Using a geographical information system to plan a malaria control programme in South Africa

Introduction Sustainable control of malaria in sub-Saharan Africa is jeopar dized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic. In Mpumalanga province, South Africa, rational planning ha s historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdi vision of a province). Methods To better map control programme activities to their geographical lo cation, the malaria notification system was overhauled and a geographical i nformation system implemented. The introduction of a simplified notificatio n form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographic al information system. Results The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria r isk within those magisterial districts at highest risk, Barberton and Nkoma zi. The conspicuous west- to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interv al = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. Discussion The geographical information system for malaria was enormously v aluable in enabling malaria risk at town and village level to be shown. Mat ching malaria control measures to specific strata of endemic malaria has pr ovided the opportunity for more efficient malaria control in Mpumalanga pro vince.