Despite praising the Department of Health for effectively managing malaria, the South African Health Review today warned that there had been a dramatic rise since 1996.

Authors of the chapter on malaria said that 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 SA Health Review, produced annually by the Health Systems Trust, aims to provide a combination of detailed information on health status and health care coupled with in-depth analysis of policies and practices affecting the provision of health services in the country.

Analysis of the malaria trends in the country shows an increase since the mid-1980s, rising dramatically since 1996, with district and sub-district analysis clearly indicating a geographical spread to previous lower risk areas.

“However, there is no reason to believe that malaria cannot again be controlled effectively by use of appropriate insecticides and effective drugs, and sustained in the longer term through a regional approach to control,” the authors, including experts from the Medical Research Council and health department, stated.

The Review revealed that the 1999/2000 malaria season had seen close to 40 000 cases, concentrated mainly in a small number of districts of the three north-eastern provinces and along the Mozambique border.

Malaria reaches into South Africa only at its very fringe, affecting the three north-eastern provinces of KwaZulu-Natal, Mpumalanga and the Northern Province.

Due to the local climate, malaria transmission follows a distinctly seasonal pattern, resulting in periodic epidemics. Peak rates in malaria outpatients at health facilities usually occur in April and decline by June.

“While it is difficult to pinpoint the exact cause for the spread of malaria over the last 15 years, there is no doubt that drug resistance and lately the re-emergence of An. Funfests are largely to blame,” according to the Health Review.

Experts said that more detailed analysis was required to dissect the contribution of other likely and possible factors such as irrigation schemes, increased cross-border travel between South Africa and Mozambique, the spread of HIV, the change from DDT to synthetic pyrethroids and reduced spraying coverage.

Authors stated that the Department of Health’€™s policy was in line with the recommendations made by the World Health Organisation in their Global Malaria Control Strategy and the Implementation of the Global Malaria Control Strategy.

Within the overall policy, the Health Sector Strategic Framework (HSSF) targets activities to ensure the efficient and nationwide control of malaria through establishing and maintaining an effective control programme.

The objectives of the current HSSF are to:

• Decrease the incidence of indigenous malaria by 50% in the next five years;
• Improve the malaria information system
• Test alternative methods of vector control to strengthen the control programme;
• Establish sentinel sites to monitor drug resistance patterns and trends;
• Clarify risk perception in malaria areas to encourage tourism;
• Encourage community involvement in vector control programmes;
• Assist with the implementation of the Spatial Developmental Initiatives;
• Develop forecasting mechanisms to identify potential epidemics;
• Develop a regional approach to control.

The implementation of the HSSF is closely monitored by the Malaria Advisory Group, a core group of experts from the national and provincial governments and from research institutes and academia.