title: Census-derived migration data as a tool for informing malaria elimination policy.
abstract: Numerous countries around the world are approaching malaria elimination. Until global eradication is achieved, countries that successfully eliminate the disease will contend with parasite reintroduction through international movement of infected people. Human-mediated parasite mobility is also important within countries near elimination, as it drives parasite flows that affect disease transmission on a subnational scale.
  
  
  
  Movement patterns exhibited in census-based migration data are compared with patterns exhibited in a mobile phone data set from Haiti to quantify how well migration data predict short-term movement patterns. Because short-term movement data were unavailable for Mesoamerica, a logistic regression model fit to migration data from three countries in Mesoamerica is used to predict flows of infected people between subnational administrative units throughout the region.
  
  
  
  Population flows predicted using census-based migration data correlated strongly with mobile phone-derived movements when used as a measure of relative connectivity. Relative population flows are therefore predicted using census data across Mesoamerica, informing the areas that are likely exporters and importers of infected people. Relative population flows are used to identify community structure, useful for coordinating interventions and elimination efforts to minimize importation risk. Finally, the ability of census microdata inform future intervention planning is discussed in a country-specific setting using Costa Rica as an example.
  
  
  
  These results show long-term migration data can effectively predict the relative flows of infected people to direct malaria elimination policy, a particularly relevant result because migration data are generally easier to obtain than short-term movement data such as mobile phone records. Further, predicted relative flows highlight policy-relevant population dynamics, such as major exporters across the region, and Nicaragua and Costa Rica's strong connection by movement of infected people, suggesting close coordination of their elimination efforts. Country-specific applications are discussed as well, such as predicting areas at relatively high risk of importation, which could inform surveillance and treatment strategies.
authors.affiliation: WorldPop, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK. nick.ruktanonchai@flowminder.org.|Flowminder Foundation, Stockholm, Sweden. nick.ruktanonchai@flowminder.org.
authors.forename: Nick W
authors.initials: NW
authors.lastname: Ruktanonchai
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Bhavnani
authors.affiliation: WorldPop, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sorichetta
authors.affiliation: WorldPop, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.|Karolinska Institute, Stockholm, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Bengtsson
authors.affiliation: Pan American Health Organization/World Health Organization, Washington, DC, USA.
authors.forename: Keith H
authors.initials: KH
authors.lastname: Carter
authors.affiliation: Department of Health Surveillance, Costa Rica Ministry of Health, San Jose, Costa Rica.
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Córdoba
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Le Menach
authors.affiliation: Flowminder Foundation, Stockholm, Sweden.|Karolinska Institute, Stockholm, Sweden.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Flowminder Foundation, Stockholm, Sweden.|Stockholm School of Economics, Stockholm, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Wetter
authors.affiliation: WorldPop, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Zu Erbach-Schoenberg
authors.affiliation: WorldPop, Geography and Environment, University of Southampton, Southampton, SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.|Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
mesh_terms: D019352:Censuses; D003364:Costa Rica; D060740:Disease Eradication; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006205:Haiti; D006291:Health Policy; D063426:Human Migration; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D009527:Nicaragua / Q000453:epidemiology; D014195:Travel
keywords: Census data; Human mobility; Malaria elimination; Migration; Mobile phone data