Patterns and determinants of malaria risk in urban and peri-urban areas of Blantyre, Malawi

Abstract

BackgroundAlthough malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study.MethodsA health facility-based, age and location-matched, case–control study of children 6–59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively.ResultsA total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones (OR = 5.1; 95% CI = 1.62, 15.8). Use of long-lasting insecticide nets (LLINs) the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households.ConclusionTravel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is critical to the design of more targeted interventions for the urban setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1623-9) contains supplementary material, which is available to authorized users.

Implication of Anopheles funestus in malaria transmission in the city of Yaoundé, Cameroon

“…Transmission levels recorded during this study in the city of Yaoundé were far above these values as well as those previously recorded [23,60]. Additionally, such high levels likely point to the negative influence of unplanned urbanisation on malaria transmission and are consistent with studies conducted in other major sub-Saharan African cities [6,30,34,37,42,43,48,50,54,69].…”

Malaria in children under-five: A comparison of risk factors in lakeshore and highland areas, Zomba district, Malawi

“…Other risk factors for malaria revealed in the study include lower education level, not sleeping under bed nets and not using Indoor Residual Spraying (IRS). Mathanga et al [ 14 ] compared malaria risk factors in urban and peri-urban areas in Malawi. Univariate analysis indicated that lower risk was associated with possession of a TV, electricity in the household and having a higher education.…”

“…Univariate analysis indicated that lower risk was associated with possession of a TV, electricity in the household and having a higher education. People living in urban and peri-urban areas had the same risk factors associated with contracting malaria [ 14 ]. Zgambo et al [ 15 ] compared malaria risk factors identified in the 2012 and 2014 Malaria Indicator Survey (MIS) and found that older children and those living in poor households were associated with contracting malaria in both 2012 and 2014 [ 15 ].…”

Eight-year Retrospective Analysis of Malaria Trends in Gedeo Zone, South Ethiopia (2012-2019)

“…Possible justi cations for the higher occurrence of malaria among males and older age group could be their engagement in various outdoor activities and staying outdoors during the nights [38]. Apart from outdoor exposures, differences in treatment-seeking behavior, access to health facilities and travel history [39] might be the possible contributors for the sex-and age-based variations of malaria cases. In addition, a review report revealed that adult females are better protected from parasitic diseases than males due to genetic and biological (hormonal) factors [40].…”

“…This could be because of massive construction activities (like road, house and small dams) and presence of coffee processing sites in Dilla town and its vicinity that could create suitable habitat for mosquito breeding. Travel history [39], differences in the competence and skills of the laboratory personnel and relatively good reporting system might also be the main responsible factors in uencing the prevalence of malaria in Dilla town compared to rural districts. There have been healthy ongoing malaria control activities incorporating environmental management, indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs) and artemisinin-based combination therapy in the area.…”