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Globalization and the expansion of transport networks has transformed migration into a major policy issue because of its effects on a range of phenomena, including resource flows in economics, urbanization, as well as the epidemiology of infectious diseases. Quantifying and modeling human migration can contribute towards a better under- standing of the nature of migration and help develop evidence-based interventions for disease control policy, economic development, and resource allocation. In this study we paired census microdata from 10 countries in sub-Saharan Africa with additional spatial datasets to develop models for the internal migration flows in each country, including key drivers that reflect the changing social, demographic, economic, and environmental landscapes. We assessed how well these gravity-type spatial interaction models can both explain and predict migration. Results show that the models can explain up to 87 percent of internal migration, can predict future within-country mi- gration with correlations of up to 0.91, and can also predict migration in other coun- tries with correlations of up to 0.72. Findings show that such models are useful tools for understanding migration as well as predicting flows in regions where data are sparse, and can contribute towards strategic economic development, planning, and disease control targeting.

1Local and regional control is complicated by the facts that no vaccine has yet been licensed for broad-scale application and that dengue epidemiology is complex. Not only are there four different virus serotypes with potentially different ecologies, but transmission dynamics are also influenced by variation in the behavior and population dynamics of mosquito vectors and human hosts and the nature of their interactions with the environment and each other. 2 Mathematical and computer simulation models provide a systematic way to explore and analyze the complexity of dengue transmission and can be useful tools for devising more effective disease surveillance and control strategies. Models can integrate data from different sources and at different spatiotemporal scales, identify and prioritize gaps in data or knowledge, and address questions that are too complex, expensive, or dangerous to address in other ways. 3, 4 Models, therefore, provide a basic theoretical framework so that the intricate transmission processes of dengue can be represented in a simplified form that can be analyzed in ways that are not possible in the natural system itself. To explore the complexity of infectious disease systems, both simple 5 and complex 6– 8 models have been developed. More complex disease models tend to be more realistic and can be used to develop location-specific control strategies. However, the behavior of complex models can be difficult to explore analytically, 9 and as the number of model parameters increases, the likelihood also increases that parameters for which little empirical data exist are included. Evaluating the suitability, accuracy, and performance of complex disease models can be difficult. Sensitivity analysis provides a way to explore the behavior of complex disease models by identifying how variation in model parameters affects model output. 9 Model outputs obtained with different parameter values are evaluated to identify the parameters to which the model is most sensitive. In this way, sensitivity analysis can be useful not only for understanding model behavior, but also for identifying the biological processes that may be most important in determining pathogen transmission. Obtaining accurate empirical estimates of the parameters capturing the most important biological processes may then improve the accuracy of disease models and the ability of models to inform surveillance and control strategies. In this study, we conducted a sensitivity analysis of the complex dengue simulation models originally developed by Focks and others. 7, 8

Background Identifying human and malaria parasite movements is important for control planning across all transmission intensities. Imported infections can reintroduce infections into areas previously free of infection, maintain ‘hotspots’ of transmission and import drug resistant strains, challenging national control programmes at a variety of temporal and spatial scales. Recent analyses based on mobile phone usage data have provided valuable insights into population and likely parasite movements within countries, but these data are restricted to sub-national analyses, leaving important cross-border movements neglected. Methods National census data were used to analyse and model cross-border migration and movement, using East Africa as an example. ‘Hotspots’ of origin-specific immigrants from neighbouring countries were identified for Kenya, Tanzania and Uganda. Populations of origin-specific migrants were compared to distance from origin country borders and population size at destination, and regression models were developed to quantify and compare differences in migration patterns. Migration data were then combined with existing spatially-referenced malaria data to compare the relative propensity for cross-border malaria movement in the region. Results The spatial patterns and processes for immigration were different between each origin and destination country pair. Hotspots of immigration, for example, were concentrated close to origin country borders for most immigrants to Tanzania, but for Kenya, a similar pattern was only seen for Tanzanian and Ugandan immigrants. Regression model fits also differed between specific migrant groups, with some migration patterns more dependent on population size at destination and distance travelled than others. With these differences between immigration patterns and processes, and heterogeneous transmission risk in East Africa and the surrounding region, propensities to import malaria infections also likely show substantial variations. Conclusion This was a first attempt to quantify and model cross-border movements relevant to malaria transmission and control. With national census available worldwide, this approach can be translated to construct a cross-border human and malaria movement evidence base for other malaria endemic countries. The outcomes of this study will feed into wider efforts to quantify and model human and malaria movements in endemic regions to facilitate improved intervention planning, resource allocation and collaborative policy decisions.

