Malaria mortality in a hypoendemic area of North-Eastern South Africa : population-based surveillance from 1992 to 2013 reveals an increasing malaria burden

• Introduction: Most of South Africa is malaria-free, but hypoendemic levels of transmission persist in lowveld areas in the north-east of the country, adjacent to Mozambique. Many families have links to relatives in Mozambique, where malaria transmission remains much higher, and cross-border travel is commonplace, although the Kruger National Park provides something of a depopulated buffer zone along the border. Malaria diagnosis and treatment is relatively easily available at public and private facilities in the endemic area.Methods: The Agincourt Health and Socio-Demographic Surveillance Site has monitored population health in a defined area within Mpumulanga Province, around 24.7°S, 31.2°E, since 1992. A circumscribed semi-rural area with a population ranging from approximately 60 000 in 1992 to 90 000 in 2013 was covered. All households were visited regularly to consistently record demographic and health data, including the documentation of deaths and their causes using verbal autopsy.Results: From 1992 to 2013 a total of 13 251 deaths were documented over 1.58 million person-years observed. Of that total mortality burden, 1.2% of deaths were ascribed to malaria. Half of the malaria deaths were among children aged under 15 years, with most of the remainder among working-age adults. Malaria deaths were strongly correlated with temperature and rainfall. The malaria mortality rate was over 50% higher during the last 5 years of the surveillance period, compared with earlier years. A huge HIV/AIDS epidemic that developed and receded in this population during the period of observation had no apparent effect on malaria mortality.Conclusions: This detailed longitudinal examination of malaria mortality showed that although malaria is a relatively minor cause of death in this population, it has become more common in recent years, and shows no sign of retreating despite rapid socioeconomic development. In addition to local relevance, these findings are important for understanding potential population burdens of hypoendemic malaria in other areas of sub-Saharan Africa as progress towards malaria control and elimination targets is realised.

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MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

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