Saturday, October 1, 2022

Malaria eradication: South Africa needs to regroup and refocus to get there

For the second time in a decade, South Africa is set to miss its malaria-elimination target

In recent years, South Africa has made significant progress in its effort to eliminate malaria. The World Health Organization (WHO) has listed it as one of the countries that has the potential to eliminate the disease in the near future.

In 2021, the WHO also commended South Africa for bucking the dire trend. It was one of the few malaria-endemic countries in Africa that did not see any major jump in malaria cases due to the disruptions related to COVID.

But it’s not all good news. For the second time in a decade, South Africa is set to miss its malaria eradication target. The country had pledged to eliminate malaria by 2018, but it did not happen. In 2019, the government set a target of eliminating malaria by 2023. Despite implementing several new interventions that have reduced the country’s malaria burden, South Africa failed to stop the transmission of malaria within its borders.

The country’s number of malaria cases has also started to rise since the travel ban was lifted in early 2022. It comes after very few malaria cases during 2020 and 2021 – a result of a reduction in cross-border movements due to COVID regulations as well as proactive, innovative actions. Malaria control programs in some South African provinces.

It is important that South Africa’s malaria control program is realigned and refocused. With this, the country will be able to get back on track its efforts to eradicate malaria.

a complicated situation

There are many more complex reasons why South Africa missed its elimination target. COVID is one of them and has played a vital role in setting back the country’s malaria control efforts.

Before the pandemic, South Africa was on track to declare some malaria-endemic districts as malaria-free. This is one of the major goals of the current elimination strategy. Then resources were diverted to deal with COVID; Travel and movement were banned and staff absenteeism increased.

The situation was further complicated by delays in visits to health facilities by people with fever or flu-like symptoms. People feared being infected with COVID or were concerned that they had COVID and could pass it on to others.

Malaria eradication: South Africa needs to regroup and refocus to get there
Ozair Patel / WHO

The delivery of essential eradication interventions, particularly those involving vector control and surveillance, has also been severely compromised over the past two years.

The testing and treatment activities of the Mobile Malaria Border Surveillance Units were particularly hampered. These units have played a major role in reducing malaria in border communities and highly mobile migratory populations. It is important for these units to be fully operational again as soon as possible.

So, what can South Africa do to repair the damage caused by COVID to malaria control efforts?

room for improvement

Some work is already going on. The National Malaria Control Program is expanding access to essential services during this current malaria season. This initiative will last until South Africa is declared malaria-free. Certified malaria environmental health practitioners will conduct community testing using rapid diagnostic tests. They would be able to treat any person with uncomplicated malaria with artemisinin-based combination therapy (ACT).

This is a good plan. But for this to work it is essential that effective rapid diagnostic tests and ACTs are available. There are frequent reports of African parasites being able to avoid detection by these tests or survive ACT treatment.

South Africa was one of the first African countries to establish a program to regularly assess drug and clinical efficacy. Unfortunately this program is underutilized by provincial malaria control programs. Samples from the South African province of Limpopo most affected by malaria are rarely evaluated by this program.

If South Africa is serious about its eradication goals and wants to prevent the drug-resistant and pesticide-resistant malaria outbreaks experienced during the 1999/2000 malaria season, rapid tests used for vector control, The effectiveness of ACTs and insecticides should be regularly assessed. ,

The country has a long history of using insecticide based indoor residual spraying to successfully control malaria. But in recent years it has struggled to adequately protect communities using this intervention. This is due to delays in procurement or distribution of insecticides and spray pumps. People are also denying their homes exposure to indoor residual spraying because they think malaria is no longer a problem in South Africa.

to do more

Processes and procedures should be put in place immediately to improve procurement and delivery. Community awareness campaigns showing the benefits of indoor residual spraying are also important. To improve this critical intervention, these should be developed and delivered as needed. Failing to address these issues will result in a rebound in vector populations – and most likely an increase in malaria cases.

Better real-time case reporting is also imperative. This allows health officials to respond quickly to every confirmed case to prevent any possibility of further transmission. Connectivity challenges in many endemic areas and overburdened with multiple competing diseases and reports are two reasons for employee reporting gaps. This issue must be addressed by improving connectivity in rural malaria endemic areas and with dedicated staff for reporting malaria and other notable conditions.

South Africa is getting closer to eliminating malaria. But the country needs to do more. Working as usual is no longer enough – malaria eradication requires extra effort from all stakeholders. There must be sustainable funding to support the effective implementation of eradication interventions, with all cadres of the Malaria Task Force willing to go above and beyond if South Africa is to achieve malaria eradication.Conversation

Jayashree Raman, Principal Medical Scientist and Head of the Laboratory for Antimalarial Surveillance and Malaria Operational Research, National Institute of Communicable Diseases

This article is republished from Conversation Under Creative Commons license. read original article,

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