Evaluating the acceptability and feasibility of new mosquito bite prevention tools in a “forest pack” to support malaria elimination in Cambodia

Background Cambodia is nearing malaria elimination after years of sustained progress. The remaining challenges are at-risk populations living or working in forested areas exposed to outdoor and early evening biting and where treated nets or residual spraying is not practical. This study evaluates the acceptability and feasibility of additional mosquito bite protection products, delivered to these high-risk populations. Methods This study was conducted in two high-malaria burden operational districts (OD) in Cambodia, targeting high-risk individuals: forest goers, forest dwellers, and forest rangers. A total of 28,000 forest packs containing a Spatial Emanator (SE) and topical repellent (TR), were distributed over four rounds and clothing was treated with insecticide over two rounds. Social and Behavior Change Communication (SBCC) materials to support adoption was included. The evaluation included surveys, key informant interviews, and focus group discussions. Outcomes were assessed using implementation science frameworks and descriptive statistics. Results A total of 2,935 individuals from 18 villages were enrolled. Product distribution reached 85% of the target population in Sen Monorom OD and between 72–102% in Phnom Srouch OD, though pack fidelity varied, with fewer complete packs delivered than planned, particularly in Phnom Srouch. Reported acceptability and appropriateness of the products increased over time, with up to 96% of participants finding the SE acceptable, 93% for TR, and 100% for insecticide treated clothing (ITC). Reported product use was high, particularly among forest dwellers; forest rangers had lower reported use, especially for topical repellent. Users indicated earlier and better engagement with targeted SBCC would improve use. Having trusted members of the community provide tools and instructions is important. Each tool was most useful in different scenarios and at different times. Implementers believed the products were appropriate for the targeted groups and that, while delivery to remote communities can be difficult, they would support delivery to larger populations. Conclusion This study demonstrated the acceptability of new products distributed together with SBCC, from the perspective of forest-exposed, at-risk community members. It highlighted the need for better implementation to ensure more timely and consistent dissemination of product and SBCC materials. Further studies are needed to assess the epidemiological impact of combined bite prevention tools.