Improving equitable access to malaria care among hard-to-reach Amazonian gold miners: a promising self-diagnosis and self-treatment kit (Malakit)
1
Centre d'Investigation Clinique Guyane Amazonie - Inserm1424, Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana
2
Parasitic diseases Laboratory, Foundation Oswaldo Cruz, Rio de Janeiro, Brazil
3
Parasitology Laboratory, Centre National de référence du paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
4
DPAC-Fronteira non-profit, Oiapoque, Brazil
5
National Malaria Programme of Suriname, Paramaribo, Suriname
6
Foundation for the Advancement of Scientific Research in Suriname, Paramaribo, Suriname
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Isolated and mobile gold mining populations in French Guiana face major barriers to healthcare access, sustaining malaria transmission and increasing the risk of artemisinin resistance in hard-to-reach settings (1,2). Aligned with SDG 3 (ending malaria epidemics), the Malakit project developed with Suriname and Brazil addressed these inequities through a context-adapted self-diagnosis and self-treatment strategy for gold miners.
METHODS:
This strategy was implemented through an interventional study assessing both implementation and effectiveness (3). Gold miners were trained to use a self-diagnosis and self-treatment malaria kit, supported by culturally and linguistically adapted illustrated materials, videos, and a smartphone application developed through community engagement. Kits were distributed by community health workers at key cross-border points between French Guiana, Brazil, and Suriname to individuals travelling to mining sites in French Guiana. Evaluation relied on questionnaires completed at inclusion and follow up visits, as well as on cross sectional pre and post intervention studies. The primary outcome was the proportion of participants correctly using artemisinin based combination therapy following a malaria test. Secondary outcomes included kit use practices and intervention’s impact on malaria transmission.
RESULTS:
From 2018 to 2020, 4766 kits were distributed to 3733 individuals. The kit was used correctly by 71.7% of participants (N=223, 95%CI=65.8–77.7). The proportion of individuals using both a diagnostic test and a certified ACT treatment—either through the Malakit program or the formal health system—increased after the intervention (OR=1.8; 95%CI=1.1–3.0) (4). Modelling suggests that the intervention contributed to a 43% reduction in regional malaria incidence (5). Qualitative survey indicates strong acceptance by the target population (6).
CONCLUSIONS:
The Malakit project shows that underserved populations can safely manage malaria with adapted training. This equity driven model offers a sustainable pathway to improving care access for communities living “beyond borders” and provides a replicable approach for similar contexts worldwide (7,8).
Isolated and mobile gold mining populations in French Guiana face major barriers to healthcare access, sustaining malaria transmission and increasing the risk of artemisinin resistance in hard-to-reach settings (1,2). Aligned with SDG 3 (ending malaria epidemics), the Malakit project developed with Suriname and Brazil addressed these inequities through a context-adapted self-diagnosis and self-treatment strategy for gold miners.
METHODS:
This strategy was implemented through an interventional study assessing both implementation and effectiveness (3). Gold miners were trained to use a self-diagnosis and self-treatment malaria kit, supported by culturally and linguistically adapted illustrated materials, videos, and a smartphone application developed through community engagement. Kits were distributed by community health workers at key cross-border points between French Guiana, Brazil, and Suriname to individuals travelling to mining sites in French Guiana. Evaluation relied on questionnaires completed at inclusion and follow up visits, as well as on cross sectional pre and post intervention studies. The primary outcome was the proportion of participants correctly using artemisinin based combination therapy following a malaria test. Secondary outcomes included kit use practices and intervention’s impact on malaria transmission.
RESULTS:
From 2018 to 2020, 4766 kits were distributed to 3733 individuals. The kit was used correctly by 71.7% of participants (N=223, 95%CI=65.8–77.7). The proportion of individuals using both a diagnostic test and a certified ACT treatment—either through the Malakit program or the formal health system—increased after the intervention (OR=1.8; 95%CI=1.1–3.0) (4). Modelling suggests that the intervention contributed to a 43% reduction in regional malaria incidence (5). Qualitative survey indicates strong acceptance by the target population (6).
CONCLUSIONS:
The Malakit project shows that underserved populations can safely manage malaria with adapted training. This equity driven model offers a sustainable pathway to improving care access for communities living “beyond borders” and provides a replicable approach for similar contexts worldwide (7,8).
| eISSN: | 2654-1459 |
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