Lubombo Spatial Development Initiative and malaria control
Malaria control forms a component of the Lubombo
Spatial Development Initiative (LSDI). The LSDI is a programme by the
governments of Mozambique, Swaziland and South Africa to develop the Lubombo
region into a globally competitive economic zone, ensuring sustainable employment
and equity in access to economic opportunity in the region. The geographic
region targeted by this initiative is broadly defined as eastern Swaziland,
southern Mozambique and north-eastern KwaZulu Natal, an area linked by the
Lubombo mountains.
Malaria was identified as a critical deterrent to the development of the Lubombo
region. This led to the creation of the Lubombo Malaria Control initiative,
a cross-border collaboration aimed at the reduction of malaria throughout
the LSDI area.
The objective of the malaria component is to put in place a
malaria control programme that will protect the economic interest of the Lubombo
Spatial Development Initiative (LSDI) and stimulate development. Promoting
the area for development will only be effective once it has been clearly shown
that the risk of being infected with malaria is decreased, and that there
is an ongoing, sustainable malaria control programme in place.
Intervention is through both parasite and vector mosquito reduction.
The Regional Malaria Control Commission (RMCC) is the coordinating
and decision-making body of the LSDI programme, which comprises malaria control
programme managers, public health specialists and scientists from the three
countries. The MRC Malaria Research Programme undertakes direct management
of the day-to-day running of the programme on behalf of the RMCC, and provides
secretarial, financial management, fund-raising and research support as well
as chairing the RMCC.
The objectives of the LSDI Malaria Control Initiative are briefly
outlined:
- extending indoor residual spraying (IRS) to Maputo Province, Mozambique
and ensuring effective malaria control was maintained in South Africa and
Swaziland.
- monitoring and evaluating malaria control in the region and developing
a regional GIS-based Malaria Information System (MIS).
- providing updated tourist information booklets containing definitive
malaria risk maps and prophylaxis guidelines.
- monitoring the negative impact of malaria and the beneficial effects
of malaria control on communities, tourism and development.
- ensuring sustainability of malaria control through appropriate capacity
development, fund raising and integration of control activities within the
provincial health system in Mozambique.
Since effective malaria control requires both vector control
and early effective treatment, the RMCC decided to extend their objectives
to ensure that the best malaria treatment was introduced across the LSDI.
Widespread use of artemisinin-based combination therapy (ACT) offers the benefits
of not only improving cure rates, but, unlike other malaria treatments, of
also directly decreasing malaria transmission and potentially slowing drug
resistance. To optimise the synergistic effects of indoor residual spraying
(IRS) and ACTs on reducing malaria transmission and thus disease burden, while
minimising programme costs, the implementation of ACTs has been timed to follow
the establishment of effective vector control.
The effectiveness of the malaria control programme in the long-term
will be assessed by the incidence of malaria over time in Mozambique as well
as in the neighbouring malarious areas of South Africa and Swaziland. The
success of intervention is not only measured using process (e.g. spraying
and artemisinin-based combination therapy coverage) and biological markers
(e.g. parasite prevalence rates, health facility patient numbers and mosquito
vector reductions), but also by the effects on tourism (e.g. bed occupancy,
job creation and risk perceptions) in all three countries over the course
of the 7 year period (2000 – 2007).
From the baseline malaria season of 1999/2000 to 2003/2004,
these improvements in malaria control have resulted in dramatic reductions
in malaria incidence of over 90% in KwaZulu-Natal, over 65% in Mpumalanga
and over 90% in Swaziland. Parasite prevalence in children has decreased by
over 88% in Zone 1 in Mozambique. The documentation of process and outcome
indicators has supported evidence-based decision-making within the LSDI and
has played a significant role in informing policy makers across the African
region.
This collaborative study between MRC and the Departments of
Health in South Africa, Mozambique and Swaziland is part of the Lubombo Spatial
Development Initiative.
Funding for the project was by the Business Trust in South
Africa, MOZAL, the Department of Health in South Africa and the Ministry of
Health in Mozambique. These sources continued to fund the project, with the
Business Trust funding ended in June 2004. Calculated to June 2003, 70% of
the funding for the project came from the private sector. The Global Fund
for Aids, TB and Malaria started funding in 2003.
Project Components:
See Lubombo
SDI Malaria Control Programme Web site
