Integrated Urban Malaria Control: A Case Study in Dar Es Salaam, Tanzania

Abstract

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.

Epidemiología de malaria urbana en Quibdó, Chocó.

“…El uso de sistemas de información geográfica con alta resolución para identificación y vigilancia de criaderos es una herramienta útil para la planeación de estrategias de manejo ambiental. La actualización de mapas en tiempo real según el tipo de actividades de control realizadas es conveniente para la vigilancia y la evaluación de la efectividad de las medidas de control adoptadas (20).…”

“…Sin embargo, la implementación de esta estrategia en lo posible debe ser validada con estudios entomológicos de hábitos de picadura del vector. El control de malaria en las áreas identificadas como zonas de mayor riesgo en la ciudad de Quibdó se podría alcanzar a través de un manejo integrado que incluya identificación y control de criaderos, diagnóstico y tratamiento temprano y adecuado de los pacientes, uso de medidas de protección personal y educación comunitaria en salud (20). Las actividades de manejo ambiental orientadas a la eliminación de criaderos han demostrado ser sostenibles y costo efectivas por la facilidad operacional, el bajo costo y por la participación de la comunidad en las actividades de control (20).…”

Prevalence of Malaria among Patients Attending Public Health Facilities in Maputo City, Mozambique

“…14,15 In addition, environment management of surface water may also be needed as part of a comprehensive malaria prevention and control plan in this context. 12,16 The low percentage of patients who slept under ITNs or lived in houses that had been sprayed may indicate a relative lack of access to effective prevention measures in Maputo City compared with other parts of the country 3 ; unfortunately, this evaluation was not designed to accurately estimate these indicators. Taking into account that HF-based surveys tend to overestimate access to prevention strategies, actual coverage may be even lower if assessed by the globally recommended household survey approach.…”

A Temporal-Spatial Analysis of Malaria Transmission in Adama, Ethiopia

“…These interventions are cost effective, 16,31,32 particularly when malaria clusters are focal and relatively stable over the malaria transmission season, 33 which is common in urban areas of Africa. 34 This study highlights the utility of small-scale malaria mapping to identify transmission hot spots within communities, a method that has been successfully used in at least two urban malaria control programs in Africa. 1,34 Further studies should assess how small-scale malaria mapping can be used in conjunction with targeted vector control interventions to enhance the effectiveness of urban malaria control in Africa.…”