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.

Keywords: Bangladesh; Malaria epidemiology; Population movement.

Fig. 1

Study sites, districts and forest distribution

Fig. 2

Spatial distribution of a total malaria cases enrolled in the study by study site and place of residence and b malaria incidence reported by NMEP during the study period

Fig. 3

Number of people travelling on a given route from place of residence to study site or health facility. a Whole country and b Chittagong Division (highlighted in green are the locations of the 5 study sites (1–5) with highest enrolment). The panels on the right show in descending order the health catchment by residence of patients at the 5 study sites (1–5) with the highest enrolment. c Ramu Upazila Health Complex 221 (10%), d Lama Ekata Laboratory Office 195 (9%), e BRAC Dighinala Laboratory 163 (8%), f Alikadam Upazila Health Complex 120 (6%) and g Chittagong Medical College Hospital 115 (5%)

Fig. 4

Days travelled from residence to destination over 2 months

Fig. 5

Numbers of days of travel between residence and destination over 2 months by gender

Fig. 6

Distance travelled (km) by reasons for visiting forest