Journal
TROPICAL MEDICINE & INTERNATIONAL HEALTH
Volume 9, Issue 12, Pages 1258-1266Publisher
WILEY
DOI: 10.1111/j.1365-3156.2004.01341.x
Keywords
Anopheles; drug resistance; epidemiological factors; human immunodeficiency virus; incidence; insect control; insecticide resistance; irrigation; malaria; South Africa
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Malaria transmission is a multifactorial phenomenon. Climate is a major limiting factor in the spatial and temporal distribution of malaria, but many non-climatic factors may alter or override the effect of climate. Thirty years of monthly malaria incidence data from KwaZulu-Natal province, South Africa, reveal strong medium and long-term trends, which were not present in the climate data. This paper explores various non-climatic factors that may have contributed towards the observed trends. The development of antimalarial drug resistance, available information on human immunodeficiency virus (HIV) prevalence, cross-border people movements, agricultural activities, emergence of insecticide resistance and the case reporting system are reviewed and their potential effect on malaria transmission examined. Single-variable linear regression analysis showed significant association between seasonal case totals (log-transformed) and the measured level of drug resistance (log-transformed) (r(2) = 0.558, n = 10, P = 0.013) as well as relative measures of HIV infection since 1990 (r(2) = 0.846, n = 11, P = 0.001). The other factors appear to have affected the level of malaria transmission at certain periods and to some degree. The importance of surveillance and inclusion of non-climatic variables in analysis of malaria data is demonstrated.
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