Rolling Back Malaria in the cross-border Lubombo region

The Lubombo Spatial Development Initiative is a collaborative project of the governments of Mozambique, South Africa and Swaziland to develop the cross-border Lubombo region into a competitive economic area.

The region has a population of approximately four million and has historically been a zone of endemic malaria, particularly on the Mozambique side, which has 400,000 cases per year. The bordering areas in South Africa and Swaziland are the places in these two countries at highest risk for malaria.

At the start of a community-based vector control program in 2000, the prevalence of the parasite among children aged two to 15 was 64 percent in the two southern most districts in Mozambique, bordering Swaziland and KwaZulu Natal.

Financing of US$7 million over two years from the Global Fund will improve malaria control in the Maputo Province in Mozambique, maintain effective malaria control programs in the adjoining regions of South Africa and Swaziland and develop human resource capacity to sustain the program.

Support from the Global Fund will expand communitybased vector control programs and implement artemisinin-based combination therapy as the first line treatment of uncomplicated malaria.

Baseline studies of the efficacy of sulfadoxine/ pyrimethamine monotherapy, traditionally used as the first-line therapy for uncomplicated malaria cases, have been completed in five sites in the Lubombo region. Results indicated a high level of resistance to this therapy, particularly in the KwaZulu Natal region of South Africa.

As a result, artemisinin-based combination therapy was introduced as a first-line treatment in 2001. Since then, incidence of malaria has decreased by 80 percent. Unfortunately, coverage of artemisinin-based combination therapy is extremely limited outside of KwaZulu Natal.

The grant to the Lubombo region will begin its widespread introduction. Training programmes and strengthening of drug management systems are currently underway in southern Mozambique to initiate the successful implementation of artemisinin-based combination therapy at the district level.

In addition, communitybased indoor residual spraying of insecticide will be supported as a complementary component to reduce the incidence of malaria throughout the region. Country-specific control programs have limitations, as vector-borne infectious diseases transcend national boundaries.

The malaria control program in the Lubombo Spatial Development Initiative area repre- sents a unique collaboration among three separate Country Coordinating Mechanisms —those of Mozambique, South Africa and Swaziland. Multicountry programs supported by the Global Fund offer the opportunity for nations to complement and coordinate activities across borders.

In July 2003 the Medical Research Council of South Africa, a non-governmental Principal Recipient, received disbursements that totaled more than 30 percent of the two-year grant commitment, and work is expected to progress quickly with this new influx of funds.