#Opinion: Malaria down, but not out
Malaria has plagued mankind for millennia and dates back to 3200 BC and 1304 BC, evidence of which was found in Egyptian remains.
Malaria was a leading cause of death in traders and settlers to Africa in the late 1400s and early 1500s, and the disease was referred to as the “killing fever”. It was only in 1880 that a French army doctor, Lavern, identified the parasite responsible for malaria; and in 1897 a British surgeon, Major Ronald Ross, made the association that malaria is transmitted by mosquitoes.
In South Africa the first documented case of malaria was around 1836-1837, during the time of the Great Trek to Maputo-Mozambique.
Malaria continues to reign in many parts of the world. In the World Health Organisation’s 2018 Malaria Report, malaria cases decreased globally from an estimated 239 million in 2010 to 217 million in 2016, a decline of 9%. Most cases in 2017 were estimated to have occurred in the WHO African region (92%), followed by the South-East Asia region (5%) and the Eastern Mediterranean region (2%).
In the Southern African Development Community (SADC) region, the WHO estimates that three-quarters of the population is at risk of contracting malaria, with 35 million of these being children under 5 years of age and 8.5 million being pregnant women.
The level of malaria transmission varies from highly endemic to stable all year round.
While many parts of Africa have a high burden of malaria, some southern African countries, including South Africa, report relatively lower numbers.
South Africa has made steady progress in reducing malaria morbidity and mortality over the past decades. Malaria cases have decreased by 73%: from 64622 cases in the year 2000 compared to 17625 cases in 2018; malaria deaths have decreased 74%, from 459 to 116 deaths between 2000 and 2018.
Most of the locally transmitted cases occur in Limpopo province - mainly in the Vhembe and Mopani districts, with the lowest-burden province being KwaZulu-Natal.
The challenges South Africa faces in sustaining its control programme and eliminating the disease are varied.
On the technical front, movements of people into South Africa from neighbouring countries and from non-endemic to endemic parts poses a threat to local transmission. In addition, malaria teams are often baffled by transmission in areas where all the mosquito vector suppression strategies are in place. This begs the question: From where are these cases arising?
Dr Yogan Pillay gives the keynote address during the launch of the Tshwane Insulin Project at University of Pretoria’s Prinshof campus. Bongani Shilubane/ African News Agency (ANA) Human behaviour in the prevention and treatment of malaria is also cause for concern. This stems mainly from the issue of prevention of mosquito breeding, mosquito avoidance and presenting themselves at clinics when the disease’s signs and symptoms manifest.
With regards to ensuring adequate resourcing for malaria interventions, provinces are often above budget for rendering effective services. This is no fault of their own, as outbreaks and epidemics occur from time to time at localised levels, requiring additional resources to be mobilised.
South Africa, justifiably, relies strongly on mosquito vector control to address the preventive aspects of the programme, however adequate coverage of this intervention is often threatened due to older technologies.
Coverage of screening and treatment components of the programme is often hindered by population movements into the country, and undocumented migrants who don’t seek treatment early.
The key issues to tackling malaria effectively will be source reduction. In this regard, South Africa is undertaking screening and treatment in hot-spot municipalities and localities. More-over, there is strong collaboration with Mozambique and Eswatini to control malaria at the source.
The National Treasury has made additional resources available to bolster provincial efforts to tackle malaria in South Africa. This is in line with “Zero Malaria Starts With Me”, a continent-wide campaign which seeks to mobilise resources and recognise global efforts to control malaria.
This campaign is co-led by the AU Commission and the RBM Partnership to End Malaria, and supported by African leaders to get more people involved in the fight against the disease that kills over 400000 Africans every year.
Implementation research is ongoing to determine sources of local transmission and innovative approaches to malaria mosquito control.
Coupled with this, transmission- blocking drugs are being rolled out to prevent onward transmission from people to mosquitoes.
Dr Pillay is the deputy Director-General for Communicable and Non-Communicable Diseases, Prevention, Treatment and Rehabilitation at the National Health Department.