Malaria has long been entrenched in rural and peri-urban settings; however, malaria transmission is increasingly becoming a major focus in urban areas. This shift is due to the landscape of hyper-urban transition—characterized by rapid urbanization and population growth—which, in turn, along with changing environmental conditions, creates distinct challenges for malaria prevention in cities. Consequently, sustaining impact necessitates specific strategies that are suited to the dynamics of urban environments. In light of this, this article presents strategies for urban malaria prevention, including innovativeness as well as sustainability.
Understanding Malaria Transmission in Urban Areas
Urbanization can influence malaria transmission in several ways:
- In contrast to rural transmission, urban malaria can be associated with continued lower levels of infection. Cities support localized pockets of malaria transmission caused by mosquitoes breeding in discarded tires, stagnant water, and poorly managed municipal waste.
- High population density: In urban areas, high population density gives mosquitoes ample places to breed and colonize in small living conditions, presenting an ideal opportunity for them to multiply. Informal settlements are prone to have weak sanitation and vector control systems, which further exacerbate the risk of mosquito-borne diseases spreading.
- Environmental Factors: Urbanisation often changes natural landscapes, modifying existing mosquito habitats and creating new ones due to the presence of standing water from construction sites; changes in the way we retain and use water; and changes in land usage.
- Access to Health Care: To the extent that urban residents suffer worse rates of malaria than rural residents (which, as we’ve seen, they often do), this is likely due to disparities in access to proven means of prevention and treatment of malaria prevalent in urban populations. Living in an informal settlement or slum, for instance, might entail a lack of access to malaria services and health care.
Strategies for Sustainable Malaria Prevention in Urban Areas
Enhanced Vector Control Measures
- Larviciding: Implemented targeted programs to control mosquito larvae in urban stagnant water breeding sites to significantly curtail mosquito populations. Entomological indices: Utilised entomological indices where the number of adults is measured against the potential to transmit disease; this informs the level of vector control effort required. Human behavior: Understanding human behavior is crucial for designing a successful program and communicating with program participants.
- Indoor Residual Spraying (IRS): Use vector control measures, such as IRS, which involves spraying the inside walls of houses with insecticides to kill adult mosquitoes that land or touch these treated surfaces. IRS works best when combined with other vector control measures.
- Community-based vector control: Involve communities in vector control efforts (eg, through the removal of standing water and better waste disposal), with community health workers identifying and addressing local mosquito breeding sites.
Improving Urban Infrastructure
- Waste Management: Proper sanitation and investments in basic infrastructure to eliminate mosquito breeding sites. This includes frequent waste collection, adequate disposal such as incineration as well as the maintenance of drainage systems are key to eliminating mosquito breeding habitats.
- Water Management: Ensure that urban water storage does not create breeding for mosquitoes, such as by covering water containers or using larvicidal treatments in collections and containers.
- IX. Urban Planning: Include elements of malaria controls into urban planning and development. Designing cities with good drainage systems, having space for green spaces, and managed water (ie, ponds), can minimize the number of mosquito habitats and in turn lower the rate of malaria transmission.
Strengthening Healthcare Systems
- Access to and Quality of Health Care: Improve access to malaria prevention, diagnosis and treatment in urban areas. Make sure health facilities are prepared and equipped to provide quality health care to malaria patients.
- Training and capacity-building. Improve the ability of health workers to detect and manage malaria cases. Capacity building should cover revising treatment protocols, updating diagnostics, and ensuring the proper availability of antimalarials.
Consolidation with Primary Health Care: Consolidate malaria services within other primary health care services, where technically feasible and appropriate, to take advantage of existing infrastructure and delivery systems to maximize efficiency and coverage. Culturally or technically appropriate integration of malaria services with maternal and child health programs will optimize overall health outcomes.
Public Awareness and Education
- Awareness campaign: Conduct specific awareness campaigns targeting urban people about malaria prevention and symptoms, through social media, community events, and local print, and TV media.
- Behavior Change Communication: Alter behavior by making exhaustive risk- and prevention-related information applicable to an urban setting. Induce ITN use, recognizing when one needs to seek care and destroying mosquito breeding sites.
- Community Engagement: Local or regional community leaders and groups can be engaged in malaria prevention awareness. Doing so can aid in tailoring messages to city-specific contexts, and bolstering community participation efforts.
Leveraging Technology and Innovation
- Digital health tools: Leverage digital health tools – such as apps and geographic information systems (GIS) – for enhanced malaria surveillance and control; apps can provide information on malaria prevention, allow for symptom reporting, and enable access to healthcare services.
- Smart Vector Control Use new technologies – such as specific mosquito traps, gene-drive and deletion technology, and remote sensing – to control mosquito populations, with a special priority on the former as well as testing new technologies for improving urban malaria control.
- Data-driven: approaches using analytics can monitor malaria trends, pinpoint high-risk areas, and evaluate the effectiveness of control measures. Data-driven decision-making can help direct resources in the most effective way to achieve program objectives.
Promoting Intersectoral Collaboration
- Cross-sector partnerships: are essential for creating strong connections between health agencies, urban planners, environmental management agencies, and community movements. Developing malaria prevention programs requires a multi-sectoral framework that effectively integrates health, environmental, and urban development strategies.
- Engage government and private sector: Utilise governmental resources and the expertise and innovation of private partners in malaria control and prevention efforts. Within cities, for example, public-private partnerships can be a resource for effective malaria prevention.
- Collaborate with CBOs on delivering and sustaining malaria-prevention interventions Local organizations can be important channels for mobilizing resources, stimulating community engagement, and tailoring interventions to the governance challenges of cities.
Monitoring and Evaluation
- Regular Assessment: regularly test the efficacy of malaria control programs, carrying out evaluations to ensure programs are achieving their aims, and spot gaps and areas for improvement. Monitoring should focus on tracking malaria incidence, vector control coverage, and community engagement.
- Feedback loops: Develop feedback loops to gather information from communities and health care providers. This can help adjust strategies to better address the local challenges and successes, and enhance the program’s impact.
- Adaptive Management: Learn from evaluation results to adapt and adjust malaria prevention strategies. We must be flexible and adaptive – we have to respond periodically to changing urban realities to maintain sustainable impact.
Successful Examples of Urban Malaria Prevention
Several other global cities have implemented programmes that successfully reduce urban malaria: Here are some examples:
- Dar es Salaam, Tanzania: Implementation of combined larviciding (for mosquito larvae) and IRS (indoor residual spraying) together with community participation has led to an impressive decline in the city.
- Mumbai, India: With GIS (geographic information systems) and mobile apps now aiding malaria surveillance and vector control, Mumbai now combines these creative technologies with waste management and community education initiatives to help solve the problems posed by the presence of malaria within an urban landscape.
- Port Harcourt, Nigeria: The city of Port Harcourt incorporated malaria prevention objectives at the local government level as part of integrating the disease into urban planning and development. The city took steps to prioritize waste management and improve drainage systems in a bid to reduce mosquito-breeding sites, thereby curtailing malaria transmission.
The strategies and coping models must be tailored to the peculiar complexities of urban malaria. This piece first appeared on Aedes – The Lancet Infectious Diseases blog. It is possible to achieve a sustainable impact through enhanced vector control, adequate infrastructure, strong health systems, heightened awareness, the use of new technologies, good collaboration, and appropriate monitoring and evaluation approaches.
Cities pose an array of biological, social, and ecological opportunities and threats for malaria control. With focused and innovative approaches, we can significantly strengthen global malaria control efforts, protect vulnerable populations, and achieve malaria elimination worldwide.
