Volume 71, Issue 2_suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Malaria not only remains a leading cause of morbidity and mortality, but it also impedes socioeconomic development, particularly in sub-Saharan Africa. Rapid and unprecedented urbanization, going hand-in-hand with often declining economies, might have profound implications for the epidemiology and control of malaria, as the relative disease burden increases among urban dwellers. Reviewing the literature and using a modeling approach, we find that entomologic inoculation rates in cities range from 0 to 54 per year, depending on the degree of urbanization, the spatial location within a city, and overall living conditions. Using the latest United Nations figures on urbanization prospects, nighttime light remotely sensed images, and the “Mapping Malaria Risk in Africa” results on climate suitability for stable malaria transmission, we estimate that 200 million people (24.6% of the total African population) currently live in urban settings where they are at risk of contracting the disease. Importantly, the estimated total surface area covered by these urban settings is only approximately 1.1–1.6% of the total African surface. Considering different plausible scenarios, we estimate an annual incidence of 24.8–103.2 million cases of clinical malaria attacks among urban dwellers in Africa. These figures translate to 6–28% of the estimated global annual disease incidence. Against this background, basic health care delivery systems providing early diagnosis and early treatment and preventive actions through mother and child health programs and the promotion of insecticide-treated bed nets for the rapidly growing numbers of the urban poor must be improved alongside well-tailored and integrated malaria control strategies. We propose environmental management and larviciding within well-specified productive sites as a main feature for such an integrated control approach. Mitigation of the current burden of malaria in urban African settings, in turn, is a necessity for stimulating environmentally and socially sustainable development.


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  1. World Health Organization, 2002. The World Health Report 2003, Shaping the Future: Reducing Risks, Promoting Healthy Life. Geneva: World Health Organization.
  2. Breman JG, 2001. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg 64 (Suppl): 1–11.
  3. Holding PA, Snow RW, 2001. Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence. Am J Trop Med Hyg 64 (Suppl): 68–75.
  4. Sachs J, Malaney P, 2002. The economic and social burden of malaria. Nature 415 : 680–685.
  5. Harpham T, Tanner M, 1995. Urban Health in Developing Countries: Progress and Prospects. London: Earthscan Publications.
  6. Robert V, Macintyre K, Keating J, Trape JF, Duchemin JB, Warren M, Beier JC, 2003. Malaria transmission in urban sub-Saharan Africa. Am J Trop Med Hyg 68 : 169–176.
  7. United Nations, 2002. World Urbanization Prospects: the 2001 Revisions. New York: Population Division Department of Economics and Social Affair of the United Nations.
  8. Knudsen AB, Slooff R, 1992. Vector-borne disease problems in rapid urbanization: new approaches to vector control. Bull World Health Organ 70 : 1–6.
  9. Martens P, Hall L, 2000. Malaria on the move: human population movement and malaria transmission. Emerg Infect Dis 6 : 103–109.
  10. Chinery WA, 1984. Effects of ecological changes on the malaria vectors Anopheles funestus and the Anopheles gambiae complex of mosquitoes in Accra, Ghana. J Trop Med Hyg 87 : 75–81.
  11. Hutubessy RC, Bendib LM, Evans DB, 2001. Critical issues in the economic evaluation of interventions against communicable diseases. Acta Trop 78 : 191–206.
  12. Carter R, Mendis KN, Roberts D, 2000. Spatial targeting of interventions against malaria. Bull World Health Organ 78 : 1401–1411.
  13. Silimperi D, 1995. Linkages for Urban Health- the Community and Agencies. Harpham T, Tanner M, eds. Urban Health in Developing Countries. London: Earthscan Publications, 9–33.
  14. Phillips DR, 1993. Urbanization and human health. Parasitology 106 (Suppl): 93–107.
  15. El Sayed BB, Arnot DE, Mukhtar MM, Baraka OZ, Dafalla AA, Elnaiem DE, Nugud AH, 2000. A study of the urban malaria transmission problem in Khartoum. Acta Trop 75 : 163–171.
  16. WHO/UNICEF, 2003. Africa Malaria Report 2003. Geneva: World Health Organization.
  17. Woyessa A, Gebre-Michael T, Ali A, Kebede D, 2002. Malaria in Addis Ababa and its environs: assessment of magnitude and distribution. Ethiop J Health Dev 16 : 147–155.
  18. International Energy Agency, 2002. Energy Statistics and Balances of Non-OECD Countries. Paris: International Energy Agency.
