Marshall John M, Touré Mahamoudou, Ouédraogo André Lin, Ndhlovu Micky, Kiware Samson S, Rezai Ashley, Nkhama Emmy, Griffin Jamie T, Hollingsworth T Deirdre, Doumbia Seydou, Govella Nicodem J, Ferguson Neil M, Ghani Azra C
Department of Infectious Disease Epidemiology, MRC Center for Outbreak Analysis and Modelling, Imperial College London, London, UK.
Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
Malar J. 2016 Apr 12;15:200. doi: 10.1186/s12936-016-1252-3.
As malaria prevalence declines in many parts of the world due to widescale control efforts and as drug-resistant parasites begin to emerge, a quantitative understanding of human movement is becoming increasingly relevant to malaria control. However, despite its importance, significant knowledge gaps remain regarding human movement, particularly in sub-Saharan Africa.
A quantitative survey of human movement patterns was conducted in four countries in sub-Saharan Africa: Mali, Burkina Faso, Zambia, and Tanzania, with three to five survey locations chosen in each country. Questions were included on demographic and trip details, malaria risk behaviour, children accompanying travellers, and mobile phone usage to enable phone signal data to be better correlated with movement. A total of 4352 individuals were interviewed and 6411 trips recorded.
A cluster analysis of trips highlighted two distinct traveller groups of relevance to malaria transmission: women travelling with children (in all four countries) and youth workers (in Mali). Women travelling with children were more likely to travel to areas of relatively high malaria prevalence in Mali (OR = 4.46, 95% CI = 3.42-5.83), Burkina Faso (OR = 1.58, 95% CI = 1.23-1.58), Zambia (OR = 1.50, 95% CI = 1.20-1.89), and Tanzania (OR = 2.28, 95% CI = 1.71-3.05) compared to other travellers. They were also more likely to own bed nets in Burkina Faso (OR = 1.77, 95% CI = 1.25-2.53) and Zambia (OR = 1.74, 95% CI = 1.34 2.27), and less likely to own a mobile phone in Mali (OR = 0.50, 95% CI = 0.39-0.65), Burkina Faso (OR = 0.39, 95% CI = 0.30-0.52), and Zambia (OR = 0.60, 95% CI = 0.47-0.76). Malian youth workers were more likely to travel to areas of relatively high malaria prevalence (OR = 23, 95% CI = 17-31) and for longer durations (mean of 70 days cf 21 days, p < 0.001) compared to other travellers.
Women travelling with children were a remarkably consistent traveller group across all four countries surveyed. They are expected to contribute greatly towards spatial malaria transmission because the children they travel with tend to have high parasite prevalence. Youth workers were a significant traveller group in Mali and are expected to contribute greatly to spatial malaria transmission because their movements correlate with seasonal rains and hence peak mosquito densities. Interventions aimed at interrupting spatial transmission of parasites should consider these traveller groups.
由于大规模防治努力，世界许多地区疟疾流行率下降，且耐药寄生虫开始出现，对人类流动的定量理解在疟疾控制中变得越来越重要。然而，尽管其很重要，但关于人类流动仍存在重大知识空白，特别是在撒哈拉以南非洲。
在撒哈拉以南非洲的四个国家（马里、布基纳法索、赞比亚和坦桑尼亚）对人类流动模式进行了定量调查，每个国家选择三至五个调查地点。问卷包括人口统计学和行程细节、疟疾风险行为、旅行者携带的儿童以及手机使用情况，以便使手机信号数据能更好地与流动情况相关联。共采访了4352人，记录了6411次行程。
对行程的聚类分析突出了与疟疾传播相关的两个不同旅行者群体：携带儿童旅行的妇女（在所有四个国家）和青年工作者（在马里）。与其他旅行者相比，携带儿童旅行的妇女在马里（比值比[OR]=4.46，95%置信区间[CI]=3.42 - 5.83）、布基纳法索（OR = 1.58，95% CI = 1.23 - 1.58）、赞比亚（OR = 1.50，95% CI = 1.20 - 1.89）和坦桑尼亚（OR = 2.28，95% CI = 1.71 - 3.05）更有可能前往疟疾流行率相对较高的地区。她们在布基纳法索（OR = 1.77，95% CI = 1.25 - 2.53）和赞比亚（OR = 1.74，95% CI = 1.34 - 2.27）也更有可能拥有蚊帐，而在马里（OR = 0.50，95% CI = 0.39 - 0.65）、布基纳法索（OR = 0.39，95% CI = 0.30 - 0.52）和赞比亚（OR = 0.60，95% CI = 0.47 - 0.76）拥有手机的可能性较小。与其他旅行者相比，马里的青年工作者更有可能前往疟疾流行率相对较高的地区（OR = 23，95% CI = 17 - 31）且行程持续时间更长（平均70天对21天，p < 0.001）。
在所有四个被调查国家中，携带儿童旅行的妇女是一个非常一致的旅行者群体。她们预计会对疟疾的空间传播有很大贡献，因为她们携带的儿童往往寄生虫感染率很高。青年工作者是马里的一个重要旅行者群体，预计会对疟疾的空间传播有很大贡献，因为他们的流动与季节性降雨相关，从而与蚊子密度高峰相关。旨在阻断寄生虫空间传播的干预措施应考虑这些旅行者群体。
