Beyond mobile populations: a critical review of the literature on malaria and population mobility and suggestions for future directions

Background: Although population mobility is frequently cited as a barrier to malaria elimination, a comparatively small body of literature has attempted to systematically examine this issue. This article reviews the literature on malaria and mobile populations in order to critically examine the ways that malaria elimination experts perceive the risks surrounding population mobility. The article brings in perspectives from HIV/AIDS and other infectious disease control programmes working in areas of high population mobility. The article aims to move beyond the current tendency to identify mobile populations as a risk group and suggests ways to reconceptualize and respond to population mobility within malaria elimination. Methods: The review was commissioned by the Asia Pacific Malaria Elimination Network (APMEN). Searches were made using PubMed, ProQuest, Google and Google Scholar. The review includes English language published peer-reviewed literature and grey literature published up to November 2013. Results: The review identified three key themes in the literature: mobility, economic development and shifting land use; concerns about accessing mobile populations; and imported and border malaria. The review found that the literature treats mobile populations as a homogenous entity and is yet to develop a more accurate understanding of the true risks surrounding population mobility. Concerns about accessing mobile populations are overstated, and methods are suggested for working collaboratively with mobile populations. Finally, the review found that many concerns about mobile populations and imported malaria would be more productively framed as border health issues. Conclusion: The focus on mobile populations is both excessive and insufficiently examined within the current literature. By its very nature, population mobility requires malaria elimination programmes to look beyond isolated localities and demographic groups to respond to the interconnections that mobility creates between localities and population groups. Malaria programmes will gain greater clarity by refocusing the discussion away from mobile populations as a risk group and toward mobility as a system involving interconnected localities and multiple demographic groups. Rather than focusing on mobile populations as a risk group and a barrier to elimination, malaria elimination programmes ought to develop collaborative community engagement efforts in border areas and regions of high population mobility and where imported malaria is of concern.