Malaria case trends using routine surveillance data – Gauteng, South Africa, 2012–2018

Background: Gauteng is a non-endemic malaria province but imported and odyssean malaria infections (locally acquired infections from imported mosquitoes) are of public health importance. Malaria notification data are an important source for monitoring trends. To this end, South Africa's notifiable medical conditions surveillance system (NMCSS) was re-engineered in 2017 to include laboratory notification. The aim of this surveillance project was to describe trends in notified malaria cases in Gauteng for the period 2012–2018. Methods and materials: A descriptive analysis of malaria case data for Gauteng, from 2012 to 2018, was performed. Data were obtained from the communicable disease control unit of the Gauteng Department of Health (2012–2017) and the re-engineered NMCSS at the National Institute for Communicable Diseases (2018). Results: During the review period, 11,832 malaria cases (range 1142–2847 cases/year) with 173 deaths (case fatality rate 1.5%) were notified. The number of reported cases decreased from 1736 (case fatality rate 1.3%) in 2013 to 1142 (case fatality rate 1.6%) in 2016 and peaked at 2847 (case fatality rate 0.7%) in 2018. Overall, the 20–49 years age group (60.7%; 6683/11,010) and males (67%; 7830/11,631) were most affected; annual notifications peaked between January and May, with the greatest numbers generally recorded in January. Geographically, Ekurhuleni and West Rand Districts recorded the highest number of malaria cases and corresponding deaths. Travel histories were recorded for 90% (8126/8984) of the cases between 2012 and 2017, but are unknown for 58% (1654/2847) of cases recorded in 2018. Mozambique was the source of the vast majority of imported cases. Conclusion: These trends in imported malaria highlight the need for pre-travel counselling and chemoprophylaxis in public health sector as a preventative measure. The drop in the case fatality rate in 2018 is possibly due to wider availability of artesunate. Notification data suffers from under-reporting and as such, the increase in reported cases in 2018 is likely not due to increased incidence but to mandatory notification according to NMC regulations. Travel histories not recorded on laboratory reports explains the large proportion of cases with unknown travel history.

Abstract licence: CC BY-NC-ND

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.