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Progress & Impact Series PROGRESS & IMPACT SERIES Country Reports Number 8 • October 2013 Focus on South Africa PROGRESS & IMPACT SERIES Country Reports Number 8 • October 2013 Focus on South Africa WHOLibraryCataloguing-in-PublicationData Focus on South Africa. (Progress&impactseries–countryreportsn.8) 1.Malaria-preventionandcontrol.2.Malaria-therapy.3.Malaria-economics.4.Financing,Health.5.SouthAfrica.I.Global Partnership to Roll Back Malaria. II.Series. ISBN9789241506144 (NLMclassiþcation:WC765) ©2013WorldHealthOrganizationonbehalfoftheRollBackMalariaPartnershipSecretariat Allrightsreserved.PublicationsoftheWorldHealthOrganizationareavailableontheWHOwebsite(www.who.int)orcanbe purchasedfromWHOPress,WorldHealthOrganization,20AýenueAppia,1211Geneýa27,Switzerland(tel.:+41227913264; fax:+41227914857;e-mail:[email protected]). RequestsforpermissiontoreproduceortranslateWHOpublications–whetherforsaleorfornon-commercialdistribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoeveronthepartoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaor of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlinesforwhichtheremaynotyetbefullagreement. The mention of speciþc companies or of certain manufacturers’ products does not imply that they are endorsed or recommendedbytheWorldHealthOrganizationinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsand omissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters. AllreasonableprecautionshavebeentakenbytheWorldHealthOrganizationtoverifytheinformationcontainedinthis publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshalltheWorldHealth Organization be liable for damages arising from its use. PROGRESS & IMPACT SERIES Photo credits |Frontcoýerandpp.6,8,16,19,27,28,29,30,33,34,37,39,44,47,49,53,58,65,66,69,70:©NationalDepartment ofHealth,SouthAfrica|p.4:©LaurentBergeron|p.10:©PeterMorey|pp.13,21,22:©TheGlobalFund/JonxPillemer| p.51:©TheGlobalFund/JudaNgwenya Enquiries | Roll Back Malaria Partnership Secretariat | Hosted by the World Health Organization | Avenue Appia 20 | 1211Geneýa27|Switzerland|Tel.:+41227915869|Fax:+41227911587|E-mail:[email protected] Designed by messaggio | Printed in France FOCUS ON SOUTH AFRICA 2 CONTENTS CONTENTS Abbreviations............................................................................................................................................................. 5 Acknowledgements.................................................................................................................................................. 7 Foreword .................................................................................................................................................................... 9 Executive summary................................................................................................................................................. 11 Box 1: The extent of malaria in South Africa................................................................................................ 14 I. History of malaria in South Africa: the early years........................................................................................ 17 II. Malaria control progress since 2000............................................................................................................... 23 a. Malaria control period........................................................................................................................ 24 b. Scaling up control ............................................................................................................................... 24 c. Strengthening the programme towards elimination ..................................................................... 25 Box 2: Interviews with key players in malaria control in the country .............................................................. 28 III. Gearing up a national malaria control programme for elimination .......................................................... 31 a. Management and planning................................................................................................................ 31 Box 3: Cross-border partnerships................................................................................................................ 34 b. Securing appropriate funding ........................................................................................................... 40 c. Intervention strategies ....................................................................................................................... 44 Box 4: Malaria health promotion from control to elimination......................................................................... 53 d. Impact and cases averted ................................................................................................................. 55 Box 5: Malaria surveillance and response: the crux of a strong elimination programme .................................. 59 PROGRESS & IMPACT SERIES IV. Paving the way towards malaria elimination ............................................................................................... 67 V. Conclusion........................................................................................................................................................... 71 Annex: List of National Malaria Control Programme Partners ....................................................................... 72 FOCUS ON SOUTH AFRICA 3 |CONTENTS | Tableofþgures 1.Malariaincidencebyprovince,SouthAfrica,January–December2012..........................15 2.Breakdownofallreportedmalariacases(a)andlocalcases(b)perdistrictinthethreemalaria-endemicprovinces, SouthAfrica,April2012–March2013........................................15 3.MapofSouthAfricawithformerdivisions(pre-1994) .................................17 4.MalariadistributionmapforSouthAfricain1938...................................18 5.Annualnumberofmalariacasesandassociateddeaths,SouthAfrica,1971–2012 .....................20 6.IRSspraycoverageinKwaZulu-Natal,LimpopoandMpumalanga,2005–2012.......................25 7.Malariaincidenceinendemicprovincesduringthemalariatransmissionseasonsof1999/2000and2010/2011 .........26 8.SouthAfrica’sprogressonthemalariacontinuum...................................27 9.GoalandobjectivesofSouthAfrica’s2012–2018malariaeliminationstrategy .......................32 10.LSDIinterventiondistrictsandoutcomes ......................................35 11.IncidenceofmalariainTLMIinterventiondistricts,2009–2012 .............................37 12.IncidenceofmalariainMOZIZAinterventionareas,2009 ...............................39 13.Domesticandexternalfundingformalariacontrolandelimination,SouthAfrica,2007–2012 .................41 14.Malariaeliminationcostsbyprovince,SouthAfrica,2012–2018.............................42 15.Malariaeliminationfundinggapsbyintervention,SouthAfrica,2012–2018 ........................43 16.NumberofstructuressprayedwithIRSandoperationalcoverageinthethreemalaria-endemicprovinces, South Africa, 2000–2012.............................................46 17.Diagnostictoolsusedforconÿrmingmalariacases,SouthAfrica,2011 ..........................48 18.NumberofACTtreatmentcoursesdeliveredtothepublicandprivatesectors,SouthAfrica,2008–2012 ............50 19.ProjectednumberofmalariacasesavertedannuallythroughIRS,casemanagementandregionalcontrol, PROGRESS & IMPACT SERIES South Africa, 2003–2012.............................................57 20.Activecaseinvestigationanddetectionatfacilitylevel ................................60 21.Activecaseinvestigationanddetectionatcommunitylevel...............................60 22.InvestigatedcasesofmalariaamongallprovincesofSouthAfrica,2011and2012 .....................63 23.Proportionoflocal,unclassiÿedandimportedcases,malaria-endemicprovinces,2011–2012.................64 FOCUS ON SOUTH AFRICA 4 ABBREVIATIONS ACD Active case detection ACT Artemisinin-based combination therapy AL Artemether-lumefantrine DDT Dichlorodiphenyltrichloroethane DHS District health system GIS Geographic information system IEC Information, education and communication IRS Indoor residual spraying IVM Integrated vector management KAP Knowledge, attitudes and practices KZN KwaZulu-Natal LSDI Lubombo Spatial Development Initiative MRC Medical Research Council (Durban, South Africa) NDOH National Department of Health NHLS National Health Laboratory Service NMCP National Malaria Control Programme PCR Polymerase chain reaction PHC Primary health care RBM Roll Back Malaria RDT Rapid diagnostic test SADC Southern African Development Community SAMEC South African Malaria Elimination Committee PROGRESS & IMPACT SERIES SP Sulfadoxine-pyrimethamine TLMI Trans-Limpopo Malaria Initiative WHO World Health Organization FOCUS ON SOUTH AFRICA 5 South African Malaria Elimination Committee 2012 and partners/advisors (photo from 2013) PROGRESS & IMPACT SERIES FOCUS ON SOUTH AFRICA 6 ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS This report was prepared under the auspices of the Roll Back Malaria (RBM) Partnership
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