Combatting malaria together: key findings from a rapid formative assessment on Royal Thai Army malaria practices and military-civilian collaboration in Sisaket Province, Thailand.

backgroundIn the Greater Mekong Subregion, militaries constitute a critical but often underserved malaria transmission reservoir, given their high mobility, deployment to endemic areas, and frequent exposure to vectors. In Thailand, the Royal Thai Army (RTA) is a key risk population, yet their malaria practices, perceptions, and the scale and scope of coordination with the Ministry of Public Health (MoPH) are not well understood. A joint military-civilian research team conducted a rapid formative assessment in Sisaket Province, a persistent transmission hotspot, to characterize the unique RTA risk profile and identify opportunities to strengthen RTA-MoPH coordination on malaria elimination efforts.

methodsUsing a mixed-methods design, the research team conducted a five-year (2016-2020) retrospective analysis of Sisaket's malaria case and program response data, alongside 16 focus group discussions (FGDs) and 17 key informant interviews (KIIs) with RTA and MoPH respondents across all military ranks and health system levels in the province's three highest-burden districts (Kantharalak, Khun Han, Phu Sing). Qualitative data were collected between December 2021-January 2022 and thematically analyzed using an inductive content analysis approach. Quantitative data were descriptively analyzed using statistical methods to characterize the RTA malaria risk profile and identify and compare recent trends in program response between military and non-military populations in Sisaket Province.

results432 military malaria cases were reported in Sisaket between 2016 and 2020, accounting for 18% of the province's total 2425 cases (with the proportion ranging from 14 to 30% annually). All military malaria cases were male, with a median age of 28 years. 96% of military cases were diagnosed and treated at MoPH facilities, with 41% of cases classified as indigenous and 40% as imported from abroad. Qualitative data were collected from a total of 116 respondents (72 RTA, 44 MoPH) through 16 FGDs and 17 KIIs. Malaria prevention and treatment practices and perceptions among soldiers were largely consistent across the three study districts. RTA-MoPH coordination occurred at all levels through both formal and informal channels and was reported to be improving and expanding by some respondents. Though several areas could benefit from increased collaboration: patient follow-up, border control efforts, vector control, and further capacitation of military medics. The RTA and MoPH both expressed strong interest in strengthening military-civilian coordination; though to better enable this, several identified challenges may need to be addressed, including restricted MoPH access to military sites, lack of continuity in relationships due to frequent RTA rotations, communication constraints, and broader differences in military versus civilian operating procedures.

conclusionStrengthening RTA-MoPH coordination towards successfully interrupting malaria transmission in Thailand may require formalizing and standardizing some joint operating procedures, increasing communication and military-civilian touchpoints, and further capacitating the RTA to carry out malaria prevention, diagnosis and treatment, and patient follow-up activities. For Thailand to achieve its goal of nationwide malaria elimination, it is crucial that the RTA as a high-risk population be fully engaged in the country's malaria control and response efforts.