ArticleMalaria journal2020
High levels of imported asymptomatic malaria but limited local transmission in KwaZulu-Natal, a South African malaria-endemic province nearing malaria elimination.
Article in Malaria journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Pooled it
- Nanomedicine drug delivery in South Africa: a retrospective study on research, funding and collaboration.Frontiers in pharmacology · 2023Pooled it
- Biophotonics point-of-care diagnostics in low-resource settings: a South African perspective.Journal of biomedical optics · 2026Review
- Malaria at the margins: climatic extremes, migration, and urban informal settlement risk in South Africa.Malaria journal · 2026Article
- Feasibility of self-testing for acute malaria using rapid diagnostic tests in three peri-urban sub-Saharan African community settings.Malaria journal · 2025Article
- Experiences of Community Members and Health Workers Regarding Malaria Control Programmes in the Rural Ingwavuma Community, uMkhanyakude District Municipality, KwaZulu-Natal Province, South Africa.Public health challenges · 2025Article
- Integrating mobility, travel survey, and malaria case data to understand drivers of malaria importation to Zanzibar, 2022-2023.Malaria journal · 2025Article
- Integrating mobility, travel survey, and malaria case data to understand drivers of malaria importation to Zanzibar, 2022-2023.medRxiv : the preprint server for health sciences · 2025Article
- Anopheles arabiensis larval habitats characterization and Anopheles species diversity in water bodies from Jozini, KwaZulu-Natal Province.Malaria journal · 2025Article
- The epidemiology of malaria in four districts in southern Mozambique receiving indoor residual spray as part of a cross-border initiative.Malaria journal · 2025Article
- Recent Advancement in Drug Development for Treating Malaria using Herbal Medicine and Nanotechnological Approach.Current pharmaceutical design · 2025Review
- Host Preferences and Impact of Climate on Blood Feeding inTropical medicine and infectious disease · 2024Article
- Impact of six-month COVID-19 travel moratorium on Plasmodium falciparum prevalence on Bioko Island, Equatorial Guinea.Nature communications · 2024Article
- Molecular detection of sub-microscopic infections and Plasmodium falciparum histidine-rich protein-2 and 3 gene deletions in pre-elimination settings of South Africa.Scientific reports · 2024Article
- Malaria Transmission at The Zimbabwe-Mozambique Border: An Observational Study of Parasitemia by Travel History and Household Location.The American journal of tropical medicine and hygiene · 2024Observational
- Modeling the effect of imported malaria on the elimination programme in KwaZulu-Natal province of South Africa.The Pan African medical journal · 2024Article
- Design of a novel intelligent computing framework for predictive solutions of malaria propagation model.PloS one · 2024Article
- The provision of malaria services in border districts of four countries in Southern Africa: results from a cross-sectional community assessment of malaria border health posts.Malaria journal · 2023Article
- Towards malaria elimination: analysis of travel history and case forecasting using the SARIMA model in Limpopo Province.Parasitology research · 2023Article
- Temporal and spatial analysis of Plasmodium falciparum genomics reveals patterns of parasite connectivity in a low-transmission district in Southern Province, Zambia.Malaria journal · 2023Article
Corrections and comments
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Authors and funding
25 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundKwaZulu-Natal, one of South Africa's three malaria endemic provinces, is nearing malaria elimination, reporting fewer than 100 locally-acquired cases annually since 2010. Despite sustained implementation of essential interventions, including annual indoor residual spraying, prompt case detection using malaria rapid diagnostics tests and treatment with effective artemisinin-based combination therapy, low-level focal transmission persists in the province. This malaria prevalence and entomological survey was therefore undertaken to identify the drivers of this residual transmission.
methodsMalaria prevalence as well as malaria knowledge, attitudes and practices among community members and mobile migrant populations within uMkhanyakude district, KwaZulu-Natal were assessed during a community-based malaria prevalence survey. All consenting participants were tested for malaria by both conventional and highly-sensitive falciparum-specific rapid diagnostic tests. Finger-prick filter-paper blood spots were also collected from all participants for downstream parasite genotyping analysis. Entomological investigations were conducted around the surveyed households, with potential breeding sites geolocated and larvae collected for species identification and insecticide susceptibility testing. A random selection of households were assessed for indoor residual spray quality by cone bioassay.
resultsA low malaria prevalence was confirmed in the study area, with only 2% (67/2979) of the participants found to be malaria positive by both conventional and highly-sensitive falciparum-specific rapid diagnostic tests. Malaria prevalence however differed markedly between the border market and community (p < 0001), with the majority of the detected malaria carriers (65/67) identified as asymptomatic Mozambican nationals transiting through the informal border market from Mozambique to economic hubs within South Africa. Genomic analysis of the malaria isolates revealed a high degree of heterozygosity and limited genetic relatedness between the isolates supporting the hypothesis of limited local malaria transmission within the province. New potential vector breeding sites, potential vector populations with reduced insecticide susceptibility and areas with sub-optimal vector intervention coverage were identified during the entomological investigations.
conclusionIf KwaZulu-Natal is to successfully halt local malaria transmission and prevent the re-introduction of malaria, greater efforts need to be placed on detecting and treating malaria carriers at both formal and informal border crossings with transmission blocking anti-malarials, while ensuring optimal coverage of vector control interventions is achieved.
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