Abstract
Malaria remains a persistent public health challenge in specific South African locales, particularly in rural areas where the disease is endemic. The Bushbuckridge Sub-District within Mpumalanga Province exemplifies such an area. Despite significant national advancements in the pursuit of malaria eradication, local transmission endures. Consequently, this circumstance necessitates a crucial investigation into the factors contributing to malaria's continued prevalence in a region approaching its elimination objectives. This study aimed to understand the factors that sustain malaria transmission in Bushbuckridge, using a thorough, systems-based approach. Rather than looking at a single issue in isolation, the research explored how environmental conditions, vector control efforts, case management practices, surveillance systems, and broader health system challenges interact to influence ongoing transmission.
A mixed-methods design was used, combining analysis of routine malaria case data (n = 198) with insights from healthcare workers (n = 39) and malaria case investigators (n = 4). Quantitative data were analysed using statistical methods, while qualitative findings provided context to operational and system-level challenges.
The results show a clear picture indicating that malaria transmission in Bushbuckridge is not driven by one dominant factor, but by a combination of interconnected issues. Most cases occurred in rural areas, where environmental conditions favour mosquito breeding. More than half of the cases were linked to specific breeding sites, many of which were created by humans, highlighting the impact of local environmental practices. Concurrently, deficiencies in vector control became apparent, as the majority of reported cases were concentrated within households that had not undergone spraying. These shortcomings transcended mere technical inadequacies, instead being associated with accessibility issues, including locked residences and regions situated beyond the designated spray zones.
Case management practices further highlighted missed chances to reduce transmission. The infrequent application of Primaquine, a crucial intervention for disrupting the transmission cycle, highlights discrepancies between established policy and its practical implementation. Surveillance systems exhibited variable efficacy; although diagnoses were typically prompt, delays in case notification and operational limitations, such as transportation and staffing deficiencies, impeded swift responses...