For the second time in a decade, South Africa will miss its goal of eliminating malaria
In recent years, South Africa has made significant progress in its efforts to eradicate malaria. The World Health Organization (WHO) identifies it as one of the countries that has the potential to eliminate the disease in the near future.
In 2021, the WHO also congratulated South Africa on overcoming the grim trend. It was one of the few malaria-endemic countries in Africa that did not show a significant increase in malaria cases caused by COVID-related disorders.
But not everything is good news. For the second time in a decade, South Africa will miss its goal of eliminating malaria. The country is committed to ending malaria by 2018, but this has not happened. In 2019, the government set a goal to end malaria by 2023. Despite a number of new interventions that have reduced the burden of malaria in the country, South Africa has failed to stop the transmission of malaria within its borders.
The number of malaria cases in the country has also started to rise after travel restrictions were lifted in early 2022. This comes after much lower malaria cases in 2020 and 2021 – as a result of reduced cross-border traffic due to regulations COVID, as well as proactive, innovative actions from malaria control programs in some South African provinces.
It is crucial that the malaria control program in South Africa be regrouped and refocused. This will allow the country to return its efforts to eradicate malaria.
Complicated situation
There are many and complex reasons why South Africa misses its goal of elimination. COVID is one of them and has played a key role in restoring malaria control efforts in the country.
Prior to the pandemic, South Africa was on the verge of declaring some malaria-endemic areas malaria-free. This is one of the main goals of the current elimination strategy. Resources were then diverted to deal with COVID; travel and traffic restrictions were introduced and staff absences increased.
The situation is further complicated by people with fever or flu-like symptoms who delay visits to health facilities. People were afraid of contracting COVID or worried that they had COVID and could pass it on to others.
Ozair Patel / WHO
The provision of basic elimination interventions, especially those related to vector control and monitoring, has also been severely compromised in the last two years.
The testing and treatment activities of mobile malaria surveillance units have been particularly difficult. These units have played a key role in reducing malaria in border communities and in the highly mobile migrant population. It is crucial that these units become fully operational as soon as possible.
So what can South Africa do to repair the damage done to COVID’s malaria control efforts?
Room for improvements
Some work is already underway. The National Malaria Control Program is expanding access to basic services during the current malaria season. This initiative will continue until South Africa is declared free of malaria. Certified environmentalists in the field of malaria will conduct tests in the community using rapid diagnostic tests. They will also be able to treat all individuals with uncomplicated malaria with artemisinin-based combination therapies (ACT).
This is a good plan. But for it to work, it is important that effective rapid diagnostic tests and ACT are available. Reports of African parasites that may escape detection through these tests or survive ACT treatment are becoming more common.
South Africa was one of the first African countries to set up a program for routine evaluation of drug and diagnostic efficacy. Unfortunately, the program is not used enough by provincial malaria control programs. Samples from the South African province most affected by malaria, Limpopo, are rarely evaluated by this program.
If South Africa is serious about its elimination goals and wants to prevent an outbreak of malaria resistant to drugs and insecticides, as happened during the 1999/2000 malaria season, the effectiveness of rapid tests, ACT and insecticides used to vector control should be evaluated regularly.
The country has a long history of using insecticide-based indoor spraying to successfully control malaria. But in recent years, she has struggled to adequately protect communities using this intervention. This is due to delays in the purchase or delivery of insecticides and spray pumps. People are also increasingly refusing to be exposed to residual indoor spraying because they believe malaria is no longer a problem in South Africa.
More to do
Urgent processes and procedures need to be put in place to improve deliveries and deliveries. Community awareness campaigns that illustrate the benefits of residual indoor spraying are also crucial. They need to be developed and provided as a matter of urgency to improve the perception of this critical intervention. If these problems are not addressed, vector populations will recover – and are likely to increase malaria.
Improved real-time case reporting is also needed. This allows health authorities to respond promptly to any confirmed case to prevent any possibility of further transmission. Connectivity challenges in many endemic regions and overcrowded staff with many competing diseases and reports are just two of the reasons for the backlog. This problem needs to be addressed by improving connectivity in malaria endemic areas in rural areas and deploying dedicated staff to report malaria and other notifiable conditions.
South Africa is approaching the elimination of malaria. But the country needs to do more. Work as usual is no longer enough – eliminating malaria requires additional efforts from all stakeholders. Sustainable funding must be available to support the effective implementation of eradication interventions, and all malaria workers are ready to do more if South Africa is to eradicate malaria.
Jaishree Raman, Chief Medical Scientist and Head of the Laboratory for Monitoring Antimalarial Resistance and Operative Malaria Research, National Institute of Infectious Diseases
This article was republished by The Conversation under a Creative Commons license. Read the original article.
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