One village in Africa has made great strides in the fight against malaria, with the number of deaths falling from 350 in 2000 to 15 in 2005. Bill Corcoran reports from KwaZulu Natal
Oazile Bary is a rarity in the KwaZulu Natal (KZN) village he calls home.
The 18-year-old has been living with extended family in a bush homestead at Tetepan, a remote area of the South African province near Mozambique known for its malaria infestations, yet he has never been infected.
As he sits amidst the family possessions piled around him and watches the men in blue jumpsuits spraying their buildings with the insecticide DDT, he reveals he has been living at Tetepan for six years and has never had malaria even though people get bitten by mosquitoes regularly.
"My family members have all been infected [ with malaria], but when I came here the government began a new malaria programme and there has been no malaria since," he says.
While preventable and treatable, the World Health Organisation (WHO) estimates that up to 124 million people in Africa live in areas at risk of seasonal epidemic malaria, and many more in areas outside the continent where transmission is less intense.
In fact, the disease has made such a comeback over the past few years that the WHO maintains it "kills more than one million people - most of them young children living in Africa - each year", and that infection rates are on the rise across the globe.
But the one place on the African continent to have made significant inroads against the disease is in KZN, where they have had recent spectacular results despite the fact the eastern province suffered a 15-fold increase in malaria cases during the 1990s.
Department of Health figures show that since the turn of the century KZN has seen the number of malaria infections fall from nearly 45,000 in 2000, to less than 1,500 in 2005, and the number of deaths has fallen from 350 to 15 for the same period.
Although a less high profile disease than the HIV/Aids virus, malaria has been around the African continent far longer and is just as significant a killer.
Jonathon Korea Gumede knows the symptoms well: headaches, persistent shivering, a high temperature and sore joints are the initial warning signs of infection, but if not treated quickly, a person can become mentally deranged and die within a matter of days.
Gumede, a KZN malaria programme district manager, has been fighting the spread of the disease in the province for 25 years. And, in that time he has succumbed to the infection caused by a parasite and carried from one person to another by female mosquitoes seeking nutrition to hatch their eggs.
"It's unfortunate that I was infected but it does give me an understanding of what the people who contract the disease have to go through, which is important.
"Over a period of three days if you don't get medical help you can die, and the time period is even shorter if you are not from a malaria zone," he says.
The key elements of the new strategy introduced in KZN were the introduction of the drug, artemether-lumefantrine (AL), and an intensification of mosquito control efforts including the reintroduction of the insecticide DDT - discontinued in the 1990s due to environmental and health concerns - for spraying traditional homesteads.
The strategic planning needed to effectively control the spread of the disease revolves around the annual climatic conditions and the geographical position of certain parts of KZN in relation to neighbouring Mozambique, which also has a serious malaria problem.
Each bush homestead is sprayed once a year, at the start of the rainy season just before Christmas, says Gumede, who adds that after the first rains they hunt out the breeding sites to collect mosquito larvae in order to find out what type of species is prevalent.
The spraying enables the malaria programme to protect locals from mosquitoes during their breeding season as well as allowing them to isolate and treat infected Mozambiqueans visiting relatives or friends in KZN over the festive season.
"When we go to a homestead the occupants are asked if any one has arrived from Mozambique recently. If they have, we take a blood sample to check them for infection. If they are, we put them on the drug treatment programme.
"This is to protect our own people really, as if some one has been infected with malaria, they can easily pass it on to others if they get bitten by a mosquito," says Gumede.
While the recent results are indeed impressive, they cannot solely be put down to the introduction of the drug AL and the re-introduction of the insecticide DDT.
Equally important, says Gumede, are the community perceptions that malaria diagnosis and treatment should be sought urgently if one becomes infected, and the availability of a strong primary healthcare service to facilitate this desire.
"We have media campaigns and information days regularly so the people don't get complacent, believe they are safe from the disease," he says.
However, despite the success, anthamologist - anthamology is the study of insects - at KZN's department of health, Keith Hargraves, believes the current level of control being exerted over the disease is by no means a certainty in the future.
He maintains it is extremely difficult to ensure an all-encompassing malaria programme that covers all the whole species due to the way individual sub species behave and react to insecticides.
Hargraves also warns a similar situation to the 1990s epidemic could easily arise again because the various genuses are becoming increasingly immune to the insecticides and drugs being released on the market due to modern farming methods.
"The business of coming up with new insecticides and drugs is becoming increasingly complex and expensive.
"One of the big problems we face here is the rise in cotton farming," according to Hargraves.
"Cotton requires lots of insecticides and the stuff gets into the ground water, and because mosquitoes breed near water they become increasingly exposed to it and consequently more resistant.
"In trials we are finding individual types are resistant to insecticides that are not even on the market yet, and since there is no regulation on the type of insecticides used by farmers the situation looks set to continue," Hargraves suggests.