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Summary

The Population Connectivity across Borders (PopCAB) toolkit is a toolkit for gathering and analyzing information about population mobility to inform public health interventions. It determines the types of travelers moving through an area, the routes taken, and the reasons for travel. Understanding these patterns of movement can help inform preparedness and response strategies for communicable diseases, including COVID-19.

Background

Global mobility and cross-border movement have contributed to continued spread of COVID-19 worldwide. Border closures, movement restrictions, and other COVID-19 mitigation policies have altered where people are moving and how they are getting there. Characterizing these patterns of movement is crucial to informing tailored public health interventions. Public health officials can implement CDC’s PopCAB toolkit to visualize population movement patterns and identify areas where officials can strengthen tailored interventions to prevent, detect, and respond to the spread of communicable diseases. For example, the information can guide how to allocate resources for COVID-19 response, including prioritizing points of entry (POE) with high connectivity to outbreak areas. The information can also contribute to preparing multisectoral partners for the reopening of borders to international travel.

Goal

The overall goal of implementing PopCAB is to gather, analyze, and apply information about population mobility to inform public health interventions.

PopCAB Toolkit Contents

  • Trainings modules
  • Job aids
  • FGD and KII template guides
  • Orientation scripts
  • Participant sign-in sheet
  • Example spatial database
  • Example annotated map

Approach

PopCAB consists of focus group discussions (FGD) and key informant interviews (KII), each with a participatory mapping component. Public health practitioners implement the PopCAB toolkit to facilitate activities with key stakeholders at the national, subnational, and community levels. They conduct these activities in areas of interest that are close to an outbreak zone, border crossing points, large gathering points, or heavily trafficked transportation routes. The team can complete data collection and analysis within a matter of days to support outbreak response, or over extended periods for longitudinal analyses.

The PopCAB process incorporates a tiered data collection approach that employs qualitative and quantitative methods and builds on existing information (Annex 1, Annex 2). The implementation team adapts the PopCAB toolkit contents and template question guide to the specific project objectives (Annex 3). Based on these PopCAB objectives, the team can engage with representatives from many sectors, including economic, health, transportation, etc.

Example PopCAB Objectives to Address COVID-19

  • Describe COVID-19 healthcare-seeking behavior
  • Map the connectivity of towns near a COVID-19 outbreak
  • Identify best placement for health screening checkpoints
  • Describe resource availability at points of interest
  • Map transportation routes after border closures
  • Identify points of interest for increased COVID-19 risk communication
  • Identify high-risk communities for strengthening community-based surveillance
  • Characterize seasonality of movement
  • Identify priority POE for COVID-19 surveillance

Example Stakeholder Groups to Engage

  • Healthcare workers
  • Traditional healers
  • Transportation workers
  • Marketplace vendors
  • Religious leaders
  • Tourists

Impact

Public health practitioners can use the information and spatial data gathered through PopCAB activities to visualize population movement patterns and identify areas where officials can strengthen their tailored interventions to prevent, detect, and respond to the spread of a communicable disease such as COVID-19 (Annex 4).

PopCAB Adaptations for COVID-19

Public health leadership can adapt PopCAB methods to inform COVID-19 mitigation strategies.

Mitigation measures to decrease risk of disease transmission during field activities

The implementation team can modify field activities by enforcing social distancing and mask wearing during focus group discussions, participatory mapping exercises, and other community engagement activities. If possible, the team can conduct PopCAB activities outdoors or in indoor spaces with good ventilation. Alternatively, if capacity and resources are available for remote sessions, FGD and KII with participatory mapping may be conducted virtually.

Key considerations for designing PopCAB implementation

The implementation team can tailor the PopCAB toolkit to collect information about the movement patterns and behaviors of specific populations of interest where COVID-19 risk of transmission is elevated. Public health leadership should consider implementing PopCAB in areas where the risk of transmission or proximity to a COVID-19 outbreak is high. Other areas of interest for PopCAB implementation include border areas with official or unofficial crossing points, heavily trafficked transportation routes or busy markets. By asking prioritized populations a wide array of questions about their mobility, the implementation team can help to not only inform public health decisions, but also to evaluate changes in movement and connectivity patterns after COVID-19 response policies have been put into effect.

