title: Urbanization, malaria transmission and disease burden in Africa.
abstract: Many attempts have been made to quantify Africa's malaria burden but none has addressed how urbanization will affect disease transmission and outcome, and therefore mortality and morbidity estimates. In 2003, 39% of Africa's 850 million people lived in urban settings; by 2030, 54% of Africans are expected to do so. We present the results of a series of entomological, parasitological and behavioural meta-analyses of studies that have investigated the effect of urbanization on malaria in Africa. We describe the effect of urbanization on both the impact of malaria transmission and the concomitant improvements in access to preventative and curative measures. Using these data, we have recalculated estimates of populations at risk of malaria and the resulting mortality. We find there were 1,068,505 malaria deaths in Africa in 2000 - a modest 6.7% reduction over previous iterations. The public-health implications of these findings and revised estimates are discussed.
authors.affiliation: TALA Research Group in the Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK. simon.hay@zoo.ox.ac.uk
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Guerra
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.forename: Peter M
authors.initials: PM
authors.lastname: Atkinson
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000293:Adolescent; D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D000818:Animals; D002648:Child; D002980:Climate; D009033:Culicidae / Q000469:parasitology; D006801:Humans; D007223:Infant; D007299:Insect Bites and Stings / Q000469:parasitology; D007303:Insect Vectors / Q000469:parasitology; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D009026:Mortality; D010270:Parasite Egg Count; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011158:Population Growth; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization