Understanding imported malaria in western Nepal: Implications for malaria control and elimination

Imported malaria has emerged as a key challenge for malaria elimination efforts in Nepal, particularly in border regions with high labor migration to malaria-endemic areas. Identifying the geographic origin and demographic characteristics of imported cases is essential to inform targeted interventions and prevent local transmission. A community-based cross-sectional study was conducted in Narainapur Rural Municipality, Banke District, from November 2024 to January 2025. Data were collected from 113 imported malaria cases reported between October 1, 2023, and September 30, 2024, using structured face-to-face interviews and medical record reviews. Socio-demographic, travel, occupational, and clinical information were analyzed descriptively. All 113 respondents were male, with the majority aged 20-29 years (46.02%). Most belonged to the Muslim ethnic group (84.07%). Almost all (99.11%) had traveled to India for work, with Maharashtra being the primary destination state (96.47%) and South Mumbai the most common destination area (95.60%). Bhendi Bazar (52.21%), Bohri Muhalla (23.90%), and Null Bazar (7.96%) were the most frequently reported localities. The predominant occupation was catering services (71.43%). A significant number (85.84%) lacked fixed housing and stayed on the streets. Only 56.64% had received malaria-related information before travel, and over half (59.30%) were unwilling to use Long Lasting Insecticidal Nets, citing unsuitability for their living conditions. Imported malaria in Narainapur disproportionately affects young male labor migrants, predominantly from the Muslim community, whose occupational and living conditions place them at continued risk of infection. Frequent mobility, night and mixed indoor-outdoor work, and unstable housing limit the effectiveness of conventional prevention measures. The risk of malaria among Nepali labor migrants is not random but concentrated in well-defined urban hotspots in destination countries. These findings highlight the urgent need for targeted, migrant-sensitive prevention strategies and improved cross-border collaboration to support Nepal's malaria elimination efforts.