He was called up to the South Africa squad from relative obscurity and little first-class experience for the series against Sri Lanka and impressed in the second test with pace and bounce claiming in the Sri Lankan first-innings and capturing in the second. He suffered an injury during an unofficial T20 series in Zimbabwe in early and was forced to remodel his action to prevent further recurrences of the injury happening again. He took the wicket of Martin Guptill on his debut. That season he played in three matches and picked up 3 wickets at an average of He debuted for them in their second match against Delhi Daredevils replacing their best bowler Lasith Malinga.
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It was an important match as Mumbai needed to win all their in order to qualify for the playoffs. He went for 10 in his first over but impressed everyone with a great comeback, bowling Dinesh Karthik out in the first ball he bowled to him and later getting the important wicket of Manoj Tiwary. From Wikipedia, the free encyclopedia. South African cricketer. South Africa. Retrieved 27 December The Age. Retrieved 28 December A local autochthonous case is defined as a malaria infection acquired within a malaria-receptive area of South Africa where there is no history of travel to another malaria endemic country and where local transmission cannot be disproven.
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An imported malaria case is defined as an infection whose origin can be traced to a known malarious area outside of South Africa to which the individual has travelled. In instances where local transmission is unlikely but the malaria patient cannot be traced to verify travel history, the case is categorized as unclassified. Currently in South Africa generalized IRS operations are conducted in the malaria-affected areas of the three malaria-endemic provinces, using a mosaic strategy comprising pyrethroids and DDT and, in certain instances carbamates, irrespective of malaria incidence.
At the beginning of each malaria season provincial MCPs determine the number of structures to be sprayed, guided by the number of structures within the malaria endemic area, availability of insecticide and available insecticide resistance data.
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Spray personnel record the number of rooms and structures sprayed with insecticide on spray cards. Data on the surveillance, monitoring and evaluations systems, programme human and infrastructure capacity, as well as community knowledge of malaria, were sourced from the report produced following the mid-term review of the national malaria elimination strategy [ 13 ]. Descriptive statistical analysis was conducted for all variables identified as important. Although malaria case numbers increased marginally from in and to in , they declined markedly to in Fig. Unfortunately since the number of reported malaria cases has increased annually, peaking at 11, in Over the review period malaria case numbers from all three malaria endemic provinces mirrored the national trend Fig.
The major contributor to the national malaria burden from the endemic provinces alternated between Limpopo and Mpumalanga, with Limpopo accounting for majority of the cases reported in Fig. Between and national malaria-related deaths almost halved from 63 in to 34 in , but have subsequently increased annually, mirroring the trend in malaria cases Fig. Over the review period malaria deaths increased significantly from 63 in to by OR 1. Univariate analysis revealed that while females were marginally more likely to contract malaria OR 1. A closer inspection of the morbidity and mortality data revealed that the major source of the malaria infection varied greatly between the provinces Fig.
By malaria incidence in uMkhanyakude, uThungulu and Zululand districts was 0. The number of imported cases increased significantly across three endemic provincial districts from 92 in to in OR 1. Although malaria-related mortality remained unchanged over the study period OR 0. Of the five provincial malaria endemic districts, Vhembe is the highest burdened district, followed by Mopani, with the remaining three districts mainly reporting imported cases. By malaria incidence in Vhembe was 2. The number of locally-acquired cases increased significantly over the study period from in to in OR 1.
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Although unclassified cases decreased markedly from in to in , they began increasing thereafter, reaching by Despite this sharp increase in unclassified cases since , the odds of a case remaining unclassified declined significantly over the study period OR 0. Individuals who acquired an infection locally were two times less likely to survive than individuals who acquired the infection outside of South Africa OR 2. The number of imported cases increased over the study period from in to in OR 1.
Once again females OR 1. Individuals who acquired an infection within Mpumalanga Province were three times less likely to survive the malaria infection compared to those infected with malaria outside of South Africa OR 3. Of the 36, cases reported over the review period 17, Mozambique accounted for These delays in case notification impeded both prompt reactive case investigations and the monitoring of malaria case data in real time at the provincial and national levels. In an attempt to improve h case reporting, the National Malaria Directorate together with the Clinton Health Access Initiative developed a cellular application, MalariaConnect, which allows for immediate case reporting using cellular devices at no cost to the end user.
Since the phased roll-out of the application commenced in August , facilities across five districts Vhembe, Mopani, Ehlanzeni, uMkhanyakude and uThungulu within the three endemic provinces have received training on the MalariaConnect application. Currently each malaria endemic province has its own MIS where all malaria case data are captured. Although data collected by these three information systems are not uniform, a core set of essential data variables are maintained and captured by all three systems. Captured provincial case data are transferred to the national integrated MIS on a regular basis using a web-based platform.
In addition, certain provincial control programmes developed their own epidemic thresholds using retrospective provincial case data. While provincial response plans in the event of a threshold being breached are in place, financing of these responses remains a challenge. Varying levels of entomological surveillance and insecticide resistance monitoring are being undertaken in all three provinces, depending on available resources human, infrastructural and financial. Detailed information on insecticide susceptibility status by vector species and province can be found in Brooke et al.
Both the national and provincial MCP are experiencing a severe shortage of technical experts at all levels. This lack of capacity continues to impact negatively on every facet of the elimination programme. The limited funds available for effective implementation of the highly resource-dependent elimination agenda is placing increased strain on already financially over-stretched provincial control programmes. The Malaria Directorate has attempted to garner funds from external sources but thus far funds raised have been insufficient to fill the identified resource gaps.
The potential for onward transmission has been significantly reduced by the increased access to point-of-care malaria diagnostics, prompt reactive case investigations facilitated through the implementation of a h case reporting system, and improved surveillance for vectors and insecticide resistance. In addition the collection of more detailed travel and behavioural data during case investigations has enabled more rigorous case verification and more accurate case classification.
