BACKGROUND: Malaria remains a serious epidemic threat in Mpumalanga Province. In order to appropriately target
interventions to achieve substantial reduction in the burden of malaria and ultimately eliminate the disease, there
is a need to track progress of malaria control efforts by assessing the time trends and evaluating the impact of
current control interventions. This study aimed to assess the changes in the burden of malaria in Mpumalanga
Province during the past eight malaria seasons (2001/02 to 2008/09) and whether indoor residual spraying (IRS)
and climate variability had an effect on these changes.
METHODS: This is a descriptive retrospective study based on the analysis of secondary malaria surveillance data
(cases and deaths) in Mpumalanga Province. Data were extracted from the Integrated Malaria Information System.
Time series model (Autoregressive Integrated Moving Average) was used to assess the association between climate
RESULTS: Within the study period, a total of 35,191 cases and 164 deaths due to malaria were notified in
Mpumalanga Province. There was a significant decrease in the incidence of malaria from 385 in 2001/02 to 50
cases per 100,000 population in 2008/09 (P < 0.005). The incidence and case fatality (CFR) rates for the study
period were 134 cases per 100,000 and 0.54%, respectively. Mortality due to malaria was lower in infants and
children (CFR < 0.5%) and higher in those >65 years, with the mean CFR of 2.1% as compared to the national
target of 0.5%. A distinct seasonal transmission pattern was found to be significantly related to changes in rainfall
patterns (P = 0.007). A notable decline in malaria case notification was observed following apparent scale-up of IRS
coverage from 2006/07 to 2008/09 malaria seasons.
CONCLUSIONS: Mpumalanga Province has achieved the goal of reducing malaria morbidity and mortality by over
70%, partly as a result of scale-up of IRS intervention in combination with other control strategies. These results
highlight the need to continue with IRS together with other control strategies until interruption in local malaria
transmission is completely achieved. However, the goal to eliminate malaria as a public health problem requires
efforts to be directed towards the control of imported malaria cases; development of strategies to interrupt local
transmission; and maintaining high quality surveillance and reporting system.