Maintaining focus on administering effective malaria treatment during the COVID-19 pandemic.

As September marks the start of the malaria season in South Africa (SA), it is essential that healthcare professionals consider both COVID- 19 and malaria when a patient who lives in or has recently travelled to a malaria area presents with acute febrile illness. Early diagnosis of malaria by either a rapid diagnostic test or microscopy enables prompt treatment with the effective antimalarial, artemether-lumefantrine, preventing progression to severe disease and death. Intravenous artesunate is the preferred treatment for severe malaria in both children and adults. Adding single low-dose primaquine to standard treatment is recommended in endemic areas to block onward transmission. Use of the highly effective artemisinin-based therapies should be limited to the treatment of confirmed malaria infections, as there is no clinical evidence that these antimalarials can prevent or treat COVID-19. Routine malaria case management services must be sustained, in spite of COVID-19, to treat malaria effectively and support SA's malaria elimination efforts.

Re-defining the extent of malaria transmission in South Africa: implications for chemoprophylaxis.

BACKGROUND: Malaria case numbers reported in South Africa have reduced considerably over the last decade, necessitating a revision of the national risk map to guide malaria prevention, including the use of chemoprophylaxis. OBJECTIVES: To update the national malaria risk map based on recent case data and to consider the implications of the new transmission profile for guiding prophylaxis. METHODS: The geographical distribution of confirmed malaria cases detected both passively and actively over the last six malaria seasons was used to redefine the geographic distribution and intensity of malaria transmission in the country. RESULTS: The national risk map was revised to reflect zones of transmission reduced both in their extent and their intensity. Most notably, the area of risk has been reduced in the north-western parts of Limpopo Province and is limited to the extreme northern reaches of KwaZulu-Natal Province. Areas previously considered to be of high risk are now regarded to be of moderate risk. CONCLUSION: Chemoprophylaxis is now only recommended from September to May in the north-eastern areas of Limpopo and Mpumalanga Provinces. The recommended options for chemoprophylaxis have not changed from mefloquine, doxycycline or atovaquone-proguanil.

A Study of Health Workers' Knowledge and Practices Regarding Leprosy Care and Control at Primary Care Clinics in Eerstehoek area of Gert Sibande District in Mpumalanga Province; South Africa

Background: Leprosy is now a rare disease in South Africa. It does still occur; however; and it is an important cause of preventable disability. The target of eliminating leprosy as a public health problem has long been reached in the country in terms of the World Health Organization (WHO) definition of less than one case of leprosy per 10 000 population. However; there is still a commitment to the eradication of the disease in the country. 1 Also; as leprosy is a chronic communicable disease with an extraordinary long incubation period; it is expected that even in areas where the elimination target has been reached; a proportion of the population infected several years ago will show clinical disease; resulting in the occurrence of new cases for many years to come. There is; therefore; a continuing need for vigilance regarding leprosy in South Africa. The low prevalence of leprosy in South Africa is found mostly in the eastern coastal areas and the south-eastern Highveld region; comprising mostly the provinces of Eastern Cape; KwaZulu-Natal and Mpumalanga. The strategy of leprosy care and control programmes in the country is currently that of decentralisation and integration into the general health care services at the primary health care (PHC) level in accordance with the WHO recommendations. The low prevalence of leprosy is associated with a fear of the loss of leprosy-specific skills within the healthcare services that could result in considerable delay in the diagnosis and treatment of the disease. One of the goals of the South African leprosy care and control programme is the maintenance of a high level of awareness of leprosy by health workers (HWs) at the primary care level of the general healthcare services in order to ensure early diagnosis and treatment of the disease in the light of the low prevalence. A successful leprosy care and control programme within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of; and practical training on; leprosy.Methods: This study describes PHC workers' knowledge of leprosy; and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province; South Africa; where leprosy still occurs.Results: The results of the study reveal that the PHC workers have a general lack of basic clinical knowledge of leprosy; and a very low level of practical involvement in leprosy work at the PHC clinics in the area. A majority of the PHC workers expressed the desire for training on leprosy; and the willingness to provide care to leprosy patients at the PHC clinics.Conclusion: Training strategies that are recommended to improve the PHC workers' knowledge of leprosy and to promote their practical involvement in leprosy work at the PHC clinics include: more emphasis on leprosy teaching during the training of PHC workers at training institutions; more leprosy-specific in-service training of the PHC workers; special training of the PHC workers on practical leprosy work; and regular follow-up and supervision of the PHC workers at PHC clinics by specialised or experienced leprosy workers