What is this article about?

This article reports on the differences in epidemiological characteristics and antimalarial drug-resistance marker prevalence between imported and locally acquired malaria cases from two South African malaria-endemic districts targeting elimination. The analysis was conducted using parasite drug-resistance profiles linked to individual patient demographic data for samples collected between 2022 and 2024. The article highlights the risk that malaria importation poses to elimination efforts, while emphasising the importance of sustaining routine active case detection activities in low-transmission settings. It identifies key differences between imported and locally acquired cases that can be exploited to help interrupt focal residual transmission in these districts.

Why does this article matter?

Over 80% of malaria cases detected in South Africa’s low-transmission districts targeting elimination are imported. These cases pose a significant threat to South Africa’s elimination efforts, as they can potentially introduce drug-resistant parasites into these low-transmission settings, sustaining focal residual transmission. This surveillance article provides an in-depth analysis of the epidemiological characteristics and drug-resistance marker prevalence among imported and locally acquired cases. This is essential to guide the appropriate selection and targeting of interventions to reduce local transmission and edge closer to elimination.  

How did this article come about?

This surveillance article was derived from the analysis of genomic surveillance data routinely generated by the National Institute for Communicable Diseases (NICD) in support of National Malaria Programme’s elimination surveillance activities. Used malaria rapid diagnostic tests (RDTs) from RDT-malaria-positive individuals are routinely collected in eliminating districts and transported to the malaria molecular laboratory at the NICD for genomic analysis.

What was your role in the development of this article?   

As the lead author, I co-developed the concept for this surveillance article with the senior author, Dr Jaishree Raman. I then led data extraction, management, and analysis and co-ordinated the drafting and revision of the manuscript in collaboration with the co-authors.

Why should people read this article?

This surveillance article provides practical, valuable insights and actionable recommendations for communities living in affected areas, healthcare professionals, malaria control programmes, and policymakers. It outlines the specific roles that each can play in strengthening prevention, enhancing early detection, and ensuring timely and effective treatment of all malaria cases to stop focal residual transmission in these eliminating districts.

What impact do you hope this article will have on public health policy and healthcare access?

We hope that the findings of this surveillance article will help accelerate elimination efforts in South Africa by guiding the selection and deployment of the appropriate, targeted, and effective interventions. These include routine, active test-and-treat activities along known migratory routes to detect untreated malaria, as well as increased malaria awareness among local individuals living in low-transmission areas to encourage early treatment-seeking behaviours and reduce the risk of progression to severe disease. Finally, we hope the article highlights the need for sustaining malaria genomic surveillance in South Africa to enable prompt detection and response to antimalarial drug resistance.

Mr Maxwell Mabona is a Field Epidemiologist at the Centre for Emerging Zoonotic and Parasitic Diseases at the National Institute for Communicable Diseases. 

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