Malaria transmission in urban sub-Saharan Africa
Malaria transmission in urban sub-Saharan Africa
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DOI：
10.4269/ajtmh.2003.68.169
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发表时间：
2003-02-01
影响因子：
3.3
通讯作者：
Beier, JC
中科院分区：
文献类型：
--
作者：
Robert, V;MacIntyre, K;Beier, JC
世界城市人口的迅速增加对疟疾的流行病学产生了重大影响。对撒哈拉以南非洲城市疟疾传播的审查表明，无论其生物生态环境的规模或特征如何，在这些庞大的城市内发生传播的可能性都很大。对撒哈拉以南非洲疟疾传播研究结果的荟萃分析表明，年平均昆虫接种率（EIR）与城市化水平之间存在松散的线性负相关关系。很少有研究未能找到某些传播的昆虫学证据。我们的结果显示，城市中心的平均年 EIR 为 7.1，城郊地区为 45.8，农村地区为 167.7。在平均降雨量较低且季节性的地区，城市化对减少传播的影响更为明显。城市之间以及同一城市不同地区之间的传播水平存在很大差异。本文提供了过去文献中的证据，以构建一个概念框架来开始解释这种异质性。由于自然免疫力水平下降而导致疟疾流行的可能性可能会被城市化对按蚊幼虫生态的负面影响所抵消。由于城市化，城市环境中的疟疾控制可能会更加简单；然而，我们对农村环境中疟疾传播的大部分了解可能不适用于城市环境。
The rapid increase in the world's urban population has major implications for the epidemiology of malaria. A review of malaria transmission in sub-Saharan African cities shows the strong likelihood of transmission occurring within these sprawling cities, whatever the size or characteristics of their bioecologic environment. A meta-analysis of results from studies of malaria transmission in sub-Saharan Africa shows a loose linear negative relationship between mean annual entomologic inoculation rates (EIR) and the level of urbanicity. Few studies have failed to find entomologic evidence of some transmission. Our results show mean annual EIRs of 7.1 in the city centers, 45.8 in periurban areas, and 167.7 in rural areas. The impact of urbanization in reducing transmission is more marked in areas where the mean rainfall is low and seasonal. Considerable variation in the level of transmission exists among cities and within different districts in the same city. This article presents evidence from past literature to build a conceptual framework to begin to explain this heterogeneity. The potential for malaria epidemics owing to decreasing levels of natural immunity may be offset by negative impacts of urbanization on the larval ecology of anopheline mosquitoes. Malaria control in urban environments may be simpler as a result of urbanization; however, much of what we know about malaria transmission in rural environments might not hold in the urban context.