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Trop Med Health. 2019 Jan 25;47:11. doi: 10.1186/s41182-019-0138-9. eCollection 2019.

Malaria prevalence, knowledge, perception, preventive and treatment behavior among military in Champasak and Attapeu provinces, Lao PDR: a mixed methods study.

Author information

1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara-cho, Okinawa, 903-0215 Japan.
2Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR.
SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.
Military Institute of Diseases Prevention, Department of Military Medical, Ministry of Defense, Vientiane, Lao PDR.
5Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan.
6Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao PDR.
7Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, 625 Pedro Gil Street, Ermita, 1000 Manila, Philippines.
8Academic Affairs Division, University of Health Sciences, Vientiane, Lao PDR.
9Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR.



Malaria is a major health problem in Lao People's Democratic Republic (Lao PDR) with high transmission in remote and forest areas, particularly in the South. The military is at risk of malaria infection especially those deployed in forest areas. This study determined the prevalence of malaria infection and assessed knowledge, perception, and preventive and treatment behavior regarding malaria among military personnel in two southern provinces in Lao PDR.


Quantitative and qualitative approaches were undertaken in Champasak and Attapeu provinces in 2017. From 313 military personnel, quantitative data were collected through questionnaire-based interviews and blood samples used for parasite detection by polymerase chain reaction (PCR). Qualitative data were collected through 7 focus group discussions and 17 in-depth interviews among 49 military personnel. Fisher's exact test and Mann-Whitney U test were used to assess the association between malaria infection and participant characteristics. Content analysis for qualitative data was performed to explore perception and treatment behaviors regarding malaria.


The prevalence of malaria infection was 11.2% (Plasmodium falciparum: 1.3%, Plasmodium vivax: 9.3% and mixed infections: 0.6%). Many participants understood that malaria is transmitted through mosquito bites, although they did not necessarily know the name of vector mosquitoes (Anopheles). Surprisingly, more than a half also believed that malaria is transmitted through drinking stream water. One-third of the participants used long-lasting insecticidal nets. Due to limited supply, participants were often unable to use mosquito repellent and coils when necessary. Because participants were unable to receive timely diagnosis and appropriate treatment for malaria in their camps, they commonly practiced self-treatment using antibiotics, painkillers, and/or traditional medicines. They only go to a healthcare facility through their supervisor if their conditions worsen.


The prevalence of symptomatic and asymptomatic malaria was conspicuous among military in forest areas. Many participants believed that malaria is transmitted not only by mosquito bites but also from drinking stream water. Preventive equipment was often insufficient. Self-treatment was practiced before referring to healthcare facility. To further prevent military from contracting malaria, the National Malaria Control Program and military body should provide adequate and suitable health education, protective equipment, and on-site malaria case management.


Knowledge; Laos; Malaria; Military; Perception; Prevalence; Preventive measure; Treatment behavior

Conflict of interest statement

Ethical clearance was obtained from the National Ethics Committee for Health Research, Lao PDR (No. 073/NECHR), and from the Ethics Review Committee for Epidemiology Study, University of the Ryukyus (No. 1172). The permission to conduct the study was given by the General Logistic Department, the Ministry of Defense (No. 358), Lao PDR, and also from the camp leaders. The interviewers and moderator explained the purpose of the study and procedures in Laotian. The participants were also informed that their participation was voluntary, and that the results of the blood analyses and interviews would be treated in confidence. Moreover, they were informed that they can withdraw from the interview and discussion anytime without consequences.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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