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. 2012 Dec 19:11:423.
doi: 10.1186/1475-2875-11-423.

The feasibility of malaria elimination in South Africa

Rajendra Maharaj  1 , Natashia Morris, Ishen Seocharan, Philip Kruger, Devanand Moonasar, Aaron Mabuza, Eric Raswiswi, Jaishree Raman
Affiliations

The feasibility of malaria elimination in South Africa

Rajendra Maharaj et al. Malar J. .

Abstract

Background: Following the last major malaria epidemic in 2000, malaria incidence in South Africa has declined markedly. The decrease has been so emphatic that South Africa now meets the World Health Organization (WHO) threshold for malaria elimination. Given the Millennium Development Goal of reversing the spread of malaria by 2015, South Africa is being urged to adopt an elimination agenda. This study aimed to determine the appropriateness of implementing a malaria elimination programme in present day South Africa.

Methods: An assessment of the progress made by South Africa in terms of implementing an integrated malaria control programme across the three malaria-endemic provinces was undertaken. Vector control and case management data were analysed from the period of 2000 until 2011.

Results: Both malaria-related morbidity and mortality have decreased significantly across all three malaria-endemic provinces since 2000. The greatest decline was seen in KwaZulu-Natal where cases decreased from 42,276 in 2000 to 380 in 2010 and deaths dropped from 122 in 2000 to six in 2010. Although there has been a 49.2 % (8,553 vs 4,214) decrease in the malaria cases reported in Limpopo Province, currently it is the largest contributor to the malaria incidence in South Africa. Despite all three provinces reporting average insecticide spray coverage of over 80%, malaria incidence in both Mpumalanga and Limpopo remains above the elimination threshold. Locally transmitted case numbers have declined in all three malaria provinces but imported case numbers have been increasing. Knowledge gaps in vector distribution, insecticide resistance status and drug usage were also identified.

Conclusions: Malaria elimination in South Africa is a realistic possibility if certain criteria are met. Firstly, there must be continued support for the existing malaria control programmes to ensure the gains made are sustained. Secondly, cross border malaria control initiatives with neighbouring countries must be strongly encouraged and supported to reduce malaria in the region and the importation of malaria into South Africa. Thirdly, operational research, particularly on vector distribution and insecticide resistance status must be conducted as a matter of urgency, and finally, the surveillance systems must be refined to ensure the information required to inform an elimination agenda are routinely collected.

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Figures

Figure 1
Figure 1
Number of malaria cases and deaths reported annually in South Africa (1971–2002).
Figure 2
Figure 2
Numbers of malaria cases and malaria deaths by year and malaria-endemic province.
Figure 3
Figure 3
Phase of malaria elimination continuum per district in KwaZulu-Natal, Limpopo and Mpumalanga, South Africa (1999/2000 and 2010/2011 malaria seasons).
Figure 4
Figure 4
Indoor residual spraying coverage in KwaZulu-Natal, Limpopo and Mpumalanga, South Africa (2005/2006 and 2010/2011 malaria seasons).
Figure 5
Figure 5
Prevalence of molecular markers associated with chloroquine and sulphadoxine-pyrimethamine resistance in KwaZulu-Natal, Limpopo and Mpumalanga, South Africa in 2010.
See this image and copyright information in PMC

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