An approach to integrate population mobility patterns and sociocultural factors in communicable disease preparedness and response

Human movement significantly impacts the spread of communicable diseases. Factors influencing these patterns include economic conditions, health status, social connections, and environmental factors. Cross-border movement further complicates responses due to variations in public health systems. While quantitative methods exist to analyze movement, there's a lack of readily applicable tools for gathering community-level mobility data in public health settings. This paper introduces the PopCAB toolkit, designed to address this gap by integrating qualitative, spatial, and quantitative data collection to understand the 'who, where, when, why, and how' of human mobility and its relation to disease spread. The study focuses on the application of PopCAB in Togo and Benin during Lassa fever outbreaks, highlighting its effectiveness in informing cross-border preparedness and response strategies. The authors aim to demonstrate how PopCAB can bridge the gap between sophisticated analytical methods and practical public health decision-making, particularly in situations involving complex cross-border movement.

The paper reviews existing methods for analyzing population mobility and its effect on disease spread. Contact tracing and travel history investigations are highlighted as important response strategies but limited in their ability to provide a comprehensive understanding of potential transmission pathways. Quantitative methods such as analyzing call data records, mobile phone location data, and mathematical modeling are discussed for their strengths in quantifying risk. However, these methods are noted to lack information on the social and cultural drivers of movement. Social network analysis is presented as a valuable approach to investigate relationships and their influence on disease transmission, but its applicability in practical public health settings is limited. The paper emphasizes the need for a flexible, rapidly deployable tool to complement these existing methods, particularly for understanding the social and cultural context of mobility.

The PopCAB toolkit is a mixed-methods approach consisting of four phases: **Phase 1: Prepare:** This phase involves defining specific objectives, reviewing existing information, developing a work plan, identifying key informants and stakeholders, selecting geographic areas, adapting the toolkit materials to the local context, and preparing base maps for participatory mapping. **Phase 2: Characterize:** This phase uses key informant interviews (KIIs) and focus group discussions (FGDs) with participatory mapping to gather qualitative and spatial data on population movement and connectivity. The method involves using uniquely identified participants and features on maps for data linkage. Site-specific surveys may be included to gather quantitative data at specific points of interest. **Phase 3: Visualize:** This phase involves creating maps and visualization products to effectively communicate the findings. The information is integrated to show the connections between points of interest and routes, layered with qualitative themes such as cultural identities, health-seeking behaviors, and economic systems. **Phase 4: Apply:** This phase involves translating the findings into tailored recommendations and action plans to improve public health interventions. This could involve targeted training, resource allocation strategies, improved surveillance, and integration of traditional healers into response efforts. The paper details the application of PopCAB in two rounds in Togo and Benin. Round 1 involved a binational meeting to identify priority geographic areas, while Round 2 involved training MOH staff to conduct FGDs across 14 cities, resulting in data on 167 points of interest and 176 routes.

The application of PopCAB in Togo and Benin yielded several key findings: * **Round 1 (March 2017):** A binational FGD identified key movement patterns and highlighted the need for enhanced cross-border collaboration and targeted training in high-connectivity areas. * **Round 2 (April 2018):** Training 54 MOH staff allowed for 21 FGDs across 14 cities, gathering data on 167 points of interest and 176 routes related to a circular migration pathway between Togo, Benin, and Nigeria. This data highlighted the significance of seasonal agricultural migration and its connection to cross-border Lassa fever transmission. * **Improved preparedness and response:** PopCAB facilitated more effective cross-border information sharing, improved collaboration, the selection of health facilities for enhanced training based on their connectivity, and strategies to better integrate traditional healers into surveillance and community education. * **Rapid response to subsequent outbreak:** The findings from PopCAB informed the rapid and integrated multinational response to a new Lassa fever case in December 2018, demonstrating its practical value in real-world settings. The participatory mapping component of PopCAB allowed for more efficient data collection and integration of local knowledge, improving the accuracy and applicability of the data.

The successful application of PopCAB in Togo and Benin demonstrates its effectiveness in integrating population mobility and sociocultural factors into communicable disease preparedness and response. The study highlights the importance of community engagement and participatory methods in gathering accurate and context-specific information. The results emphasize the need for flexible and adaptable tools that can be rapidly deployed to address the unique challenges of cross-border disease outbreaks. PopCAB's success in informing real-time public health decision-making, as evidenced by the rapid response to the December 2018 Lassa fever case, underscores its value as a practical tool for improving global health security.

The PopCAB toolkit provides a valuable method for incorporating population mobility patterns and sociocultural factors into communicable disease preparedness and response efforts. Its successful implementation in Togo and Benin demonstrates its effectiveness in improving cross-border collaboration, targeting resources, and integrating traditional health practices. Future research could explore the application of PopCAB in other disease contexts and geographical settings. Further refinement of the toolkit, including standardized data analysis procedures and expanded visual communication techniques, could further enhance its impact.

While PopCAB proved effective, limitations include the potential for limited information depth if objectives aren't clearly defined or facilitators lack necessary skills. Results interpretation depends on the geographical areas and stakeholder groups included. The data, while valuable for decision-making, doesn't represent social network analyses. The need for a qualified GIS analyst also presents a practical limitation.