Human population movement and behavioural patterns in malaria hotspots on the Thai–Myanmar border: implications for malaria elimination

Background Malaria is heterogeneously distributed across landscapes. Human population movement (HPM) could link sub-regions with varying levels of transmission, leading to the persistence of disease even in very low transmission settings. Malaria along the Thai–Myanmar border has been decreasing, but remains heterogeneous. This study aimed to measure HPM, associated predictors of travel, and HPM correlates of self-reported malaria among people living within malaria hotspots. Methods 526 individuals from 279 households in two malaria hotspot areas were included in a prospective observational study. A baseline cross-sectional study was conducted at the beginning, recording both individual- and household-level characteristics. Individual movement and travel patterns were repeatedly observed over one dry season month (March) and one wet season month (May). Descriptive statistics, random effects logistic regressions, and logistic regressions were used to describe and determine associations between HPM patterns, individual-, household-factors, and self-reported malaria. Results Trips were more common in the dry season. Malaria risk was related to the number of days doing outdoor activities in the dry season, especially trips to Myanmar, to forest areas, and overnight trips. Trips to visit forest areas were more common among participants aged 20–39, males, individuals with low income, low education, and especially among individuals with forest-related occupations. Overnight trips were more common among males, and individual with forest-related occupations. Forty-five participants reported having confirmed malaria infection within the last year. The main place of malaria blood examination and treatment was malaria post and malaria clinic, with participants usually waiting for 2–3 days from onset fever to seeking diagnosis. Individuals using bed nets, living in houses with elevated floors, and houses that received indoor residual spraying in the last year were less likely to report malaria infection. Conclusion An understanding of HPM and concurrent malaria dynamics is important for consideration of targeted public health interventions. Furthermore, diagnosis and treatment centres must be capable of quickly diagnosing and treating infections regardless of HPM. Coverage of diagnosis and treatment centres should be broad, maintained in areas bordering malaria hotspots, and available to all febrile individuals.</p

Spatial heterogeneity and temporal trends in Malaria on the Thai–Myanmar Border (2012–2017): a retrospective observational study

Malaria infections remain an important public health problem for the Thai-Myanmar border population, despite a plan for the elimination by the end of 2026 (Thailand) and 2030 (Myanmar). This study aimed to explore spatiotemporal patterns in Plasmodium falciparum and Plasmodium vivax incidence along the Thai-Myanmar border. Malaria cases among Thai citizens in 161 sub-districts in Thailand's Kanchanaburi and Tak Provinces (2012-2017) were analyzed to assess the cluster areas and temporal trends. Based on reported incidence, 65.22% and 40.99% of the areas studied were seen to be at elimination levels for P. falciparum and P. vivax already, respectively. There were two clear clusters of malaria in the region: One in the northern part (Cluster I), and the other in the central part (Cluster II). In Cluster I, the malaria season exhibited two peaks, while there was only one peak seen for Cluster II. Malaria incidence decreased at a faster rate in Cluster I, with 5% and 4% reductions compared with 4% and 3% reductions in P. falciparum and P. vivax incidence per month, respectively, in Cluster II. The decreasing trends reflect the achievements of malaria control efforts on both sides of the Thai-Myanmar border. However, these clusters could act as reservoirs. Perhaps one of the main challenges facing elimination programs in this low transmission setting is maintaining a strong system for early diagnosis and treatment, even when malaria cases are very close to zero, whilst preventing re-importation of cases

Advancing integrative “one-health” approaches to global health through multidisciplinary, faculty-led global health field courses

AbstractBackgroundSince 2003, the University of Wisconsin-Madison Global Health Institute, together with collaborating campus and in-country partners, has offered immersive, multidisciplinary, faculty-led, global health field courses in Ecuador and Thailand. These courses aim to help students to develop a working understanding of integrative one-health approaches and acquire the skills to work effectively across disciplines. That is, we aim to foster an appreciation of the role of culture in perceptions of health, disease, and health care; the complex interactions of animal-human-ecosystem health and disease; and the value of integrating cross-disciplinary and cross-cultural perspectives and skills to solve complex public health problems.MethodsStudents from various University of Wisconsin-Madison health faculties travelled, lived (accommodation included homestays in indigenous or rural communities), learnt, and engaged in community-health assessments or service-learning projects as a multidisciplinary team. We recruited students through annual presentations in each University of Wisconsin school or college and through recommendations from past participants. We recorded student reflections during the course, at course completion, and after graduation.FindingsBetween 2003 and 2014: 215 students from the University of Wisconsin have taken part in the global health field courses. Students came from the fields of human medicine (53 [25%]), veterinary medicine (35 [16%]), nursing (40 [19%]), pharmacy (41 [19%]), and other degree programs (46 [21%]). Results of the in-course and post course assessments consistently show strong student satisfaction with many aspects of the programme, including safety, faculty mentorship, the value of the multidisciplinary approach, depth of learning, and programme cost. Former participants also report use of cross-cultural skills in their professional practice, work with populations from cultures other than their own, positive effects on their decisions for career activities, and the belief that immersive cross-cultural experiences should be a required part of professional training for all health professional students. Finally, the courses undergo independent programme evaluations (including in-country observation and interviews with participants and stakeholders) approximately every 5 years.InterpretationProgramme directors continue to seek improvements related to: sustainable faculty engagement from various disciplines; development of increasingly specific course group learning objectives, competencies, and assessment tools; sustainability of impacts on community-level health and wellbeing; continuity between University of Wisconsin-Madison and in-country university and community partners; and scholarship support and other approaches so that cost does not exclude interested students from participating.FundingThe GHI is supported through a combination of university, grants, and philanthropic funding; these field courses do not have specific, separate funding. Students self-fund participation in the courses

