According to the National Institutes of Communicable Diseases’ (NICD’s) Outbreak Response and Surveillance unit’s Professor Lucille Blumberg, studies have shown that in malaria-prone areas people living with HIV are disproportionately susceptible to malaria.
‘We have overlapping epidemics of HIV and malaria. A number of studies have been done to show what the interactions are. Adults who are HIV-infected have much more parasitemias and are much more likely to be symptomatic with malaria infections versus those who are HIV-negative. There’s an increased prevalence of severe malaria in HIV-positive adults in South Africa’¦ higher rates of renal failure, and it may be due to treatment-seeking behaviour, where they present quite late. We review all the malaria deaths in the country and HIV-infected (people) appear disproportionately in the number of deaths’, says Professor Blumberg.
Blumberg says the reason for this is that people don’t usually realise that they have malaria.
‘That was due to delays in treatment, people were going to traditional healers’¦ not recognising that this was a malaria-related illness, putting it down to HIV, resulting in a lot of misdiagnosis of malaria in health facilities’.
She advises that if you live in an area with a high prevalence of malaria or have visited one recently, you should seek treatment immediately if you feel unwell with flu-like symptoms. This is irrespective of whether you are HIV-positive or not.
‘The key factors in successful outcome of malaria cases is early and accurate diagnosis and urgent treatment with effective drugs. The signs and symptoms of malaria are non-specific and very often confused with other common diseases, like influenza. The progression from first symptom to complications is very rapid and can develop in less than 48 hours, particularly in children and pregnant women. So, there’s not a lot of time’¦ opportunity to intervene’, she says.
The good news is that since the rollout of the Roll Back Malaria campaign over the last decade significant progress has been made in reducing the number of people getting ill or dying from malaria. However, malaria ‘ a mosquito-borne disease ‘ still remains a major killer internationally.
‘To compare to 2000, by the year 2010 there’s been almost a one-third reduction in the number of deaths from malaria. But the reality remains that in the year 2010, from the latest WHO estimates to date, there are still about 600 000 deaths which occur from malaria annually, making it the single most important pathogen causing death globally’, according to Professor Shabir Madhi, Executive Director of the NICD.
Malaria is endemic in Africa, with 90% of the deaths that occur as a result of malaria occurring on the continent. In South Africa, malaria cases have also come down. But the proximity of the three provinces where malaria occurs to neighbouring countries with less successful programmes to combat malaria makes it difficult to contain.
‘In the past 10 years, in response to the Roll Back Malaria programme, there has been considerable gain in the morbidity and mortality of malaria cases from over 60 000 cases – about 62 000 cases – in the year 1999/2000 malaria season to less than 10 000 cases. The most gain was by KwaZulu-Natal province’.
‘The highest incidence of malaria is in the provinces that neighbour Mozambique and Zimbabwe. We have local transmission in KwaZulu-Natal, Limpopo and Mpumalanga only. But we continue to get imported malaria cases, such that last year 64% of all the cases were imported. And when we are talking about importation of malaria, the neighbouring country from which we get the largest percentage ‘ up to 90% in Mpumalanga, is Mozambique’, says Dr Eunice Misiani, the Deputy Director of the Malaria Control Programme in the national Health Department.
Although certain parts of the country such as portions of KwaZulu-Natal, Mpumalanga and Limpopo are malaria hotspots, especially during rainy seasons, astonishingly high levels of malaria infection have been seen in Gauteng.
‘Where we are seeing malaria, however, is in returning travelers. And Gauteng, although it’s not a transmission area, is a hub for these returning travelers. We did a study in 2005/2006 looking at laboratory notifications and we were alarmed to find in just half the year 4 500 cases. And this is more than they are seeing in the malaria transmission areas’, explains the NICD’s Professor Blumberg.