Malaria in Mpumalanga Province, South Africa, with special reference to the period 1987-1999

We have reviewed data on malaria cases collected routinely by both passive and active methods for the period 1987 to 1999. Malaria transmission in Mpumalanga was markedly seasonal and unstable, occurring between October and May, and was essentially influenced by both temperature and rainfall. Malaria control in the province is by a combination of residual intradomicillary spraying with synthetic pyrethroids and prompt effective therapy of cases at primary health-care clinics. The prevalence of malaria in the province decreased from east to west in direct relation to altitude, with the highest prevalence in the east (600 m altitude). Although the number of notified cases has increased since 1993, with epidemics recorded in 1996 and 1999, the mortality ratio has remained under 0.5% of notified cases per annum. A large proportion (30%) of malaria cases was found in patients younger than 15 years and affected school attendance. The majority of malaria cases were in the economically active age group of 15-50 years. Current malaria control in the province should be continued and the development of additional tools such as insecticide-treated nets is recommended.