Malaria's Relentless March
starts in the morning, a blinding pain that cripples Bonisiwe Mathenjwa as
she tackles the routine tasks of a poor single mother with three children
at her river bank hut in northern KwaZulu-Natal. She doesn't need the body
pains, fever and flushes, dizziness and diarrhoea that follow to know she's
down with malaria - for the third time in eight months.
first Mathenjwa, 28, avoids the local clinic, not wanting to leave the kids
with their elderly grandmother and hoping that this time her body will thwart
the disease. But she's desperately ill by the time she's rushed by ambulance
to Mosvold Hospital in Ingwavuma, a small rural town tucked in a corner near
Swaziland and Mozambique. It is three days later and a stream of lifesaving
quinine drips into her veins as she lies exhausted, shaky and sweaty in a
tatty pink nightdress on a bed she shares with a woman and baby in a crowded
isolation ward. "I feel a bit better so I'm not frightened anymore," she
whispers. "This time I thought I was going to die."
There are 20 women and children packed into a ward built for half their number
in the years before the current malaria epidemic. South Africa has not seen
the disease on this scale since the 1930s. Northern KwaZulu-Natal (KZN) is
in the grip of a malaria scourge moving down from heavily infested southern
Mozambique and the surrounding regions, where some areas report 70 percent
The parasite is running rampant along the border and is on the march south
towards Durban. Earlier this year, two-year-old Craig Paul from Sea Cow Lake
died of malaria - the first death of someone who contracted the disease in
Durban in half a century. Health authorities were sure that Craig was infected
locally, most likely by a mosquito brought in by a traveller in their luggage.
Malaria cases and deaths in South Africa have increased more than five-fold
in as many years. In just the first three months of this year, there were
24000 reported cases. Malaria infections have risen even more sharply in
KZN, where there were 27206 cases last year - double the 1998 number and
seven times the 4117 infections of 1995. The prediction for KZN this year
is more than 30000 infections.
Mpumalanga and the Northern Province, too, have experienced a big upsurge
in the disease, especially in regions bordering neighbouring countries. Cases
in those provinces soared from fewer than 2000 in the 1989-1990 malaria season
to 9543 in Mpumalanga and over 11500 in the Northern Province last year.
Thousands more South Africans will perish if the blood-red splashes warning
against malaria continue to seep down African maps which are becoming eerily
reminiscent of those of the mid-1900s, the darkest days of the disease. If
the epidemic were allowed to spread totally unchecked, we could possibly
find ourselves back at the level of malaria fatalities of November 1931 to
June 1932, when more than 22000 people died in KZN, says Dr Brian Sharp,
director of the National Malaria Research Programme (NMRP) of the Medical
Research Council. But he is optimistic that the tide will be turned. "All
the right policies are in place and we are confident that next season will
see an arrest in the number of cases and a reduction in the geographical
distribution of malaria." To try to turn the tide, the authorities in KZN
have had to resort to a huge house-spraying programme with one of the most
controversial pesticides in history - DDT.
The hut in sweltering Ndumu is empty. Mathenjwa's meagre possessions are
piled outside, to avoid being contaminated by the clouds of DDT. A masked
man in blue overalls is spraying DDT through a fan nozzle onto the hut's
inside walls, thatch ceiling and eves. There, the insecticide will last for
some nine months and repel the mosquitoes that have nearly claimed her life
three times. "I want the spray," Mathenjwa tells me. "I don't want to be
sick again and I'm worried about my children." The programme began in February,
four years after DDT was withdrawn under pressure from environmental groups.
It was discovered last December that malaria-bearing Anopheles
mosquitoes had become resistant to the more environmentally-friendly insecticides
that had been sprayed since 1996. The consequent resurgence of mosquitoes
included even the virulent Anopheles funestus,
which was eliminated 50 years ago.
South Africa, which in the 1940s was one of the first countries in the world
to use DDT against malaria, is now among the first to re-introduce it. Experts
and the government will resist attempts by northern countries, which have
money and medicine but not malaria, to stop the anti-malarial use of DDT
at the UN Environmental Programme treaty meeting this month in Johannesburg.
Barry Bredenkamp, an NMRP researcher in Durban, says a ban would be disastrous.
"DDT is extremely effective and cheap. The case for it being a medical hazard
is unproven, and should have little environmental impact in the small quantities
we are using it." Returning to DDT was controversial but essential, agrees
Dave McGlew, a provincial health department spokesman. "Given the deteriorating
malaria situation and the growing threat to human life, we had little choice
but to opt for the most effective way of combating the disease." Sharp concurs.
"DDT is the best we have available, but it is only an interim measure until
a better solution is found." The health department has gone to a great deal
of trouble to minimise the toxic effects of DDT, consulting with environmental
bodies, scientists and poison experts to ascertain how, where and what concentrations
to spray inside homes. Strict procedures are followed to avoid environmental
contamination. "There is a very small chance of harming people or animals,"
says McGlew. Since February, KZN's malaria control unit has sprayed 241020
structures (mostly one-room homesteads). Already surveys show a reduction
in the number of mosquitoes inside homes. DDT spraying is being supported
by other methods, says Jotham Mthembu, malaria co-ordinator for KZN. One
is a natural oily solution applied to still waters to kill off mosquito larvae.
People are being randomly screened for the disease, and bed nets and coils
are being distributed. "We're also running a major information and education
campaign warning people of the dangers of malaria and how to prevent it."
Under the Lubombo Spatial Development Initiative South Africa, Mozambique
and Swaziland are working together to thwart malaria. Dr Hervey Vaughan-Williams emerges from a consulting room at Mosvold Hospital. "I reckon at least half the people in here have malaria," he declares, striding through a packed outpatients hall. "The epidemic has gone through the roof. We've moved from seasonal to all-year malaria." He says monthly deaths are still in single
figures, probably because some people are becoming immune. "But with malaria
moving south to places where there is no resistance, there will be lots of
severe cases. More people could die." Malaria experts are hoping that the
mosquito that infected young Craig Paul in Durban was transported there and
that the Anopheles species found in northern KZN are not migrating to the
city. There are also concerns about the epidemic growing in Mpumalanga and
the Northern Province, which are not yet using DDT, and spreading towards
cities such as Pretoria.
Marlize Booman, geographic information systems officer for the Malaria Control
Programme in Mpumalanga - where DDT spraying is about to begin - says it
will not be a quick fix and it could be quite a few seasons before a decrease
is seen. While the stopping of DDT spraying in South Africa in 1996 is largely responsible for the current epidemic, other factors are contributing. There have been several years of good rainfall and very hot weather, which created
perfect conditions for mosquitoes. Also, since 1994 there have been far greater
movements of people across South Africa's borders, especially from hard-hit Mozambique. The malaria-transmitting species can travel in from other countries
in taxis or aircraft. The cheapest, malaria drug - chloroquine - is rapidly losing its effectiveness and in some parts of the world malaria is resistant to the four leading frontline drugs. South Africa is hoping soon to introduce a combination therapy, that includes a powerful anti-malarial drug developed
by the Chinese, into the arsenal of weapons being used to fight the killer disease. Still, hopes are largely pinned on DDT to thwart malaria as it did
half a century ago.