An example for tailoring PopCAB implementation to address COVID-19 response

Long-distance truck drivers have been identified as a population of interest for some African countries because these drivers typically cross several international borders along their routes. The truck drivers pose a risk for both international and domestic transmission of COVID-19 and can offer valuable information during PopCAB activities about transmission hotspots. Focus group discussions with truck drivers may generate discussions about the routes they take, where they stop, how long they stay at the stops, amount of interaction with the local community at each stop, where they go for emergency medical care during their routes, how their mobility has changed due to COVID-19 restrictions, and places along their routes where they are required to undergo screening for COVID-19.

The results gathered through PopCAB activities with truck drivers can be used to develop tailored risk communication campaigns at key truck stops in order to educate drivers about possible symptoms, testing requirements at POE, and the risk of COVID-19 transmission.

Annex 1: Data Sources for Migration and Movement

To further understand population movement in a specific area, additional mobility data sources can be used in tandem with PopCAB data. By combining multiple mobility data sources in an analysis, a country or region can achieve a more well-rounded understanding of connectivity patterns within and across its borders. The data sources listed in the table below provide a diverse set of information about population mobility patterns worldwide.

Annex 2: Additional Reading Materials

Harvey B, Dalal W, Amin F, McIntyre E, Ward S, Merrill RD, Mohamed A, Hsu C (2020). Planning and implementing a targeted polio vaccination campaign for Somali mobile populations in Northeastern Kenya based on migration and settlement patternsexternal icon, Ethnicity & Health, DOI: 10.1080/13557858.2020.1838455

Kakaï CG, Okunromade O, Dan-Nwafor C, Chabi A, Martial G, Dalhat M, Ward S, Tante O, Nguku P, Hamadi A, Ilori E, Lokossou V, Brito C, Ojo O, Kone I, Agbeko T, Ihekweazu C, Merrill RD (2020) Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019external icon. Health Secur;18, S1;S105-S112

Merrill RD, Rogers K, Ward S, Ojo O, Kakaī CG, Agbeko TT, Garba H, MacGurn A, Oppert M, Kone I, Bamsa O, Schneider D, Brown C. (2017) Responding to communicable diseases in internationally mobile populations at points of entry and along porous borders, Nigeria, Benin, Togoexternal icon. Emerg Infect Dis; Supp 23;13:2250-56.

Nakiire L, Mwanja H, Pillai S, Gasanani J, Ntungire D. Nsabiyumva S, Mafigiri R, Muneza N, Ward S, Daffe Z, Ahabwe P, Kyazze S, Ojwang J, Homsy J, Mclntyre E, Lamorde M, Walwema R, Makumbi I, Muruta A, Merrill RD (2020) Population Movement Patterns Among the Democratic Republic of the Congo, Rwanda, and Uganda During an Outbreak of Ebola Virus Disease: Results from Community Engagement in Two Districts — Uganda, March 2019external icon. MMWR Morb Mortal Wkly Rep;2020 Jan 10;69(1):10-13

Nanziri C, Ario A, Ntono V, Nsereko G, Monje F, Aliddeki D, Bainomugisha K, Bulage L, Kadobera D, Kyazze S, Kayiwa J, Tusiime P, Mabumba E, Makumbi I, Nakiire L, Walwema R, Lomarde M, Ocom F, Kasule J, Ward S, Merrill RD. Ebola Virus Disease Preparedness Assessment and Risk Mapping in Uganda, August – September 2018external icon. Health Secur Mar/Apr 2020;18(2):105-113. doi: 10.1089/hs.2019.0118.

Annex 3: Discussion Template Guide

The discussion guide template provides adaptable questions to facilitate the collection of qualitative information and inform more targeted public health interventions. This list of questions will aid stakeholders in identifying points, routes and populations of interest to discuss in subsequent questions. These questions can be tailored to any stakeholder group and country’s objective in characterizing population movement.

Annex 4: PopCAB Package Implementation Matrix

This matrix helps a PopCAB implementation team determine the level of activities and resources needed to achieve the desired outputs that would best inform their objectives. The first tier would be useful for countries that need to quickly collect and summarize mobility data to respond to a COVID-19 outbreak. Teams that have previously conducted PopCAB or that have more time and resources to dedicate to PopCAB activities can consider adding-on components such as digitizing spatial data garnered from map annotations and identifying common themes in the data through qualitative analysis. The implementation team can tailor these PopCAB add-ons to inform different COVID-19 response efforts by targeting populations or areas of interest that are at high risk of COVID-19 transmission.

Source of original article: Centers for Disease Control and Prevention (CDC) / 2019 Novel Coronavirus (tools.cdc.gov).
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