Malaria elimination in the Southern African Development Community (SADC) region by 2030 is possible, according to Dr Taneshka Kruger, project manager and coordinator for the University of Pretoria Institute for Sustainable Malaria Control (UP ISMC).
“This can be achieved by strengthening collaboration across borders, leveraging leadership and management skills, implementing novel and innovative strategies along with existing control measures, constantly raising awareness, and encouraging community participation,” she said.
Dr Kruger made these comments in light of SADC Malaria Day, which is commemorated annually on 6 November to create awareness about the disease and mobilise the community to participate in malaria control programmes.
On this day in 1899, French physician Dr Alphonse Laveran identified the malaria parasite Plasmodium as the causal agent of the disease. “This microscopic organism that is transmitted to humans through the bite of an infected female Anopheles mosquito is one of the most cunning and adaptable killers, and has been keeping the malaria research and control community on their toes for decades,” Dr Kruger said.
The SADC also commemorates the fight against malaria on 6 November annually because the date coincides with the period of increased malaria transmission in the southern hemisphere.
According to the World Health Organisation (WHO), malaria claimed more than 627 000 lives across the globe in 2021, with more than 260 000 of those being African children under the age of five. In the SADC region, malaria distribution is extremely heterogeneous, varying from highly endemic (in Angola, the Democratic Republic of Congo, Malawi, Mozambique and Tanzania) to stable all year round. The WHO estimates that three-quarters of the population in the region is at risk of contracting malaria, including about 35 million children under five and 8.5 million pregnant women.
Collaboration across borders
Malaria elimination in any southern African country requires regional collaboration and cooperation. In 2009, the SADC region renewed its malaria control efforts by establishing the Elimination 8 (E8) initiative: a coalition of eight countries – Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia and Zimbabwe – working together to limit the spread of the disease. Despite a decline in malaria transmission across the E8 countries, transmission dynamics remain extremely interconnected; this enables the constant movement of malaria parasites across borders, in most cases, from high- to low-burden countries.
“This interconnectedness highlights gaps and challenges, but also identifies opportunities for more effective malaria control across the region,” Dr Kruger says. “As transmission patterns extend across national borders, so should these countries extend their surveillance, intervention and advocacy activities beyond their borders.”
On 18 August 2018 in Windhoek, Namibia, southern African countries stepped up their commitments to eliminate malaria by 2030. Sixteen heads of state signed the Windhoek Declaration on Eliminating Malaria in the SADC Region, which saw the endorsement of key actions to put the region back on track to achieve malaria elimination targets. Leadership training was listed as a key action.
Capacity in malaria management and leadership
The malaria landscape is changing constantly and rapidly. “Gaps in existing control strategies require new approaches, and highlight the need for continuous innovative, transdisciplinary research and collaboration to develop alternative interventions against the disease,” said Professor Tiaan de Jager, Director of the UP ISMC. “A major gap is the lack in human resources and leadership capacity.”
Sub-optimal leadership and management skills within SADC national malaria control programmes (NMCPs) have been identified as problematic in the region. Leadership training in NMCPs is a priority in the E8’s Acceleration Plan for Malaria Elimination. To address the lack in capacity, the UP ISMC and stakeholders are offering leadership development and management training to the NMCPs of the E8 countries. The course provides leaders and managers with core leadership skills, effective management techniques and decision-making tools to be innovative and more able to adapt to rapidly changing situations. The participation of women is strongly encouraged, allowing for the potential transition of women within these NMCPs into more senior positions. The pilot project is funded by the Bill & Melinda Gates Foundation, and more financial support is being sourced so that the project can be continued beyond a second year.
Individual contributions towards malaria elimination
“One of the best tools in the fight against malaria is awareness creation,” Dr Kruger said. “Commemoration days act as reminders for people to take note. Each person, regardless if they are living in an endemic or non-endemic area, can make a difference in the fight against the disease. People need to be empowered with knowledge about malaria for them to take responsibility for their own health. Travellers need to be aware that they may enter a malaria-endemic area and ensure that they protect themselves from contracting the disease. At the same time, endemic communities need to be aware of malaria research taking place and/or control interventions being implemented in their area to understand their purpose and benefits.”
Malaria is preventable and treatable, but precautions must be taken to prevent contracting the disease and prompt treatment must be sought as soon as symptoms are noticed. The UP ISMC coordinates and promotes collaborative research on innovative, safer and sustainable malaria control and elimination tools and strategies, allowing for transdisciplinary approaches and translational applications towards malaria elimination.