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Reviewing South Africa's malaria elimination strategy (2012-2018): progress, challenges and priorities.
Malar J. 2016 08 27; 15(1):438.MJ

Abstract

BACKGROUND

With a sustained national malaria incidence of fewer than one case per 1000 population at risk, in 2012 South Africa officially transitioned from controlling malaria to the ambitious goal of eliminating malaria within its borders by 2018. This review assesses the progress made in the 3 years since programme re-orientation while highlighting challenges and suggesting priorities for moving the malaria programme towards elimination.

METHODS

National malaria case data and annual spray coverage data from 2010 until 2014 were assessed for trends. Information on surveillance, monitoring and evaluation systems, human and infrastructure needs and community malaria knowledge was sourced from the national programme mid-term review.

RESULTS

Malaria cases increased markedly from 6811 in 2013 to 11,711 in 2014, with Mpumalanga and Limpopo provinces most affected. Enhanced local transmission appeared to drive malaria transmission in Limpopo Province, while imported malaria cases accounted for the majority of cases reported in Mpumalanga Province. Despite these increases only Vhembe and Mopani districts in Limpopo Province reported malaria incidences more than one case per 1000 population at risk by 2014. Over the review period annual spray coverage did not reach the recommended target of 90 % coverage, with information gaps identified in parasite prevalence, artemether-lumefantrine therapeutic utilization, asymptomatic/sub-patent carriage, drug efficacy, vector distribution and insecticide resistance.

CONCLUSIONS

Although South Africa has made steady progress since adopting an elimination agenda, a number of challenges have been identified. The heterogeneity of malaria transmission suggests interventions in Vhembe and Mopani districts should focus on control, while in KwaZulu-Natal Province eliminating transmission foci should be prioritized. Cross-border initiatives with neighbouring countries should be established/strengthened as a matter of urgency since malaria importation poses a real threat to the country's elimination efforts. It is also critical that provincial programmes are adequately resourced to effectively conduct the necessary targeted elimination activities, informed by current vector/parasite distribution and resistance data. More sensitive methods to detect sub-patent infections, primaquine as a transmission-blocking drug, and alternative vector control methods need to be investigated. Knowledge gaps among malaria health workers and affected communities should be identified and addressed.

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Authors+Show Affiliations

Raman J
Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa. jaishreer@nicd.ac.za. Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa. jaishreer@nicd.ac.za. Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa. jaishreer@nicd.ac.za.
Morris N
Health GIS Centre, South African Medical Research Council, Durban, South Africa.
Frean J
Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa. Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa.
Brooke B
Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa. Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa.
Blumberg L
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
Kruger P
Department of Health and Social Welfare, Limpopo Provincial Government, Tzaneen, South Africa.
Mabusa A
Department of Health and Social Services, Mpumalanga Provincial Government, Nelspruit, South Africa.
Raswiswi E
Department of Health KwaZulu-Natal, KwaZulu-Natal Provincial Government, Jozini, South Africa.
Shandukani B
Malaria Directorate, National Department of Health, Pretoria, South Africa.
Misani E
Malaria Directorate, National Department of Health, Pretoria, South Africa.
Groepe MA
WHO Intercountry Support Team, Pretoria, South Africa.
Moonasar D
Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa. Malaria Directorate, National Department of Health, Pretoria, South Africa.

MeSH

AdolescentAdultAgedAged, 80 and overChildChild, PreschoolCommunicable Disease ControlDisease EradicationFemaleHumansInfantInfant, NewbornMalariaMaleMiddle AgedSouth AfricaYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27567642

