Programme Impact
The programme has shown impact as measured directly by a
significant decrease in malaria disease burden, by an increase in malaria
control capacity, by positive perceptions in the tourism industry, and by
creation of a regional malaria monitoring system, all only made possible by
the broad nature of the collaboration and the political support of the programme.
Success is based on many factors but is largely attributable to the commitment
of all partners, as well as sound decision-making and implementation strategies,
based on experience and supported by good scientific infrastructure and evidence.
Mozambique
A total of 15 613 children between the ages 2 and <15
years were tested for parasitaemia at the sentinel sites in the 5 zones of
the study area between December 1999 and June 2005.
Following five years of sustained effort of implementing
malaria vector control in the LSDI area, the overall prevalence of the disease
decreased dramatically. At all seven sentinel sites in Zone 1 in Mozambique,
the prevalence of the disease has been reduced to less than 20%, attaining
the 5 year objective after only three years. Four of the seven sites have
parasiteamia of < 10%.
- In zone 1 the average infection rate from all sites was 62 % in 2000,
which reduced to 7.2% in June 2004. In zone 1A overall prevalence of infection
in June 2000 was 86%. This reduced to 20.8 % in June 2004.
- In zone 2 overall prevalence of infection at baseline was 70% in June
2002, dropping to 29.8% in June 2004 after spraying.
- In Zone 3 the prevalence was 69.6% pre spraying and dropped to 58.4%
after the first spray round.
Data on all children from the 4 zones for the period 1999
- 2005 are summarized in the graph below, clearly showing marked decreases
in the prevalence of malaria infection.
Average Parasite Prevalence in children aged 2-<15
years of age in Mozambique, 1999 – 2005
Swaziland
Malaria incidence has steadily decreased in Swaziland. A
decrease of 91% was achieved by 2002/2003 in comparison to the baseline year
of 1999/2000 despite no changes in insecticide or drug policy during this
period.
South Africa
Dramatic reductions in malaria incidence have taken place
in KwaZulu-Natal and Mpumalanga since 1999 due to effective mosquito and parasite
control interventions by the respective provincial control programmes.
Dramatic reductions in malaria incidence have taken place in KwaZulu-Natal
and Mpumalanga since 1999 due to effective mosquito and parasite control interventions
by the respective Provincial control programmes. The prevalence at the three
sentinel sites in KwaZulu-Natal ranged from 10 to 40% in 1999. By 2001, these
parasite prevalence rates had dropped to below 5%. Malaria incidence rates,
as monitored by the MIS, reduced from the 1999/2000 baseline year to 2003/2004
by >90%. In Mpumalanga, baseline parasite prevalence rates at 4 sites in
2001 ranged between 2 and 3%. Malaria incidence has reduced by >60% since
the baseline malaria season of 1999/2000 to 2003/2004.
The extension of malaria control to the Mozambique sector
has had the effect of dramatically reducing disease transmission in this area
and has also resulted in a significant reduction in transmission in the highest
risk malaria districts in South Africa (Ingwavuma and Komatipoort) and
in Swaziland. See map of Malaria
Reduction.
Sustainability of project outcomes
From an operational perspective, starting a malaria control
programme in a largely underdeveloped rural area as well as in an area designated
for industrial development, was successful, and the necessary skills to run
and evaluate the control programme are in place. The future sustainability
of the programme, the first regional project of this nature in Africa that
aims to create a platform for development, is reliant on appropriately skilled
personnel, funding, and access to effective insecticides and anti-malarial
drugs. As outlined, training has been ongoing, and an appropriate skills base
exists in the region to effectively implement a vector control programme based
on house spraying.
The project area is an extension and consolidation of the
existing malaria control area around Maputo city and forms part of the broader
LSDI malaria controlled areas of Mpumalanga, KwaZulu-Natal Provinces and Swaziland.
This is a strong factor towards sustainability and a major advantage over
newly initiated control programmes that are spatially isolated from other
control programmes and that do not have the necessary expertise base.
Management of the programme consists of five tiers:
i. Tri-Lateral Ministers meeting
ii. LSDI management
iii. RMCC management
iv. Management structures in Mozambique
v. Research and control management
Management structures were set up at a Provincial and District
level in Zone 1 in Mozambique that permitted the implementation of the programme
with the help of external experts (RMCC and scientists) and built capacity
at both levels. In 2003 further integration of the programme into the Provincial
health structure of Maputo Province, Mozambique was undertaken.
