Malaria control in South Africa 2000–2010: beyond MDG6

Abstract

BackgroundMalaria is one of the key targets within Goal 6 of the Millennium Development Goals (MDGs), whereby the disease needs to be halted and reversed by the year 2015. Several other international targets have been set, however the MDGs are universally accepted, hence it is the focus of this manuscript.MethodsAn assessment was undertaken to determine the progress South Africa has made against the malaria target of MDG Goal 6. Data were analyzed for the period 2000 until 2010 and verified after municipal boundary changes in some of South Africa’s districts and subsequent to verifying actual residence of malaria positive cases.ResultsSouth Africa has made significant progress in controlling malaria transmission over the past decade; malaria cases declined by 89.41% (63663 in 2000 vs 6741 in 2010) and deaths decreased by 85.4% (453 vs 66) in the year 2000 compared to the year 2010. Coupled with this, malaria cases among children under five years of age have also declined by 93% (6791 in 2000 vs 451 in 2010). This has resulted in South Africa achieving and exceeding the malaria target of the MDGs. A series of interventions have attributed to this decrease, these include: drug policy change from monotherapy to artemisinin combination therapy, insecticide change from pyrethroids back to DDT; cross border collaboration (South Africa with Mozambique and Swaziland through the Lubombo Spatial Development Initiative– LSDI) and financial investment in malaria control. The KwaZulu-Natal Province has seen the largest reduction in malaria cases and deaths (99.1% cases- 41786 vs 380; and 98.5% deaths 340 vs 5), when comparing the year 2000 with 2010. The Limpopo Province recorded the lowest reduction in malaria cases compared to the other malaria endemic provinces (56.1% reduction- 9487 vs 4174; when comparing 2000 to 2010).ConclusionsSouth Africa is well positioned to move beyond the malaria target of the MDGs and progress towards elimination. However, in addition to its existing interventions, the country will need to sustain its financing for malaria control and support programmed reorientation towards elimination and scale up active surveillance coupled with treatment at the community level. Moreover cross-border malaria collaboration needs to be sustained and scaled up to prevent the re-introduction of malaria into the country.

Towards the implementation of malaria elimination policy in South Africa: the stakeholders’ perspectives

“…While there is no denial that over the years malaria morbidity and mortality have been drastically reduced in South Africa [13,15] and elsewhere in the world [1,2], informants shared mixed views as to what led to these reductions. Some claimed that these achievements were as a result of effective malaria control interventions [5,13,35].…”

“…The Lubombo Spatial Development Initiative (LSDI – the cross-border malaria control collaboration between Mozambique, Swaziland and South Africa) has been partly lauded for these reductions [5,12–14]. Malaria cases and deaths in South Africa dropped by 89.4% and 85.4%, respectively, between 2000 and 2010 [15]. Unfortunately, LSDI funding ceased in 2011 [13,15], owing to the global financial difficulties and changes in the Global Fund funding model introduced in 2012 [7].…”

“…Malaria cases and deaths in South Africa dropped by 89.4% and 85.4%, respectively, between 2000 and 2010 [15]. Unfortunately, LSDI funding ceased in 2011 [13,15], owing to the global financial difficulties and changes in the Global Fund funding model introduced in 2012 [7]. The launch of MOSASWA (a malaria collaboration between Mozambique, South Africa and Swaziland intended to fill the gap left by LSDI) in July 2015 [16] rekindled hope that the gains made will be protected.…”

Case management of malaria: Treatment and chemoprophylaxis

“…[6,7] Malaria endemic areas in today's SA are the north-eastern part of KwaZuluNatal (KZN) Province and the low altitude regions of Mpumalanga and Limpopo provinces. [4,8] Although the Northern Cape and North West provinces are classified as non-endemic, malaria transmission occurs occasionally in areas adjacent to the Molopo and Orange rivers. [5] Malaria treatment strategies in the country differ slightly in endemic and non-endemic provinces.…”

“…Year in which first-line malaria treatment policy was changed, by province, in South Africa [8] is the recommended first-line antimalarial medicine for the treatment of uncomplicated falciparum malaria. Primaquine is used for radical cure of Plasmodium vivax and P. ovale infections.…”