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Progress

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%.

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

House Spraying

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.

Update 2005

Update on Malaria in Southern Africa January 2003


Annual Report for SA Business Trust 2004

Report for SA Business Trust 2003

Report for SA Business Trust 2002

Annual Report for SA Business Trust 2001 - Executive Summary

Entomological Aspects of Vector Control

Advice on Malaria Prophylaxis in pdf format