World Cup: South Africa 10 Malaria 0

Jasson Urbach | 25 Jun 2023
Health Policy Unit Soccer World Cup fans and other visitors to South Africa can relax.

Although many perceive Africa as a place of wars and deadly diseases, thanks to great malaria control, South Africa has shown that this disease is preventable and to a very large extent, is being stopped at the borders.
Malaria affects approximately 40 percent of the world's population in over 100 countries. Every year, of the 2.5 billion people at risk, between 300 and 500 million become severely sick and over 1 million people die. Africa is the worst affected continent where one childhood death out of every five is due to the effects of this disease. The long-term effects of malaria on a child's health and development are often insufficiently recognised and poorly managed. According to a report by the Centre for Global Development, "A severe form of the disease, cerebral malaria, kills 10-20 percent of those children it affects, while an additional 7 percent are left with permanent neurological problems, including blindness, epilepsy, and speech and learning difficulties."

The WHO estimates that in the SADC region alone, malaria accounts for 30 percent of outpatient attendance and 40 percent of healthcare facility admissions and that approximately 300,000 deaths are as a result of malaria every year. Of the approximately 75 percent of the population they consider at risk, around 35 million children under the age of five years and 8.5 million pregnant women are especially vulnerable to the ravages of the disease.

However, tourists can take comfort in the knowledge that South Africa is a world leader in malaria control - thanks to good scientists and researchers that base malaria control policies on sound scientific evidence. South Africa's relative wealth allows the government to pay for the best interventions for our circumstances without interference from donor agencies. In fact, South Africa is one of four southern African countries committed to eliminating all local transmission of malaria. The other countries are Botswana, Namibia and Swaziland.

The malaria parasite exists only in humans and mosquitoes. It does not respect political borders and with the movement of people, it can easily be transported by the human host from one country to another. Therefore, one of the key strategies for preventing the reintroduction of malaria into previously malaria transmission free areas is to initiate cross border malaria control strategies.

The Lubombo Spatial Development Initiative (LSDI), a cross border malaria control programme, is arguably the world's best cross border initiative of its kind. It is a tri-lateral agreement between the governments of Mozambique, South Africa and Swaziland, and has substantial input from South Africa's Medical Research Council (MRC). Since its inception in 1998, this programme has reduced the incidence of malaria on the border between South Africa and Swaziland from over 25 percent to less than 2 percent. In Maputo province the parasite prevalence was over 60 percent in 1999, and presently, is well below 5 percent.

It is hoped that the successes of the LSDI programme can be emulated by establishing cross border initiatives between Angola, Botswana, Namibia, Zambia and Zimbabwe in a regional initiative known as the Trans Zambezi Cross Border Initiative. It is envisioned that the cornerstones of the Trans Zambezi programme, like the highly successful LSDI programme, will be the use of effective insecticides and anti-malarial treatments. Without the use of insecticides, it will be impossible to break the transmission cycle and reduce malaria related morbidity and mortality in the region.

One of the most successful pesticides used to eliminate malaria from much of the developed world is DDT. In South Africa, DDT was introduced in 1946, and, where it was applied, annual cases of malaria fell from 1,177 (1945-46) to just 61 by 1951. In 1996, South Africa stopped using DDT and introduced an alternative insecticide. Shortly afterwards, a massive malaria outbreak occurred and, from 1996 to 2000, malaria deaths increased eight-fold throughout the country. The number of malaria cases increased at a similar rate from 5,000 per annum to more than 60,000. In 2000, they reintroduced DDT and the number of malaria cases and deaths dropped by a remarkable 80 percent.

DDT remains an integral part of many malaria control programmes on the African continent. Presently, the insecticide is used by South Africa, Namibia, Swaziland, Zambia, Zimbabwe, Mozambique, Uganda, Ethiopia and Eritrea - they use it because it works. Tanzania, Madagascar and Malawi are seriously considering introducing DDT, and Botswana, Cameroon and Senegal are thinking about re-introducing it due to the need to manage resistance to other insecticides.

There can be no disputing the extraordinary impact that DDT has made, and continues to make in disease control programmes in South Africa and around the world. Communities have grown and prospered thanks to the remarkable degree to which DDT saves lives - contrary to the expectations of critics who argue that it is harmful to humans. Broadly speaking, no meaningful data on deaths or diseases as a consequence of coming into contact with DDT support the concerns that it may be harmful to human health. Instead, they are further contradicted by evidence gathered over many decades of reduced disease and rising populations wherever the insecticide has been used.

South Africa's leadership in malaria control continues to be a beacon of light that other African countries strive to emulate. The Department of Health should be applauded for all of its work in malaria control, making South Africa a truly awesome place for tourists to visit.

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