{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:22:17Z","timestamp":1779265337344,"version":"3.51.4"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013891","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000}}],"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mahidol University (Fundamental Fund: Fiscal year 2025 by the National Science Research and Innovation Fund"},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U19AI181583"],"award-info":[{"award-number":["U19AI181583"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["D43 TW011509"],"award-info":[{"award-number":["D43 TW011509"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Plasmodium knowlesi<\/jats:italic>\n                      poses an emerging challenge for malaria control in Southeast Asia due to its zoonotic nature, diagnostic complexity and lack of species-specific control strategies. These factors complicate both prevention and case management efforts. Understanding both community awareness and healthcare provider perspectives is critical for informing targeted responses. This study aimed to assess awareness of\n                      <jats:italic>P. knowlesi<\/jats:italic>\n                      malaria among at-risk community members in southern Thailand and to explore contextual challenges through qualitative insights from healthcare providers, including provincial officers, district-based malaria control staff, and village health volunteers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An explanatory sequential mixed-methods design was employed between April and May 2025. A cross-sectional survey of 300 adults residing in three\n                      <jats:italic>P. knowlesi<\/jats:italic>\n                      -endemic districts was conducted using a structured questionnaire that included eight items assessing overall awareness. Descriptive statistics, violin plots, and multivariable generalized linear modeling were used to identify factors associated with awareness scores. Subsequently, semi-structured interviews were conducted with 28 healthcare providers across various administrative levels. Qualitative data were thematically analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall awareness of\n                      <jats:italic>P. knowlesi<\/jats:italic>\n                      malaria was moderate (mean score: 10.7\/23; SD\u2009\u00b1\u20092.9; range: 3.0\u201320.0). Female individuals, living farther from health facilities, receiving malaria-related health education, and having higher attitude scores were significantly associated with increased awareness (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Healthcare providers reported a decline in\n                      <jats:italic>P. knowlesi<\/jats:italic>\n                      incidence, alongside persistent transmission risks in forested areas. Health education efforts were largely reactive, delivered following case detection, but often included information about monkey-to-human transmission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Awareness of\n                      <jats:italic>P. knowlesi<\/jats:italic>\n                      malaria remains suboptimal among high-risk populations, particularly among men, those who had received limited health education, and individuals with poor attitudes toward malaria. Integrated, proactive, and male-focused health promotion strategies are essential to enhance community knowledge and support disease control efforts.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013891","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:41:10Z","timestamp":1771440070000},"page":"e0013891","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Community awareness and health providers\u2019 perspectives on zoonotic Plasmodium knowlesi malaria in Thailand: A mixed-methods assessment"],"prefix":"10.1371","volume":"20","author":[{"given":"Piyarat","family":"Sripoorote","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nichakan","family":"Inthitanon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yupaporn","family":"Wattanagoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liwang","family":"Cui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wang","family":"Nguitragool","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Fornace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jetsumon","family":"Sattabongkot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4635-3701","authenticated-orcid":true,"given":"Pyae Linn","family":"Aung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"pntd.0013891.ref001","doi-asserted-by":"crossref","DOI":"10.30875\/9789287076717","volume-title":"World