  19. International Energy Agency, 2002. Energy Statistics of OECD Countries. Paris: International Energy Agency.
  20. United Nations, 1999. Energy Statistics Yearbook. New York: United Nations.
  21. Hay SI, Rogers DJ, Toomer JF, Snow RW, 2000. Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, Internet access and review. Trans R Soc Trop Med Hyg 94 : 113–127.
  22. Dietz K, Molineaux L, Thomas A, 1974. A malaria model tested in the African savannah. Bull World Health Organ 50 : 347–357.
  23. Hagmann R, Charlwood JD, Gil V, Ferreira C, Do Rosario V, Smith TA, 2003. Malaria and its possible control on the island of Principe. Malar J 2 : 15–23.
  24. Molineaux L, Gramiccia G, 1980. The Garki Project: Research on the Epidemiology and Control of Malaria in the Sudan Savanna of West Africa. Geneva: World Health Orgnaization.
  25. Press WH, Flannery BP, Teukolsky SA, Vetterling WT, 1988. Numerical Recipes in C: the Art of Scientific Computing. Cambridge, United Kingdom: Cambridge University Press.
  26. Dossou-Yovo J, Doannio JM, Diarrassouba S, Chauvancy G, 1998. The impact of rice fields on malaria transmission in the city of Bouaké, Côte d’Ivoire. Bull Soc Pathol Exot 91 : 327–333.
  27. Sabatinelli G, Rossi P, Belli A, 1986. Dispersion of Anopheles gambiae s.l. in an urban zone of Ouagadougou (Burkina Faso). Parassitologia 28 : 33–39.
  28. Sabatinelli G, Bosman A, Lamizana L, Rossi P, 1986. Prevalence of malaria in Ouagadougou and the surrounding rural environment during the period of maximal transmission. Parassitologia 28 : 17–31.
  29. Staedke SG, Nottingham EW, Cox J, Kamya MR, Rosenthal PJ, Dorsey G, 2003. Proximity to mosquito breeding sites as a risk factor for clinical malaria episodes in an urban cohort of Ugandan children. Am J Trop Med Hyg 69 : 244–246.
  30. Julvez J, Mouchet J, Michault A, Fouta A, Hamidine M, 1997. Eco-epidemiology of malaria in Niamey and in the river valley, the Republic of Niger, 1992–1995. Bull Soc Pathol Exot 90 : 94–100.
  31. Manga L, Traoré O, Cot M, Mooh E, Carnevale P, 1993. Malaria in the village of Yaoundé (Cameroon). 3. Parasitological study in 2 central districts. Bull Soc Pathol Exot 86 : 56–61.
  32. Watts TE, Wray JR, Ng’andu NH, Draper CC, 1990. Malaria in an urban and a rural area of Zambia. Trans R Soc Trop Med Hyg 84 : 196–200.
  33. Snow RW, Omumbo JA, Lowe B, Molyneux CS, Obiero JO, Palmer A, Weber MW, Pinder M, Nahlen B, Obonyo C, New-bold C, Gupta S, Marsh K, 1997. Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349 : 1650–1654.
  34. Snow RW, Craig M, Deichmann U, Marsh K, 1999. Estimating mortality, morbidity and disability due to malaria among Africa’s non-pregnant population. Bull World Health Organ 77 : 624–640.
  35. Coene J, 1993. Malaria in urban and rural Kinshasa: the entomological input. Med Vet Entomol 7 : 127–137.
  36. Watson MS, 1953. African Highway: The Battle for Health in Central Africa. London: John Murray.
  37. Utzinger J, Tozan Y, Singer BH, 2001. Efficacy and cost-effectiveness of environmental management for malaria control. Trop Med Int Health 6 : 677–687.
  38. Utzinger J, Tozan Y, Doumani F, Singer BH, 2002. The economic payoffs of integrated malaria control in the Zambian copper-belt between 1930 and 1950. Trop Med Int Health 7 : 657–677.
  39. Ault SK, 1994. Environmental management: a re-emerging vector control strategy. Am J Trop Med Hyg 50 : 35–49.
  40. Dua VK, Sharma SK, Srivastava A, Sharma VP, 1997. Bioenvi-ronmental control of industrial malaria at Bharat Heavy Electricals Ltd., Hardwar, India: results of a nine-year study (1987–95). J Am Mosq Control Assoc 13 : 278–285.
  41. Killeen GF, McKenzie FE, Foy BD, Schieffelin C, Billingsley PF, Beier JC, 2000. The potential impact of integrated malaria transmission control on entomologic inoculation rate in highly endemic areas. Am J Trop Med Hyg 62 : 545–551.
