oa South African Health Review - Malaria : chapter 18
Malaria has devastating effects on African communities and economies. South Africa is not exempt, illustrated by the high poverty and unemployment rates in the most affected districts. In the early decades of this century malaria was much more widely distributed and much more severe than it is now. This reduction has been due to intensive control activities that have targeted both the Anopheles vector and the Plasmodium parasite. Unfortunately recent developments, such as resistance of the parasite to drugs, re-emergence of an eradicated vector species and its resistance to insecticide, have resulted in considerable resurgence of malaria. The number of malaria cases started rising in the mid-1980's, when chloroquine resistance was first detected, and has continued to rise exponentially ever since. The 1999/2000 malaria season saw close to 40 000 cases, concentrated mainly in a small number of districts of the three north-eastern provinces and along the Mozambique border. Spatial analysis has confirmed a spread to previously low-risk areas. While the situation is far from that in the early 1930's, the trend is likely to continue unless radical steps are taken to stop the spread of the disease. Efforts to overcome the escalating problem have involved a range of activities. To keep pace with changes in drug efficacy, drug policy has been updated repeatedly. Insecticide usage has been changed recently in an attempt to once more eliminate the dangerous vector An. Funestus. The wider implementation of insecticide treated bed nets is under discussion. A major regional control effort - the Lubombo Spatial Development Initiative - is underway, and better malaria reporting and information systems have been introduced. The national policy, in line with international malaria control strategies, and guided by the National Malaria Advisory Group, addresses specific situations in each province. Future priorities should focus on appropriate control strategies, using effective drugs and insecticides, both within South Africa and, through collaboration, within the SADC region; adequate information flow to drive evidence-based policy decisions, again both nationally and regionally; ongoing monitoring of control operations; ongoing surveillance of drug and insecticide efficacy; and ongoing research into key areas.
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