Land Use Engagement and Malaria Prevalence in Ann Township, Myanmar: The Role of Forest-Related Activities

Effecting over 200 million people a year, the life-threatening vector-borne disease, malaria, remains a global health crisis. Encouragingly, some regions of the world have made immense progress, including Myanmar, which has reduced its number of malaria cases by 82% since 2012. However, the remaining malaria transmission foci in Myanmar are heterogeneous and complex, with many remaining infections clinically silent, rendering them invisible to routine monitoring. Current elimination strategies focus on prevention from within the home (i.e., bednets and indoor residual spraying). While these measures have likely been partially responsible for the drop in malaria cases across the country, within the remote region of Ann Township, Myanmar, malaria prevalence has remained steady at 10% of the population from 2016 - 2019. It is reasonable to assume that this remaining malaria pool may not be suitably eliminated through these home-centric strategies. Little is known about how people live, work, and move through their landscape in Ann, especially as it relates to their exposure to malaria. We investigate the role of human land use activities with malaria prevalence through the combined use of land use surveys, blood samples from 1000 participants across 5 rural villages, and satellite imagery. The data show that the land use factors that contribute most significantly to increased malaria risk are those which put people in direct contact with forests, including conducting forest chores, having an outdoor job, and having a primary occupation in the logging and/or plantation industry. While land use practices varied widely within the study population, it is clear that the current reservoir of malaria remaining in Ann Township is held by people who are exposed to malaria through their land use behaviors outside of their homes. New prevention methods should focus on populations that engage in land use activities which bring them in close proximity to forested landscapes.