This paper represents the consensus of participants in a cross-disciplinary conference on Urban Malaria in Africa, held at Pretoria, South Africa, December 2-4 2004. The aim of the meeting was to identify a strategy for the assessment and control of urban malaria.

This policy briefing paper reflects the discussions held during the meeting and is aimed at informing decision-makers of the potential for containing and reversing the emerging problem of urban malaria.

Recommendations include:

• Urban malaria is already a problem and is likely to increase as urbanisation continues. In order to avert an increase in disease burden, concerted action needs to be taken quickly.
• There is a need to target the most vulnerable sections of society who suffer a double burden of insufficient protection from malaria transmission due to inadequate housing and living conditions, and limited financial resources. These factors restrict their access to appropriate preventive and curative services.
• Inter-sectoral interventions are the key to successful urban malaria control and must include close collaboration between water, agricultural, urban planning, commercial, health and community players.
• Existing health and governance structures in urban environments need to invest in programmes to manage urban malaria effectively using established methods and tools for mosquito control and malaria prevention, diagnosis and treatment.
• Since most fevers in urban areas are not due to malaria, presumptive diagnosis and treatment of fevers as ‘malaria’ will result in greater wastage of resources, ill health and loss of life. The need for accurate diagnosis is made more urgent by the fact that combination therapies for malaria are expensive.

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