Citation

Raman, Jaishree, et al. "Reviewing South Africa's Malaria Elimination Strategy (2012-2018): Progress, Challenges and Priorities." Malaria Journal, vol. 15, no. 1, 2016, p. 438.
Raman J, Morris N, Frean J, et al. Reviewing South Africa's malaria elimination strategy (2012-2018): progress, challenges and priorities. Malar J. 2016;15(1):438.
Raman, J., Morris, N., Frean, J., Brooke, B., Blumberg, L., Kruger, P., Mabusa, A., Raswiswi, E., Shandukani, B., Misani, E., Groepe, M. A., & Moonasar, D. (2016). Reviewing South Africa's malaria elimination strategy (2012-2018): progress, challenges and priorities. Malaria Journal, 15(1), 438. https://doi.org/10.1186/s12936-016-1497-x
Raman J, et al. Reviewing South Africa's Malaria Elimination Strategy (2012-2018): Progress, Challenges and Priorities. Malar J. 2016 08 27;15(1):438. PubMed PMID: 27567642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reviewing South Africa's malaria elimination strategy (2012-2018): progress, challenges and priorities. AU - Raman,Jaishree, AU - Morris,Natashia, AU - Frean,John, AU - Brooke,Basil, AU - Blumberg,Lucille, AU - Kruger,Philip, AU - Mabusa,Aaron, AU - Raswiswi,Eric, AU - Shandukani,Bridget, AU - Misani,Eunice, AU - Groepe,Mary-Anne, AU - Moonasar,Devanand, Y1 - 2016/08/27/ PY - 2016/06/09/received PY - 2016/08/18/accepted PY - 2016/8/29/entrez PY - 2016/8/29/pubmed PY - 2017/5/23/medline KW - Case management KW - Challenges KW - Elimination KW - Malaria KW - Priorities KW - South Africa KW - Surveillance KW - Vector control SP - 438 EP - 438 JF - Malaria journal JO - Malar J VL - 15 IS - 1 N2 - BACKGROUND: With a sustained national malaria incidence of fewer than one case per 1000 population at risk, in 2012 South Africa officially transitioned from controlling malaria to the ambitious goal of eliminating malaria within its borders by 2018. This review assesses the progress made in the 3 years since programme re-orientation while highlighting challenges and suggesting priorities for moving the malaria programme towards elimination. METHODS: National malaria case data and annual spray coverage data from 2010 until 2014 were assessed for trends. Information on surveillance, monitoring and evaluation systems, human and infrastructure needs and community malaria knowledge was sourced from the national programme mid-term review. RESULTS: Malaria cases increased markedly from 6811 in 2013 to 11,711 in 2014, with Mpumalanga and Limpopo provinces most affected. Enhanced local transmission appeared to drive malaria transmission in Limpopo Province, while imported malaria cases accounted for the majority of cases reported in Mpumalanga Province. Despite these increases only Vhembe and Mopani districts in Limpopo Province reported malaria incidences more than one case per 1000 population at risk by 2014. Over the review period annual spray coverage did not reach the recommended target of 90 % coverage, with information gaps identified in parasite prevalence, artemether-lumefantrine therapeutic utilization, asymptomatic/sub-patent carriage, drug efficacy, vector distribution and insecticide resistance. CONCLUSIONS: Although South Africa has made steady progress since adopting an elimination agenda, a number of challenges have been identified. The heterogeneity of malaria transmission suggests interventions in Vhembe and Mopani districts should focus on control, while in KwaZulu-Natal Province eliminating transmission foci should be prioritized. Cross-border initiatives with neighbouring countries should be established/strengthened as a matter of urgency since malaria importation poses a real threat to the country's elimination efforts. It is also critical that provincial programmes are adequately resourced to effectively conduct the necessary targeted elimination activities, informed by current vector/parasite distribution and resistance data. More sensitive methods to detect sub-patent infections, primaquine as a transmission-blocking drug, and alternative vector control methods need to be investigated. Knowledge gaps among malaria health workers and affected communities should be identified and addressed. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/27567642/Reviewing_South_Africa's_malaria_elimination_strategy__2012_2018_:_progress_challenges_and_priorities_ DB - PRIME DP - Unbound Medicine ER -