Shr-Jie Sharlenna Wang: Changing Malaria Epidemiology in Four Urban Settings in Sub-Saharan AfricaChanging Malaria Epidemiology in Four Urban Settings in Sub-Saharan Africa

PhD-thesis, Faculty of Science, 2005

With the aim to overcome significant gaps in knowledge of malaria transmission and epidemiology in the urban environment in sub-Saharan Africa, a series of case studies in form of a RUMA (Rapid Urban Malaria Appraisal) were conducted in four cities: Abidjan (Côte d’Ivoire), Ouagadougou (Burkina Faso), Cotonou (Benin) and Dar es Salaam (Tanzania). Malaria in urban settings presents various challenges such as: the inadequate development of immunity, changes in age-specific pattern and symptoms, the heterogeneity of malaria transmission in cities, the continuous changing of spatial and temporal patterns of malaria in response to urban and environmental development, the increasing accessibility of antimalarial drugs.

The research gives evidence that there is a low prevalence of malaria in the surveyed cities and that fever alone is no longer a good indicator for the diagnosis of malaria in sub-Saharan African urban areas. Cases of over-diagnosis and mistreatment are frequent and contribute to the waste of resources. In the cities, risk of malaria infection is associated with socio-economic situation and with environmental conditions that vary among and in the cities. The author advocates for the integration of public and private sectors as well as traditional healers into the government health planning. The study further provides evidence that interventions such as drain cleaning, chemical larvicide and environmental management are effective urban malaria control strategies and should be integrated into the urban upgrade plan