The prevalence and distribution of malaria in Mpumalanga Province before and during COVID-19 (2017 - 2022)
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i8.1736Keywords:
Coartem, Primaquine, Elimination, Pandemic, Imported, P. falciparumAbstract
Background. South Africa (SA) has committed to eliminating malaria by 2028. However, the initial target was set for 2023. Additionally, the ongoing COVID-19 pandemic and the emergence of drug and insecticide resistance have been identified as potential stumbling blocks in the achievement of this goal. The impact of COVID-19 on the prevalence and distribution of malaria in SA is unclear.
Objective. To describe the trends and distribution of malaria before and during the pandemic and its associated lockdown strategies in one of the country’s malaria-endemic provinces, Mpumalanga Province.
Method. A descriptive, retrospective and cross-sectional study was conducted using Mpumalanga provincial malaria case data extracted from the provincial District Health Information System 2. The impact of COVID-19 on the prevalence and distribution of malaria was assessed in Mpumalanga Province between 2017 and 2022 using descriptive trend analysis. Malaria cases before (2017 - 2019) and post- COVID-19 (2020 - 2022) were cross-tabulated using Stata version 17. We used χ2 tests to test for significant differences, set at p<0.05.
Results. During the study period, 25 380 malaria cases were reported, with the majority men (61%) >26 years old, with reported international travel, primarily to Mozambique. Limpopo Province (93%) accounted for most of the locally imported cases. Headaches and fever were the most common symptoms before and post COVID-19, while asymptomatic malaria carriage was higher during and post COVID (p<0.05). Prior to the pandemic reporting of the preferred treatment for uncomplicated malaria, Coartem use was at 53%, declining to 21% thereafter. Although COVID-19-related restrictions on human movement greatly reduced the malaria burden in Mpumalanga Province, the high-risk group (young mobile men) remained unchanged over the study period. Of concern were the marked reduction in the reporting of Coartem doses administered and the increased prevalence of asymptomatic carriage since 2020. The importation of malaria poses one of the biggest challenges to malaria elimination in Mpumalanga Province.
Conclusion. This study highlighted the impact of COVID-19 and its related lockdown restrictions on the delivery of malaria health services in Mpumalanga Province. If malaria elimination is to be achieved, all aspects of the malaria programme must be strengthened urgently. Additionally, the health system and cross-border collaborations must also be strengthened.
References
Plowe CV. Malaria chemoprevention and drug resistance: A review of the literature and policy implications. Malar J 2022;21(1):104. https://doi.org/10.1186/s12936-022-04115-8
World Health Organization. Malaria Fact Sheet: WHO Global Malaria Programme. Geneva: WHO, 2022. 3. Park J, Kang S, Seok D, et al. Barriers against and strategies for malaria control during the COVID-19 pandemic in low- and middle-income countries: A systematic review. Malar J 2023;22(1):41. https://
doi.org/10.1186/s12936-023-04452-2
Ataba E, Dorkenoo AM, Nguepou CT, et al. Potential emergence of plasmodium resistance to artemisinin induced by the use of artemisia annua for malaria and COVID-19 prevention in sub- African region. Acta Parasitol 2022;67(1):55-60. https://doi.org/10.1007/s11686-021-00489-y
World Health Organization. The potential impact of health service disruptions on the burden of malaria – a modelling analysis for countries in sub-Saharan Africa. Geneva: WHO Global Malaria Programme, 2020.
World Health Organization. World malaria report 2021. Geneva: World Health Organization; 2021. 7. World Health Organization. Third round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic: November - December 2021: Interim report. Geneva:
WHO, 7 February 2022.
World Health Organization. World malaria report 2021. Geneva: WHO, Geneva, 2021.
Chen Y, Shiu T, Tseng L, et al. Dynamic changes in genetic diversity, drug resistance mutations, and
treatment outcomes of falciparum malaria from the low-transmission to the pre-elimination phase on the islands of São Tomé and Príncipe. Malar J 2021;20(1):467. https://doi.org/10.1186/s12936-021- 04007-3
Runtuwene L, Tuda J, Mongan A, et al. Nanopore sequencing of drug resistance-associated genes in malaria parasites, Plasmodium falciparum. Sci Rep 2018;8(1):8286. https://doi.org/10.1038/s41598- 018-26334-3
WHO Global Technical Strategy for Malaria 2016 - 2030. Geneva: WHO Global Malaria Programme, 2015.
WHO Global Malaria Programme. Report on antimalarial drug efficacy, resistance and response: 10 years of surveillance (2010 - 2019). Geneva: WHO Global Malaria Programme, 2020.
