Summary of Malaria Reductions in LSDI regionKwaZulu-Natal and Mpumalanga Mozambique
Swaziland |
MALARIA CONTROL IN THE LUBOMBO SPATIAL DEVELOPMENT
AREA
A REGIONAL COLLABORATION BETWEEN THREE COUNTRIES 1999 TO PRESENT
The Lubombo Spatial Development Initiative (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.
In July 1999 President Mbeki, President Chissano and His Majesty, King Mswati III signed the General Protocol which put in place a platform for regional cooperation and delivery. In October 1999 the Lubombo Malaria Protocol and tri-national malaria programme was launched. The Malaria Protocol of understanding was signed at ministerial level between the three countries in October 1999. The malaria component of the LSDI project is managed by the Regional Malaria Control Commission (RMCC), comprised of malaria control programme managers, public health specialists and scientists from the three countries. A comprehensive proposal outlining the LSDI malaria control programme and budgets was drawn up by the RMCC over the course of two three days meetings, funded by the development bank of SA and co-ordinated by the Medical Research Council.
The primary emphasis of the LSDI malaria control programme was to extend malaria control to southern Mozambique and thereby address a number of aspects central to increasing the effectiveness of malaria control in the two highest risk malaria provinces in South Africa and Swaziland, There was increasing consensus that even if malaria control measures were optimal in South Africa and Swaziland (with effective treatment and insecticides in place), the disease burden could only be further reduced by a regional approach to control. There is also increasing evidence that effective malaria control is a positive precursor to development with the situation prior to malaria control in South Africa supporting this view, given the well documented negative effects of malaria on tourism and agricultural development in the 1930’s.
The LSDI malaria programme was targeted at creating a platform
for development, the beneficiaries being communities in areas with the lowest
socio-economic development in the region as well as tourism, business and governments.
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).
The malaria vector control component in Mozambique has been implemented in phases starting with Zone 1, in 2000, which is the area extending from the KwaZulu-Natal border to Maputo. Zone 1A is the area surrounding the MOZAL Plant which introduced malaria control as part of their social responsibility campaign, implemented in 2001. Phase three, initiated in 2002, focussed on Zone 2A comprising part of the Boane District, and Zone 2 and 3 extending north along the Kruger National Park border, covering an area of over 20 0002 Km. The contiguous malaria control area in the region now exceeds 100 0002 Km.
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 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.
KwaZulu Natal was the first Ministry of Health in Africa to implement an ACT malaria treatment policy, when it introduced Coartem in January 2001. The planned phased implementation of ACTs, which resulted in their introduction in Mpumalanga in 2003 and in two districts in southern Mozambique in 2004, is ahead of schedule and will ensure that ACTs will be in place throughout the LSDI region by 2006. These changes are being comprehensively assessed through the South East African Combination Antimalarial Therapy (SEACAT) evaluation, which is nested within the LSDI partnership.
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 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.
The original objectives of the LSDI Malaria Control Programme are clearly being met. This has largely been achieved through the rare strength of partnership between MRC, UCT, Private partners and Governments (both National and Provincial) who are equally committed to and share a common vision for ensuring malaria control in the region, primarily through indoor residual spraying and ACT implementation, with ongoing monitoring and evaluation to support evidence based decision making.
• Reduce malaria prevalence in the LSDI
• Remove malaria as a barrier to investment, and economic and tourism
development in the LSDI
Mozambique
A total of 9 718 children between the ages 2 and <15 years were tested for
parasitaemia at sentinel sites in the 4 zones of the study area between December
1999 and June 2004. All zones clearly show marked decreases in the prevalence
of malaria infection.
In zone 1 the average infection rate from all sites at baseline was 62 %, which
reduced to 38% in June 2001, to 22% in June 2002 and 8% in June 2003 and remained
low at 7.2% in June 2004.
In zone 1A overall prevalence of infection at baseline in June 2000 was 86%. This reduced to 62% post spraying in June 2001, 36% in June 2002 and 18% in June 2003 and remained low at 20.8 % in June 2004.
In zone 2 overall prevalence of infection at baseline was 70% in June 2002, reducing to 34% in June 2003, after spraying and dropping to 29.8% in June 2004.
In Zone 3 the prevalence was 69.6% pre spraying and dropped to 58.4% after the first spray round
Swaziland
Survey results for adults and children at the 4 sentinel sites ranged from 2-8%
in 1999. By 2003 these were all <3% and by June 2004 averaged 0.25%. The
malaria incidence rates over the same period reduced dramatically by >90%.
KwaZulu-Natal and Mpumalanga
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.
For interactive mapping information visit
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
Advice
on Malaria Prophylaxis in pdf format