The key role of socio-demographic and socio-environmental factors in urban malaria occurrence and control - An illustration using the city of Yaoundé

Cities in developing countries are experiencing an unprecedented population growth that illustrates a demographic transition and a shift towards modernization with consequences on their epidemiological profiles. However, this change is characterized by an important rural-to-urban social and cultural transfer that can bias the expected epidemiological transition; at the same time, this transfer renders the understanding of the occurrence of communicable diseases more complex than it appears. Urban malaria occurrence was modeled for the city of Yaoundé in Cameroon. Retrospective interviews were conducted to describe a variety of epidemiological, social and environmental variables at the household level. Various ecological variables originating from remote sensing data were also integrated. Multivariate multilevel negative binomial analyses were developed to evaluate the distinct contributions of explanatory social and ecological variables. Spatial models based on the level of urbanity were implemented to understand the intelligence of urban malaria as characterized by those variables. The results showed an overall higher statistical importance of socio-environmental variables, particularly those describing rural origin socio-cultural features in terms of non-conventional housing types and urban agriculture (UA). The spatial patterns of the urban malaria occurrences displayed a complex combination of population density gradients and socio-environmental factors, illustrating the importance of conventional urban features over rural/non-conventional features in reducing the occurrence of urban malaria.