Travel patterns and demographic characteristics of malaria cases in Swaziland, 2010-2014

• Published in: Malaria journal Vol. 16; no. 1; p. 359
• Main Authors: Tejedor-Garavito, Natalia, Dlamini, Nomcebo, Pindolia, Deepa, Soble, Adam, Ruktanonchai, Nick W, Alegana, Victor, Le Menach, Arnaud, Ntshalintshali, Nyasatu, Dlamini, Bongani, Smith, David L, Tatem, Andrew J, Kunene, Simon
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.09.2017; BioMed Central; BMC
• Subjects: Adult; Analysis; Communicable Disease Control - statistics & numerical data; Demographic aspects; Demography; Disease transmission; Diseases; Emigration and Immigration; Epidemiological Monitoring; Female; Health aspects; Health facilities; Health risks; Human diseases; Humans; Identification; Importation; Imported malaria; Infections; Malaria; Malaria - epidemiology; Malaria - prevention & control; Malaria - transmission; Malaria elimination; Male; Males; Mozambique; Parasites; Reactive case detection; Risk Factors; Seasons; Sociodemographics; South Africa; Surveillance; Surveillance system; Swaziland - epidemiology; Travel; Travel - statistics & numerical data; Travel history; Travelers; Travellers; Vector-borne diseases; United Kingdom; Sweden; Swaziland; Travel history; Malaria elimination; Surveillance system; Imported malaria; Reactive case detection
• DOI: 10.1186/s12936-017-2004-8
• ISSN: 1475-2875

As Swaziland progresses towards national malaria elimination, the importation of parasites into receptive areas becomes increasingly important. Imported infections have the potential to instigate local transmission and sustain local parasite reservoirs. Travel histories from Swaziland's routine surveillance data from January 2010 to June 2014 were extracted and analysed. The travel patterns and demographics of rapid diagnostic test (RDT)-confirmed positive cases identified through passive and reactive case detection (RACD) were analysed and compared to those found to be negative through RACD. Of 1517 confirmed cases identified through passive surveillance, 67% reported travel history. A large proportion of positive cases reported domestic or international travel history (65%) compared to negative cases (10%). The primary risk factor for malaria infection in Swaziland was shown to be travel, more specifically international travel to Mozambique by 25- to 44-year old males, who spent on average 28 nights away. Maputo City, Inhambane and Gaza districts were the most likely travel destinations in Mozambique, and 96% of RDT-positive international travellers were either Swazi (52%) or Mozambican (44%) nationals, with Swazis being more likely to test negative. All international travellers were unlikely to have a bed net at home or use protection of any type while travelling. Additionally, paths of transmission, important border crossings and means of transport were identified. Results from this analysis can be used to direct national and well as cross-border targeting of interventions, over space, time and by sub-population. The results also highlight that collaboration between neighbouring countries is needed to tackle the importation of malaria at the regional level.