Malaria remains a public health problem in regions of Northeastern India because of favourable bio-geographic transmission conditions, poor access to routine healthcare, and inadequate infrastructure for public health and disease prevention. This study was undertaken to better understand community members’ and health workers’ perceptions of malaria, as well as their knowledge, attitudes, and prevention practices related to the disease in Meghalaya state. The study included participants from three malaria endemic districts: West Khasi Hills, West Jaiñtia Hills, and South Garo Hills from 2019 to 2021. A total of 82 focus group discussions (FGD) involving 694 community members and 63 in-depth interviews (IDI) with health personnel and traditional healers residing within the three districts were conducted. A thematic content analysis approach was employed, using NVivo12 software for data management. Most participants reported a perceived reduction in malaria during recent years, attributing this to changes in attitudes and behaviours in health seeking, and to more effective government interventions. Local availability of testing and treatment, and an improved, more responsive health system contributed to changing attitudes. Long-lasting insecticidal nets (LLINs) were largely preferred over indoor residual spraying (IRS), as LLINs were perceived to be effective and more durable. Community members also reported using personal protective measures such as applying repellents, burning neem tree leaves, straw/egg trays, wearing long sleeve clothes, and applying ointments or oils to protect themselves from mosquito bites. While most participants acknowledged the role of mosquitoes in malaria transmission, other conditions that are not mosquito-borne were also attributed to mosquitoes by some participants. The communities surveyed have largely shifted from seeking treatment for malaria from traditional healers to using public facilities, although some participants reported switching between the two or using both simultaneously. Improved understanding of cerebral malaria, which some participants previously attributed to mental illness due to ‘bad spirits’, is an example of how cultural and ritualistic practices have changed. The findings reveal diverse perceptions among community members regarding malaria, its prevention, practices to prevent mosquito-transmitted diseases, and their opinions about the healthcare system. A key finding was the shift in malaria treatment-seeking preferences of community members from traditional healers to the public sector. This shift highlights the changing dynamics and increasing acceptance of modern healthcare practices for malaria treatment and prevention within tribal and/or indigenous communities. By recognizing 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.

中文翻译：

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印度梅加拉亚邦社区和卫生工作者对疟疾的看法：到 2030 年消除疟疾的最后一英里

由于有利的生物地理传播条件、常规医疗保健机会差以及公共卫生和疾病预防基础设施不足，疟疾仍然是印度东北部地区的一个公共卫生问题。进行这项研究是为了更好地了解梅加拉亚邦社区成员和卫生工作者对疟疾的看法，以及他们与该疾病相关的知识、态度和预防实践。该研究包括2019年至2021年来自三个疟疾流行区：西卡西山、西杰尼亚山和南加罗山的参与者。总共进行了82次焦点小组讨论（FGD），涉及694名社区成员和63次深度访谈（IDI）与居住在三个地区的卫生人员和传统治疗师进行了交流。采用主题内容分析方法，使用 NVivo12 软件进行数据管理。大多数参与者报告说，近年来疟疾发病率有所下降，这归因于寻求健康的态度和行为的变化以及更有效的政府干预措施。当地检测和治疗的可用性以及改进的、反应更快的卫生系统有助于改变态度。长效杀虫网 (LLIN) 在很大程度上优于室内滞留喷洒 (IRS)，因为 LLIN 被认为更有效且更耐用。社区成员还报告说，他们采取了个人防护措施，例如使用驱虫剂、燃烧印楝树叶、稻草/鸡蛋托盘、穿长袖衣服以及涂抹药膏或油来保护自己免受蚊虫叮咬。虽然大多数参与者承认蚊子在疟疾传播中的作用，但一些参与者也将其他非蚊子传播的疾病归因于蚊子。接受调查的社区基本上已经从传统治疗师寻求疟疾治疗转向使用公共设施，尽管一些参与者报告说在两者之间切换或同时使用两者。人们对脑型疟疾的认识有所提高，一些参与者之前将脑型疟疾归因于“精神不好”导致的精神疾病，这是文化和仪式实践发生变化的一个例子。研究结果揭示了社区成员对疟疾、疟疾预防、预防蚊媒疾病的做法以及他们对医疗保健系统的看法的不同看法。一个重要发现是社区成员寻求疟疾治疗的偏好从传统治疗师转向公共部门。这一转变凸显了部落和/或土著社区内疟疾治疗和预防的现代医疗保健实践的动态变化和日益接受。通过认识到这些不断变化的态度，