Nepal has made substantial progress in controlling malaria since since the late 90's. The country is divided into three ecological zones that run east to west - but malaria is primarily an issue of the Terai zone, the lower strip of land in the south with a subtropical climate. The Terai is home to 13 highly malaria-endemic districts. Malaria transmission occurs year round, peaking in July during the seasonal monsoon.

Mortality from malaria in Nepal has historically been very low, because most cases are caused by Plasmodium vivax. However, there has been a recent uptick in Plasmodium falciparum cases, assumed to be primarily imported from India.

The Ministry of Health and Population of Nepal recognizes that mobile and migrant populations (MMPs) pose a large risk to Nepal's national malaria elimination target of 2026. How to connect MMPs with malaria prevention and treatment services while effectively targeting cross-border importation is not well understood.

I studied this phenomenon while based in Dhangadhi, Nepal in 2016. I conducted a mixed-methods formative assessment to characterize travel patterns, socio-demographic characteristics, current health-seeking behaviors and perceptions of proposed cross-border interventions of MMPs based in three high-burden border districts. This was done through utilization of local surveillance networks to identify local and imported cases, semi-structured interviews with identified cases, as well as focus group discussions with MMPs and their social contacts. Geo-spatial analysis was conducted to better understand the localization of cases and clusters of case origin among frequented travel destinations in India.

This study was conducted by The University of California, San Francisco, Tribhuvan University (Kathmandu), and was funded by The Bill and Melinda Gates Foundation. Results and publication in process.