  42. McKenzie FE, Baird JK, Beier JC, Lal AA, Bossert WH, 2002. A biologic basis for integrated malaria control. Am J Trop Med Hyg 67 : 571–577.
  43. Vlahov D, Galea S, 2003. Urban health: a new discipline. Lancet 362 : 1091–1092.
  44. Caldas de Castro M, Yamagata Y, Mtasiwa D, Tanner M, Utzinger J, Keiser J, Singer BH, 2004. Integrated urban malaria control: a case study in Dar es Salaam, Tanzania. Am J Trop Med Hyg 71 (Suppl 2): 103–117.
  45. Vercruysse J, Jancloes M, Van de Velden L, 1983. Epidemiology of seasonal falciparum malaria in an urban area of Senegal. Bull World Health Organ 61 : 821–831.
  46. Greenwood BM, Bradley AK, Greenwood AM, Byass P, Jammeh K, Marsh K, Tulloch S, Oldfield FS, Hayes R, 1987. Mortality and morbidity from malaria among children in a rural area of The Gambia, West Africa. Trans R Soc Trop Med Hyg 81 : 478–486.
  47. Velema JP, Alihonou EM, Chippaux JP, van Boxel Y, Gbedji E, Adegbini R, 1991. Malaria morbidity and mortality in children under three years of age on the coast of Benin, West Africa. Trans R Soc Trop Med Hyg 85 : 430–435.
  48. Mbogo CN, Snow RW, Kabiru EW, Ouma JH, Githure JI, Marsh K, Beier JC, 1993. Low-level Plasmodium falciparum transmission and the incidence of severe malaria infections on the Kenyan coast. Am J Trop Med Hyg 49 : 245–253.
  49. Delacollette C, Barutwanayo M, 1993. Mortality and morbidity at young ages in a stable hyperendemic malaria region, community Nyanza-Lac, Imbo South, Burundi. Bull Soc Pathol Exot 86 : 373–379.
  50. Marbiah NT, Petersen E, David K, Magbity E, Lines J, Bradley DJ, 1998. A controlled trial of lambda-cyhalothrin-impregnated bed nets and/or dapsone/pyrimethamine for malaria control in Sierra Leone. Am J Trop Med Hyg 58 : 1–6.
  51. Diallo S, Konate L, Ndir O, Dieng T, Dieng Y, Bah IB, Faye O, Gaye O, 2000. Malaria in the central health district of Dakar (Senegal). Entomological, parasitological and clinical data. Santé 10 : 221–229.
  52. Raccurt CP, Arouko H, Djossou F, Macaigne F, Massougbodji A, Zohoun T, Sadeler BC, Ripert C, 1990. In vivo amodiaquine sensitivity of Plasmodium falciparum in the town of Cotonou and in the vicinity (Benin). Med Trop (Mars) 50 : 21–26.
  53. Akogbeto M, 2000. Lagoonal and coastal malaria at Cotonou: entomological findings. Santé 10 : 267–275.
  54. Rossi P, Belli A, Mancini L, Sabatinelli G, 1986. A longitudinal entomologic survey on the transmission of malaria in Ouagadougou (Burkina Faso). Parassitologia 28 : 1–15.
  55. Carnevale P, Robert V, Le Goff G, Fondjo E, Manga L, Akogbeto M, Chippaux J, Mouchet J, 1993. Données entomologiques sur le paludisme urbain en Afrique tropicale. Cah Santé 3 : 239–245.
  56. Gazin PP, Goncalves K, Kone B, Lochouarn L, 1996. Effects of malaria outbreak in a quarter of the city of Bobo-Dioulasso (Burkina Faso). Bull Soc Pathol Exot 89 : 200–203.
  57. Lochouarn L, Gazin P, 1993. Malaria transmission in the city of Bobo-Dioulasso (Burkina Faso). Ann Soc Belg Med Trop 73 : 287–290.
  58. Robert V, Gazin P, Ouedraogo I, Carnevale P, 1986. Le paludisme urbain a Bobo-Dioulasso (Burkina Faso). Cah ORSTOM 24 : 121–128.
  59. Cornet M, Le Hesran JY, Fievet N, Cot M, Personne P, Gounoue R, Beyeme M, Deloron P, 1998. Prevalence of and risk factors for anemia in young children in southern Cameroon. Am J Trop Med Hyg 58 : 606–611.
  60. Robert V, Le Goff G, Toto JC, Mulder L, Fondjo E, Manga L, Carnevale P, 1993. Anthropophilic mosquitoes and malaria transmission at Edea, Cameroon. Trop Med Parasitol 44 : 14–18.
