Abstract
BackgroundSeveral studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. This study aims at doing that by applying qualitative and participatory-based system analysis and mapping to elicit the system’s emergent properties.MethodsIn two experts’ workshops, the system was sketched and refined. This system was represented through a causal loop diagram, where the identification of leverage points was done using network analysis.Results45 determinants interplaying through 56 linkages, and three subsystems: urbanization-related transmission, infection-prone behaviour and healthcare efficiency, and Plasmodium resistance were identified. Apart from the number of breeding sites and malaria-positive cases, other determinants such as drug prescription and the awareness of householders were identified by the network analysis as leverage points and emergent properties of the system of transmission and persistence of malaria.ConclusionBased on the findings, the ongoing efforts to control malaria, such as the use of insecticide-treated bed nets and larvicide applications should continue, and new ones focusing on the public awareness and malaria literacy of city dwellers should be included. The participatory approach strengthened the legitimacy of the recommendations and the co-learning of participants.
Highlights
Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity
A system model of malaria transmission and persistence The transmission and persistence of malaria in Accra are portrayed in a Causal loop diagram (CLD) of the complex system model, entailing 56 interactions among 45 determinants (Additional file 1: Table S1)
Urbanization‐related transmission and resistance of Anopheles to insecticides The deficient city planning and planning enforcement, inadequate housing conditions, and limited waste and sewage infrastructure lead to the proliferation of Anopheles breeding sites, which is worsened by the excavation of wells for urban and peri-urban agriculture and rainfall
Summary
Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. Malaria is still the deadliest infectious disease, responsible for more than 380,000 deaths in 2018 only [1]. Africa’s population is expected to triple by 2050 [5], with major growth occurring in urban areas. Urbanization has shifted the priorities of the public health system from the control of vector-borne diseases such as malaria to environmental public health challenges, such as traffic congestion, slumming, and pollution [7]. In Accra, the capital of Ghana, urbanization-related issues often overshadow the infectious diseases related ones, with the local government investing less than 50USD per person per year on health [8]. The poorest communities experience the greatest harm [8], like
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