Advancing integrative “one-health” approaches to global health through multidisciplinary, faculty-led global health field courses

Background: Since 2003, the University of Wisconsin-Madison Global Health Institute, together with collaborating campus and in-country partners, has offered immersive, multidisciplinary, faculty-led, global health field courses in Ecuador and Thailand. These courses aim to help students to develop a working understanding of integrative one-health approaches and acquire the skills to work effectively across disciplines. That is, we aim to foster an appreciation of the role of culture in perceptions of health, disease, and health care; the complex interactions of animal-human-ecosystem health and disease; and the value of integrating cross-disciplinary and cross-cultural perspectives and skills to solve complex public health problems. Methods: Students from various University of Wisconsin-Madison health faculties travelled, lived (accommodation included homestays in indigenous or rural communities), learnt, and engaged in community-health assessments or service-learning projects as a multidisciplinary team. We recruited students through annual presentations in each University of Wisconsin school or college and through recommendations from past participants. We recorded student reflections during the course, at course completion, and after graduation. Findings: Between 2003 and 2014: 215 students from the University of Wisconsin have taken part in the global health field courses. Students came from the fields of human medicine (53 [25%]), veterinary medicine (35 [16%]), nursing (40 [19%]), pharmacy (41 [19%]), and other degree programs (46 [21%]). Results of the in-course and post course assessments consistently show strong student satisfaction with many aspects of the programme, including safety, faculty mentorship, the value of the multidisciplinary approach, depth of learning, and programme cost. Former participants also report use of cross-cultural skills in their professional practice, work with populations from cultures other than their own, positive effects on their decisions for career activities, and the belief that immersive cross-cultural experiences should be a required part of professional training for all health professional students. Finally, the courses undergo independent programme evaluations (including in-country observation and interviews with participants and stakeholders) approximately every 5 years. Interpretation: Programme directors continue to seek improvements related to: sustainable faculty engagement from various disciplines; development of increasingly specific course group learning objectives, competencies, and assessment tools; sustainability of impacts on community-level health and wellbeing; continuity between University of Wisconsin-Madison and in-country university and community partners; and scholarship support and other approaches so that cost does not exclude interested students from participating. Funding: The GHI is supported through a combination of university, grants, and philanthropic funding; these field courses do not have specific, separate funding. Students self-fund participation in the courses

Spatial and temporal patterns of dengue infections in Timor-Leste, 2005–2013

Abstract Background Dengue remains an important public health problem in Timor-Leste, with several major epidemics occurring over the last 10 years. The aim of this study was to identify dengue clusters at high geographical resolution and to determine the association between local environmental characteristics and the distribution and transmission of the disease. Methods Notifications of dengue cases that occurred from January 2005 to December 2013 were obtained from the Ministry of Health, Timor-Leste. The population of each suco (the third-level administrative subdivision) was obtained from the Population and Housing Census 2010. Spatial autocorrelation in dengue incidence was explored using Moran’s I statistic, Local Indicators of Spatial Association (LISA), and the Getis-Ord statistics. A multivariate, Zero-Inflated, Poisson (ZIP) regression model was developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling. Results The analysis used data from 3206 cases. Dengue incidence was highly seasonal with a large peak in January. Patients ≥ 14 years were found to be 74% [95% credible interval (CrI): 72–76%] less likely to be infected than those < 14 years, and females were 12% (95% CrI: 4–21%) more likely to suffer from dengue as compared to males. Dengue incidence increased by 0.7% (95% CrI: 0.6–0.8%) for a 1 °C increase in mean temperature; and 47% (95% CrI: 29–59%) for a 1 mm increase in precipitation. There was no significant residual spatial clustering after accounting for climate and demographic variables. Conclusions Dengue incidence was highly seasonal and spatially clustered, with positive associations with temperature, precipitation and demographic factors. These factors explained the observed spatial heterogeneity of infection