BackgroundMalaria remains a serious epidemic threat in Mpumalanga Province. In order to appropriately target interventions to achieve substantial reduction in the burden of malaria and ultimately eliminate the disease, there is a need to track progress of malaria control efforts by assessing the time trends and evaluating the impact of current control interventions. This study aimed to assess the changes in the burden of malaria in Mpumalanga Province during the past eight malaria seasons (2001/02 to 2008/09) and whether indoor residual spraying (IRS) and climate variability had an effect on these changes.MethodsThis is a descriptive retrospective study based on the analysis of secondary malaria surveillance data (cases and deaths) in Mpumalanga Province. Data were extracted from the Integrated Malaria Information System. Time series model (Autoregressive Integrated Moving Average) was used to assess the association between climate and malaria.ResultsWithin the study period, a total of 35,191 cases and 164 deaths due to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09 (P < 0.005). The incidence and case fatality (CFR) rates for the study period were 134 cases per 100,000 and 0.54%, respectively. Mortality due to malaria was lower in infants and children (CFR < 0.5%) and higher in those >65 years, with the mean CFR of 2.1% as compared to the national target of 0.5%. A distinct seasonal transmission pattern was found to be significantly related to changes in rainfall patterns (P = 0.007). A notable decline in malaria case notification was observed following apparent scale-up of IRS coverage from 2006/07 to 2008/09 malaria seasons.ConclusionsMpumalanga Province has achieved the goal of reducing malaria morbidity and mortality by over 70%, partly as a result of scale-up of IRS intervention in combination with other control strategies. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved. However, the goal to eliminate malaria as a public health problem requires efforts to be directed towards the control of imported malaria cases; development of strategies to interrupt local transmission; and maintaining high quality surveillance and reporting system.


  • Malaria remains a serious epidemic threat in Mpumalanga Province

  • Malaria case notification and incidence rate From July 2001 to June 2009, a total of 35,191 confirmed malaria cases were notified in Mpumalanga Province (Table 1)

  • The case fatality rate fluctuated over the years ranging from 0.28% to 0.74%, higher during the 2006/07 (0.71%) and 2007/08 (0.74%) malaria seasons and subsequently followed by a marked decline in the last malaria season (2008/09) reaching the 0.5% national target for malaria case fatality rate in South Africa (Table 1)

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Malaria remains a serious epidemic threat in Mpumalanga Province. According to the World Malaria Report 2010, the global prevalence of the disease was estimated at 225 million cases and 781 000 deaths in 2009 [3]. In 2000, malaria was estimated to contribute to the loss of nearly 45 million disability-adjusted life years (DALYs), which represents about 13% of all infectious diseases [6]. South Africa is not exempt from the impact of seasonal and unstable malaria transmission, in the northern and eastern parts of the country [7]. For more than five decades, Mpumalanga Province has maintained a successful control programme, with control strategies including rapid detection and treatment of confirmed malaria cases at Primary Health Care clinics and vector control through IRS with insecticides and focal larviciding [9]. Plasmodium falciparum accounts for the majority of the cases, transmitted mainly by Anopheles arabiensis [10]


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