This improved case classification helped inform appropriate intervention implementation while providing an indication of progress towards elimination. Like most of the malaria endemic countries within southern Africa, South Africa experienced an upsurge in malaria cases in [ 19 ]. This regional increase appears to have been driven primarily by favourable climatic conditions optimum rainfall and ideal temperatures.
The two districts, Vhembe and Mopani, where the WHO elimination threshold [ 11 ] was exceeded, are located in Limpopo Province, the highest-burdened malaria-endemic province. As malaria transmission intensity decreases, malaria incidence becomes more heterogeneous [ 11 ], resulting in a stratification of intervention needs.
The elevated malaria incidence in both Vhembe and Mopani districts implies a need for the implementation of enhanced integrated generalized control measures in which options for controlling malaria importation are explored. In total contrast to Limpopo Province, all three malaria endemic districts in KwaZulu-Natal had reached the minimum elimination threshold by [ 6 ] and remained there through the review period. Although these districts did not achieve the critical milestone of zero local cases by , the sustained low incidence suggests local elimination is possible if hotspots areas of persistent residual transmission are eliminated [ 20 , 21 ].
Hotspots fuel onward transmission, therefore targeting them reduces transmission intensity, positively impacting both the most affected households and the community as a whole. To facilitate hotspot elimination and possibly fast-track malaria elimination in KwaZulu-Natal, a needs assessment for hotspot identification and elimination should be prioritized. Mathematical models [ 23 ] support the view that malaria elimination cannot be realized in the presence of sustained malaria importation [ 24 — 26 ].
In its recently launched global technical strategy GTS for malaria [ 27 ], the WHO acknowledged the importance of reducing malaria importation in an elimination setting by including a supportive strategy dedicated to cross-border collaborations. In line with the GTS recommendations, South Africa is engaging in the Elimination Eight E8 regional initiative whose core objective is to strengthen regional collaborations to eliminate malaria in eight participating countries [ 28 ].
Underpinning all these cross-border initiatives is the need for a surveillance system sensitive enough to track mobile and migrant populations, diagnostics that accurately detect asymptomatic individuals, sub-patent carriers and gametocyte carriers, transmission-blocking anti-malarials, novel vector surveillance and control methods, as well as appropriately skilled personnel.
The accurate detection of all malaria carriers symptomatic and asymptomatic is a fundamental requirement of an elimination agenda.
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However, as transmission intensity continues to decline, the commonly used diagnostic tools, light microscopy and RDTs, lack the sensitivity required to detect sub-patent infections [ 29 , 30 ]. Novel tools such as ultra-sensitive polymerase chain reaction uPCR and loop-mediated isothermal amplification LAMP , which have been shown to be more sensitive in low transmission settings [ 31 — 33 ], need to be assessed for cost-effectiveness in a rural South African setting.
Similar to other countries where malaria transmission intensity has decreased markedly, adults, as opposed to children and pregnant women, bear the higher malaria risk [ 34 — 36 ]. In contrast to previous studies, adult females were slightly more at risk of contracting malaria, particularly if locally transmitted, compared to adult males. A rather concerning finding was the increased risk of a negative outcome across all age groups if malaria was contracted within South Africa.
Malaria awareness campaigns aimed at improving health-seeking behaviours and case management practices of the general public and health-care workers, respectively, should be prioritized. All malaria endemic countries neighbouring South Africa have implemented a single-dose primaquine policy as a means of reducing onwards transmission [ 19 ], in accordance with a WHO recommendation [ 37 ]. As this anti-malarial drug is currently not registered in South Africa, this policy cannot be implemented locally at present. The scientific basis of a single-dose primaquine policy for malaria elimination in South Africa needs to be carefully evaluated.
In addition to the maintenance and improvement of current IRS-based vector control interventions, South Africa needs to explore alternate vector control strategies such as larval source management and technologies that target outdoor-resting adult mosquito vectors. Finally, as community and malaria health worker engagement in, and support of, the elimination agenda is fundamental to its success, knowledge gaps, if any, need to be identified and appropriately addressed. Implementation of foci of transmission identification and elimination in the three malaria endemic districts of KwaZulu-Natal, as a means of realising the lapsed milestone of zero local cases in these districts.
Maintaining generalized control intervention with blanket coverage in Vhembe and Mopani districts, Limpopo Province. Operationalisation of cross-border initiatives, particularly with Mozambique, to reduce the importation of malaria. Ideally as part of this investigation either a day 3 or 7 follow-up filter-paper blood sample should be collected from all individuals treated for malaria to allow for the assessment of artemether-lumefantrine efficacy.
Additional vector control measures, especially those targeting out-door resting vectors, need to be evaluated. Entomological surveillance activities, including routine insecticide resistance monitoring, need to be scaled up.
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Knowledge gaps among the affected communities and malaria health workers must be regularly assessed and addressed. Appropriate messaging that targets high-risk groups need to be developed. Despite the marked increase in local malaria case numbers reported in , South Africa has made considerable progress in implementing its elimination agenda. A h malaria reporting system has been implemented in facilities within the malaria endemic regions, enhanced surveillance for vectors and insecticide resistance has commenced and improved case management measures have been implemented.
The sustained implementation of effective interventions has decreased transmission intensity causing malaria to become more heterogeneous. This heterogeneity calls for a stratification of interventions implemented. In areas of high transmission intensity, such as Vhembe and Mopani districts, generalized activities focussed at control should continue. In areas nearing elimination, such as KwaZulu-Natal, targeted activities aimed at identifying and eliminating foci of transmission must become a priority.