Despite recording about 9 800 cases last year, South Africa is on course to “eliminate” malaria by 2028 as outlined in the National Malaria Elimination Strategic Plan, says the national Health Department.
The 9 795 cases and 106 deaths last year were mostly reported in Limpopo, Mpumalanga and KwaZulu-Natal, reports News24, but department spokesperson Foster Mohale said there was “sub-national elimination of malaria” in the King Cetshwayo District of KZN in 2023.
Professor Rajendra Maharaj, director of the SA Medical Research Council’s Malaria Research Group, said provinces were at differing stages of the “WHO elimination continuum”.
KwaZulu-Natal is in the elimination stage, Mpumalanga in the pre-elimination phase, and Limpopo in the control and pre-elimination phase. KZN and Mpumalanga still have one district to eliminate, while Limpopo still has two, he said.
Dr Jantjie Taljaard, head of the division of infectious diseases at Stellenbosch University, said eliminating a disease did not necessarily mean zero cases would be reported.
Instead, the WHO could put forward a minimum threshold for local cases and reports, which might indicate elimination status. The measurement would not include cases imported from other countries.
Public health expert Professor Alex van den Heever said one of the challenges in eradicating malaria in South Africa was the large number of cases introduced from its neighbours, like Mozambique.
“Whether malaria can be eradicated by 2028 will largely depend on how the government intends to control the spread from neighbouring countries,” he said, adding that eradication was unlikely to be achieved by “killing mosquitoes”, and that alternatives such as vaccination should be considered.
Under five
But Maharaj said South Africa's intervention relied on managing the Anopheles mosquito, and vaccination was not an option.
“Vaccines won’t work in SA since the disease burden is too low, and vaccines usually target children under five.”
He said malaria elimination still faced numerous challenges.
“Disease transmission is still occurring at very low levels. Resistance to the chemicals being used to control mosquitoes has developed in all classes of insecticides. Climate change is also expected to expand the range of environments available for transmission of malaria.”
Mohale said elimination malaria was an ambitious task requiring “sustainable resources, collaboration with neighbouring countries (including Botswana, Eswatini, Mozambique, Namibia and Zimbabwe), evidence-based policies, strong partnerships and a dedicated workforce”.
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