Malaria Research Unit

Research highlights

Drug resistance in Plasmodium falciparum
The development of drug resistance continues to have a major impact on malaria treatment. A number of mutations in the dihydrofolate reductase and dihydropteroate synthase systems of Plasmodium falciparum have been shown to have an association with resistance to sulphadoxine-pyrimethamine.

Monitoring the frequencies of these mutations in the local population of parasites by means of a Polymerase Chain Reaction (PCR) assay allows predictions to be made on the spread of drug resistance.

On a national front, the first community-based in vivo anti-malarial drug efficacy trials were carried out in collaboration with provincial authorities in all three malarious provinces of South Africa, with a high level of chloroquine resistance being detected in 1996.

Drug policy in Mpumalanga was consequently changed to Sulphadoxine/pyrimethamine as first line treatment in malaria, the policy in KwaZulu-Natal Province having been changed a number of years previously.

The drug policy in KwaZulu-Natal was again revised in 2000 due to high levels of Sulphadoxine/pyrimethamine resistance following a community based in vivo study carried out as part of the South East African Combination Anti-Malarial Therapy study.

MARA (Mapping Malaria Risk in Africa)
The fundamental objective of MARA/ARMA is to establish an atlas of the spatial epidemiology of malaria in Africa. This will provide support for the planning and implementation of research into malaria in any given region, as well as for control, since the distribution and transmission intensity of malaria in Africa are far from homogenous.

At the Pan African level the MARA/ARMA project, with five regional and two sub centres in Africa, has proven to be a highly successful collaboration with increasing African networking. This has been an excellent project regarding capacity development, with a number of specialised GIS courses having been run in Durban and four PhDs currently being in progress.

Several benchmark publications have been produced and the first technical report completed. The success of the project, geared to describing malaria distribution in Africa, has been such that the Roll Back Malaria initiative of the WHO has commissioned the project to produce malaria distribution maps (A0) for all countries in Africa.

MARA/ARMA website: http://www.mara.org.za

Malaria control in the Lubombo Spatial Development Area (LSDI)
The Lubombo Spatial Development Initiative (LSDI) is a programme by the governments of Mozambique, Swaziland and South Africa to develop the Lubombo region into a globally competitive economic zone. The geographic area targeted by this initiative is broadly defined as eastern Swaziland, southern Mozambique and north-eastern KwaZulu Natal and is linked by the Lubombo mountains. It also aims to create sustainable employment and equity in access to economic opportunity in the region.

In July 1999 President Mbeki, President Chissano and His Majesty, King Mswati III signed the General Protocol which puts in place a platform for regional cooperation and delivery. In October of 1999 the Lubombo Malaria Protocol and tri-national malaria programme was launched. In December of 1999 the World Heritage Convention Act was promulgated and the Greater St Lucia Wetlands Park inscribed on the World Heritage Convention list. In June 2000 the three countries signed the Lubombo Transfrontier Conservation and Resource Area Protocols (TFCA).

Although the malaria control project addresses a number of aspects central to increasing the effectiveness of malaria control in the two highest risk malaria provinces in South Africa and those in Swaziland, the primary emphasis was to extend malaria control to southern Mozambique. There is increasing consensus that even if malaria control measures are optimal in South Africa and Swaziland (i.e. effective drugs and insecticides in place), disease incidence can only be further reduced by a regional approach to control.

There is increasing evidence that malaria control is a positive precursor to development and the situation prior to malaria control in South Africa supports this view, given the well documented negative effects of malaria on tourism and agricultural development in the 1930's. The malaria programme is targeted at creating a platform for development and the beneficiaries are communities in some of the areas with the lowest socio-economic development in the region, tourism, business and governments.

The project is managed by the Regional Malaria Control Commission (RMCC), comprised of malaria control programme managers, public health specialists and scientists from the three countries.

Lubombo Spatial Development Initiative: http://www.lubombomapping.org.za