  61. Oduola AM, Moyou-Somo RS, Kyle DE, Martin SK, Gerena L, Milhous WK, 1989. Chloroquine resistant Plasmodium falciparum in indigenous residents of Cameroon. Trans R Soc Trop Med Hyg 83 : 308–310.
  62. Josse R, Merlin M, Combe A, Josseran R, Le Hesran JY, Avennec F, Ngnintedem B, Nkongtso AM, Kamwa M, Eboumbou JT, 1988. Comparative study of the malaria indices in Nanga-Eboko, Yaoundé and Edea (Cameroon). Med Trop (Mars) 48 : 201–208.
  63. Fondjo E, Robert V, Le Goff G, Toto JC, Carnevale P, 1992. Urban malaria in Yaoundé (Cameroon). 2. Entomologic study in 2 suburban districts. Bull Soc Pathol Exot 85 : 57–63.
  64. Chambon R, Lemardeley P, Boudin C, Ringwald P, Chandenier J, 1997. Surveillance of the in vivo sensitivity of Plasmodium falciparum to antimalarial agents: the results of initial tests of the OCEAC Malaria Network. Med Trop (Mars) 57 : 357–360.
  65. Michel R, Carnevale P, Bosseno MF, Molez JF, Brandicourt O, Zoulani A, Michel Y, 1981. Plasmodium falciparum and drepanocytic gene in Popular Republic of Congo. I. Prevalence of malaria and drepanocytic trait among school children in Brazzaville area. Med Trop (Mars) 41 : 403–412.
  66. Trapé JF, 1987. Malaria and urbanization in central Africa: the example of Brazzaville. Part IV. Parasitological and serological surveys in urban and surrounding rural areas. Trans R Soc Trop Med Hyg 81 (Suppl 2): 26–33.
  67. Tshikuka JG, Gray-Donald K, Scott M, Olela KN, 1997. Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting. Trop Med Int Health 2 : 374–382.
  68. Dossou-Yovo J, Doannio J, Riviere F, Duval J, 1994. Rice cultivation and malaria transmission in Bouaké city (Côte d’Ivoire). Acta Trop 57 : 91–94.
  69. Ngimbi NP, Beckers A, Wery M, 1982. Survey of the epidemiological status of malaria in Kinshasa (Republic of Zaire) in 1980. Ann Soc Belg Med Trop 62 : 121–137.
  70. Paluku KM, Breman JG, Moore M, Ngimbi NP, Sexton JD, Roy J, Steketee RW, Weinman JM, Kalisa R, ma-Disu M, 1988. Response of children with Plasmodium falciparum to chloroquine and development of a national malaria treatment policy in Zaire. Trans R Soc Trop Med Hyg 82 : 353–357.
  71. Karch S, Asidi N, Manzambi ZM, Salaun JJ, 1992. The Anopheles fauna and the transmission of human malaria in Kinshasa (Zaire). Bull Soc Pathol Exot 85 : 304–309.
  72. Yohannes M, Petros B, 1996. Urban malaria in Nazareth, Ethiopia: parasitological studies. Ethiop Med J 34 : 83–91.
  73. Ollomo B, Karch S, Bureau P, Elissa N, Georges AJ, Millet P, 1997. Lack of malaria parasite transmission between apes and humans in Gabon. Am J Trop Med Hyg 56 : 440–445.
  74. Elissa N, Karch S, Bureau P, Ollomo B, Lawoko M, Yangari P, Ebang B, Georges AJ, 1999. Malaria transmission in a region of savanna-forest mosaic, Haut-Ogooue, Gabon. J Am Mosq Control Assoc 15 : 15–23.
  75. Lindsay SW, Campbell H, Adiamah JH, Greenwood AM, Bangali JE, Greenwood BM, 1990. Malaria in a peri-urban area of The Gambia. Ann Trop Med Parasitol 84 : 553–562.
  76. Riley EM, Morris-Jones S, Blackman MJ, Greenwood BM, Holder AA, 1993. A longitudinal study of naturally acquired cellular and humoral immune responses to a merozoite surface protein (MSP1) of Plasmodium falciparum in an area of seasonal malaria transmission. Parasite Immunol 15 : 513–524.
  77. Gardiner CN, Biggar RJ, Collins W, Nkrumah F, 1984. Malaria in urban and rural areas of southern Ghana: a survey of parasitaemia and of anti-malarial practice. J Trop Pediatr 30 : 296–299.
