THE LUBOMBO SPATIAL DEVELOPMENT INITIATIVE MALARIA CONTROL PROGRAMME

Background:

The Lubombo Spatial Development Initiative (LSDI) is a tri-lateral agreement by the governments of , Swaziland and South Africa to develop the Lubombo region into a globally competitive economic zone The geographic area targeted by this initiative is broadly defined as eastern Swaziland, southern Mozambique and north-eastern KwaZulu-Natal

The Lubombo Spatial Development Initiative is aimed at accelerated development in regards to agriculture and tourism in the area spanning the three countries

LSDI 1 Zones 1,2&3 Main Towns

Limpopo International Boundaries Province Nature Reserves and Parks LSDI (Lubombo Spatial Development Initiative)

ZoneZone 33 AdditionalAdditional AreasAreas WithWith MalariaMalaria ControlControl Provincial Boundaries (SA)

Kruger National M O Z A M B I Q U E Park ZoneZone 22 Nelspruit Province Province ZoneZone 1A1A Maputo City ZoneZone 2A2A

Manzini ZoneZone 11

S W A Z I L A N D Lubombo Mountains Lubombo Mountains S W A Z I L A N D Lubombo Mountains Lubombo Mountains Lubombo Mountains Lubombo Mountains Lubombo Mountains Lubombo Mountains Lubombo Mountains

INSET:INSET:INSET: ADDITIONALADDITIONALADDITIONAL AREASAREASAREAS UNDERUNDERUNDER CONTROLCONTROLCONTROL INININ SOUTHSOUTHSOUTH AFRICAAFRICAAFRICA

LimpopoLimpopoLimpopo M O Z A B I Q U E M O Z A B I Q U E M O Z A B I Q U E M O Z A B I Q U E M O Z A B I Q U E M O Z A B I Q U E Greater St. Lucia M O Z A B I Q U E M O Z A B I Q U E M O Z A B I Q U E

Wetland Park MpumalangaMpumalanga KwaZulu Natal SSS W WW A AA Z ZZ I I I L LL A AA N NN D DD Province SSS W WW A AA Z ZZ I I I L LL A AA N NN D DD

S O U T H A F R I C A KwaZuluKwaZulu NatalNatal

Data Sources: Mozambique Ministry of Health; Swaziland Ministry of Health; Municipal Demarcation Board (SA)

St. Lucia Map produced by the Malaria Research 0 45 90 Lead Programme, Medical Research Council of SA kilometres Malaria risk in 1938

Regional Malaria Reduction

BASELINESOUTH AFRICA 2004 / 2005

Incidence Per 1000 Population 1998/19991998/1999CC vsvs 2004/20052004/2005 MOZAMBIQUE MOZAMBIQUE 18 to 66 6 to 18 3 to 6 1.5 to 3 Zone3Zone3 1 to 1.5 ZoneZone 33 0 to 1

KrugerKruger MOZAMBIQUE KrugerKruger NationalNational NationalNational PlasmodiumPlasmodium falciparumfalciparum ParkPark ParkPark infection in children aged Mpumalanga 2 to < 15 years Mpumalanga ZoneZone 22 ZoneZone 22 Province BASELINE (1999) Province ZoneZone 11 Ave 64 % 1999 ZoneZone 1A1A Ave 86 % 2000 Zone 1A Zone 1A ZoneZone 22 Ave 70 % 2002 Zone 1A ZoneZone 2A2A Ave 73 % 1999 Zone 2A ZoneZone 33 Ave 76 % 2003 Zone 2A JUNE 2005 ZoneZone 11 ZoneZone 11 Ave 4.3 % 2003 ZoneZone 11 ZoneZone 1A1A Ave 21.0 % 2003 SWAZILAND ZoneZone 1A1A SWAZILAND ZoneZone 22 Ave 20.3 % 2003 ZoneZone 2A2A Ave 22.8 % 2003 ZoneZone 33 Ave 32.9 % 2003

