Background. South Africa (SA) in general, and KwaZulu-Natal (KZN) Province in particular, have stepped up efforts to eliminate malaria. To strengthen malaria control in KZN, a relevant malaria forecasting model is important. Objectives. To develop a forecasting model to predict malaria cases in KZN using the Seasonal Autoregressive Integrated Moving Average (SARIMA) time series approach. Methods. The study was carried out retrospectively using a clinically confirmed monthly malaria case dataset that was split into two. The first dataset (January 2005 -December 2013) was used to construct a SARIMA model by adopting the Box-Jenkins approach, while the second dataset (January -December 2014) was used to validate the forecast generated from the best-fit model. Results. Three plausible models were identified, and the SARIMA (0,1,1)(0,1,1) 12 model was selected as the best-fit model. This model was used to forecast malaria cases during 2014, and it was observed to fit closely with malaria cases reported in 2014. Conclusions. The SARIMA (0,1,1)(0,1,1) 12 model could serve as a useful tool for modelling and forecasting monthly malaria cases in KZN. It could therefore play a key role in shaping malaria control and elimination efforts in the province.
The change of the malaria control intervention policy in South Africa (SA), re-introduction of dichlorodiphenyltrichloroethane (DDT), may be responsible for the low and sustained malaria transmission in KwaZulu-Natal (KZN). We evaluated the effect of the re-introduction of DDT on malaria in KZN and suggested practical ways the province can strengthen her already existing malaria control and elimination efforts, to achieve zero malaria transmission. We obtained confirmed monthly malaria cases in KZN from the malaria control program of KZN from 1998 to 2014. The seasonal autoregressive integrated moving average (SARIMA) intervention time series analysis (ITSA) was employed to model the effect of the re-introduction of DDT on confirmed monthly malaria cases. The result is an abrupt and permanent decline of monthly malaria cases (w=-1174.781, p-value=0.003) following the implementation of the intervention policy. The sustained low malaria cases observed over a long period suggests that the continued usage of DDT did not result in insecticide resistance as earlier anticipated. It may be due to exophagic malaria vectors, which renders the indoor residual spraying not totally effective. Therefore, the feasibility of reducing malaria transmission to zero in KZN requires other reliable and complementary intervention resources to optimize the existing ones.
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