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Open Access Highly Accessed Research

The feasibility of malaria elimination in South Africa

Rajendra Maharaj1*, Natashia Morris1, Ishen Seocharan1, Philip Kruger2, Devanand Moonasar3, Aaron Mabuza4, Eric Raswiswi5 and Jaishree Raman1

Author Affiliations

1 Malaria Research Unit, Medical Research Council, 491 Ridge Road, Durban, KwaZulu-Natal 4001, South Africa

2 Department of Health and Social Welfare, Limpopo Provincial Government, PO Box 33, Tzaneen, 0850, South Africa

3 National Department of Health, 1916 Hallmark Building, Private Bag X828, Pretoria, 001, South Africa

4 Department of Health and Social Services, Mpumalanga Provincial Government, Private Bag X11278, Nelspruit, Mpumalanga, 1200, South Africa

5 Department of Health-KwaZulu-Natal, KwaZulu-Natal Provincial Government, Private Bag X002, Jozini, KwaZulu-Natal, 3969, South Africa

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Malaria Journal 2012, 11:423  doi:10.1186/1475-2875-11-423

Published: 19 December 2012

Abstract

Background

Following the last major malaria epidemic in 2000, malaria incidence in South Africa has declined markedly. The decrease has been so emphatic that South Africa now meets the World Health Organization (WHO) threshold for malaria elimination. Given the Millennium Development Goal of reversing the spread of malaria by 2015, South Africa is being urged to adopt an elimination agenda. This study aimed to determine the appropriateness of implementing a malaria elimination programme in present day South Africa.

Methods

An assessment of the progress made by South Africa in terms of implementing an integrated malaria control programme across the three malaria-endemic provinces was undertaken. Vector control and case management data were analysed from the period of 2000 until 2011.

Results

Both malaria-related morbidity and mortality have decreased significantly across all three malaria-endemic provinces since 2000. The greatest decline was seen in KwaZulu-Natal where cases decreased from 42,276 in 2000 to 380 in 2010 and deaths dropped from 122 in 2000 to six in 2010. Although there has been a 49.2 % (8,553 vs 4,214) decrease in the malaria cases reported in Limpopo Province, currently it is the largest contributor to the malaria incidence in South Africa. Despite all three provinces reporting average insecticide spray coverage of over 80%, malaria incidence in both Mpumalanga and Limpopo remains above the elimination threshold. Locally transmitted case numbers have declined in all three malaria provinces but imported case numbers have been increasing. Knowledge gaps in vector distribution, insecticide resistance status and drug usage were also identified.

Conclusions

Malaria elimination in South Africa is a realistic possibility if certain criteria are met. Firstly, there must be continued support for the existing malaria control programmes to ensure the gains made are sustained. Secondly, cross border malaria control initiatives with neighbouring countries must be strongly encouraged and supported to reduce malaria in the region and the importation of malaria into South Africa. Thirdly, operational research, particularly on vector distribution and insecticide resistance status must be conducted as a matter of urgency, and finally, the surveillance systems must be refined to ensure the information required to inform an elimination agenda are routinely collected.

Keywords:
Malaria elimination; Feasibility; South Africa; Vector control; Case management; Surveillance