Volume 100, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Multidrug-resistant malaria on the Cambodia–Thailand border is associated with working in forested areas. Beyond broad recognition of “forest-going” as a risk factor for malaria, little is known about different forest-going populations in this region. In Oddar Meanchey Province in northwestern Cambodia, qualitative ethnographic research was conducted to gain an in-depth understanding of how different populations, mobility and livelihood patterns, and activities within the forest intersect with potentiate malaria risk and impact on the effectiveness of malaria control and elimination strategies. We found that most forest-going in this area is associated with obtaining precious woods, particularly Siamese rosewood. In the past, at-risk populations included large groups of temporary migrants. As timber supplies have declined, so have these large migrant groups. However, groups of local residents continue to go to the forest and are staying for longer. Most forest-goers had experienced multiple episodes of malaria and were well informed about malaria risk. However, economic realities mean that local residents continue to pursue forest-based livelihoods. Severe constraints of available vector control methods mean that forest-goers have limited capacity to prevent vector exposure. As forest-goers access the forest using many different entry and exit points, border screening and treatment interventions will not be feasible. Once in the forest, groups often converge in the same areas; therefore, interventions targeting the mosquito population may have a potential role. Ultimately, a multisectoral approach as well as innovative and flexible malaria control strategies will be required if malaria elimination efforts are to be successful.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW, , 2004. The global distribution and population at risk of malaria: past, present, and future. Lancet Infect Dis 4: 327336. [Google Scholar]
  2. Ferguson HM, Dornhaus A, Beeche A, Borgemeister C, Gottlieb M, Mulla MS, Gimnig JE, Fish D, Killeen GF, , 2010. Ecology: a prerequisite for malaria elimination and eradication. PLoS Med 7: e1000303. [Google Scholar]
  3. Kar NP, Kumar A, Singh OP, Carlton JM, Nanda N, , 2014. A review of malaria transmission dynamics in forest ecosystems. Parasit Vectors 7: 265. [Google Scholar]
  4. Guerra CA, Snow RW, Hay SI, , 2006. A global assessment of closed forests, deforestation and malaria risk. Ann Trop Med Parasitol 100: 189204. [Google Scholar]
  5. Prothero RM, , 1999. Malaria, forests and people in southeast Asia. Singap J Trop Geogr 20: 7685. [Google Scholar]
  6. Wen S, 2016. Targeting populations at higher risk for malaria: a survey of national malaria elimination programmes in the Asia Pacific. Malar J 15: 271. [Google Scholar]
  7. Stibig H-J, Achard F, Carboni S, Rasi R, Miettinen J, , 2014. Change in tropical forest cover of southeast Asia from 1990 to 2010. Biogeosciences 11: 247. [Google Scholar]
  8. Cui L, 2012. Malaria in the Greater Mekong Subregion: heterogeneity and complexity. Acta Tropica 121: 227239. [Google Scholar]
  9. Incardona S, Vong S, Chiv L, Lim P, Nhem S, Sem R, Khim N, Doung S, Mercereau-Puijalon O, Fandeur T, , 2007. Large-scale malaria survey in Cambodia: novel insights on species distribution and risk factors. Malar J 6: 37. [Google Scholar]
  10. Guyant P, Canavati SE, Chea N, Ly P, Whittaker MA, Roca-Feltrer A, Yeung S, , 2015. Malaria and the mobile and migrant population in Cambodia: a population movement framework to inform strategies for malaria control and elimination. Malar J 14: 252. [Google Scholar]
  11. Dysoley L, Kaneko A, Eto H, Mita T, Socheat D, Börkman A, Kobayakawa T, , 2008. Changing patterns of forest malaria among the mobile adult male population in Chumkiri District, Cambodia. Acta Tropica 106: 207212. [Google Scholar]
  12. Sluydts V, 2014. Spatial clustering and risk factors of malaria infections in Ratanakiri Province, Cambodia. Malar J 13: 387. [Google Scholar]
  13. Durnez L, Mao S, Denis L, Roelants P, Sochantha T, Coosemans M, , 2013. Outdoor malaria transmission in forested villages of Cambodia. Malar J 12: 329. [Google Scholar]
  14. Peeters Grietens K, 2015. Characterizing types of human mobility to inform differential and targeted malaria elimination strategies in northeast Cambodia. Sci Rep 5: 16837. [Google Scholar]
  15. Bhumiratana A, Intarapuk A, Sorosjinda-Nunthawarasilp P, Maneekan P, Koyadun S, , 2013. Border malaria associated with multidrug resistance on Thailand-Myanmar and Thailand-Cambodia borders: transmission dynamic, vulnerability, and surveillance. Biomed Res Int 2013: 363417. [Google Scholar]