An application to the Global Fund towards financially sustaining
the programme has been successful. Effective anti-malarial treatment in all
the LSDI areas is being phased in as a result of this funding through the
SEACAT project which is now fully part of the LSDI.
The RMCC
membership as outlined encompasses a group of African scientists, public
health professionals and malaria control programme managers with exceptional
experience in communicable disease control in Africa. The expertise base extends
from individuals who have started malaria control programmes in 3 countries
through to extensive experience in research, intervention and health
management.
See Malaria
and Tourism
The malaria control component in Mozambique has been implemented
in phases starting with Zone 1 which is the area extending from the border
with KwaZulu-Natal to Maputo City. Zone 1A covers the area surrounding the
MOZAL plant that has been sprayed as part of their social responsibility campaign.
Zone 2A comprises part of the Boane District, and Zone 2 extends northward
of Zone 1 to approximately ¼ of the length of the Kruger National Park.
Zone 3 lies north of Zone 2. The control programme covers an area of approximately
20 500 km2. See map
House spraying in Zone 1 was suspended in February 2000
due to the detection of resistance in Anopheles funestus to synthetic
pyrethroids in South Africa. Investigations to date have confirmed synthetic
pyrethroid resistance in An. funestus from Mozambique. ( See
Insecticide resistance
) Increasing levels of insecticide resistance as well as a limited number
of available insecticides restrict the options with respect to the residual
house spraying programme in southern Mozambique. Discussions emanating from
the discovery of pyrethroid and carbamate resistance have emphasized the need
to consider rotational insecticide use as the only way forward, and to avoid
fixing resistant genes in the vector population. These findings have implications
for the future of malaria control in the region and funding from NIH will
allow the evaluation of rotational spraying during the next three years.
The table below outlines the house spraying activities that
have been carried out in the different zones in Mozambique. Both Zones 1 and
1A have had 4 spray rounds since 2000. Zone 2A was first sprayed in 2001 and
the first spray round was completed in Zone 3.(See
map of sprayed areas )
| |
Spraying |
| Zone 1 |
2000, 2001, 2002, 2003, 2004, 2005 |
| Zone 1A |
2000, 2001, 2002, 2003, 2004, 2005 |
| Zone 2 |
2002, 2003, 2004, 2005 |
| Zone 3 |
2003, 2004, 2005 |
View a Slide show
of the SprayDatabase: Powerpoint
or html
(best viewed: 800 x 600)
For further information, email:Marlize
Booman
Training
The foundation of a successful, efficient and effective spraying
programme is optimally trained staff at every level. Experience was lacking
in Mozambique, and training was therefore a key priority before a spraying
programme could be introduced. Training of supervisors and spray persons has
taken place each year of the project. Training of field staff, whether spray
operators or supervisors, followed a similar pattern i.e. 85% practical and
15% theory. However, supervisors received more in-depth training on environmental
hazards, toxicity, first aid and safe handling/disposal of insecticides.
The table below indicates the number of spray operators who
have been trained during the course of the initiative to undertake the indoor
residual house spraying for vector control.
Zone |
Year |
Trained Spray Operators |
1 |
2000 |
48 |
|
2001 |
48 |
|
2002 |
95 |
|
2003 |
80 |
1A |
2000 |
25 |
|
2001 |
98 |
|
2002 |
70 |
|
2003 |
70 |
2 |
2002 |
93 |
|
2003 |
118 |
2A |
2001 |
35 |
|
2002 |
50 |
|
2003 |
54 |
3 |
2003 |
60 |
|
|
|
Training was extended to include intervention assessment and
in this regard, window-trap caught mosquitoes were morphologically identified
in Mozambique, and residual efficacy bio-assays carried out. The latter required
the maintenance of an insectary and the ability to undertake both susceptibility
and biochemical resistance testing which are increasingly being done in the
country and will lead to a postgraduate degree. Training has been undertaken
to equip field entomologists with the necessary research techniques, field
staff to use global positioning system (GPS) receiver hand-held units, office
staff in the use of the MIS and insectory staff in Maputo. 
An important factor identified prior to the implementation
of the spraying programme was the necessity to adequately supervise the spray
operations. A relational database (Microsoft Access) was therefore designed
as an information repository for all spraying activities. The data generated
from computerized reports made it possible to evaluate productivity and spraying
performance on an ongoing basis. Quality control was undertaken by the malaria
control programme managers of Swaziland, KwaZulu-Natal and Mpumalanga during
each spraying round.
