Abstract
A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area. If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission.
Highlights
Malaria is typically considered mainly a problem of the rural poor, this disease has been a concern in urban settings for centuries
Malaria in urban areas ranges from foci of intense transmission to obvious importations in travelers returning from highly endemic areas
Because the intensity of transmission is typically lower in urban than rural areas, proof of urban malaria transmission is uncommon. This inadvertently means that the term “urban malaria” is often applied empirically to all persons whose malaria was diagnosed in urban areas
Summary
Malaria is typically considered mainly a problem of the rural poor, this disease has been a concern in urban settings for centuries.
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