SAHR 2007 - Health Systems Trust

Malaria
Malaria control has been regarded as a success story over
the past few years. The national Department of Health’s
2005/06 Annual Report contained the following statements:
➤ “South Africa experienced an upsurge in malaria cases
and deaths in the 1990s. This was reversed in 2000
after controlled spraying of homes with DDT was reintroduced
with permission from the relevant international
environmental body. The results were dramatic – every
year saw a further fall in the number of cases recorded.
South Africa worked successfully with Mozambique,
Swaziland and Zimbabwe to achieve progress on both
sides of its borders.”
➤ “Deaths decreased from 458 in 1999 to 55 in 2005.”
These figures do not exactly match those extracted from
the Notifiable Disease Reporting System (Table 16) as more
data were probably received after finalisation of the annual
report. However it is more difficult to explain why the figures
vary so considerably from those extracted from the StatsSA
Causes of death 2005 database using the appropriate
ICD-10 codes (B50-B54) for underlying cause of death. As
before, these are reported without any adjustment for underreporting
of death registration. The NDoH Annual Report
thus mentioned 55 deaths due to malaria in 2005, whereas
the Notifiable Disease database showed 64 deaths (from
only KZN, LP and MP). A total of 644 deaths were however
reported with the underlying cause being noted as malaria,
and these occurred in all 9 provinces. The majority (79%)
were from the 3 affected provinces. It seems unlikely, therefore,
that the un-notified deaths all occurred in private sector
facilities, or reflected malaria contracted by travellers to
other countries. The most likely explanation is that there is
extensive under-reporting of notifiable diseases, probably
affecting both the public and the private sectors. The trends
reported in the NDoH may well hold true, if the degree of
under-reporting has remained constant over time, but the
extent of the health gains attributable to the use of DDT and
artemesinin combination products may be overstated.
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“The number of malaria cases has dropped from a
peak of 64 000 in 1999 to 7 250 in 2005.”
The success of preventive measures is due to:
✧ The extensive coverage of the spraying programme
which reached 83% of targeted households in
2004.
✧ Low rainfall in the malaria endemic areas during
2005.
✧ Stronger collaboration with neighbouring countries.”
“All provinces are now using a combination of two
drugs to treat malaria. This is to reduce the risk of
malaria strains becoming resistant to the drugs – a
development that has plagued malaria treatment in
the past. Dual therapy leads to quicker recovery and
fewer deaths.”
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