Malaria Report 2024","author":"World Health Organization","year":"2024"},{"key":"pntd.0013891.ref002","volume-title":"Malaria surveillance dashboard","author":"National Malaria Elimination Program","year":"2025"},{"issue":"1","key":"pntd.0013891.ref003","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12936-022-04229-z","article-title":"Assessing Thailand\u2019s 1-3-7 surveillance strategy in accelerating malaria elimination","volume":"21","author":"P Sudathip","year":"2022","journal-title":"Malar J"},{"issue":"1","key":"pntd.0013891.ref004","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s12936-019-2852-5","article-title":"Transmission risk beyond the village: entomological and human factors contributing to residual malaria transmission in an area approaching malaria elimination on the Thailand-Myanmar border","volume":"18","author":"HM Edwards","year":"2019","journal-title":"Malar J"},{"issue":"6","key":"pntd.0013891.ref005","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.4269\/ajtmh.19-0063","article-title":"Case Report: Case Series of Human Plasmodium knowlesi Infection on the Southern Border of Thailand","volume":"101","author":"S Ngernna","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pntd.0013891.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(23)00298-0","article-title":"Simian malaria: a narrative review on emergence, epidemiology and threat to global malaria elimination","volume":"23","author":"KM Fornace","year":"2023","journal-title":"Lancet Infect Dis"},{"issue":"9414","key":"pntd.0013891.ref007","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0140-6736(04)15836-4","article-title":"A large focus of naturally acquired Plasmodium knowlesi infections in human beings","volume":"363","author":"B Singh","year":"2004","journal-title":"Lancet"},{"issue":"1","key":"pntd.0013891.ref008","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12936-022-04131-8","article-title":"Plasmodium knowlesi: the game changer for malaria eradication","volume":"21","author":"W-C Lee","year":"2022","journal-title":"Malar J"},{"issue":"1","key":"pntd.0013891.ref009","doi-asserted-by":"crossref","DOI":"10.4084\/mjhid.2012.013","article-title":"Biology of human malaria plasmodia including Plasmodium knowlesi","volume":"4","author":"S Antinori","year":"2012","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"pntd.0013891.ref010","volume-title":"Preparing for certification of malaria elimination","author":"World Health Organization","year":"2022"},{"issue":"1","key":"pntd.0013891.ref011","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12936-022-04129-2","article-title":"Zoonotic malaria transmission and land use change in Southeast Asia: what is known about the vectors","volume":"21","author":"B van de Straat","year":"2022","journal-title":"Malar J"},{"issue":"10","key":"pntd.0013891.ref012","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.3201\/eid1710.110349","article-title":"Plasmodium knowlesi Malaria in humans and macaques, Thailand","volume":"17","author":"S Jongwutiwes","year":"2011","journal-title":"Emerg Infect Dis"},{"issue":"7","key":"pntd.0013891.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002978","article-title":"Transmission and control of Plasmodium knowlesi: a mathematical modelling study","volume":"8","author":"N Imai","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0013891.ref014","doi-asserted-by":"crossref","first-page":"5750","DOI":"10.1038\/s41467-023-41546-6","article-title":"Zoonotic malaria requires new policy approaches to malaria elimination","volume":"14","author":"KM Fornace","year":"2023","journal-title":"Nat Commun"},{"issue":"9","key":"pntd.0013891.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003670","article-title":"Expanding the roles of malaria post workers in Thailand: A qualitative study of stakeholder perspectives","volume":"4","author":"M Jongdeepaisal","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"4","key":"pntd.0013891.ref016","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3390\/tropicalmed4040143","article-title":"The Evolution of the Malaria Clinic: The Cornerstone of Malaria Elimination in Thailand","volume":"4","author":"P Sudathip","year":"2019","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pntd.0013891.ref017","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12936-021-03740-z","article-title":"Implementation and success factors from Thailand\u2019s 1-3-7 surveillance strategy for malaria elimination","volume":"20","author":"C Lertpiriyasuwat","year":"2021","journal-title":"Malar J"},{"issue":"1","key":"pntd.0013891.ref018","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1186\/s12936-024-05095-7","article-title":"Knowledge, attitude and practice levels regarding malaria among the Semai sub-ethnic indigenous Orang Asli communities in Pahang, Peninsular Malaysia: a stepping stone towards the prevention of human malaria re-establishment","volume":"23","author":"L Samsudin","year":"2024","journal-title":"Malar J"},{"issue":"3","key":"pntd.0013891.