Mapping the travel patterns of people with malaria in Bangladesh

Abstract

Background: Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking.Methods: Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months. Results: Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas. Conclusions:The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Analysing human population movement data for malaria control and elimination

“…Sinha et al 2020 [ 17 ], Guerra et al 2019 [ 18 ], Chang et al 2018 [ 19 ], Ihantamalala et al 2018 [ 20 ], Tatem et al 2014 [ 21 ], Wesolowski et al 2014 [ 22 ], Wesolowski et al 2012 [ 23 ],…”

“…Travel surveys ranging from a sample size of less than 3000 to national surveys have often been used [ 17 – 19 , 22 , 29 ]. These were combined with national malaria incidence or prevalence data [ 17 , 18 , 20 , 22 , 29 ]. Travel surveys were also combined with mobile phone call data records (CDRs) and genetic data, thereby applying genetic epidemiologic data at the national level [ 19 ].…”

“…Mobile phone CDRs were combined with malaria prevalence data [ 20 – 23 ] and traffic data [ 24 ]. Most studies used mathematical models to analyse the combined data, with the exception of three studies [ 17 , 21 , 29 ].…”

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

“…A study conducted in Uganda showed that Kampala residents who travelled overnight out of the city were at substantially higher risk of malaria, with women less likely to use LLINs during travel than men [ 8 ]. However, information on use of malaria preventive measures in travellers is limited [ 17 ].…”

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

“…A study conducted in Uganda showed that Kampala residents who travelled overnight out of the city were at substantially higher risk of malaria with women less likely to use LLINs during travel than men [8]. However, information on use of malaria preventive measures in travellers is limited [15].…”