilities or seeking care from traditional healers.
The study found growing acceptance of public health providers, with the majority of participants preferring public healthcare institutions like PHCs for malaria treatment, citing affordability and the availability of free services. In the three districts, participants and healthcare providers noted that frontline health workers were now equipped with basic rapid diagnostic tests (RDT) for malaria, allowing for prompt identification and timely referral for appropriate treatment. This improved outcomes and reduced the risk of complications.
In the SGH district, community members reported a significant decline in seeking traditional healers for malaria treatment due to increased awareness of diagnostic tests, treatments, and services available at PHCs or hospitals. The availability of diagnostic tools used by village ASHA and ANM workers at health sub-centres also encouraged villagers to seek help from these healthcare providers.
Recognising these shifting attitudes is crucial for policymakers and healthcare practitioners to tailor interventions and communication strategies more effectively as India approaches the final stages of malaria elimination, said the study's lead author, Carinthia B. Nengnong, from the Indian Institute of Public Health, Shillong.