title: Is there malaria transmission in urban settings in Colombia?
abstract: BACKGROUND
  Colombia contributes a significant proportion of malaria cases in the Americas, which are predominantly rural. However, in the last 8 years ~ 10 % of the endemic municipalities have also reported urban and peri-urban malaria cases, a growing concern for health authorities. This study focused on the characterization of the officially reported urban malaria cases.
  
  
  METHODS
  A descriptive retrospective study based on secondary information provided by the Colombian National Surveillance System-SIVIGILA for the 2008-2012 period was conducted. A total of 17 municipalities with consistent and persistent reports of urban and peri-urban malaria were selected for analysis, which included site of origin and of residence, age, gender and ethnicity of patients, health system affiliation, Plasmodium species and the presence of malaria vectors.
  
  
  RESULTS
  A total of 18,113 malaria cases were reported from urban and peri-urban areas of 17 endemic municipalities. Almost 70 % of the reports originated in localities in the departments of Chocó and Nariño, located on the Pacific Coast where a predominantly Afro-Colombian population, of individuals of under 30 years of age, was the most affected (80.7 %), mainly with Plasmodium falciparum infections (52.1 %). Median annual parasite index (API) was 6.4 per 1000 inhabitants (3.4 in 2008; 10.8 in 2010 and 6.0 in 2012). Between 2011 and 2012 complicated cases (2.4 %) and malaria in pregnant women (1.4 %) were reported. Study areas reported the presence of at least seven Anopheles species considered malaria vectors. These analyses did not allow ascertaining the presumable origin of the recorded urban cases due to the lack of a consensus on a definition of urban, peri-urban and rural limits and the lack of proper verification of the geographical source of infection.
  
  
  CONCLUSIONS
  The study indicates the probable presence of endemic, unstable and low-intensity malaria transmission in Colombian urban and peri-urban areas of a group of municipalities located mainly on the Pacific coast region and a few others in the eastern region. There is a need to unequivocally confirm the urban or peri-urban origin of the malaria cases reported and the transmission conditions, as well as to develop and implement new strategies for urban and peri-urban malaria control and elimination.
authors.affiliation: Ministerio de Salud y Protección Social de Colombia, Bogotá, Colombia. jpadilla@minsalud.gov.co.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Padilla
authors.affiliation: Instituto Nacional de Salud, Bogotá, Colombia. pchaparro@ins.gov.co.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Chaparro
authors.affiliation: Malaria Vaccine and Drug Development Center, Cali, Colombia. karen.molina@inmuno.org.|Centro de Investigación Científica Caucaseco, Cali, Colombia. karen.molina@inmuno.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Molina
authors.affiliation: Malaria Vaccine and Drug Development Center, Cali, Colombia. marevalo@inmuno.org.|Faculty of Health, Universidad del Valle, Cali, Colombia. marevalo@inmuno.org.
authors.forename: Myriam
authors.initials: M
authors.lastname: Arevalo-Herrera
authors.affiliation: Centro de Investigación Científica Caucaseco, Cali, Colombia. sherrera@inmuno.org.
authors.forename: Sócrates
authors.initials: S
authors.lastname: Herrera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000852:Anopheles / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D003105:Colombia; D018562:Disease Transmission, Infectious; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011247:Pregnancy; D012189:Retrospective Studies; D013383:Suburban Population; D014505:Urban Population; D055815:Young Adult