SOUTH AFRICA: Winning the war against malaria, so far

[ This report does not necessarily reflect the views of the United Nations]

JOZINI, 7 Feb 2006 (IRIN) - Jonathon Gumede knows the symptoms of malaria well: headaches, persistent shivering, a high temperature and sore joints are the initial warning signs of infection, and if not treated quickly, a person can die within a matter of days.

Gumede, a malaria programme district manager in the eastern province of KwaZulu-Natal (KZN), has been fighting the spread of the disease in South Africa for 25 years.

Although preventable and treatable, the World Health Organisation (WHO) estimates that up to 124 million people in Africa live in areas at risk of seasonal epidemic malaria, caused by a parasite and carried from one person to another by female mosquitoes seeking nutrition to hatch their eggs.

The disease has actually made such a come back over the past few years and "kills more than one million people — most of them young children living in Africa — each year", according to WHO.

While the majority of African countries do not have the financial resources or infrastructure to tackle the spread of the disease, the one place on the continent to have made significant inroads in the fight against malaria is in KZN, where they have had recent spectacular results.

Department of Health figures show that since the turn of the century, the province has seen the number of malaria infections fall from nearly 45,000 in 2000, to less than a 1,500 in 2005, and the number of deaths has fallen from 350 to 15 for the same period.

The key elements of the strategy were the introduction of a new drug, artemether-lumefantrine (AL), and an intensification of mosquito control efforts including the reintroduction of the insecticide DDT – discontinued in the 1990s due to environmental and health concerns - for spraying traditional homesteads.

"In Jozini [where KZN's provincial dept of health is based] between 1998 and 2000 all the clinics were full; in all the corners of the court yards you would find people lying down, sick and unable to move because of malaria," recalled Gumede.

The strategic planning needed to effectively control the spread of the disease revolves around awareness of annual climatic conditions, and the movement of migrants from neighbouring Mozambique, which also has a serious malaria problem.

Each bush homestead is sprayed once a year, at the start of the rainy season before Christmas, and after the first rains. Mosquito breeding sites are also hunted down for the collection of larvae in order to find out what type of mosquito is prevalent.

Spraying each homestead enables the malaria programme to protect local communities during the breeding season, as well as allowing them to isolate and treat infected Mozambicans visiting relatives or friends in KZN over the festive period.

"When we go to a homestead the occupants are asked if any one has arrived from Mozambique recently. If they have we take a blood sample to check them for infection. If they are infected, we put them on the drug treatment programme," said Gumede.

"This is to protect our own people really, as if some one has been infected with malaria they can easily pass it on to others if they get bitten by a mosquito," he noted.

according to Gumede, who adds each insecticide sprayer needs to visit 20 homesteads each day so the process can be finished over a four to six week period.

While the recent results are indeed impressive they cannot solely be put down to the introduction of the drug AL and the re-introduction of the insecticide DDT.

Equally important, maintains Gumede, are the community perceptions that malaria diagnosis and treatment should be sought urgently if one becomes infected, and the availability of a strong primary health care service.

"We have media campaigns and information days regularly so the people don't get complacent believe they are safe from the disease," he noted.

However, despite the success, Keith Hargraves at KZN's department of health believes the current level of control over the disease is by no means guaranteed in the long term.

A mosquito known as Funestus, the main culprit in the 1950s, was eradicated by spraying the insects' breeding areas with DDT, the use of which was discontinued in the 1990s for environmental reasons.

However, a different type of mosquito, the Arabiensis, which was widespread in Mozambique, turned out to be resistant to DDT's replacement insecticide, deltamethrin, and proceeded to re-colonise KZN causing an epidemic in the 1990s with a 15-fold increase in malaria cases.

Hargraves maintains the constant shift in the type of dominant mosquitoes year to year makes it extremely difficult to put together an all-encompassing malaria programme.

The problem is compounded by the fact that mosquito types are so similar in appearance they can only be told apart through the use of DNA sampling or by observing behavioural patterns that are exclusive to a particular type of mosquito.

Hargraves also warned that mosquitoes are becoming increasingly immune to the insecticides and drugs being released on the market, even before they are in general use.

"One of the big problems we face here is the rise in cotton farming. Cotton requires lots of insecticides and the stuff gets into the ground water, and because mosquitoes breed near water they become increasingly exposed to it and consequently more resistant.

"In trials we are finding that individual species are resistant to insecticides that are not even on the market yet, and since there is no regulation on the type of insecticides used by farmers the situation looks set to continue," he said.

[ENDS]