This information was provided by
The Malaria Research
Programme of the Medical Research Council, South Africa
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| Treatment Guidelines KwaZulu Natal 2001 | Malaria Update 2003 |
Recent
Developments: |
Background
"Malaria is a major impediment to health and development in Africa. It is one of the biggest killers in the world. More than one million people die from the disease every year and about half a billion others are afflicted in some other way. Nine out of every ten of these deaths occur in Africa..
Malaria contributes significantly to sustained poverty, creating untold suffering for 40% of the world's population. Pregnant women and children are especially vulnerable to the disease. This problem has been effectively tackled by Malaria Control Programmes in the malarious provinces of South Africa with effective drugs and insecticides. However, there is increasing consensus that malaria needs to be addressed on a regional level. Therefore, the Lubombo Spatial Development Initiative (LSDI) Malaria Programme was initiated to address the malaria problem in the Lubombo region.
The Lubombo Region
The geographic area targeted by this initiative is broadly defined as eastern Swaziland, southern Mozambique and north-eastern-KwaZulu Natal, South Africa and is linked by the Lubombo mountains. The malaria programme is part of a broader initiative aiming to develop the Lubombo region into a globally competitive economic zone while creating sustainable employment and equity in access to economic opportunity. Promoting the area for agriculture and tourist 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.
There is increasing evidence that malaria control is a positive precursor to development. The beneficiaries of the LSDI malaria programme are communities in areas with the lowest socio-economic development in the region.
The Lubombo programme is run by the Regional Malaria Control Commission (RMCC), comprising of the malaria control programme managers from the three countries, public health specialists and scientists, all of whom have exceptional experience in communicable disease control in Africa.
Programme Objectives
The programme aims, within 5 years, to reduce the prevalence of Plasmodium falciparum
in Maputo province – perhaps the hardest hit area of the Lubombo SDI –
from 600 per 1000 to less than 200 per 1000. It aims to reduce the incidence
of such infections in the South African and Swaziland parts of the region from
250 per 1000 to 5 per 1000 within five years. This will have a positive impact
on socio-economic development in the region.
Malaria control in Swaziland is carried out by the Swaziland
malaria control programme, and in KwaZulu-Natal by the KwaZulu-Natal malaria
control programme. Both programmes use insecticide residual house spraying.
Insecticide residual house spraying was introduced by the LSDI malaria programme
in southern Mozambique in late 2000, where spraying had previously been confined
to Maputo city.
Progress
It is evident that after just two years of sustained effort in implementing
malaria control in the LSDI area, great inroads have been made in freeing the
area from this debilitating disease. In comparison to the 1999/2000 malaria
season, the overall prevalence of the disease in children had decreased by the
2001/2002 malaria season by 70% in Mozambique, while malaria incidence had been
reduced by 80% in Swaziland and a staggering 91% in KwaZulu-Natal. In certain
areas in Mozambique, the prevalence of the disease has been reduced to less
than 20%, attaining, in part, the 5 year objective of the programme after just
two years.
The gains that have been made by the KwaZulu-Natal Department of Health and LSDI programme are reflected in Figure 1.
Figure 1. Malaria cases by season, KwaZulu-Natal
The reduction in malaria cases in KwaZulu-Natal since 2000 (Figure 1) can be attributed to a number of new interventions such as:
• the introduction of effective combination drug therapy
(Artemether-lumefantrine) in KwaZulu-Natal.
• insecticide policy changes to DDT in KwaZulu-Natal Province due to resistance
to pyrethroids detected in Anopheles funestus.
• the regional approach to malaria control between South Africa, Swaziland
and Mozambique and the extension of vector control to southern Mozambique which
is believed to have had a major influence on malaria incidence in the Lubombo
corridor.
Malaria and Tourism
Figures 2 and 3 show the location of sampled tourist facilities with regard to malaria incidence in KwaZulu-Natal Province, and show the decrease in case incidence from 1999/2000 to 2001/2002. In the 1999/2000 malaria season, 57% of the sampled tourist facilities were in areas with over 50 malaria cases per 1000 people, and 42% were in areas where 5-25 malaria cases per 1000 people were recorded (Figure 2).
A major reduction in malaria cases in the 2001/2002 malaria season
was achieved. Only 3% of the sampled tourist facilities were in areas where
5-25 malaria cases per 1000 people were recorded and 96% were in areas where
the malaria incidence was very low, with 0.001-5 cases per 1000 people being
recorded (Figure 3). The reductions in the 2001/2002 malaria season indicate
the positive effect of the regional approach to malaria control in the Lubombo
corridor. It is essential that this information is made available through all
media to encourage tourists to visit the area.
| Figure 2: Malaria incidence per 1000 people: July 1999 to June 2000 | Figure 3: Malaria incidence per 1000 people: July 2001 to June 2002 |
Funding
Funding for the project for the first two years (2000/2001) has been by The Business Trust, Mozal, The Department of Health in South Africa and the Ministry of Health in Mozambique. The LSDI is an exemplary model that demonstrates the commitment of the private sector – not only to the health and welfare of their employees but also to the need for promoting economic growth and development in general. This is a vitally important factor and underlies the partnership between the public and the private sector, upon which the entire Lubombo initiative is based.
In conclusion, it should be noted that the implementation of appropriate interventions, based on scientific research and monitoring as well as regional collaboration, have effectively controlled malaria and reduced the burden of disease in the populations of all three countries involved in this tri-lateral programme with obvious advantages to tourism and development in the region.