BACKGROUND : The Lubombo Spatial Development Initiative (LSDI) was a tri-country project between South Africa,
Swaziland and Mozambique with the aim of accelerating socio-economic development in the region. The malaria
component of the project was introduced to decrease the transmission of malaria in the region. This goal was met
but with termination of this project resulted in an upsurge of malaria cases in the sub-region mainly as a result of
migration from high transmission areas to low transmission ones. The movement of people across borders in southern
Africa remains a challenge in sustaining malaria control and elimination.
METHODS : Malaria case data for Swaziland and South Africa were obtained from their respective national Malaria
Information Systems. Data for Mozambique was obtained from the Mozambican Ministry of Health. Data obtained
during the course of the LSDI project was compared to the case data post the termination of the LSDI.
RESULTS : The 12-year period of the LSDI showed a substantial decrease in disease burden amongst the three countries
involved when compared to the baseline year of 2000. The decrease in malaria cases was 99 % in South Africa
and 98 % in Swaziland. Malaria prevalence in Mozambique decreased by 85 % over the same period. However, after
the LSDI ended, between 2012 and 2014, there was an upward trend in case data that was counter to the goal of
CONCLUSION : South Africa and Swaziland benefitted from the LSDI and were able to sustain malaria control and progress
to the stage of elimination. Mozambique could not sustain the gains made during the LSDI and case numbers
increased. Technical and financial resources are key challenges for malaria control and elimination interventions.
Data used in this study are available from the Ministries of Health in South
Africa, Swaziland and Mozambique.