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/S2542-5196(17)30031-1","article-title":"Individual-level factors associated with the risk of acquiring human Plasmodium knowlesi malaria in Malaysia: a case-control study","volume":"1","author":"MJ Grigg","year":"2017","journal-title":"Lancet Planet Health"},{"issue":"1","key":"pntd.0013891.ref020","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s12936-021-03741-y","article-title":"Perceptions and prevention practices on malaria among the indigenous Orang Asli community in Kelantan, Peninsular Malaysia","volume":"20","author":"MB Munajat","year":"2021","journal-title":"Malar J"},{"key":"pntd.0013891.ref021","doi-asserted-by":"crossref","first-page":"953585","DOI":"10.3389\/fcimb.2022.953585","article-title":"Seroepidemiological surveillance, community perceptions and associated risk factors of malaria exposure among forest-goers in Northeastern Thailand","volume":"12","author":"MAFA Rahim","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"issue":"1","key":"pntd.0013891.ref022","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s12936-024-05066-y","article-title":"Demographic and socioeconomic obstacles to access to malaria services for Myanmar migrants in Thailand","volume":"23","author":"P Sripoorote","year":"2024","journal-title":"Malar J"},{"issue":"1","key":"pntd.0013891.ref023","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1186\/s12936-025-05539-8","article-title":"Malaria care-seeking behaviours and infection prevalence among short-term Myanmar migrants in Thailand","volume":"24","author":"PL Aung","year":"2025","journal-title":"Malar J"},{"issue":"6","key":"pntd.0013891.ref024","first-page":"551","article-title":"Knowledge and practices regarding malaria and its prevention and their associated socio-demographic factors among those living along the Thailand-Myanmar border","volume":"53","author":"S Yongchaitrakul","year":"2022","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"pntd.0013891.ref025","doi-asserted-by":"crossref","first-page":"107030","DOI":"10.1016\/j.actatropica.2023.107030","article-title":"Zoonotic simian malaria parasites in free-ranging Macaca fascicularis macaques and human malaria patients in Thailand, with a note on genetic characterization of recent isolates","volume":"248","author":"D Narapakdeesakul","year":"2023","journal-title":"Acta Trop"},{"key":"pntd.0013891.ref026","volume-title":"Biostatistics: a foundation for analysis in the health sciences","author":"WW Daniel","year":"2018"},{"issue":"11","key":"pntd.0013891.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259950","article-title":"Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia","volume":"16","author":"RD Guntur","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pntd.0013891.ref028","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1186\/s12889-023-16173-x","article-title":"Exploring barriers to and facilitators of malaria prevention practices: a photovoice study with rural communities at risk to Plasmodium knowlesi malaria in Sabah, Malaysia","volume":"23","author":"NA Naserrudin","year":"2023","journal-title":"BMC Public Health"},{"issue":"6","key":"pntd.0013891.ref029","doi-asserted-by":"crossref","first-page":"3675","DOI":"10.3390\/ijerph19063675","article-title":"The Role of Human Behavior in Plasmodium knowlesi Malaria Infection: A Systematic Review","volume":"19","author":"NA Naserrudin","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pntd.0013891.ref030","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3390\/encyclopedia5010018","article-title":"Likert-Type Scale","volume":"5","author":"M Koo","year":"2025","journal-title":"Encyclopedia"},{"issue":"7","key":"pntd.0013891.ref031","doi-asserted-by":"crossref","first-page":"4419","DOI":"10.3390\/ijerph19074419","article-title":"The Emerging Threat of Plasmodium knowlesi Malaria Infection: A Concept Paper on the Vulnerable Factors in Human","volume":"19","author":"NA Naserrudin","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"8","key":"pntd.0013891.