“We and malaria are already friends, becoming one,” A qualitative study on malaria risk perception in Eastern Indonesia

Background: Despite the Government of Indonesia’s success in eliminating malaria in 372 out of 514 districts in 2022, the disease is still highly prevalent in Eastern Indonesia. In 2021, 95% of the total malaria cases in Indonesia were reported from Papua, West Papua and Nusa Tenggara Timur (NTT) provinces. In the context of the persistence of malaria in these areas, there is an increased recognition that malaria elimination will require an understanding of the social determinants of malaria prevention and treatment, informed by local context and local practice. Methods This study is based on qualitative data collected through participatory community assessment and participatory barrier analysis implemented through an adapted immersion approach. For the adapted immersion, researchers immersed themselves in the communities during the day and early evening over a period of 5 days. Researchers gathered insights through informal conversations, discussions using visual tools, and direct observation. The study was conducted in 4 districts of high endemic areas across Papua, West Papua, and Sumba Islands in NTT. Results The study highlights how people’s perception of the disease in high malaria endemic areas affects their health behaviors in dealing with malaria infection, particularly in their decision making for early testing, adherence to malaria treatment, and practices taken to prevent mosquito bites. Conclusions People in high-endemic areas of Eastern Indonesia perceived malaria as inseparable from their daily lives and with little link to mosquitos. These views underpinned behaviors that hindered the effectiveness of malaria programs, including delays in malaria testing, low adherence to malaria treatment, and inconsistent practices to prevent mosquito bites or control mosquitos. The effectiveness of public health interventions that aim to eliminate malaria in Eastern Indonesia may be improved by addressing these behaviors and underlying beliefs.