Cross-border initiatives and projects towards malaria elimination in Southern Africa

Malaria is a very complex, widespread and particularly lethal human infectious disease. The disease is both preventable and treatable, but control, management and elimination of the disease is impeded by its complexity and other challenges. The epidemiology of malaria is greatly affected by rapid environmental and social changes. These changes affect both parasite transmission and vector ecology but also the vulnerability of human populations.

Malaria does not respect national borders. Significant advances have been made in reducing the overall burden of malaria in Southern Africa, but cross-border transmission of the disease is still common and it is unlikely that any single country will be able to achieve malaria elimination on its own. In an effort to achieve elimination in the area, eight malaria endemic Southern African countries – including South Africa – have banded together under the auspices of the Elimination 8 or E8 Initiative, to coordinate the implementation of malaria control and elimination strategies.

South Africa is largely in the pre-elimination phase towards malaria and has achieved major successes in reducing malaria incidence over the past decades; however, frustrating challenges keep moving the elimination goal posts further. In South Africa, it is estimated that approximately 10% (5.1 million) of South Africa’s population live in higher malaria risk areas. Local malaria transmission occurs mainly in the low altitude regions of the Limpopo, Mpumalanga, and KwaZulu-Natal provinces, especially in areas bordering Zimbabwe and Mozambique. As South Africa shares borders with countries that have high malaria transmission burdens, the potential exists for importation of drug resistant parasites and/or insecticide resistant mosquitoes that can cause focal outbreaks. At one point, imported malaria cases in South Africa constituted around 63% of the total cases reported with some provinces (e.g. Mpumalanga) having more than 80% importation rates.

The University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) is one of the leaders in Malaria research in Southern Africa and endeavours to contribute towards eliminating malaria through high quality, trans-disciplinary research, new innovation and education. The diverse group of researchers collaborating within the Institute includes all aspects of malaria, with research clusters focussing on human health, parasite control and vector control, as well as a strong focus on the education of communities affected by malaria. Much of the research currently being done by UP ISMC researchers focusses on combatting malaria in E8 countries. The Institute also has a number of cross-border research initiatives and projects in place.

One of these initiatives is a collaboration agreement with Goodbye Malaria. Neighbouring Mozambique is one of the poorest developing nations and has one of the highest malaria case-loads in the world, with continuous cross-border spill-over of infection from that country into South Africa.

LTR: Mr Robert Brozin (GBM), Prof Tiaan de Jager (UP ISMC) and Mr Sherwin Charles (GBM)

The idea behind Goodbye Malaria is that African creativity can lead to stopping the disease in Africa. The organisation raises funds in an assortment of ways, which go directly to support its indoor residual spraying (IRS) programme in Southern Mozambique. The organisation also seeks to inspire people to join the fight against malaria by educating them that elimination is ultimately possible. The UP ISMC was awarded a Centre of Excellence in Mozambique for Goodbye Malaria. A Memorandum of Understanding (MoU) was signed between the University of Pretoria as represented by Prof Tiaan de Jager (Director of the UP ISMC) and Goodbye Malaria as represented by Mr Sherwin Charles (CEO and co-founder of Goodbye Malaria) on 20 April 2016. The University of Pretoria is the academic partner in this collaboration. The aim is to do research that focuses on the elimination of malaria in southern Mozambique and South Africa in order to guide Goodbye Malaria and the National Malaria Control Programme in Mozambique in their malaria control endeavours.

Prof de Jager is very excited about the opportunities for post-graduate students the collaboration between the UP ISMC and Goodbye Malaria will create. The research done by the UP ISMC will contribute towards eliminating the disease in southern Mozambique, assist in the prevention of cross-border malaria transmission thereby aiding the drive towards malaria elimination in South Africa, and establish a sustainable programme for other African countries with similar cross-border challenges. Other partners that will contribute to this collaboration includes the Manhiça Health Research Centre (Centro de Investigação em Saúde de Manhiça – CISM), the University of Eduardo Mondlane in Maputo, and the National malaria control programme in Mozambique.

Another cross-border initiative of the UP ISMC is the Remote Sensing for Malaria Control in Africa (ReSMaCA) programme. The programme, established in mid-2014, is a collaboration with French partners, the Centre National d’Études Spatiales (French National Space Agency – CNES) liaised through the French Embassy in Pretoria, the South African Weather Service (SAWS), and various national, regional and international tertiary and research institutions. Zimbabwe neighbours South Africa on its northern border and has its own challenges coping with a gradient of malaria transmission, ranging from high incidence along its eastern border with Mozambique but decreasing to moderate transmission in the south along its border with South Africa. The Vhembe District Municipality of Limpopo Province borders Zimbabwe and Mozambique and has the highest number of malaria cases and deaths in South Africa. Case numbers have drastically increased since 2016, with the highest numbers reported in the Limpopo River Valley (LRV), where the most vulnerable populations are located, bordering Zimbabwe’s Matebeleland South.

ReSMaCA team in the Vhembe District, Limpopo Province.

There is no understanding of the spatiotemporal dynamics of residual malaria transmission and the geographical contributing factors including environment, meteorology, social factors and climate change in the LRV region. The UP ISMC researchers and collaborators from SAWS and the Aix-Marseille University in France are conducting a study in the LRV to collect baseline data to contribute to the larger ReSMaCA programme. The researchers hypothesise that a largely unknown subset of malaria epidemiological aspects exists in southern Africa, which needs an understanding of the multiple factors contributing to residual malaria, including cross-border movement and also climate change, amongst others. Data will be collected using remote sensing (satellite technology) and corroborated with visual (on-surface) observations. The study will identify the most useful indicators that could assist in warning about potential malaria outbreaks in the area. Ultimately this early ‘warning system’ could be implemented in any cross-border situation in southern Africa.

According to Prof de Jager, the collaboration with South Africa’s neighbouring- and the other E8 countries is not only necessary for the elimination of malaria, it is also strategically aligned with the University of Pretoria’s Africa initiative.

Story by: Dr Taneshka Kruger