Identifying malaria elimination strategies in the presence of human movement in Bangladesh

Ayesha S Mahmud; Meng-Chun Chang; Daniel T Citron; Kenth Engø-Monsen; Abdullah Abu Sayeed; Sazid Ibna Zaman; Didar Uddin; Md Mushfiqur Rahman; Mosiqure Rahaman; Md Nazmul Islam; Richard James Maude; Caroline O Buckee; Hsiao-Han Chang

doi:10.1038/s43856-025-01145-6

Identifying malaria elimination strategies in the presence of human movement in Bangladesh

Commun Med (Lond). 2025 Nov 7;5(1):461. doi: 10.1038/s43856-025-01145-6.

Authors

Affiliations

¹ Department of Demography, University of California Berkeley, Berkeley, CA, USA. mahmuda@berkeley.edu.
² Institute of Bioinformatics and Structural Biology and Department of Life Science, National Tsing Hua University, Hsinchu, Taiwan.
³ Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
⁴ Smart Innovation Norway AS, Halden, Norway.
⁵ Chittagong Medical College and Hospital, Chattogram, Bangladesh.
⁶ Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁷ National Malaria Elimination Program and ATDs Control Program, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh.
⁸ Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh.
⁹ Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.
¹⁰ Open University, Milton Keynes, UK.
¹¹ The Center for Communicable Disease Dynamics and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹² Institute of Bioinformatics and Structural Biology and Department of Life Science, National Tsing Hua University, Hsinchu, Taiwan. hhchang@life.nthu.edu.tw.

^# Contributed equally.

Abstract

Background: Malaria transmission in the Chittagong Hill Tracts (CHT) districts in Bangladesh is characterized by considerable heterogeneity in incidence and the frequent mixing and importation of parasites across districts. Thus, elimination efforts must account for human mobility between endemic and non-endemic locations, and the relative importance of local transmission and parasite importation domestically.

Methods: We construct a metapopulation malaria model, parameterized by human mobility data and fit to epidemiological data, to guide elimination efforts in the region.

Results: We find substantial heterogeneity in the transmission intensity across the CHT, with the estimated basic reproduction number varying greatly across places with similar levels of observed incidence. When vector control interventions are applied locally, the greatest impact in reducing overall incidence are in places with both high transmission intensity and high connectivity with more populated districts in the western part of the CHT.

Conclusions: Local elimination in several areas with low or intermediate incidence has a moderate impact in reducing overall incidence, indicating that only focusing on high incidence areas is not sufficient for malaria elimination. More generally, our modeling framework can be used to prioritize resource allocation and identify the conditions necessary for malaria elimination in the region.

Plain language summary

Malaria can be hard to eliminate because people move between regions. This movement can carry parasites from areas with high transmission (“source” regions) into areas with lower transmission (“sink” regions). We built a mathematical model of malaria in Bangladesh that combines human movement patterns with disease data. We found that elimination works best when control efforts target areas that have both high malaria transmission and strong connections to larger, more populated districts. Focusing only on areas with high numbers of cases is not enough to achieve elimination. Our model can facilitate public health decisions on where to focus resources and what conditions are needed to achieve malaria elimination in Bangladesh.

Abstract

Plain language summary

Grants and funding