  78. Afari EA, Akanmori BD, Nakano T, Ofori-Adjei D, 1992. Plasmodium falciparum: sensitivity to chloroquine in vivo in three ecological zones in Ghana. Trans R Soc Trop Med Hyg 86 : 231–232.
  79. Bosman A, Modiano D, Voglino MC, Pizzi L, Bartoloni P, Kandia Diallo I, De Giorgi F, 1992. Malaria transmission in a central area of Futa Djalon (Guinea): results of a parasitological survey during the 1989 rainy season. Parassitologia 34 : 135–142.
  80. Lisse IM, Aaby P, Whittle H, Knudsen K, 1994. A community study of T lymphocyte subsets and malaria parasitaemia. Trans R Soc Trop Med Hyg 88 : 709–710.
  81. Mendis C, Jacobsen JL, Gamage-Mendis A, Bule E, Dgedge M, Thompson R, Cuamba N, Barreto J, Begtrup K, Sinden RE, Hogh B, 2000. Anopheles arabiensis and An. funestus are equally important vectors of malaria in Matola coastal suburb of Maputo, southern Mozambique. Med Vet Entomol 14 : 171–180.
  82. Thompson R, Begtrup K, Cuamba N, Dgedge M, Mendis C, Gamage-Mendis A, Enosse SM, Barreto J, Sinden RE, Hogh B, 1997. The Matola malaria project: a temporal and spatial study of malaria transmission and disease in a suburban area of Maputo, Mozambique. Am J Trop Med Hyg 57 : 550–559.
  83. Le Bras M, Soubiran G, Baraze A, Meslet B, Combe A, Giap G, Fabre A, 1986. Urban and rural malaria in Niger. The case of the Department of Maradi. Bull Soc Pathol Exot Filiales 79 : 695–706.
  84. Sowunmi A, Akindele JA, 1993. Presumptive diagnosis of malaria in infants in an endemic area. Trans R Soc Trop Med Hyg 87 : 422.
  85. Ademowo OG, Falusi AG, Mewoyeka OO, 1995. Prevalence of asymptomatic parasitaemia in an urban and rural community in south western Nigeria. Cent Afr J Med 41 : 18–21.
  86. Trapé JF, Lefebvre-Zante E, Legros F, Ndiaye G, Bouganali H, Druilhe P, Salem G, 1992. Vector density gradients and the epidemiology of urban malaria in Dakar, Senegal. Am J Trop Med Hyg 47 : 181–189.
  87. Diallo S, Ndir O, Faye O, Diop BM, Dieng Y, Bah IB, Dieng T, Gaye O, Konate L, 1998. Malaria in the southern sanitary district of Dakar (Senegal). 1. Parasitemia and malarial attacks. Bull Soc Pathol Exot 91 : 208–213.
  88. Yamagata Y, 1996. Review of Tanzania-Japan Urban Malaria Control Project (UMCP) in Dar es Salaam and Tanga (1988–1996). Final report of a JICA expert on malaria control.
  89. Drakeley C, Schellenberg D, Kihonda J, Sousa CA, Arez AP, Lopes D, Lines J, Mshinda H, Lengeler C, Armstrong Schellenberg J, Tanner M, Alonso P, 2003. An estimation of the entomological inoculation rate for Ifakara: a semi-urban area in a region of intense malaria transmission in Tanzania. Trop Med Int Health 8 : 767–774.
  90. Gbary AR, Guiguemde TR, Ouedraogo JB, 1988. Emergence of chloroquine-resistant malaria in West Africa: the case of Sokode (Togo). Trop Med Parasitol 39 : 142–144.
  91. Jambou R, Tombo ML, Raharimalala L, Rakotonjanabelo A, Rabe T, Laventure S, Boisier P, 1998. Malaria in Antanan-arivo: evaluation of a post-epidemic situation. Santé 8 : 257–264.
  92. Gimnig JE, Ombok M, Kamau L, Hawley WA, 2001. Characteristics of larval anopheline (Diptera: Culicidae) habitats in western Kenya. J Med Entomol 38 : 282–288.
  93. World Health Organization, 1982. Manual on Environmental Management for Mosquito Control. Geneva: World Health Organization.
  94. Mouchet J, Carnevale P, 1998. Entomological biodiversity of malaria in the world. Res Rev Parasitol 58 : 189–195.
  95. World Health Organization, 1988. Urban Vector and Pest Control. Geneva: World Health Organization.

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  • Received : 21 Aug 2003
  • Accepted : 15 Nov 2003

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