• Ipsita Sinha, Abdullah Abu Sayeed, Didar Uddin, Amy Wesolowski, Sazid Ibna Zaman, M Abul Faiz, Aniruddha Ghose, M Ridwanur Rahman, Akramul Islam, Mohammad Jahirul Karim, Anjan Saha, M Kamar Rezwan, Abul Khair Mohammad Shamsuzzaman, Sanya Tahmina Jhora, M M Aktaruzzaman, Hsiao-Han Chang, Olivo Miotto, Dominic Kwiatkowski, Arjen M Dondorp, DayNicholas P JNPJMahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK., M Amir Hossain, Caroline Buckee, and Richard J Maude.
• Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand. ipsita@tropmedres.ac.
• Bmc Med. 2020 Mar 4; 18 (1): 4545.

BackgroundSpread 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.MethodsUsing 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.ResultsMost 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.ConclusionsThe 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.

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