SummaryPresent elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to transmission, or, more realistically, embarking on regional initiatives to dry up importation at its source.

The Lubombo Spatial Development Initiative is a joint development program between the governments of Mozambique, Swaziland, and South Africa, which includes malaria control as a core component of the initiative. Vector control through indoor residual spraying (IRS) was incrementally introduced in southern Mozambique between November 2000 and February 2004. Surveillance to monitor its impact was conducted by annual cross-sectional surveys to assess the prevalence of Plasmodium falciparum infection, entomologic monitoring, and malaria case notification in neighboring South Africa and Swaziland. In southern Mozambique, there was a significant reduction in P. falciparum prevalence after the implementation of IRS, with an overall relative risk of 0.74 for each intervention year (P < 0.001), ranging from 0.66 after the first year to 0.93 after the fifth intervention year. Substantial reductions in notified malaria cases were reported in South Africa and Swaziland over the same period. The success of the program in reducing malaria transmission throughout the target area provides a strong argument for investment in regional malaria control.

Background: The potential contribution of knowledge, attitudes and practices (KAP) studies to malaria research and control has not received much attention in most southern African countries. This study investigated the local communities' understanding of malaria transmission, recognition of signs and symptoms, perceptions of cause, treatment-seeking patterns, preventive measures and practices in order to inform the country's proposed malaria elimination programme in Swaziland.

Background: Five large insecticide-treated net (ITN) programmes and two indoor residual spraying (IRS) programmes were compared using a standardized costing methodology.

BackgroundMalaria continues to be one of the most devastating diseases in the world, killing more humans than any other infectious disease. Malaria parasites are entirely dependent on Anopheles mosquitoes for transmission. For this reason, vector population dynamics is a crucial determinant of malaria risk. Consequently, it is important to understand the biology of malaria vector mosquitoes in the study of malaria transmission. Temperature and precipitation also play a significant role in both aquatic and adult stages of the Anopheles.MethodsIn this study, a climate-based, ordinary-differential-equation model is developed to analyse how temperature and the availability of water affect mosquito population size. In the model, the influence of ambient temperature on the development and the mortality rate of Anopheles arabiensis is considered over a region in KwaZulu-Natal Province, South Africa. In particular, the model is used to examine the impact of climatic factors on the gonotrophic cycle and the dynamics of mosquito population over the study region.ResultsThe results fairly accurately quantify the seasonality of the population of An. arabiensis over the region and also demonstrate the influence of climatic factors on the vector population dynamics. The model simulates the population dynamics of both immature and adult An. arabiensis. The simulated larval density produces a curve which is similar to observed data obtained from another study.ConclusionThe model is efficiently developed to predict An. arabiensis population dynamics, and to assess the efficiency of various control strategies. In addition, the model framework is built to accommodate human population dynamics with the ability to predict malaria incidence in future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1411-6) contains supplementary material, which is available to authorized users.

The substantial impact of cross-border collaborative control efforts on the burden of malaria in southern Africa has previously been demonstrated through the successes of the Lubombo Spatial Development Initiative. Increases in malaria cases recorded in the three partner countries (Mozambique, South Africa, Swaziland) since termination of that programme in 2011 have provided impetus for the resuscitation of cooperation in the form of the MOSASWA malaria initiative. MOSASWA, launched in 2015, seeks to renew regional efforts to accelerate progress towards malaria elimination goals already established in the region. National malaria programmes, together with developmental partners, academic institutions and the private sector seek to harmonize policy, strengthen capacity, share expertise, expand access to elimination interventions particularly amongst migrant and border population groups, mobilize resources and advocate for long-term funding to ultimately achieve and sustain malaria elimination in the MOSASWA region.

Life tables provide a summary of mortality and reproductive schedules and can help explain why certain species proliferate in particular environments. Life table characteristics of Alopheles arabiensis, under a range of simulated seasonal temperature were determined. F1 progeny of field-collected material were observed at four fluctuating temperatures with means of 17.9, 23.2, 26.1, and 21.4 degrees C, representing winter, spring, summer and autumn temperature profiles. Gonotrophic cycles, egg hatchability rates, mean male and female lifespans, reproductive rate, the intrinsic rate of increase, and generation times were calculated. Immature development was fastest in summer (11 d) compared with winter (32 d), resulting in less robust adults. Mean female lifespans were greater than those of the males and also increased with decreasing temperatures. From the age-specific survivorship curve and the gonotrophic cycles, females were found to lay large numbers of eggs especially during spring and summser. Under simulated winter conditions mosquitoes did not oviposit in the laboratory. It was also determined that summer reared mosquitoes are capable of giving just one infected bite while autumn reared mosquitoes can give two infected bites, increasing their transmission potential. Thus life table data go some way toward explaining late season transmission of malaria in South Africa.

Antimalarial drug resistance is a major obstacle to malaria control and eventual elimination. The routine surveillance for molecular marker of resistance is an efficient way to assess drug efficacy, which remains feasible in areas where malaria control interventions have succeeded in substantially reducing malaria transmission. Community based asexual parasite prevalence surveys were conducted annually in sentinel sites in Gaza Province, Mozambique from 2006 until 2010, before, during and after antimalarial policy changes to artesunate plus sulfadoxine-pyrimethamine in 2006 and to artemether-lumefantrine in 2008. Genetic analysis of dhfr, dhps, crt, and mdr1 resistant genes was conducted on 3 331 (14.4%) Plasmodium falciparum PCR positive samples collected over the study period from 23 229 children aged 2 to 15 years. The quintuple dhfr/dhps mutation associated with sulfadoxine-pyrimethamine resistance increased from 56.2% at baseline to 75.8% by 2010. At baseline the crt76T and mdr186Y mutants were approaching fixation, 96.1% and 74.7%, respectively. Following the deployment of artemisinin-based combination therapy, prevalence of both these chloroquine-resistance markers began declining, reaching 32.4% and 30.9%, respectively, by 2010. All samples analysed over the 5-year period possessed a single copy of the mdr1 gene. The high and increasing prevalence of the quintuple mutation supports the change in drug policy from artesunate plus sulfadoxine-pyrimethamine to artemether-lumefantrine in Mozambique. As chloroquine related drug pressure decreased in the region, so did the molecular markers associated with chloroquine resistance (crt76T and mdr186Y). However, this reversion to the wild-type mdr186N predisposes parasites towards developing lumefantrine resistance. Close monitoring of artemether-lumefantrine efficacy is therefore essential, particularly given the high drug pressure within the region where most countries now use artemether-lumefantrine as first line treatment.