Malaria outbreak investigation - Mopani and Vhembe districts, Limpopo province, South Africa, May 2017
Khuliso Goodman Ravhuhali1,&, Ntsieni Ramalwa1, Carl Reddy1
1South African Field Epidemiology Training Programme, Johannesburg, South Africa
Khuliso Goodman Ravhuhali, South African Field Epidemiology Training Programme, Johannesburg, South Africa
South Africa (SA) has set a goal of malaria elimination by 2018. Malaria remains a major public health challenge in Vhembe and Mopani districts, Limpopo province - two of the five malaria endemic districts in SA. On 2 May 2017, health facilities in the two districts reported an unusual increase of malaria cases. Investigations were conducted to establish existence, magnitude and cause of the outbreak, to recommend control measures for the current outbreak and future prevention.
a cross-sectional investigation was conducted. Discussions with key stakeholders were held. We reviewed malaria case data collected through the Limpopo provincial malaria information system from April to May 2017. We defined a case as a person with malaria confirmation by microscopy or a rapid diagnostic test (RDT) in health facilities of the two districts from April to May 2017.
a total of 5 662 cases, 55.3% in Mopani, were reported with a peak in May 2017.Investigation of likely origin revealed that 5 574 (98.4%) were local cases in both districts. Fifty-four malaria deaths were reported, majority 42 (77.8%) in Mopani district. The median age of the patients who died was 44 years (IQR 35-60) with 0.95% case fatality rate (CFR). 99.9% of all cases were Plasmodium Falciparum. Indoor residual spraying (IRS) coverage was less than WHO recommended 80% universal coverage for control. An environmental assessment revealed that 2016/17 season recorded higher levels of rainfall and temperature compared to previous malaria season. Key stakeholder interviews revealed that the outbreak in the province was associated with late commencement of IRS due to late appointment of spray teams; reduced use of Dichlorodiphenyltrichloroethane (DDT) which was replaced by pyrethroids (K-Othrine and Deltamethrine); and stock outs of RDTS and anti-malaria drugs in clinics.
the investigation established that the marked increase in malaria cases in Vhembe and Mopani districts was not a seasonal phenomenon but rather an outbreak. We recommended a community awareness program through local radio stations on malaria prevention and treatment; improved supply chain of RDTs and antimalarial drugs to prevent stock outs; budget allocation for procurement of DDT and advance appointment of IRS teams.
1st Ghana Field Epidemiology and Laboratory Training Programme Scientific conference (Accra)
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