Background: To achieve the goal of malaria elimination, it is important to determine the role of human mobility of maintain parasite transmission. The Alto Jurua basin (Brazil) has one of the largest prevalence of malaria vivax and malaria falciparum in the Amazon. The goal of this work was to estimate the contribution of human commutation on the persistence of malaria in this region using data from a origin-destination survey.
Methods: Data from the origin-destination survey was used to describe the intensity and motivation for commutation between rural settlements and urban areas in two municipalities, Mancio Lima and Rodrigues Alves. The relative
time-person spent in each locality per household was estimated. A logistic model was fitted to estimate the effect of commuting on the probability of getting malaria for a householder from a zone of residence commuting to another zone.
Results: Our main results suggest that this population is not very mobile. 96% of household reported spending more than 90% of the annual person-hour at localities within the same zone of residence. Study and work are the most prevalent motivations for commuting, 40.5% and 29.5% respectively. Spending person-hours in urban Rodrigues Alves conferred relative protection to the residents of urban Mancio Lima. On the other hand, spending time in urban Rodrigues Alves conferred protection against malaria for those living in urban Mancio Lima. The opposite effect occurs for those spending time in the rural areas of both municipalities.
Conclusion: In the alto Jurua region, the place one lives is a stronger determinant of malaria risk than the place ones commute. These municipalities of a hotspot of Plasmodium transmission, thus understanding the main fluxes is essential to planning control strategies because the probability of getting malaria is dependent on the intensity of transmission of both, the area of origin and the area to which the displacement take place. The natural conditions for the circulation of pathogens such as the Plasmodium spp, combined with the pattern of mobility of humans in the Amazon, make clear the need of disease control perspective change. It is essential that intersectoral public policies be the basis for health mitigation actions.