Res Sq [Preprint]. 2026 Jun 28:rs.3.rs-9977950. doi: 10.21203/rs.3.rs-9977950/v1.
ABSTRACT
Background Mobile populations in malaria-endemic regions are at increased risk of Plasmodium falciparum infection and may contribute to the spread of antimalarial drug resistance across borders. However, evidence on infection prevalence, molecular resistance markers, and associated risk factors in these populations remains limited. This systematic review and meta-analysis synthesized available evidence to inform mobility-responsive malaria surveillance and control strategies. Methods A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Studies published between January 2000 and October 2025 reporting P. falciparum infection and resistance-associated mutations in PfK13, PfCRT, PfMDR1, PfDHFR, and PfDHPS among mobile populations were included. PubMed, EMBASE, Global Health, and Scopus were searched. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Pooled prevalence estimates were generated using random-effects models in Stata 17, with subgroup analyses by WHO region and population type. Heterogeneity was assessed using I² statistics. Results Twenty-six studies involving 7,217 participants from 10 countries were included. Populations studied comprised refugees, migrant workers, travellers, forest-goers, gold miners, and nomadic groups. The pooled prevalence of P. falciparum infection was 18% (95% CI: 15-21%), with higher prevalence in Africa (36%) and lower prevalence in South-East Asia (6%). Refugees had the highest pooled prevalence (38%), whereas short-term travellers had lower prevalence (8%). Resistance markers were widely reported, although prevalence varied across settings and time periods. PfK13 mutations were generally infrequent but heterogeneous; validated mutations such as C580Y were repeatedly detected in Myanmar and neighbouring areas of Cambodia and Vietnam, indicating artemisinin resistance hotspots. PfCRT K76T remained common in older studies. PfMDR1 mutations, especially N86Y and Y184F, were frequently reported and reached up to 68% in African refugee populations, although declining trends were noted in recent African studies. PfDHFR and PfDHPS mutations were widely distributed. Infection risk was associated with mobility patterns, occupational exposure, and parasite origin. Substantial heterogeneity was observed (I² = 97.8%). Conclusion Mobile populations bear a substantial burden of P. falciparum infection and frequently harbor antimalarial drug-resistance markers. Integrating these populations into genomic and cross-border surveillance systems may improve early detection of resistance and strengthen malaria elimination efforts.
PMID:42396518 | PMC:PMC13321344 | DOI:10.21203/rs.3.rs-9977950/v1
