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Urbanization and the global malaria recession

Andrew J Tatem12*, Peter W Gething3, David L Smith245 and Simon I Hay23

Author Affiliations

1 Department of Geography and Environment, University of Southampton, Highfield, Southampton, UK

2 Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA

3 Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK

4 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

5 Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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Malaria Journal 2013, 12:133  doi:10.1186/1475-2875-12-133

Published: 17 April 2013



The past century has seen a significant contraction in the global extent of malaria transmission, resulting in over 50 countries being declared malaria free, and many regions of currently endemic countries eliminating the disease. Moreover, substantial reductions in transmission have been seen since 1900 in those areas that remain endemic today. Recent work showed that this malaria recession was unlikely to have been driven by climatic factors, and that control measures likely played a significant role. It has long been considered, however, that economic development, and particularly urbanization, has also been a causal factor. The urbanization process results in profound socio-economic and landscape changes that reduce malaria transmission, but the magnitude and extent of these effects on global endemicity reductions are poorly understood.


Global data at subnational spatial resolution on changes in malaria transmission intensity and urbanization trends over the past century were combined to examine the relationships seen over a range of spatial and temporal scales.


A consistent pattern of increased urbanization coincident with decreasing malaria transmission and elimination over the past century was found. Whilst it remains challenging to untangle whether this increased urbanization resulted in decreased transmission, or that malaria reductions promoted development, the results point to a close relationship between the two, irrespective of national wealth. The continuing rapid urbanization in malaria-endemic regions suggests that such malaria declines are likely to continue, particularly catalyzed by increasing levels of direct malaria control.

Urbanization; Global malaria endemicity; Plasmodium falciparum; Plasmodium vivax; Malaria elimination