Characterizing mobile and migrant populations and their role in cross-border malaria transmission on the Nepal-India border
Nepal has made substantial progress in controlling malaria since since the late 90's. The country is divided into three ecological zones that run east to west - but malaria is primarily an issue of the Terai zone, the lower strip of land in the south with a subtropical climate. The Terai is home to 13 highly malaria-endemic districts.
Mortality from malaria in Nepal has historically been very low, as most cases are caused by the less deadly Plasmodium vivax. However, there has been a recent uptick in Plasmodium falciparum cases, assumed to be primarily imported from India. The Ministry of Health and Population of Nepal recognized anecdotally that mobile and migrant populations (MMPs) pose a large risk to Nepal's national malaria elimination target of 2026. However, this was never explicitly studied and documented in research. In addition, how to go about connecting MMPs with malaria prevention and treatment services while effectively targeting cross-border importation was not well understood.
In order to better study this phenomenon and inform targeted surveillance strategies for this high-risk population, UCSF’s Malaria Elimination Initiative conducted a mixed-methods study in 3 of the highest burden districts in Nepal during the high-peak (post-monsoon) transmission season in late summer / early fall of 2016. I was based in Dhanghadi, Nepal for this assessment and served as the primary UCSF focal point to lead data collection and analysis activities, including on-site training for health staff, data quality checks, active case finding and staff supervision of 3 field-based research assistants in each of the districts included in the study.
After the pilot phase concluded, a retrospective analysis was conducted of case-load across study districts from 2013-2016 and compared to preliminary results from the 2016 post-monsoon data. Survey data was summarized geo-spatially to characterize sources and sinks of transmission as well as travel patterns of identified imported cases and their social contacts. These results, in conjunction with preliminary qualitative findings from Key Informant Interviews and Focus Group Discussions across all 3 districts, were presented at the Annual American Society of Tropical Medicine and Hygiene (ASTMH) in November 2016.
Publications and invited lectures
Feachem RGA, Chen I, Akbari O et al. “Malaria eradication within a generation: ambitious, achievable, and necessary.” Lancet. 2019;394:1056-1112. ***Authored case-study panel on integrated community case management***
Symposium speaker at 65th Annual American Society of Tropical Medicine and Hygiene (Atlanta, November 2016): Tailored surveillance strategies for high-risk populations in elimination settings: Formative assessment of mobile and migrant populations in the Nepal-India border region. Symposium title: Tailored Surveillance Strategies for High-Risk Populations in Malaria Elimination Settings.
Collaborators
Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco.
Tribhuvan Univeristy, Kathmandu, Nepal.
Kantipur College of Medical Sciences, Kathmandu, Nepal.