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004915","article-title":"Estimating Geographical Variation in the Risk of Zoonotic Plasmodium knowlesi Infection in Countries Eliminating Malaria","volume":"10","author":"FM Shearer","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0013891.ref033","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1128\/CMR.00079-12","article-title":"Human infections and detection of Plasmodium knowlesi","volume":"26","author":"B Singh","year":"2013","journal-title":"Clin Microbiol Rev"},{"issue":"1","key":"pntd.0013891.ref034","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1186\/s12936-020-03511-2","article-title":"Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment","volume":"19","author":"LL Ekawati","year":"2020","journal-title":"Malar J"},{"key":"pntd.0013891.ref035","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ijid.2020.05.022","article-title":"Malaria cross-sectional surveys identified asymptomatic infections of Plasmodium falciparum, Plasmodium vivax and Plasmodium knowlesi in Surat Thani, a southern province of Thailand","volume":"96","author":"S Shimizu","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"4","key":"pntd.0013891.ref036","doi-asserted-by":"crossref","DOI":"10.1016\/S2542-5196(19)30045-2","article-title":"Environmental risk factors and exposure to the zoonotic malaria parasite Plasmodium knowlesi across northern Sabah, Malaysia: a population-based cross-sectional survey","volume":"3","author":"KM Fornace","year":"2019","journal-title":"Lancet Planet Health"},{"issue":"1","key":"pntd.0013891.ref037","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s41182-025-00757-x","article-title":"Community perception and preventive practices regarding malaria in low-endemicity regions on Indonesian Kalimantan border adjacent to high-endemicity zoonotic malaria in Malaysian Borneo","volume":"53","author":"D Natalia","year":"2025","journal-title":"Trop Med Health"},{"issue":"1","key":"pntd.0013891.ref038","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1186\/s12936-021-03991-w","article-title":"Guiding placement of health facilities using multiple malaria criteria and an interactive tool","volume":"20","author":"KB Toh","year":"2021","journal-title":"Malar J"},{"key":"pntd.0013891.ref039","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.47602","article-title":"Local human movement patterns and land use impact exposure to zoonotic malaria in Malaysian Borneo","volume":"8","author":"KM Fornace","year":"2019","journal-title":"Elife"},{"issue":"7","key":"pntd.0013891.ref040","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/j.1365-3156.2005.01445.x","article-title":"Community-based surveillance: a pilot study from rural Cambodia","volume":"10","author":"S Oum","year":"2005","journal-title":"Trop Med Int Health"},{"key":"pntd.0013891.ref041","doi-asserted-by":"crossref","first-page":"100128","DOI":"10.1016\/j.lansea.2022.100128","article-title":"Village malaria workers for the community-based management of vivax malaria","volume":"9","author":"B Adhikari","year":"2022","journal-title":"Lancet Reg Health Southeast Asia"},{"issue":"8","key":"pntd.0013891.ref042","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003443","article-title":"Sustaining village malaria worker programmes with expanded roles: Perspectives of communities, healthcare workers, policymakers, and implementers in Vietnam","volume":"4","author":"H Nguyen","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"4","key":"pntd.0013891.ref043","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3390\/tropicalmed4040140","article-title":"Quality of Malaria Treatment Provided under \u201cBetter Health Together\u201d Project in Ethnic Communities of Myanmar: How Are We Performing?","volume":"4","author":"PW Minn","year":"2019","journal-title":"Trop Med Infect Dis"},{"key":"pntd.0013891.ref044","article-title":"What is a planning model? An introduction to PRECEDE-PROCEED","author":"R Crosby","year":"2011","journal-title":"J Public Health Dent"},{"key":"pntd.0013891.ref045","first-page":"28","article-title":"The health belief model.","volume-title":"Predicting health behaviour","author":"C Abraham","year":"2005","edition":"2"},{"key":"pntd.0013891.ref046","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ijid.2013.12.016","article-title":"Plasmodium knowlesi in travellers, update 2014","volume":"22","author":"M M\u00fcller","year":"2014","journal-title":"Int J Infect Dis"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0013891","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T18:46:12Z","timestamp":1771958772000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013891"}},"subtitle":[],"editor":[{"given":"Miles B.","family":"Markus","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013891","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]}}}