Abstract
BackgroundAlthough malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study.MethodsA health facility-based, age and location-matched, case–control study of children 6–59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively.ResultsA total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones (OR = 5.1; 95% CI = 1.62, 15.8). Use of long-lasting insecticide nets (LLINs) the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households.ConclusionTravel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is critical to the design of more targeted interventions for the urban setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1623-9) contains supplementary material, which is available to authorized users.
Highlights
Malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood
Most study drop-outs occurred among children living in the urban setting, resulting in a total of 274 and 179 analysed from urban and peri-urban health facilities (HF), respectively, with 56%
Risk factors in urban and peri‐urban health facilities When evaluating socio-economic and housing risk factors, higher level of education, electricity in the house and possession of TV were all protective against malaria (Table 2), with similar associations in both urban and peri-urban zones (P values for interaction of all these >0.05)
Summary
Malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study. To better address the problem of malaria in urban settings, there is a need to understand epidemiologic patterns of transmission and disease in urban/peri-urban contexts and how this is different in rural settings. A few studies have focused on malaria risk within Blantyre city [6, 7], but investigations comparing malaria incidence within the city limits with that of peri-urban and rural contexts are rare [8]. Risk factors associated with malaria were evaluated in both urban and peri-urban areas to better understand the variation of malaria risk across these settings. Findings from this study highlight factors that drive urban and peri-urban malaria burden, and identify high-risk populations, which in turn should inform efficient and targeted interventions for this population
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