Heuschen AK, Abdul-Mumin A, Adokiya M, et al. Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: A retrospective analysis of routine surveillance data. Malar J 2022;21(1):149. https://doi.org/10.1186/s12936-022-04154-1
National Department of Health, South Africa. Update on COVID-19 14 December 2022. Pretoria: NDoH, 2022. https://sacoronavirus.co.za/2022/12/15/update-on-covid-19-14-december-2022/ (accessed 25 October 2023).
Pillay Y, Pienaar S, Barron P, Zondi T. Impact of COVID-19 on routine primary healthcare services in South Africa. S Afr Med J 2021;111(8):714-719. https://doi.org/10.7196/SAMJ.2021.v111i8.15786
Dorward J, Khubone T, Gate K, et al. The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: An interrupted time series analysis. Lancet HIV 2021;8(3):E158-E165. https://doi.org/10.1016/S2352-3018(20)30359-3
Mutyambizi C, Dunlop J, Maluleke C, et al. Effect of COVID-19 on HIV, tuberculosis, and prevention of mother-to-child transmission of HIV indicators in Mopani district, South Africa. S Afr Med J 2021;111(12):1181-1189. https://doi.org/10.7196/SAMJ.2021.v111i12.15822
Menard D, Dondorp A. Antimalarial drug resistance: A threat to malaria elimination. Cold Spring Harb Perspect Med 2017;7(7):a025619. https://doi.org/10.1101/cshperspect.a025619
Rocamora F, Winzeler EA. Genomic approaches to drug resistance in malaria. Annu Rev Microbiol 2020;74:761-786. https://doi.org/10.1146/annurev-micro-012220-064343
National Department of Health, South Africa. Malaria elimination strategic plan for South Africa 2019 - 2023. Pretoria: NDoH, 2019.
Raman J, Morris N, Frean J, et al. Reviewing South Africa‘s malaria elimination strategy (2012-2018): Progress, challenges and priorities. Malar J 2016;15(1):438. https://doi.org/10.1186/s12936-016- 1497-x.
Dahan-Moss Y, Munhenga G, Kaiser M, et al. Malaria vector surveillance report, South Africa, January - December 2021. Public Health Surveillance Bulletin 2021;20(2):100-120.
Raman J, Kagoro FM, Mabuza A, et al. Absence of kelch13 artemisinin resistance markers but strong selection for lumefantrine-tolerance molecular markers following 18 years of artemisinin-based combination therapy use in Mpumalanga Province, South Africa (2001 - 2018). Malar J 2019;18(1):280. https://doi.org/10.1186/s12936-019-2911-y
Brooke B, Koekemoer L, Kruger P, et al. Malaria vector control in South Africa. S Afr Med J 2013;103(10 Pt 2):784-788. https://doi.org/10.7196/samj.7447
National Department of Health, South Africa. Guidelines for the treatment of malaria in South Africa: 2018. Technical report. Pretoria: NDoH, 2018.
Statistics South Africa. South African census 2011. Technical report. Pretoria: Stats SA, 2012.
Zawawi A, Alghanmi M, Alsaady I, et al. The impact of COVID-19 pandemic on malaria elimination.
Parasite Epidemiol Control 2020;11:e00187. https://doi.org/10.1016/j.parepi.2020.e00187
Aborode AT, David KB, Uwishema O, et al. Fighting COVID-19 at the expense of malaria in Africa: The consequences and policy options. Am J Trop Med Hyg 2021;104(1):26-29. https://doi.org/10.4269/
ajtmh.20-1181
Namuganga JF, Nankabirwa JI, Maiteki-Ssebuguzi C, et al. East Africa International Center of Excellence for Malaria Research: Impact on malaria policy in Uganda. Am J Trop Med Hyg 2022;107 (4_Suppl):33-39. https://doi.org/10.4269/ajtmh.21-1305
Habibzadeh F. Malaria and the incidence of COVID-19 in Africa: An ecological study. BMC Infect Dis 2023;23(1):66. https://doi.org/10.1186/s12879-023-08032-2
Alemu K, Worku A, Berhane Y, Kumie A. Men traveling away from home are more likely to bring malaria into high altitude villages, Northwest Ethiopia. PLoS ONE 2014;9(4):e95341. https://doi. org/10.1371/journal.pone.0095341
Tesfahunegn A, Berhe G, Gebregziabher E. Risk factors associated with malaria outbreak in Laelay Adyabo district northern Ethiopia, 2017: Case-control study design. BMC Public Health 2019;19(1):484. https://doi.org/10.1186/s12889-019-6798-x.
