Human mobility and malaria risk in peri-urban and rural communities in the Peruvian Amazon

Abstract

BackgroundWhile the global burden of malaria cases has decreased over the last two decades, the disease remains a major international threat, even on the rise in many regions. More than 85% of Peruvian malaria cases are in the Amazonian region of Loreto. Internal mobility primarily related to occupation is thought to be primarily responsible for maintaining endemicity and introducing and reintroducing malaria parasites into areas of anophelism, a challenge for malaria eradication. MethodsThe assessment of connectivity produced by human mobility was evaluated in three districts of Loreto, through 10 cross-sectional population screening from 2018 to 2020. We use social network analysis (SNA) to obtain weighted and unweighted degrees of connectivity and explore its variability by socio-demographic characteristics. In addition, we integrated travel history and malaria incidence data to estimate parasite connectivity due to internal human mobility between locations. Finally, we used logistic multivariate regressions to explore the factors associated with Plasmodium spp. infection in mobile individuals. ResultsWe found that internal human mobility results in high connectivity between communities from the Mazan, Iquitos, and San Juan Bautista districts. We identified nearby destinations that may act as sinks or sources for malaria transmission, including densely populated towns and rural campsites. In addition, we found that being a male, traveling to rural campsites, and working outdoors are associated with Plasmodium spp. infection in travelers from the Mazan district. ConclusionsWe provide compelling evidence about how human mobility connects rural communities in the Peruvian Amazon. Using SNA, we uncovered district-specific patterns and destinations, providing further evidence of human mobility heterogeneity in the region. To address the challenge of human mobility and malaria in this setting, geographic heterogeneity of malaria transmission must be considered. Author summaryMalaria transmission is complex, involving interactions of parasite, vector biology and ecology, human immune response, and human host behavior. We used social network analysis to understand how the daily lives including occupation-related mobility leads to the maintenance of malaria endemicity and transmission. Rural communities (within the districts of Mazan) and peri-urban communities around the city of Iquitos have different socio-demographic characteristics that determine malaria transmission rates. Networks of fixed rural communities and occupation-related distant camp sites play a key role as reservoirs and sources of parasite movement. Factors including male sex, outdoor occupational activity outdoors, and having rural camp sites as travel destination increase the risk of Plasmodium infection. Factors associated with occupation-related mobility are correlated with incidence and prevalence of malarial disease and parasite infection rates, respectively. This work provides a detailed understanding of the importance of work-related travel to target in malaria elimination programs, key to maintaining malaria transmission both in the Amazon region and more generally.