title: Sustaining control: lessons from the Lubombo spatial development initiative in southern Africa.
abstract: The Lubombo Spatial Development Initiative (LSDI) was a tri-country project between South Africa, Swaziland and Mozambique with the aim of accelerating socio-economic development in the region. The malaria component of the project was introduced to decrease the transmission of malaria in the region. This goal was met but with termination of this project resulted in an upsurge of malaria cases in the sub-region mainly as a result of migration from high transmission areas to low transmission ones. The movement of people across borders in southern Africa remains a challenge in sustaining malaria control and elimination.
  
  
  
  Malaria case data for Swaziland and South Africa were obtained from their respective national Malaria Information Systems. Data for Mozambique was obtained from the Mozambican Ministry of Health. Data obtained during the course of the LSDI project was compared to the case data post the termination of the LSDI.
  
  
  
  The 12-year period of the LSDI showed a substantial decrease in disease burden amongst the three countries involved when compared to the baseline year of 2000. The decrease in malaria cases was 99 % in South Africa and 98 % in Swaziland. Malaria prevalence in Mozambique decreased by 85 % over the same period. However, after the LSDI ended, between 2012 and 2014, there was an upward trend in case data that was counter to the goal of elimination.
  
  
  
  South Africa and Swaziland benefitted from the LSDI and were able to sustain malaria control and progress to the stage of elimination. Mozambique could not sustain the gains made during the LSDI and case numbers increased. Technical and financial resources are key challenges for malaria control and elimination interventions.
authors: Office of Malaria Research, Medical Research Council, Durban, South Africa. rmaharaj@mrc.ac.za.|School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. rmaharaj@mrc.ac.za.|School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa. rmaharaj@mrc.ac.za.
authors: Rajendra
authors: 0000-0003-4418-3841
authors: R
authors: Maharaj
authors: Malaria Directorate, Department of Health, Pretoria, South Africa.
authors: Devanand
authors: D
authors: Moonasar
authors: National Malaria Programme, Ministry of Health, Manzini, Swaziland.
authors: Candrinho
authors: C
authors: Baltazar
authors: Malaria Programme, Ministry of Health, Maputo, Mozambique.
authors: Simon
authors: S
authors: Kunene
authors: Biostatistics and GIS, Medical Research Council, Durban, South Africa.
authors: Natashia
authors: N
authors: Morris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004641:Emigration and Immigration; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D063426:Human Migration; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology
keywords: Cross-border malaria; Elimination; Sustainability