Africa must face the challenge of urban malaria

As more Africans move from rural areas to the cities the risk of urban malaria increases. City health services need to focus on poor people who are most at risk from the disease. Malaria programmes should operate on a district by district basis as levels of malaria can vary dramatically throughout the city.

Theurban population in Africa is growing at an annual rate of 3.5 percent, morethan three times faster than the rural population. By 2025, half of Africa'spopulation will live in urban areas. Preventing disease in the cities presentsdifferent challenges and looking after the health needs of city dwellers isbecoming increasingly important. The International Water Management Institute,Accra, together with the Liverpool School of Tropical Medicine, UK, the Schoolof Medical Sciences, University of Kumasi, Ghana, andthe Noguchi Memorial Institute for Medical Research, Accra, carried out a studyinto malaria in Ghana’s two largest cities to discover which people were mostat risk and to investigate of urban agriculture increases this risk.

Inthe past malaria has been considered a rural disease. In cities there are fewerplaces for the mosquitoes to breed. City dwellers tend to have better access toclinics and treatment than people in rural areas. However, with increasing immigrationfrom rural areas, more people will be at risk and will place increasing demandson city health services. In rural areas it is mostly young children andpregnant women who are at risk. However in the cities where malaria levels arelow, people do not develop immunity at a young age and are subsequently morelikely to develop severe malaria with complications later in life.

Morethan 3,000 children under the age of five from 23 different urban communities tookpart in the study, which was carried out in the capital Accra, on the coast,and in Kumasi, situated in tropical forest. The studyfound that:

• Malaria levels in urbanareas vary from district to district much more than in rural parts ofGhana.
• In Kumasi,two areas had infection levels five times higher than other communities.
• Almost half of all childrensuffered from anaemia. Children under the age of two were much more likelyto be anaemic than older children.
• Children from poorfamilies who had travelled to rural areas in the past three weeks were themost likely to have malaria.
• Malaria was responsiblefor 23 percent of cases of moderate to severe anaemia in children.
• Urban agriculture wasfound to be a risk factor in Accra, but not in Kumasi.

Poor familiesare the worst hit by malaria. The disease greatly increases the risk of severeanaemia which affects people's long-term health and education. The differentlevels of malaria within cities have important implications for tackling thedisease. The study recommends:

• targeting specific areas ordistricts within urban areas. The measures taken will differ from districtto district depending on the level of disease, the cultural background ofthe community and the way local government operates.
• The poorest and mostvulnerable urban people who are the most at risk should be made a priority.
• The pattern of malaria incities should be plotted in order to set up appropriate health programmes.