Preventing re-introduction of malaria into Northern Cape

By Rehana Dada

Malaria is not considered to be endemic to Northern Cape, but the province is identified as a region that could become suitable for malaria vectors as a result of climate change and other environmental factors.  The Molopo and Orange River areas and the far northern parts of the province are considered to be especially important in this respect.

A small number of malaria cases are reported in the province each year: in 2011, 66 cases were reported and in 2012, 33. Danie Stander, the Northern Cape Department of Health’s Deputy Director for Environmental Health, says that most cases seem to be linked to travel.

Stander says: “We had a malaria case in 2001 in Welkom, a small village near the Kgalagadi Transfrontier Park, and the patient had no history of traveling to any malaria endemic areas. We also positively identified an Anopheles mosquito in that area in 2006. There were two cases in the Northern Cape in 2014 where there was no travel history. Unfortunately not all cases were investigated so there is a significant guess factor as to how these cases contracted the disease”.

Where Anopheles mosquitoes were found, they were thought to have travelled in vehicles or luggage rather than having bred in the area. Floods also seem to influence malaria prevalence, says Stander: “I heard rumours from “old people” that during the big floods of 1988 there were at least seven cases of malaria near Askham”.

Stander explains that the impacts of climate change on health in the province include:

  • Water shortages – drinking, bathing, hand washing, food preparation, etc.;
  • Heat stroke and heat related morbidity and mortality;
  • Skin cancer;
  • Spread of disease vectors such as flies, ticks (Congo fever), mosquitoes (malaria, Rift Valley fever);
  • Disease vectors becoming more active throughout the year – winter temperatures are higher, hence insects may survive longer or hibernate less in future;
  • Indirectly – for example uncertainty about what health impacts the solar energy farms may have on nearby communities.

Although there is no scientific indication yet that malaria distribution has increased in the province as a result of climate change, Stander believed that it is important to be proactive: “This is exactly why we have a malaria plan and why we have at least two vector surveillance campaigns every year – to be on top of things”.

Malaria control and surveillance began in Northern Cape in the early 20th century in the lower Orange River area. Anopheles gambiae was then commonly seen, but with control later progressing to intensive DDT spraying programmes, there was a marked reduction in its population.  As part of control, technicians conducted knock downs, checked for larvae, collected mosquito samples, and took blood samples and smears.

Spraying was reduced as Anopheles numbers declined and later done only if the species was found.  DDT was replaced with other pesticides.  Anopheles gambiae was eradicated in what was then the Lower Orange River region, and the spraying programme was stopped in 1996. Currently, surveillance is done on an ad hoc basis during the wet summer months when there is higher risk of malaria.

In terms of the South African Malaria Elimination Strategy, the province should be looking at preventing re-introduction.  Surveillance should be conducted at least twice a year along the Molopo and Orange rivers, and in the northern parts of the John Taolo Gaetsewe and ZF Mgcawu districts.  This includes larvae surveillance and the erection of night nets and/or knockdowns.  In addition, communities in these areas are provided with information on elimination of mosquito breeding places and conditions, as well as on the symptoms of malaria.  Medication to treat malaria and malaria prophylactics is available

With regards to advocacy, the malaria plan is distributed to health district offices, government departments, district and local municipalities and other organisations. This plan serves as a source of information and as a guide to Environmental Health Practitioners.  It is also a planning tool for the ZF Mgcawu and John Taolo Gaetsewe Health Districts. The plan will also be the reference framework for the development and distribution of malaria related information material to other stakeholders.

With regards to ongoing surveillance and monitoring, the Northern Cape Department of Health is exploring a partnership with nature reserves, where game rangers can assist with the work. The idea is that game rangers will receive training in monitoring and surveillance, and collect vector samples for analysis by the Department of Health.

Stander says that the malaria prevention programme faces a number of challenges.  Firstly, because there is a low risk of malaria in the province, it is not regarded as a priority and he says: “Funding will obviously, and understandably go to more pressing needs”.  Secondly, malaria control is preventative and the focus of the health system is traditionally still on curative health care.  Thirdly, it is difficult to convince authorities that prevention of re-introduction is visionary and relevant.

However, he says with reference to climate change: “Change is inevitable. I would rather have 20 campaigns spread over 10 years, without finding a single malaria vector, than sitting arms folded and not knowing what is happening out there. It is better to be prepared than to lose a single person because we were complacent”.

Dates to remember:

  • 25 April: World Malaria Day
  • 09 November: SADC Malaria