What will move malaria control to elimination in South Africa?

BackgroundIn South Africa malaria is endemic in Mpumalanga, Limpopo and the north–eastern areas of KwaZulu-Natal provinces. South Africa has set targets to eliminate malaria by 2018 and research into complementary vector control tools such as the Sterile Insect Technique (SIT) is ongoing. It is important to understand community perceptions regarding malaria transmission and control interventions to enable development of community awareness campaign messages appropriate to the needs of the community. We aimed to assess knowledge, attitudes, and practices regarding malaria transmission to inform a public awareness campaign for SIT in Jozini Local Municipality, Mamfene in KwaZulu-Natal province.MethodsWe conducted a cross-sectional survey in three communities in Mamfene, KwaZulu-Natal during 2015. A structured field piloted questionnaire was administered to 400 randomly selected heads of households. Descriptive statistics were used to summarize data.ResultsOf the 400 participants interviewed, 99% had heard about malaria and correctly associated it with mosquito bites. The sources of malaria information were the local health facility (53%), radio (16%) and community meetings (7%). Approximately 63% of the participants were able to identify three or four symptoms of malaria. The majority (76%) were confident that indoor residual spraying (IRS) kills mosquitoes and prevents infection. Bed nets were used by 2% of the participants. SIT knowledge was poor (9%), however 63% of the participants were supportive of mosquito releases for research purposes. The remaining 37% raised concerns and fears, including fear of the unknown and lack of information on the SIT.ConclusionAppropriate knowledge, positive attitude and acceptable treatment-seeking behaviour for malaria were demonstrated by members of the community. Community involvement will be crucial in achieving success of the SIT and future studies should further investigate concerns raised by the community. The existing communication channels used by the malaria control program can be used; however additional channels should be investigated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4583-2) contains supplementary material, which is available to authorized users.

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“…funestus was implicated in the past [4]. The Malaria Control Programme (MCP) in SA focuses on vector control and case management [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

“…Insecticides that are currently used for IRS in SA include dicloro-diphenyl-trichloroethane (DDT) and the pyrethroid deltamethrin [4, 7]. South Africa is currently targeting elimination of malaria [1, 5]. However, additional strategies are needed to strengthen the current IRS based vector control intervention to achieve elimination.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes and practices on malaria transmission in Mamfene, KwaZulu-Natal Province, South Africa 2015

et al. 2017

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“…Total programmatic costs of malaria elimination ranged from $10,472 in Iran per 500 population (or $20.95 per capita) [55] to $27 million per year in South Africa [64] (or $ 0.52 per capita) (Additional file 1: Table S1). The median annual cost per capita for malaria elimination across all studies was $3.00 (range $0.10–$20.95) In Iran the assumptions for each type of intervention included were not uniform.…”

Section: Resultsmentioning

confidence: 99%

The economics of malaria control and elimination: a systematic review

Shretta

Avanceña

Hatefi

2016

Malar J

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BackgroundDeclining donor funding and competing health priorities threaten the sustainability of malaria programmes. Elucidating the cost and benefits of continued investments in malaria could encourage sustained political and financial commitments. The evidence, although available, remains disparate. This paper reviews the existing literature on the economic and financial cost and return of malaria control, elimination and eradication.MethodsA review of articles that were published on or before September 2014 on the cost and benefits of malaria control and elimination was performed. Studies were classified based on their scope and were analysed according to two major categories: cost of malaria control and elimination to a health system, and cost-benefit studies. Only studies involving more than two control or elimination interventions were included. Outcomes of interest were total programmatic cost, cost per capita, and benefit-cost ratios (BCRs). All costs were converted to 2013 US$ for standardization.ResultsOf the 6425 articles identified, 54 studies were included in this review. Twenty-two were focused on elimination or eradication while 32 focused on intensive control. Forty-eight per cent of studies included in this review were published on or after 2000. Overall, the annual per capita cost of malaria control to a health system ranged from $0.11 to $39.06 (median: $2.21) while that for malaria elimination ranged from $0.18 to $27 (median: $3.00). BCRs of investing in malaria control and elimination ranged from 2.4 to over 145.ConclusionOverall, investments needed for malaria control and elimination varied greatly amongst the various countries and contexts. In most cases, the cost of elimination was greater than the cost of control. At the same time, the benefits of investing in malaria greatly outweighed the costs. While the cost of elimination in most cases was greater than the cost of control, the benefits greatly outweighed the cost. Information from this review provides guidance to national malaria programmes on the cost and benefits of malaria elimination in the absence of data. Importantly, the review highlights the need for more robust economic analyses using standard inputs and methods to strengthen the evidence needed for sustained financing for malaria elimination.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1635-5) contains supplementary material, which is available to authorized users.

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“…merus may be partially responsible for ongoing malaria transmission, which threatens South Africa's elimination programme. 16 Although this species has never been directly implicated in malaria transmission within South Africa, it has been implicated in neighbouring southern Mozambique. 3 A strength of this study is that it extended over a long period-9 years-allowing the gathering of sufficient entomological data to map the spread of An.…”

Section: Discussionmentioning

confidence: 99%

“…This is thought to be a possible contributory factor to the persistence of malaria cases still reported in the district. 16 Sporozoite infectivity rates and blood feeding index are markers used to incriminate Anopheles populations in malaria transmission. In Tanzania, An.…”

mentioning

confidence: 99%