SWAZILAND

Malaria Incidence Per 1000 Population: Lubombo District

Indian 1996 130 Indian Ocean 2004/2005 0.47 Ocean

Produced by: Malaria Research Lead KwaZulu-Natal Programme, MRC, Durban, 2004 KwaZulu-Natal KwaZulu-Natal Data Sources: Provincial Malaria Control Province Programmes, Statistics South Africa, Province Swaziland Ministry of Health and Annual LSDI Prevalence Surveys

0 40 80 0 40 80 kilometers kilometers

Population protected 4.7M, Structures sprayed 1.8M, contiguous control area 100,000 km2 Prevalence Reductions in Mozambique

Malaria Prevalence in Mozambique(2-<15 years)

90

80

70

60 Zone 1

50 MOZAL Zone 2 40 Zone 3

Prevalence % 30 Boane

20

10

0 1999 2000 2001 2002 2003 2004 2005

Window trap collection data Zone 1 Mozambique

Average A.funestus group and A.gambiae s l per hut per day Zone 1

3

2.5

2

Spraying Avg A.funestus. 1.5 Avg A.gambiae s.l. 134 community based 1 traps at 34 localities

0.5

0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 12 10 11 12 10 11 12 10 11 12

1999 2000 2001 2002 2003 LSDI Malaria Objectives 1. To reduce malaria incidence in the border areas of South Africa and Swaziland from 250 per 1000 to less than 20 per 1000 - Done 2. To reduce malaria infections from 625 per 1000 to less than 200 per 1000 within three year after the start of IRS in Maputo Province in Zone 1 - Done 3. To provide updated tourist information booklets containing definitive malaria risk maps and prophylaxis guideline - Done 4. To develop a regional malaria control programme - Done 5. To develop a regional GIS based malaria information system - Done 6. To implement effective treatment and definitive diagnosis SA and Zone 1 - Done

LSDI 2 Zones 4,5,6&7

N 0 40 80 Malaria Control kilometers æ PARQUEPARQUE Zones: LSDI 2 NACIONALNACIONAL GONAREZHOUGONAREZHOU Zone 4 GONAREZHOUGONAREZHOU ZINAVEZINAVE MassangenaMassangena Zone 5 NATIONALNATIONAL Zone 6 PARKPARK PARKPARK Zone 7 Zimbabwe Malaria Control Zones: LSDI 1

ChicualacualaChicualacuala Zone 1 Zone 1A PARQUEPARQUE Zone 2 NACIONALNACIONAL ZoneZone 77 NACIONALNACIONAL Zone 2A DEDE BANHINEBANHINE DEDE BANHINEBANHINE Zone 3

LIMPOPOLIMPOPO LIMPOPOLIMPOPO ChiguboChigubo MabalaneMabalane ChiguboChigubo TRANSFRONTIERTRANSFRONTIER Mozambique PARKPARK

South Africa MassingirMassingir ZoneZone 44 GuijaGuija ChibutoChibuto KRUGERKRUGER NATIONALNATIONAL PARKPARK ˜ ZoneZone 66 PARKPARK ZoneZone 33 ZoneZone 66 ChokweChokwe MagudeMagude MagudeMagude ˜ ManjacazeManjacaze ˜ ˜ BileneBilene Xai-XaiXai-Xai ˜˜ BileneBilene ZoneZone 55 ˜ ZoneZone 22 Xai-XaiXai-Xai SedeSede ˜ Xai-XaiXai-Xai SedeSede MoambaMoamba ˜ ˜ ˜ ˜ LSDI 1 Sentinel Sites ZoneZone 1A1A˜ ZoneZone 1A1A MatolaMatola ˜˜˜˜ MatolaMatola ˜ ˜˜ MaputoMaputo ZoneZone˜ 2A2A BoaneBoane ˜ NamaachaNamaacha ˜ ZoneZone ˜ 11 MatutuineMatutuine ˜ Districts and Malaria Control Zones ˜ ˜ GazaGaza andand MaputoMaputo ProvincesProvinces (Southern(Southern Mozambique)Mozambique) Importance of Intercountry Collaboration

• Collaboration ensures shared resources and expertise • Intercountry collaboration promotes local solutions for local problems (NEPAD) • Raise funds at a regional level • Standardise control measures across national boundaries • Enable effective monitoring, evaluation, planning and training