ABSTRACT Objectives Imported malaria remains a diagnostic challenge in non‐endemic countries, where timely recognition depends on healthcare workers eliciting recent travel history and initiating appropriate testing. We assessed malaria knowledge, training exposure and self‐reported travel‐history practice across healthcare worker roles at two reference centres in northern Poland. Methods We conducted an online cross‐sectional survey between October 2023 and April 2024 among doctors, nurses, paramedics and allied healthcare personnel. A 25‐item instrument covered aetiology, transmission, prevention, pharmacology, diagnosis and epidemiology. Knowledge scores were compared using non‐parametric tests. Regression models exploring sociodemographic and occupational predictors were unstable because few respondents scored highly and are reported as supplementary sensitivity analyses. Results Among 402 respondents, the mean knowledge score was 7.4 of 25 (29.6%); 91.3% scored below the predefined threshold and no respondent exceeded 64%. Knowledge gaps were greatest for complete transmission routes (4.0% correct), prevention measures (8.7%), diagnostic methods (12.7%) and contemporary pharmacology. Only 14.4% of doctors reported always asking febrile patients about travel to malaria‐endemic regions. Malaria exposure in training was limited: 22.1% recalled coverage in parasitology classes and 3.5% had attended relevant symposia or conferences. No sociodemographic or occupational factor was independently associated with knowledge in any model specification. Conclusions Preparedness for imported malaria was weak across this non‐endemic healthcare workforce. Strengthening case detection requires routine travel‐history prompts in febrile‐patient assessment, targeted continuing education and structured coverage of imported tropical infections in pre‐graduate curricula.
ABSTRACT Background Non‐communicable diseases (NCDs) account for approximately 35% of deaths in Sierra Leone, yet service delivery remains largely focused on infectious diseases and maternal and child health. The NHSSP 2026–2030 presents an opportunity to integrate NCD care within primary healthcare and district health services. This study assessed the readiness of Sierra Leone's health system to support this transition. Methods A qualitative‐dominant mixed‐methods design was employed, integrating a review of 10 policy and technical documents with 28 semi‐structured interviews. Participants were purposively selected across national, district, facility and community levels and included NCD programme officials, district health managers, clinicians, pharmacists, community health workers and patient advocates. Data were analysed using a thematic framework approach. Documentary and interview findings were triangulated, and member checking was conducted. Readiness across seven domains was assessed using a predefined rubric, with ratings agreed by all authors. Results Four overarching themes and nine sub‐themes were identified: NCD policy visibility and strategic limitations; PHC readiness and implementation gaps; medicines access, supply chain fragility and treatment barriers; and workforce capacity, referral systems and community awareness. Although NCDs have gained greater prominence within national policy discourse, participants frequently characterised this recognition as insufficiently translated into implementation. Integration at PHC level was hindered by an unoperationalised service package, inadequate diagnostic capacity, recurrent medicine stockouts, workforce competency gaps, weak referral pathways, out‐of‐pocket costs and limited public awareness. Readiness ratings indicated emerging policy commitment but substantial deficiencies in operational guidance, service delivery inputs, implementation capacity and accountability mechanisms. Conclusions The NHSSP 2026–2030 provides a critical opportunity to institutionalise integrated NCD services within PHC. Realising this potential will require context‐specific adaptation and phased implementation of the WHO Package of Essential NCD Interventions, strengthened medicines supply systems, workforce development, formalised referral pathways, community engagement and a costed financing strategy aligned with universal health coverage goals.
ABSTRACT Background Malaria elimination in the Greater Mekong Subregion (GMS) is still struggling with barriers in border regions, where population mobility, occupational exposure, and health system fragility continue to drive ongoing malaria transmission. Tak Province is a typical example of such challenges along the Thailand–Myanmar border. Qualitative evidence of the lived experience of frontline health actors is crucial for the design of contextually placed elimination strategies. Methods This qualitative descriptive study was conducted in Khane Chue Subdistrict, Mae Ramat District, Tak Province, a malaria‐endemic area bordering Myanmar. A total of 17 informants participated: 13 village health volunteers, two health workers and two non‐governmental organization staffs. Semi‐structured instruments were developed to suit each group of participants and used to guide the in‐depth interviews. Reflexive thematic analysis was used to analyse data, applying both deductive and inductive coding. Results Five factors related to malaria prevention behaviours were identified: cross‐border mobility and migration; occupational exposure of agricultural and forest workers; a knowledge–behaviour gap related to malaria risk normalization and availability of free treatment; lifestyle routines that coincide with peak vector biting hours; socioeconomic and environmental vulnerability. Five programmatic bottlenecks were also prominent: funding cuts after USAID's exit, human resource shortages and low rates of compensation for community health workers (CHWs), fear‐based avoidance of health care services by undocumented migrants, poor uptake of long‐lasting insecticidal nets and compounding external shocks such as Myanmar's political instability and COVID‐19 pandemic. Conclusion Malaria control in this border area is influenced by the interaction of many behavioural, environmental, and health system determinants on multiple levels. To achieve elimination will need migrant‐inclusive health policies, occupation‐specific vector control, active surveillance for a prolonged period, cross‐border programmatic coordination and stable financing. Findings provide specific recommendations for health planners in similar border contexts in Southeast Asia.
