Abstract
BackgroundColombia contributes a significant proportion of malaria cases in the Americas, which are predominantly rural. However, in the last 8 years ~ 10 % of the endemic municipalities have also reported urban and peri-urban malaria cases, a growing concern for health authorities. This study focused on the characterization of the officially reported urban malaria cases.MethodsA descriptive retrospective study based on secondary information provided by the Colombian National Surveillance System-SIVIGILA for the 2008–2012 period was conducted. A total of 17 municipalities with consistent and persistent reports of urban and peri-urban malaria were selected for analysis, which included site of origin and of residence, age, gender and ethnicity of patients, health system affiliation, Plasmodium species and the presence of malaria vectors.ResultsA total of 18,113 malaria cases were reported from urban and peri-urban areas of 17 endemic municipalities. Almost 70 % of the reports originated in localities in the departments of Chocó and Nariño, located on the Pacific Coast where a predominantly Afro-Colombian population, of individuals of under 30 years of age, was the most affected (80.7 %), mainly with Plasmodium falciparum infections (52.1 %). Median annual parasite index (API) was 6.4 per 1000 inhabitants (3.4 in 2008; 10.8 in 2010 and 6.0 in 2012). Between 2011 and 2012 complicated cases (2.4 %) and malaria in pregnant women (1.4 %) were reported. Study areas reported the presence of at least seven Anopheles species considered malaria vectors. These analyses did not allow ascertaining the presumable origin of the recorded urban cases due to the lack of a consensus on a definition of urban, peri-urban and rural limits and the lack of proper verification of the geographical source of infection.ConclusionsThe study indicates the probable presence of endemic, unstable and low-intensity malaria transmission in Colombian urban and peri-urban areas of a group of municipalities located mainly on the Pacific coast region and a few others in the eastern region. There is a need to unequivocally confirm the urban or peri-urban origin of the malaria cases reported and the transmission conditions, as well as to develop and implement new strategies for urban and peri-urban malaria control and elimination.
Highlights
Colombia contributes a significant proportion of malaria cases in the Americas, which are predomi‐ nantly rural
Likewise in Asia, malaria reemergence in countries, such as India has been associated with rapid peri-urban expansion and an increase in poverty in cities such as Mumbai, New Delhi and Chennai [5, 6]; malaria vectors have been found to have adapted to the urban context in this country [7,8,9]
Most of these localities have been historically reported as sites with urban transmission foci and reported entomological evidence of the presence of malaria mosquito vectors according to information from the vector borne diseases (VBD) Prevention and Control Programme of the Colombian Ministry of Health (MOH)
Summary
Colombia contributes a significant proportion of malaria cases in the Americas, which are predomi‐ nantly rural. Malaria remains an important global health problem that affects mainly poor communities in Africa, Asia and Latin America, with an estimated ~198 million clinical malaria cases and ~584,000 deaths reported worldwide in 2013 [1]. Padilla et al Malar J (2015) 14:453 from dozens of African cities have shown an increasing gradient from urban to peri-urban and to rural areas [2]. In Latin America, Brazil has shown a population movement tendency to urban and peri-urban areas of cities in the Amazon region due forest colonization, road construction and the establishment of agricultural and mining settlements during the last decades of the 20th century, with an enormous impact on malaria transmission [10, 11]. Anarchical urban colonization and the presence of malaria vectors and asymptomatic carriers led to peri-urban malaria transmission in cities from this region [14, 15]
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