  16. Kelly AH, Beisel U, , 2011. Neglected malarias: the frontlines and back alleys of global health. BioSocieties 6: 7187. [Google Scholar]
  17. Tabachnick WJ, , 2010. Challenges in predicting climate and environmental effects on vector-borne disease episystems in a changing world. J Exp Biol 213: 946954. [Google Scholar]
  18. Smith C, Whittaker M, , 2014. Beyond mobile populations: a critical review of the literature on malaria and population mobility and suggestions for future directions. Malar J 13: 307. [Google Scholar]
  19. Ashley EA, 2014. Spread of artemisinin resistance in Plasmodium falciparum malaria. New Engl J Med 371: 411423. [Google Scholar]
  20. Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM, , 2008. Evidence of artemisinin-resistant malaria in western Cambodia. New Engl J Med 359: 26192620. [Google Scholar]
  21. Dondorp AM, Smithuis FM, Woodrow C, Seidlein LV, , 2017. How to contain artemisinin- and multidrug-resistant falciparum malaria. Trends Parasitol 33: 353363. [Google Scholar]
  22. Ministry of Health, 2011. The National Strategic Plan for Elimination of Malaria in the Kingdom of Cambodia 2011–2025. Health Mo, ed. Phnom Penh, Cambodia: Royal Government of Cambodia. [Google Scholar]
  23. National Institute of Statistics, 2013. Cambodia Inter-censal Population Survey 2013 Final Report. Planning Mo, ed. Phnom Penh. [Google Scholar]
  24. Poffenberger M, , 2009. Cambodia’s forests and climate change: mitigating drivers of deforestation. Nat Resour Forum 33: 285296. [Google Scholar]
  25. Spring MD, 2015. Dihydroartemisinin-piperaquine failure associated with a triple mutant including kelch13 C580Y in Cambodia: an observational cohort study. Lancet Infect Dis 15: 683691. [Google Scholar]
  26. Timmermans S, Tavory I, , 2012. Theory construction in qualitative research. Sociol Theory 30: 167186. [Google Scholar]
  27. Coosemans M, Van Bortel W, , 2006. Malaria vectors in the Mekong countries : a complex interaction between vectors, environment and human behaviour. Proceedings of the International Conference Hubs, Harbours and Deltas in Southeast Asia: Multidisciplinary and Intercultural Perspectives, February 6–8, 2006. Phnom Penh, Cambodia: Royal Academy of Overseas Sciences, 551569. [Google Scholar]
  28. Yeung S, Van Damme W, Socheat D, White NJ, Mills A, , 2008. Access to artemisinin combination therapy for malaria in remote areas of Cambodia. Malar J 7: 96. [Google Scholar]
  29. Littrell M, 2011. Case management of malaria fever in Cambodia: results from national anti-malarial outlet and household surveys. Malar J 10: 328. [Google Scholar]
  30. Bannister-Tyrrell M, Verdonck K, Hausmann-Muela S, Gryseels C, Muela Ribera J, Peeters Grietens K, , 2017. Defining micro-epidemiology for malaria elimination: systematic review and meta-analysis. Malar J 16: 164. [Google Scholar]
  31. Ernst KC, Adoka SO, Kowuor DO, Wilson ML, John CC, , 2006. Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors. Malar J 5: 78. [Google Scholar]
  32. Roll Back Malaria Partnership and United Nations Development Programme, 2013. Multisectoral Action Framework for Malaria. New York, Geneva. [Google Scholar]
  33. Gryseels C, Uk S, Sluydts V, Durnez L, Phoeuk P, Suon S, Set S, Heng S, Siv S, Gerrets R, , 2015. Factors influencing the use of topical repellents: implications for the effectiveness of malaria elimination strategies. Sci Rep 5: 16847. [Google Scholar]
  34. Banks SD, Murray N, Wilder-Smith A, Logan JG, , 2014. Insecticide-treated clothes for the control of vector-borne diseases: a review on effectiveness and safety. Med Vet Entomol 28: 1425. [Google Scholar]
  35. Killeen GF, 2017. Developing an expanded vector control toolbox for malaria elimination. BMJ Glob Health 2: e000211. [Google Scholar]
  36. Kobylinski KC, 2017. Ivermectin susceptibility and sporontocidal effect in Greater Mekong Subregion Anopheles. Malar J 16: 280. [Google Scholar]
  37. Atkinson J-A, Vallely A, Fitzgerald L, Whittaker M, Tanner M, , 2011. The architecture and effect of participation: a systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar J 10: 225. [Google Scholar]
  38. Sanders KC, Rundi C, Jelip J, Rashman Y, Smith Gueye C, Gosling RD, , 2014. Eliminating malaria in Malaysia: the role of partnerships between the public and commercial sectors in Sabah. Malar J 13: 24. [Google Scholar]

Data & Media loading...

  • Received : 10 Aug 2018
  • Accepted : 03 Jan 2019
  • Published online : 11 Mar 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error