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.ResultsMalaria 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.ConclusionsAlthough 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.

Highlights

  • 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 bor‐ ders by 2018

  • The establishment of chloroquine-resistant parasites in the region caused a minor spike in malaria cases during the mid- to late-1980s, which was rapidly reversed by the replacement of chloroquine with sulfadoxine-pyrimethamine as first-line treatment [3]

  • The major contributor to the national malaria burden from the endemic provinces alternated between Limpopo and Mpumalanga, with Limpopo accounting for majority of the cases reported in 2014 (Fig. 2b)

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Summary

Introduction

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 bor‐ ders by 2018. A robust malaria vector control and surveillance strategy dating back to the early 1940s ensured decades of effective malaria control resulting in the near elimination of malaria in South Africa by 1970 [2]. Favourable climatic factors (elevated temperatures and rainfall), increased population movement across the country’s borders, together with the increased prevalence of drug-resistant parasites and insecticide-resistant vectors, Anopheles funestus [5], have been identified as major contributing factors [6]

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