Seeing malaria through the eyes of affected communities: using photovoice to document local knowledge on zoonotic malaria causation and prevention practices among rural communities exposed to Plasmodium knowlesi malaria in Northern Borneo Island

Abstract

Background: Many rural communities in Malaysian Borneo and Southeast Asia are at risk of Plasmodium knowlesi malaria. Multiple factors contribute to infection, however, a deep understanding of illness causation and prevention practices among at-risk communities remains limited. This study aims to document local knowledge on malaria causation and preventive practices of rural communities in Sabah, Malaysia, using photovoice-a participatory research method.

Methods: From January to June 2022, a photovoice study was conducted with rural communities in Matunggong subdistrict, Malaysia, to explore their experiences with and local knowledge of non-human primate malaria and prevention practices. The study included (1) an introductory phase in which participants were introduced to the photovoice method; (2) a documentation phase in which participants captured and narrated photos from their communities; (3) a discussion phase in which participants discussed photos and relevant topics through a series of three focus group discussions (FGDs) per village; and (4) a dissemination phase where selected photos were shared with key stakeholders through a photo exhibition. A purposively selected sample of 26 participants (adults > 18 years old, male, and female) from four villages participated in all phases of the study. The study activities were conducted in Sabah Malay dialect. Participants and the research team contributed to data review and analyses.

Results: Rural communities in Sabah, Malaysia possess local knowledge that attributes non-human primate malaria to natural factors related to the presence of mosquitoes that bite humans and which carry "kuman-malaria" or malaria parasite. Participants revealed various preventive practises ranging from traditional practises, including burning dried leaves and using plants that produce foul odours, to non-traditional approaches such as aerosols and mosquito repellents. By engaging with researchers and policymakers, the participants or termed as co-researchers in this study, showcased their ability to learn and appreciate new knowledge and perspectives and valued the opportunity to share their voices with policymakers. The study successfully fostered a balance of power dynamics between the co-researchers, research team members and policymakers.

Conclusion: There were no misconceptions about malaria causation among study participants. The insights from study participants are relevant because of their living experience with the non-human malaria. It is critical to incorporate rural community perspectives in designing locally effective and feasible malaria interventions in rural Sabah, Malaysia. Future research can consider adapting the photovoice methodology for further research with the community toward building locally tailored-malaria strategies.

Keywords: Knowledge; Local beliefs; Malaria prevention; Malaysia; Participatory study; Photovoice; Plasmodium knowlesi; Preventive practises; Zoonotic malaria.

Fig. 1

The study sites

Fig. 2

The study phases

Fig. 3

One factor a person could get malaria is a person might be unaware that he or she is being bitten by mosquitoes (Female, 49 years old, Kg Paradason)

Fig. 4

Farming activities exposed the villagers here to mosquito bites. People just wear t-shirts (Male, 41 years old, Kg Paradason)

Fig. 5

This monkey is the leader. I always see him around this area jumping from one tree to another. In his troop there are almost 50 of them. They are disturbing our farms and fruit trees! (Female, 44 years old, Kg Membatu Laut)

Fig. 6

When I come here to do my laundry or clean my body, I always can see the monkey eating the “ara” fruit (Female, 44 years old, Kg Manduri)

Fig. 7

The acacia trees and the surrounding forest in our village. There are many monkeys and mosquitoes here. They exposed us to monkey malaria (Female, 49 years old, Kg Paradason)

Fig. 8

Non-traditional practices for preventing mosquito bites

Fig. 9

Non-traditional practices for preventing mosquito bites

Fig. 10

The photo exhibition in Kudat, Sabah, Malaysia