Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. This study aims at doing that by applying qualitative and participatory-based system analysis and mapping to elicit the system’s emergent properties. In two experts’ workshops, the system was sketched and refined. This system was represented through a causal loop diagram, where the identification of leverage points was done using network analysis. 45 determinants interplaying through 56 linkages, and three subsystems: urbanization-related transmission, infection-prone behaviour and healthcare efficiency, and Plasmodium resistance were identified. Apart from the number of breeding sites and malaria-positive cases, other determinants such as drug prescription and the awareness of householders were identified by the network analysis as leverage points and emergent properties of the system of transmission and persistence of malaria. Based on the findings, the ongoing efforts to control malaria, such as the use of insecticide-treated bed nets and larvicide applications should continue, and new ones focusing on the public awareness and malaria literacy of city dwellers should be included. The participatory approach strengthened the legitimacy of the recommendations and the co-learning of participants.

中文翻译：

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加纳阿克拉城市疟疾传播和持续存在的新特性：来自参与式系统方法的证据

几项旨在加强对疟疾在城市环境中传播和持续存在的理解的研究未能解决其潜在的复杂性。本研究旨在通过应用基于定性和参与性的系统分析和映射来引出系统的紧急特性来做到这一点。在两个专家的研讨会上，该系统被勾画和完善。该系统通过因果循环图表示，其中杠杆点的识别是使用网络分析完成的。确定了通过 56 个联系和三个子系统相互作用的 45 个决定因素：城市化相关传播、易感染行为和医疗保健效率以及疟原虫抗性。除了繁殖地和疟疾阳性病例的数量，网络分析确定了其他决定因素，如药物处方和住户意识，是疟疾传播和持续存在系统的杠杆点和紧急特性。根据调查结果，控制疟疾的持续努力，例如使用经杀虫剂处理的蚊帐和杀幼虫剂的使用，应继续进行，并应包括关注公众意识和城市居民疟疾知识的新努力。参与式方法加强了建议的合法性和参与者的共同学习。例如，应继续使用经杀虫剂处理的蚊帐和杀幼虫剂，并应包括关注公众意识和城市居民疟疾知识的新蚊帐。参与式方法加强了建议的合法性和参与者的共同学习。例如，应继续使用经杀虫剂处理的蚊帐和杀幼虫剂，并应包括关注公众意识和城市居民疟疾知识的新蚊帐。参与式方法加强了建议的合法性和参与者的共同学习。