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The long road to elimination: malaria mortality in a South African population cohort over 21 years

  • P. Byass (a1) (a2), M. A. Collinson (a1) (a2) (a3), C. Kabudula (a1), F. X. Gómez-Olivé (a1), R. G. Wagner (a1), S. Ngobeni (a1), B. Silaule (a1), P. Mee (a1) (a4), M. Coetzee (a5), W. Twine (a6), S. M. Tollman (a1) (a2) (a3) and K. Kahn (a1) (a2) (a3)...
Abstract
Background

Malaria elimination is on global agendas following successful transmission reductions. Nevertheless moving from low to zero transmission is challenging. South Africa has an elimination target of 2018, which may or may not be realised in its hypoendemic areas.

Methods

The Agincourt Health and Demographic Surveillance System has monitored population health in north-eastern South Africa since 1992. Malaria deaths were analysed against individual factors, socioeconomic status, labour migration and weather over a 21-year period, eliciting trends over time and associations with covariates.

Results

Of 13 251 registered deaths over 1.58 million person-years, 1.2% were attributed to malaria. Malaria mortality rates increased from 1992 to 2013, while mean daily maximum temperature rose by 1.5 °C. Travel to endemic Mozambique became easier, and malaria mortality increased in higher socioeconomic groups. Overall, malaria mortality was significantly associated with age, socioeconomic status, labour migration and employment, yearly rainfall and higher rainfall/temperature shortly before death.

Conclusions

Malaria persists as a small but important cause of death in this semi-rural South African population. Detailed longitudinal population data were crucial for these analyses. The findings highlight practical political, socioeconomic and environmental difficulties that may also be encountered elsewhere in moving from low-transmission scenarios to malaria elimination.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: Prof. P. Byass, Epidemiology and Global Health, Umeå University, Umeå, Sweden. (Email: peter.byass@umu.se)
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