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Risk education interventions to reduce Plasmodium knowlesi infections in Sabah, Malaysia - NU/LSHTM project

Supervisors

Nagasaki University

LSHTM

External advisors

Project

Although human malaria parasites have been eliminated from Sabah, Malaysia, the emergence of zoonotic malaria caused by Plamodium knowlesi (P. knowlesi) has become an important public health problem hampering malaria control efforts. First reported to infect humans in 2014, P.knowlesi is responsible for the majority of the approximately 2,000 annual reported human malaria cases in Sabah. 

Key drivers of the dramatic increase in P. knowlesi infections are changes in land use such as agricultural practices, deforestation shifting the habitat of macaques - the natural hosts of the parasite - from forested areas to plantations, farms and semi-urban areas.  

More research is required to understand human behaviours that expose a population to zoonotic malaria in order to develop interventions to reduce cases.  

This project will contribute to a larger 5-year project for the 鈥渟ustainable control of zoonotic malaria through an integrated approach鈥, commencing in April, 2025. 

This PhD project will contribute to one of the project objectives; to develop a risk education programme to reduce the number of infections and severe cases. 

Project objectives could include:

  1. Conducting mixed methods research to understand human risk behaviours.
  2. The development of appropriate interventions to reduce infections and severe cases. 
  3. Evaluate the effectiveness of interventions.

The project will be conducted in Keningau, Sabah. In coordination with local researchers and the supervisory team, the student will be expected to assess the level of understanding amongst affected communities of the risks, causes and potential preventative measures relating to P. knowlesi malaria. This will be conducted through interviews, questionaires and discussion with community leaders and at the individual level. 

Following the collection of this baseline data, and in coordination with local experts, a community education programme will be designed to address knowledge gaps and maximise risk-awareness.

The programme will then be rolled out at the village level in selected areas of Keningau, with other areas acting as controls. Parasite prevalence rates will be collected by cross sectional sampling before, during and after the programme in order to assess effectiveness.

Part of the programme will involve investigating the effectiveness of adoption of various personal protective measures against mosquito bites by individuals at high risk of exposure.

References 

  • 锘縉aserrudin, N.A.; Hod, R.; Jeffree, M.S.; Ahmed, K.; Culleton, R.; Hassan, M.R. The Role of Human Behavior in Plasmodium knowlesi Malaria Infection: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 3675.  
  • Fornace, K.M.; Brock, P.M.; Abidin, T.R.; Grignard, L.; Herman, L.S.; Chua, T.H.; Daim, S.; William, T.; Patterson, C.L.; Hall, T.; et al. Environmental risk factors and exposure to the zoonotic malaria parasite Plasmodium knowlesi across northern Sabah, Malaysia: A population-based cross-sectional survey. Lancet Planet. Health 2019, 3, e179鈥揺186. 
  • 锘縂rigg, M.J.; Cox, J.; William, T.; Jelip, J.; Fornace, K.M.; Brock, P.M.; von Seidlein, L.; Barber, B.E.; Anstey, N.M.; Yeo, T.W.; et al. Individual-level factors associated with the risk of acquiring human Plasmodium knowlesi malaria in Malaysia: A case-control study. Lancet Planet. Health 2017, 1, e97鈥揺104.

The role of LSHTM and NU in this collaborative project

  • Osamu Kaneko is the Principal Investigator of the zoonotic malaria project in Sabah, Malaysia, and has ongoing projects on malaria across the world.  
  • Chris Smith is a co-investigator on the zoonotic malaria project in Sabah, and has previous experience of health intervention development in Cambodia, and on-going projects on other infections in the Philippines.  
  • The successful applicant will be primarily based in Nagasaki, with substantial amount of time spent with collaborators in Malaysia. Regular joint teleconferences will ensure a highly collaborative nature of the PhD.

Particular prior educational requirements for a student undertaking this project

  • Background and/or interest in infectious diseases and interdisciplinary research; Masters degree in a related field.
  • Quantitative, analytical and programming skills.
  • Basic knowledge of data analysis.
  • Evidence of collaborative work.

Skills we expect a student to develop/acquire whilst pursuing this project

  • Infectious disease epidemiology: malaria, dengue and neglected tropical diseases.
  • Social science methods.
  • Intervention development and evaluation.
  • Collaborative ethos.