No easing off in SA’s malaria war
MOST South Africans aren’t worried about malaria even though the disease is endemic in the country. Four of the country’s nine provinces carry malaria risk while 10% of the population is at risk of contracting malaria.
The lack of concern can be attributed to the fact that the country has a relatively low burden of the disease. In 2020, South Africa had 8 126 cases and 38 deaths. This is low when compared to the estimated 10 007 802 cases and 23 766 deaths in Mozambique during the same period.
The low number of cases means that South Africa is a candidate for malaria elimination. To reach this goal the country would need to record no new infections for three years. This goal has recently been achieved by China and El Salvador in 2021, and Argentina and Algeria in 2019.
The region in South Africa most likely to achieve this status is KwaZulu-Natal where the incidence rate is very low. But there are threats to achieving the goal.
Insecticide resistance is a growing threat to malaria control efforts globally. In South Africa, indoor residual spraying is the cornerstone of the malaria elimination efforts. Our research was done as part of ongoing malaria surveillance in the country. Malaria surveillance is essential for provincial control and elimination programmes.
These surveillance activities include collecting mosquitoes, identifying them and testing their sensitivity to insecticides. The aim is to provide important information on vector mosquito populations in affected areas, such as their feeding, breeding and resting behaviours and their susceptibilities to insecticide.
We collected Anopheles specimens from Mamfene, Jozini, northern KwaZulu-Natal between November 2019 and April 2021. We conducted standard insecticide susceptibility tests. These showed resistance to DDT, permethrin, deltamethrin, and bendiocarb, as well as full susceptibility to pirimiphos-methyl. These are classes of insecticides that are approved for indoor residual spraying.
It is essential that control is maintained and strengthened by adopting suitable strategies to prevent the development of insecticide resistance.
South Africa is aware of the problem, which is why it has adopted malaria control programmes that use at least two different insecticides in a mosaic spraying pattern.
This approach has proved highly successful. This is like using a multi-drug approach to combat resistance in bacteria and viruses. It will slow down the development of insecticide resistance.
South Africa’s low number of cases mean that the country is a candidate for malaria elimination. But this is not the time for complacency. The spike in malaria cases in South Africa in 2017 shows how quickly the progress can be undone. |