Malaria is a vicious disease that is Africa’s leading cause of death among children under the age of five. Millions of people in Africa are infected with it and 90% of the world’s reported cases occur on the continent.

One of the reasons for this astronomical statistic is that a large proportion of the continent’s population consists of malaria’s high-risk groups, which include displaced people, labour workers working in endemic areas and people with very low immunity (because of other common diseases in Africa such as TB and HIV/Aids). Shockingly, malaria kills over half a million people each year and most of these deaths occur in Africa. Rural and impoverished parts of the continent are particularly affected by the disease.

Travelling malaria, or cross-border malaria, is a further problem in Africa. The high numbers of people moving across borders, from Mozambique and Zimbabwe to South Africa, for example, facilitates the movement of the parasites and the transmission of the disease.

Malaria is also not as seasonal as it once was. Both the vector (the female Anopheles mosquito) and the malaria parasite favour humid and warm climates, which makes sub-Saharan Africa’s summer month’s ideal. However, malaria cases in South Africa’s winter months are on the increase. The potential impact  that climate change has on malaria therefore cannot be ignored. These cases also show how resilient the parasite is. Malaria has also been found in areas that were previously regarded ‘malaria free’. Further complicating preventative and treatment plans, the malaria parasite is highly adaptable, and in some instances has become resistant to insecticides and prophylaxis (preventative treatment).

World Malaria Day is on 25 April and the World Health Organisation (WHO) has announced this year’s theme to be ‘Ready to beat malaria’. This theme underscores the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria. While most developed countries have eliminated the disease completely, beating malaria in Africa is not a simple task. The cycle of disease and poverty cripples most of the endemic countries, which are among the poorest in the world.

Prof Tiaan de Jager, Dean of the Faculty of Health Sciences and Director of the University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) recognises that there is not just one factor at play when it comes to this very complicated disease, which is why the UP ISMC has taken on a unique, integrated multi- and trans-disciplinary approach to its research, monitoring, treatment, advisory and advocacy roles.

One of the main aims of the UP ISMC is to support the South African government to eliminate malaria in this country, as well as to contribute to neighbouring countries’ efforts of elimination.

There are four species of the parasite Plasmodium that cause human malaria, which differ immunologically, morphologically, and in geographical distribution, relapse pattern and drug response. Because of these complexities, the UP ISMC is focused on conducting collaborative research on safer and sustainable malaria control and management strategies, and on generating new knowledge and supporting new activities pertaining to safe malaria control in Africa through fundamental and applied research, supported by research collaboration with regional, national and international partners.

Two main strategies of the UP ISMC aim at finding ways to better control the vector mosquitoes and the malaria parasite. UP ISMC is one of the first research platforms in the world to look at the outdoor biting behaviour of mosquitoes. It also monitors the movements of mosquitoes to gain greater insight into their distribution patterns. Prof Lyn-Marie Birkholtz holds the SARCHi Chair in Sustainable Malaria Control and is head of the Parasite Control Cluster of the UP ISMC. She and her research team are involved in high-tech, hardcore research, working on transmission-blocking at a genetic and biochemical level.

Prof Birkholtz also leads the Community of Practice (CoP) in Malaria Elimination hosted by the UP ISMC, the first of its kind at the University of Pretoria. Stakeholder meetings and workshops form part of the CoP’s activities and are essential to communicate strategic considerations towards translational outcomes, thereby addressing societal challenges in South Africa. A recent high-stake workshop was attended by 28 scientists and international experts. Prof Birkholtz says, ‘This workshop paved the way to consider antimalarial drugs as overarching tools to affect malaria elimination in Africa and indeed will take the South African malaria elimination agenda forward.’

The UP ISMC collaborates with all nine faculties of UP to develop new approaches that continuously contribute to a sustainable fight against malaria. Together with the Institute for Applied Materials (IAM), for example, great success has been achieved in the development of innovative and more sustainable methods of vector control. One such method is a polyethylene wall lining that is impregnated with insecticidal chemicals. The linings that were installed in homes in the Vhembe District of Limpopo have shown great efficacy for over five years. This form of mosquito control could potentially reduce some of the health risks associated with the spraying of insecticides and simultaneously compliment other vector control strategies. After the success of the pilot project in Limpopo, the UP ISMC hopes to achieve similar results in other parts of Africa by incorporating and testing new insecticides in the linings to overcome vector resistance.

Human health is another dominant focus area and research cluster of the UP ISMC. Epigenetic work on male reproductive health and endocrine disrupting chemicals is being conducted to ensure a better quality of life for rural people in endemic areas. This cluster also focuses on health promotion and malaria education to inform children about the disease.

In collaboration with the Centre national d'études spatiales (CNES) (the French Government’s Space Agency), the UP ISMC recently launched the Remote Sensing for Malaria Control in Africa (ReSMaCA) programme, using satellite technology to monitor and prevent malaria. This technology also provides information about the effects climate change and the environment have on the disease.

While the UP ISMC is involved in advanced research that looks promising, it still emphasises the importance of early diagnosis and effective treatment. Close to the heart of Prof De Jager and his team is improving the quality of life for communities living in endemic areas, which is why the UP ISMC works closely with these communities. Great effort goes into creating awareness about the disease and teaching communities how to avoid being soft targets. The UP ISMC also offers support to people who are travelling to malaria areas, using a mobile application developed with Travel with Flair called Malaria Buddy. It is also involved in several international collaborations and partnerships, and firmly believes that it is only through working together that malaria will be eliminated.

While South Africa is still a long way from reaching its target of being malaria-free, with the insight and innovation of bodies like the UP ISMC, the country certainly is making great strides towards achieving this goal. And this year’s World Malaria Day theme is a perfect description of the UP ISMC. ‘The UP ISMC is ready to beat malaria because of our unique trans-disciplinary approach and the partnerships that we focus on,’ says Prof De Jager.

*Prof Tiaan de Jager is also Director of the MRC Collaborating Centre for Malaria Research and Professor of Environmental Health at the School of Health Systems & Public Health.

For more information on the WHO’s World Malaria Day campaign, go to: http://www.who.int/campaigns/malaria-day/2018/event/en/