Key to public health threats

INLSA

Picture: Karen Sandison

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• Taking fight against malaria to high land

Most cases of malaria occur in sub-Saharan Africa, where there is a significant overlap with HIV infection.

In 2010, there were an estimated 216 million episodes of malaria and an estimated 655 000 malaria deaths worldwide, 81 percent of these malaria episodes and 91 percent of malaria deaths occurred in sub-Saharan Africa.

There are 22 million people living with HIV in sub-Saharan Africa, comprising 67 percent of the 33 million people living with HIV globally.

International mobilisation to combat HIV/Aids and malaria has increased substantially since the Millennium Development Goals (MDGs). Despite the variety of prevention, treatment and care initiatives, significant challenges in curbing these diseases remain.

Malaria has been shown to induce HIV-1 replication and increase HIV viral load. HIV infection is also associated with an increased frequency of clinical malaria and parasitemia. However, the prevalence of malaria and HIV and the extent of geographic overlap vary widely within each region.

In South Africa, after decades of concerted efforts, such as spraying with insecticides and treatment with drugs, malaria has been pushed back to border areas lying in the north east, where it remains at low levels. These are also areas characterised by a high burden of the HIV pandemic.

Elsewhere on the continent, malaria and HIV continue to be public health threats and cause substantial morbidity, mortality, negative socio-economic affects and human suffering.

The geographic overlap, shared risk factors and possibility for co-infection between malaria and HIV mean that these diseases can no longer be considered in isolation.

Malaria presents the most opportunity in which increased and sustained investments could lead to a fruitful outcome. More research attention should also be given to the epidemiology of malaria and HIV co-infection.

l Dr Mkhize-Kwitshana is research co-ordinator at the UKZN College of Health Sciences