Abstract
Sub-Saharan Africa suffers by far the greatest malaria burden worldwide and is currently undergoing a profound demographic change, with a growing proportion of its population moving to urban areas. Urbanisation is generally expected to reduce malaria transmission; however the disease still persists in African cities, in some cases at higher levels than in nearby rural areas. Objective. This paper aims to collate and analyse risk factors for urban malaria transmission throughout sub-Saharan Africa and to discuss their implications for control. Methods. A systematic search on malaria and urbanisation was carried out focusing on sub-Saharan Africa. Particular interest was taken in vector breeding sites in urban and periurban areas. Results. A variety of urban vector breeding sites were catalogued, the majority of which were artificial, including urban agriculture, tyre tracks, and ditches. Natural breeding sites varied according to location. Low socioeconomic status was a significant risk factor for malaria, often present in peri-urban areas. A worrying trend was seen in the adaptation of malaria vector species to the urban environment. Urban malaria is highly focused and control programs should reflect this. Conclusion. As urbanisation continues and vector species adapt, continued monitoring and control of urban malaria in sub-Saharan Africa is essential.
Highlights
Despite recent declines in Plasmodium falciparum malaria transmission, largely due to increased distribution of longlasting insecticide-treated nets (LLINs) and a switch to artemisinin-based combination therapy (ACT) drugs, subSaharan Africa still suffers greatly from the disease
This paper aims to identify the important factors in urban malaria transmission in sub-Saharan Africa, to better understand their interactions, and to discuss their relevance to policy makers in an increasingly urbanized continent
We found that a comparable number of studies addressed the role of the vector breeding sites in urban malaria transmission (n = 51) as those addressing the role of geographic disparities (n = 48)
Summary
Despite recent declines in Plasmodium falciparum malaria transmission, largely due to increased distribution of longlasting insecticide-treated nets (LLINs) and a switch to artemisinin-based combination therapy (ACT) drugs, subSaharan Africa still suffers greatly from the disease. The general consensus is that urbanization will lead to decreased malaria transmission. One recent modelling study predicts a 53.5% reduction in malaria transmission by 2030, largely due to expected demographic changes [4]. It is thought that urbanization leads to improved infrastructure, better-quality “mosquito-proof ” housing, increased access to healthcare, and a reduction in vector breeding sites. Malaria vector species are known to prefer clean water for breeding, which is difficult to come by in polluted urban areas, and the higher ratio of humans to mosquitoes is thought to lead to a decreased human biting rate [5]
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