title: Mobility dynamics of migrant workers and their socio-behavioral parameters related to malaria in Tier II, Artemisinin Resistance Containment Zone, Myanmar.
abstract: BACKGROUND
  Areas with dynamic population movements are likely to be associated with higher levels of drug-resistant malaria. Myanmar Artemisinin Resistance Containment (MARC) Project has been launching since 2012. One of its components includes enhancing strategic approaches for mobile/migrant populations. We aimed to ascertain the estimated population of mobile migrant workers and their families in terms of stability in work setting in townships classified as tier II (areas with significant inflows of people from areas with credible evidence of artemisinin resistance) for Artemisinin resistance; to identify knowledge, attitudes and practices related to prevention and control of malaria and to recommend cost-effective strategies in planning for prevention and control of malaria.
  
  
  METHODS
  A prospective cross-sectional study conducted between June to December 2013 that covered 1,899 migrant groups from 16 tier II townships of Bago Region, and Kayin and Kayah States. Trained data collectors used a pre-tested and subsequently modified questionnaire and interviewed 2,381 respondents. Data of migrant groups were analyzed and compared by category depending upon the stability of their work setting.
  
  
  RESULTS
  The estimated population of the 1,899 migrant groups categorized into three on the nature of their work setting was 56,030. Bago region was the commonest reported source of origin of migrant groups as well as their transit. Malaria volunteers were mostly within the reach of category 1 migrant groups (43/66, 65.2 %). Less stable migrant groups in category 3 had limited access to malaria information (14.7 %) and malaria care providers (22.1 %), low level of awareness and use of long-lasting insecticide-treated nets (46.6 and 38.8 %). Also, they had poor knowledge on malaria prevention on confirming suspected malaria and on using artemisinin combined therapy (ACT). Within two weeks prior to the survey, only 16.5 % of respondents in all categories combined reported acute undifferentiated fever.
  
  
  CONCLUSIONS
  Mobility dynamics of migrant groups was complex and increased their vulnerability to malaria. This phenomenon was accentuated in less stable areas. Even though migrant workers were familiar with rapid diagnostic tests for malaria, ACT still needed wide recognition to improve practices supportive of MARC including the use of appropriate personal protection. High mobility calls for re-designation of tier II townships to optimize ACT resistance containment.
authors.affiliation: Department of Public Health, Naypyitaw, Myanmar. thaunghl@googlemail.com.
authors.forename: Thaung
authors.initials: T
authors.lastname: Hlaing
authors.affiliation: Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar. khinthetwaidmr@gmail.com.
authors.forename: Khin Thet
authors.initials: KT
authors.lastname: Wai
authors.affiliation: Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar. dr.tinoo.dmr2014@gmail.com.
authors.forename: Tin
authors.initials: T
authors.lastname: Oo
authors.affiliation: Department of Public Health, Naypyitaw, Myanmar. dr.nyansint@gmail.com.
authors.forename: Nyan
authors.initials: N
authors.lastname: Sint
authors.affiliation: Department of Public Health, Naypyitaw, Myanmar. tunminvbdc@gmail.com.
authors.forename: Tun
authors.initials: T
authors.lastname: Min
authors.affiliation: Department of Public Health, Naypyitaw, Myanmar. dr.shwemyar82@gmail.com.
authors.forename: Shwe
authors.initials: S
authors.lastname: Myar
authors.affiliation: Department of Public Health, Naypyitaw, Myanmar. nanlon1965@gmail.com.
authors.forename: Khin Nan
authors.initials: KN
authors.lastname: Lon
authors.affiliation: Malaria Unit, WHO Country Office, Yangon, Myanmar. naingm@searo.who.int.
authors.forename: Myo Myint
authors.initials: MM
authors.lastname: Naing
authors.affiliation: Malaria Unit, WHO Country Office, Yangon, Myanmar. tunt@searo.who.int.
authors.forename: Tet Toe
authors.initials: TT
authors.lastname: Tun
authors.affiliation: Malaria Unit, WHO Country Office, Yangon, Myanmar. maungn@searo.who.int.
authors.forename: Nay Lin Yin
authors.initials: NL
authors.lastname: Maung
authors.affiliation: Malaria Unit, WHO Country Office, Yangon, Myanmar. lokugalappaththyg@searo.who.int.
authors.forename: Gawrie N L
authors.initials: GN
authors.lastname: Galappaththy
authors.affiliation: Malaria Unit, WHO Country Office, Yangon, Myanmar. thimasarnk@searo.who.int.
authors.forename: Krongthong
authors.initials: K
authors.lastname: Thimarsan
authors.affiliation: Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar. moethidadmrlm2012@gmail.com.
authors.forename: Tin Tin
authors.initials: TT
authors.lastname: Wai
authors.affiliation: Department of Medical Research, No. 5 Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar. moethidadmrlm2012@gmail.com.
authors.forename: Lwin Ni Ni
authors.initials: LN
authors.lastname: Thaung
mesh_terms: D000293:Adolescent; D000328:Adult; D037621:Artemisinins / Q000627:therapeutic use*; D001364:Awareness; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D004641:Emigration and Immigration; D004651:Employment; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D002052:Myanmar; D011157:Population Dynamics; D011247:Pregnancy; D011446:Prospective Studies; D014171:Transients and Migrants; D055815:Young Adult
chemical_list: D037621:Artemisinins; C031327:artemisinin