Community perceptions and acceptance of ivermectin for malaria control on Sumba Island, Indonesia
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Background
Indonesia has made significant progress in malaria control, however hotspots such as Sumba Island continue to experience high rates of malaria transmission, driven by multiple Anopheles mosquito species. The Sumba Livestock Ivermectin for Malaria (SLIM) trial was conducted to assess the efficacy of ivermectin treatment in livestock as a vector control strategy. This study aimed to explore community perceptions of ivermectin-based malaria interventions, including ivermectin livestock treatment (ITL) and potential mass drug administration (MDA) in humans.
Methods
A social science study was conducted alongside the SLIM trial between November 2022 and September 2023 across four villages in Southwest Sumba. A mixed-methods approach was used, including focus group discussions, in-depth interviews, and feedback meetings. Community engagement activities such as puppet shows and interactive sessions on malaria transmission were also implemented. Data were transcribed, coded, and thematically analysed using NVivo.
Results
A total of 75 individuals participated in qualitative data collection, and approximately 650 individuals engaged in community events. Malaria was ranked as the most pressing health concern by study participants. Initial skepticism about ITL was mitigated through trust-building efforts and respectful communication. Community members actively contributed to the trial, demonstrating acceptance of ITL and expressing interest in future research participation. While there was openness to mass drug administration for humans, concerns about safety, particularly for children, were raised. Local authority approval was deemed essential for intervention acceptance. In one village, low social cohesion posed barriers to research participation, highlighting the importance of pre-trial engagement.
Conclusions
Community perceptions of ivermectin-based malaria control strategies were shaped by trust, engagement, and cultural considerations. The study underscores the need for sustained, respectful communication and inclusive stakeholder engagement in malaria research. Future malaria control interventions should account for local social dynamics, ensuring informed community participation to enhance trial feasibility and acceptance.