Maharaj R, Morris N, Seocharan I, et al. The feasibility of malaria elimination in South Africa. Malar J 2012;11:423. https://doi.org/10.1186/1475-2875-11-423
DePina AJ, Dia AK, de Ascenção Soares Martins A, et al. Knowledge, attitudes and practices about malaria in Cabo Verde: A country in the pre-elimination context. BMC Public Health 2019;19(1):850. https://doi.org/10.1186/s12889-019-7130-5
O’Brien D, Tobin S, Brown GV, Torresi J. Fever in returned travelers: Review of hospital admissions for a 3-year period. Clin Infect Dis 2001;33(5):603-609. https://doi.org/10.1086/322602
National Institute for Communicable Diseases. Notifiable medical conditions (NMC) case definitions flipchart: Malaria. Pretoria: NICD, 2021. https://www.nicd.ac.za/wp-content/uploads/2021/08/ Malaria-case-definition.pdf (accessed 10 January 2024).
National Department of Health, South Africa. National guidelines for the treatment of malaria, South Africa 2019. Pretoria: NDoH, 2019.
National Institute for Communicable Diseases. Guidelines for case-finding, diagnosis, management and public health response. Pretoria: NICD, 2020. https://www.nicd.ac.za/diseases-a-z-index/disease- index-covid-19/covid-19-guidelines/guidelines-for-case-finding-diagnosis-management-and-public- health-response/#:~:text=Currently%20a%20suspected%20COVID%2D19,contact%20of%20a%20co- nfirmed%20case (accessed 10 January 2024).
National Department of Health, South Africa. COVID-19 testing guidelines. Pretoria: NDoH, 2022. Covid-19-updated-testing-guidelines-PROF-NDJEKA.pdf (sacoronavirus.co.za) (accessed 10 January 2024).
Chanda-Kapata P, Kapata N, Zumla A. COVID-19 and malaria: A symptom screening challenge for malaria endemic countries. Int J Infect Dis 2020;94:151-153. https://doi.org/10.1016/j.ijid.2020.04.007 41. Feldman M, Vernaeve L, Tibenderana J, et al. Navigating the COVID-19 crisis to sustain community- based malaria interventions in Cambodia. Glob Health Sci Pract 2021;9(2):344-354. https://doi.
org/10.9745/GHSP-D-20-00528
Chanda-Kapata P, Ntoumi F, Kapata N, et al. Tuberculosis, HIV/AIDS and malaria health services in sub-Saharan Africa – a situation analysis of the disruptions and impact of the COVID-19 pandemic. Int J Infect Dis 2022;124(Suppl 1):S41-S46. https://doi.org/10.1016/j.ijid.2022.03.033
Raman J, Barnes KI, Baker L, et al. Maintaining focus on administering effective malaria treatment during the COVID-9 pandemic. S Afr Med J 2020;111(1):13-16. https://doi.org/10.7196/SAMJ.2020. v111i11.15289
Bell D, Schultz Hansen K. Relative burdens of the COVID-19, malaria, tuberculosis, and HIV/ AIDS epidemics in sub-Saharan Africa. Am J Trop Med Hyg 2021;105(6):1510-1515. https://doi. org/10.4269/ajtmh.21-0899
Gao L, Shi Q, Liu Z, Li Z, Dong X. Impact of the COVID-19 pandemic on malaria control in Africa: A preliminary analysis. Trop Med Infect Dis 2023;8(1):67. doi:10.3390/tropicalmed8010067
Monroe A, Williams NA, Ogoma S, Karema C, Okumu F. Reflections on the 2021 World Malaria Report and the future of malaria control. Malar J 2022;21(1):154. https://doi.org/10.1186/s12936-022- 04178-7
World Health Organization. World malaria report 2023. Geneva: WHO, 2023.
Dzianach PA, Rumisha SF, Lubinda J, et al. Evaluating COVID-19-related disruptions to effective malaria case management in 2020 - 2021 and its potential effects on malaria burden in sub-Saharan
Africa. Trop Med Infect Dis 2023;8(4):216. https://doi.org/10.3390/tropicalmed8040216
Rogerson SJ, Beeson JG, Laman M, et al, ACREME investigators. Identifying and combating the impacts of COVID-19 on malaria. BMC Med 2020;18(1):239. https://doi.org/10.1186/s12916-020-
-x
Hancock PA, Hendriks CJM, Tangena JA, et al. Mapping trends in insecticide resistance phenotypes in African malaria vectors. PLoS Biol 2020;18(6):e3000633. https://doi.org/10.1371/journal.pbio.3000633 51. Brooke BD, Raman J, Frean J, et al. Implementing malaria control in South Africa, Eswatini and southern Mozambique during the COVID-19 pandemic. S Afr Med J 2020;110(11):1072-1076.
doi:10.7196/SAMJ.2020.v110i11.15286
Hakizimana D, Ntizimira C, Mbituyumuremyi A, et al. The impact of COVID-19 on malaria services
in three high endemic districts in Rwanda: A mixed-method study. Malar J 2022;21(1):48. https://doi. org/10.1186/s12936-022-04071-3
Downloads
Published
License
Copyright (c) 2024 I Kleinhans, S Mahanjana, F Els, M Mabona, L A Pitso, G Malatje, G Kok, J Raman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
