# Synthesis of qualitative evidence on community experiences and perceptions of Plasmodium knowlesi malaria and factors influencing prevention and healthcare-seeking behaviours in Malaysia

## TL;DR

This study explores how Malaysian communities perceive Plasmodium knowlesi malaria and what factors influence their prevention and healthcare-seeking behaviors.

## Contribution

The paper provides a qualitative synthesis of community-level sociocultural factors influencing P. knowlesi malaria prevention and healthcare behaviors in Malaysia.

## Key findings

- Community risk perception of P. knowlesi malaria is shaped by knowledge, fear of hospitalization, and income loss.
- Environmental and social barriers limit engagement with malaria prevention and healthcare.
- Local prevention practices include natural remedies alongside formal measures.

## Abstract

Malaria remains a significant public health challenge, and Plasmodium knowlesi malaria has become the predominant cause of malaria in Malaysia. Despite progress in eliminating nonzoonotic malaria species, Malaysia continues to face challenges in controlling P. knowlesi. While epidemiological and vector control studies are reported, less is known about the community-level sociocultural dynamics influencing prevention behaviours. Therefore, this qualitative evidence synthesis (QES) aims to consolidate existing evidence on community experiences and perceptions related to P. knowlesi malaria, as well as the social, cultural, and contextual factors influencing prevention and healthcare-seeking behaviours in Malaysia.

This QES protocol has been registered in PROSPERO (CRD 420251045457). A systematic literature search was conducted in electronic databases, and data analysis followed Thomas and Harden’s thematic synthesis method.

The QES included five qualitative and mixed-method studies published between 2022 and 2024 that explored community perspectives on P. knowlesi malaria in Malaysia. Three analytical themes were synthesized: (1) ‘Knowledge and Lived Realities Shape Community Risk Perception of Knowlesi Malaria’, suggesting community understanding of P. knowlesi, fear of hospitalization and income loss influencing health-seeking behaviours; (2) ‘Environmental, Structural, and Social Barriers Constrain Community Engagement with Malaria Prevention and Healthcare Seeking’, where environmental exposure, occupational risks, challenges to the use of personal protection, and access barriers were major determinants; and (3) ‘Malaria Prevention Practices Reflect Local Knowledge, and Availability of Formal Prevention Measures’, highlighting the application of natural and household remedies for prevention, while using formal preventive measures.

This QES consolidates the available evidence for P. knowlesi malaria control strategies including prevention and healthcare seeking. It highlights that malaria prevention behaviours are shaped not only by knowledge on transmission and diseases, but also by the social, environmental, and cultural realities in local context. Therefore, integrating local community perspectives and challenges into prevention and vector control programs could enhance the sustainability and equity in rural areas in Malaysia.

The online version contains supplementary material available at 10.1186/s12936-026-05785-4.