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The rapid growth of cities in sub-Saharan Africa, much of it driven by rural-urban migration, is associated with complex transformations of these ecosystems and an intricate set of challenges for malaria control. Urban malaria transmission is substantially less intense and much more focal than in rural and peri-urban settings. However, the danger of epidemics is higher and the presence of substantial non-immune populations places people of all ages at comparable levels of risk. The limited number of breeding sites in urban centers suggests that prevention strategies based on vector control, with emphasis on environmental management, should be a central feature of urban malaria control programs. We focus on malaria in the city of Dar es Salaam, Tanzania. Following a brief review of the 100-year history of malaria control in this urban center, we describe and evaluate a control program that operated from 1988 to 1996 as a consequence of a bilateral agreement between the governments of Tanzania and Japan. We present an innovative urban malaria risk mapping methodology based on high-resolution aerial photography with ground-based validation. This strategy clarifies that remote sensing technology at a level of resolution of one meter is essential if this kind of information is to play a role in guiding the detailed specification of intervention strategies for urban malaria control. The Tanzania-Japan multiple-intervention malaria control program, adaptively implemented over time, is described and evaluated with implications for urban malaria control in sub-Saharan Africa more generally.
Received August 21, 2003. Accepted for publication November 25, 2003.
Acknowledgments: We thank Dr. Hiroshi Tanaka and Dr. Ichiro Miyagi, initial planners of the UMCP in Dar es Salaam, and Dr. Kazuyo Ichimori, who reshaped the program.
Financial support. Marcia Caldas de Castro was supported by the Bill and Melinda Gates Foundation (BMGF), the Office of Population Research and the Center for Health and Wellbeing at Princeton University, Yoichi Yamagata by the Japan International Cooperation Agency and the BMGF, and Jürg Utzinger by the Center for Health and Wellbeing at Princeton University and the Swiss Tropical Institute in Basel.
Authors’ addresses: Marcia Caldas de Castro, 263 Wallace Hall, Office of Population Research, Princeton University, Princeton, NJ 08544, Telephone: 609-258-6971, Fax: 609-258-1039, E-mail: mcaldas{at}princeton.edu. Yoichi Yamagata, Japan International Cooperation Agency, 10-5 Ichigaya, Honmura-cho, Shinjuku-ku, Tokyo 162-8443 Japan. Deo Mtasiwa Dar es Salaam City Council, PO Box 9084, City Hall, Dar es Salaam, Tanzania. Marcel Tanner, Swiss Tropical Institute, PO Box CH-4002, Basel, Switzerland. Jürg Utzinger and Jennifer Keiser, 226 Wallace Hall, Office of Population Research, Princeton University, Princeton, NJ 08544. Burton H. Singer, 245 Wallace Hall, Office of Population Research, Princeton University, Princeton, NJ 08544.
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