Urban Planning to Prevent Mosquito-Borne Diseases in the Caribbean

Abstract

Climate change could lead to a resurgence of malaria in the Caribbean. A major initiative is currently underway to eliminate malaria in Hispaniola. In order to achieve this goal, and prevent a subsequent resurgence of malaria, the anti-malaria intervention policies implemented in Hispaniola will need to account for the impact of climate change. Lessons learned from the policies implemented in Hispaniola over the next 10–20 years could be highly informative to prevent resurgences of malaria in other parts of the Caribbean that are largely free of malaria today. Current malaria funding to control malaria vectors in Hispaniola is being allocated almost entirely to the implementation of long-lasting insecticidal nets and indoor residual spraying. Urban anti-malaria planning is urban planning that includes the suppression of potential larval habitats of malaria vectors as one of its goals. While long-lasting insecticidal nets and indoor residual spraying may be cost-effective in rural areas, it is unlikely that they will always be more cost-effective than urban anti-malaria planning in urban and urbanizing malarious communities. One explanation for the lack of funding to implement urban anti-malaria planning in Hispaniola, as well as other malarious regions, is that policy makers are unaware of the historical evidence of its use to suppress malaria. This chapter presents a case study of the use of urban anti-malaria planning in the town of Cite Duvalier, Haiti in the early 1970s. Using a multi-disciplinary methodology, the cost and impact of urban anti-malaria planning in Cite Duvalier is compared to the cost and impact of indoor residual spraying, mass drug administration and larviciding. This methodology can be used in future work to continue to examine the extensive historical evidence of urban anti-malaria planning interventions. The results of these future studies will enable policy makers to understand when urban anti-malaria planning should be implemented instead of, or in addition to, other anti-malaria interventions.