Characterizing human movement patterns using GPS data loggers in an area of persistent malaria in Zimbabwe along the Mozambique border

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Abstract Background: Human mobility is a driver for the reemergence or resurgence of malaria and has been identified as a source of cross-border transmission. However, movement patterns are difficult to measure in remote rural areas where malaria risk is high. In countries with malaria elimination goals, it is essential to determine the role of mobility on malaria transmission in order to implement appropriate interventions. Methods: A study was conducted in Mutasa District, Zimbabwe, to investigate human movement patterns in an area of persistent transmission along the border with Mozambique. Over one year, a convenience sample of 20 participants per month was recruited from active malaria surveillance cohorts to carry an IgotU® GT-600 global positioning system (GPS) data logger during all daily activities. Consenting participants were tested for malaria at data logger distribution using an HRP-2 rapid diagnostic test and completed a survey questionnaire. GPS data were analyzed using a trajectory analysis tool and plotted in geographic information system maps. Participant movement patterns were characterized throughout the study area and across the border into Mozambique using movement intensity maps, activity space plots, and statistical analyses. Results: Over 12 recruitment periods from June 2016 to May 2017, 184 participants provided usable movement tracks encompassing over 350,000 data points and nearly 8,000 person-days. Participants traveled a median of 2.8 km/day and spent a median of 4.6 hours/day away from home. Movement was widespread within and outside the study area throughout the year, with participants traveling up to 500 km from their homes. Indices of mobility were higher in the dry season, including distance traveled and hours/day away from home, and male participants and adults had higher mobility compared to female participants and adolescents, respectively. Half of the participants traveled outside the study area, and 30% traveled into Mozambique, including 15 who stayed in Mozambique overnight. Conclusions: Study participants in Mutasa District, Zimbabwe, were highly mobile throughout the year. Many participants traveled long distances from home, including overnight trips into Mozambique, with clear implications for malaria control. Interventions targeted at mobile populations and cross-border transmission may be effective in preventing malaria introductions in this region.

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