Individual-based models of infectious disease transmission depend on accurate quantification of fine-scale patterns of human movement. Existing models of movement either pertain to overly coarse scales, simulate some aspects of movement but not others, or were designed specifically for populations in developed countries. Here, we propose a generalizable framework for simulating the locations that an individual visits, time allocation across those locations, and population-level variation therein. As a case study, we fit alternative models for each of five aspects of movement (number, distance from home and types of locations visited; frequency and duration of visits) to interview data from 157 residents of the city of Iquitos, Peru. Comparison of alternative models showed that location type and distance from home were significant determinants of the locations that individuals visited and how much time they spent there. We also found that for most locations, residents of two neighbourhoods displayed indistinguishable preferences for visiting locations at various distances, despite differing distributions of locations around those neighbourhoods. Finally, simulated patterns of time allocation matched the interview data in a number of ways, suggesting that our framework constitutes a sound basis for simulating fine-scale movement and for investigating factors that influence it.

Recent increases in funding for malaria control have led to the reduction in transmission in many malaria endemic countries, prompting the national control programmes of 36 malaria endemic countries to set elimination targets. Accounting for human population movement (HPM) in planning for control, elimination and post-elimination surveillance is important, as evidenced by previous elimination attempts that were undermined by the reintroduction of malaria through HPM. Strategic control and elimination planning, therefore, requires quantitative information on HPM patterns and the translation of these into parasite dispersion. HPM patterns and the risk of malaria vary substantially across spatial and temporal scales, demographic and socioeconomic sub-groups, and motivation for travel, so multiple data sets are likely required for quantification of movement. While existing studies based on mobile phone call record data combined with malaria transmission maps have begun to address within-country HPM patterns, other aspects remain poorly quantified despite their importance in accurately gauging malaria movement patterns and building control and detection strategies, such as cross-border HPM, demographic and socioeconomic stratification of HPM patterns, forms of transport, personal malaria protection and other factors that modify malaria risk. A wealth of data exist to aid filling these gaps, which, when combined with spatial data on transport infrastructure, traffic and malaria transmission, can answer relevant questions to guide strategic planning. This review aims to (i) discuss relevant types of HPM across spatial and temporal scales, (ii) document where datasets exist to quantify HPM, (iii) highlight where data gaps remain and (iv) briefly put forward methods for integrating these datasets in a Geographic Information System (GIS) framework for analysing and modelling human population and Plasmodium falciparum malaria infection movements.

INTRODUCTION: The quantification of parasite movements can provide valuable information for control strategy planning across all transmission intensities. Mobile parasite carrying individuals can instigate transmission in receptive areas, spread drug resistant strains and reduce the effectiveness of control strategies. The identification of mobile demographic groups, their routes of travel and how these movements connect differing transmission zones, potentially enables limited resources for interventions to be efficiently targeted over space, time and populations. METHODS: National population censuses and household surveys provide individual-level migration, travel, and other data relevant for understanding malaria movement patterns. Together with existing spatially referenced malaria data and mathematical models, network analysis techniques were used to quantify the demographics of human and malaria movement patterns in Kenya, Uganda and Tanzania. Movement networks were developed based on connectivity and magnitudes of flow within each country and compared to assess relative differences between regions and demographic groups. Additional malaria-relevant characteristics, such as short-term travel and bed net use, were also examined. RESULTS: Patterns of human and malaria movements varied between demographic groups, within country regions and between countries. Migration rates were highest in 20-30 year olds in all three countries, but when accounting for malaria prevalence, movements in the 10-20 year age group became more important. Different age and sex groups also exhibited substantial variations in terms of the most likely sources, sinks and routes of migration and malaria movement, as well as risk factors for infection, such as short-term travel and bed net use. CONCLUSION: Census and survey data, together with spatially referenced malaria data, GIS and network analysis tools, can be valuable for identifying, mapping and quantifying regional connectivities and the mobility of different demographic groups. Demographically-stratified HPM and malaria movement estimates can provide quantitative evidence to inform the design of more efficient intervention and surveillance strategies that are targeted to specific regions and population groups.